Report from user study

Communication requirements
for children with special needs
by
Catharina Henje & Linda Bogren
Design Research Lab
Umeå Institute of Design, Umeå University
Sweden, 2009
contents
1. introduction
1.1 background
1.2 UID design research lab
1.3 target group
1.4 objective

2. implementation
2.1 initial survey
2.2 design ethnography

3. processing
3.2 communication zones & substance
3.3 identified themes
3.3 design opportunities

4. previous experiences
4.1 pictocontact
4.2 interaction design degree projects

5. design development challenges

6. references

1. introduction
This report describes the process and result from the user study Communication
requirements for children with special needs (Kommunikationsbehov hos barn
med särskilda behov) carried out by Catharina Henje and Linda Bogren at the
Design Research Lab at Umeå Institute of Design, Umeå University during spring
2009. The user study was partly conducted in cooperation with José Ledon and
Rouien Zarin, Master degree students at the Interaction Design program at Umeå
Institute of Design.
1.1 background
In spring 2008, the industrial and interaction design office Myra Industrial De-
sign, Stockholm and the world leading company in eye tracking and eye control
Tobii Technology, Stockholm received the Swedish Grand Award of Design 2008
by the Teknikföretagen, the Association of Swedish Engineering Industries in
association with The Swedish Industrial Design Foundation and The Swedish
Society of Crafts and Design. Myra and Tobii Technology was awarded for a series
of eye-controlled screens.
Myra Industrial Design and Tobii Technology chose to use the reward to finance
this user study performed by the Design Research Lab at Umeå Institute of De-
sign.
This user study is a pre-pre study for a possible project with the intention to
develop an everyday communication tool for mentally challenged children.
1.2 UID design research lab
Umeå Institute of Design (UID) at Umeå University started in 1989 as the third
industrial design education in Sweden. Through its close cooperation with Swed-
ish and international companies and organizations, UID has created a position
as one of the world's top design programs. Business Week Online published in
October 2006 a list of the best design schools in the world and among the 33
selected design educations outside the U.S., there is only one among the Nordic
countries – Umeå Institute of Design at Umeå University.
The Design Research Lab carries out research projects in close cooperation with
leading industrial companies and organizations. The multi-disciplinary teams
work with a user-centered approach, always in close cooperation with end users
and clients. Multi-annual research collaborations have been with ABB, Umeå
Municipality, Volvo, Banverket, Telestyrelsen, Specialpedagogiska Skolmyn-
digheten and more.
As an academic research team, the Design Research Lab develops new knowl-
edge through research projects in the area of design research. The results are
published regularly in leading international journals and at conferences in the
areas of design research, interaction design, human-machine interaction and
inclusive design.
For the moment, the Design Research Group consists of eight industrial and
interaction designers and engineers.
1.4 objective
The commission is to look into the communication needs and problems in a vari-
ety of communicative situations in everyday life for children with special needs.
With help of a reference group designated by Myra Industrial Design and Tobii
Technology, the Design Research Group is expected to document the prerequi-
sites and describe and test a method how to work with this user group.
The overall vision is that this research results will provide the possibility for bet-
ter development of communication aids for children with special needs.

1.3 target group

The main target group for this user study is children with special needs in pre-
school and primary school age. In this case, children with special needs means
children with a developmental disability (as Down syndrome and/or autism)
that including results in substantial functional limitations in their receptive and
expressive language.

Image 1. Project directives for user study

“Communication requirements for children
with special needs”
 At Klara Mera at Rosenlunds Hospital in Stockholm they had a showroom with
different technologies and ideas that you can use in an apartment to promote
independence amongst cognitive disabled adults. Next to Klara Mera was Idé-
torget, an assistive technologies showroom setup so that you can test and ask
for recommendations of which devices, technical adjustments and computer
programs are available and interesting to use for people with specific needs in all
ages.

Together with Myra Industrial Design we met Mårten Skogö at Tobii Technolo-
gies´ office in Danderyd, who demonstrated their eye tracking technology which
showed on new interesting ways to interact with a computer.

In Stockholm we visited Stina Juhlin, CEO at Myra Industrial Design, and her fam-
ily. We had the fortune to meet their 6-years old son Ludwig both in his home
and during different activities in his daily life. Ludwig is borne with Down syn-
2. implementation drome and autism.

The collection of knowledge about children with special needs and their commu-
nication requirements has been done through interviews with parents, peda-
gogues and specialists, through observation of children with special needs in
their everyday situations and through a review of the subject.

Initially, we made a study visit at Kolbäckens Habilitation in Umeå were we

interviewed Lena Nilsson, specialist pedagogue in the team of Autism Spectra
Disorders.

A concentrated user study week was planned and prepared by Myra Industrial
Design in beginning of February. For this week, we prepared and tested an initial
survey, aimed for the network close to the children we were about to meet dur-
ing the week in Stockholm.

In Stockholm we visited the game developer, teaching aid and children book Image 2. Study visit at Hatten Förlag AB.
publisher Hatten Förlag AB. The pedagogic material produced at Teckenhatten
is inspired by the Swedish professor of Linguistics and Special Education Iréne
Johansson and her theories and methods to teach and train children in language
and communication development, particularly children with Down syndrome.
2.1 initial survey
The concentrated user study week that was planned and prepared by Myra
Industrial Design took part during February 2-5. The plan was to meet, follow
and observe some different children through their day, from early morning with
breakfast at home, joining the taxi to their preschool or school, all along the day
until it was time for bed again (maybe split into two or three days).
To get an overall picture of the children’s daily life before meeting them and
their families, and to better know how to plan and conduct the forthcoming user
study, we prepared an initial survey with focus on communication.
The kit was send to one family as a pre-test to see if and how it should be ad-
justed before it was send out to all families that we were going to meet.
The kit consisted of five separate parts aimed for the adult persons closest to the
child. With the kit came a small photo printer that could be connected directly to
a digital camera (the families were expected to use their own digital camera).
The survey was expected to be filled in during one single day and the main goal
was to capture the child’s communication needs and efforts during an ordinary
day in the child’s life.
Image 3 . Parts of the Initial Survey.
The survey kit contained the following parts:
¤ A local map: where the parent could draw the route that the child would
do that day.
¤ A multiple time-schedule for one day: the same day for all adult people that
meet the child that day, and where each person shortly could write when and
how they communicate with the child that day.
¤ A photo album: for photos of the people that the child would meet that day
with space for writing a short note about the role persons have in the child’s life.
¤ An album for listing communication aids: with possibility to attach photos
and describe the aid, when it’s used and how the adult experience it - what is
good and what can be done better.
¤ An album for communication situations: with possibility to attach photos of
the situation and describe when and how the child communicates and interacts,
when it happens and with whom.
Summary
It took several weeks to get the kit back from the first test family so we never
had time to test it with more families.
The test family’s experience was that the survey was far too detailed, time-
consuming and difficult to fill in (they filled in the surveys but did not take any
photos). It was hard to make notes and try to manage life at the same time.
The conclusion is that this kind of survey kit needs to be redesigned and sim-
plified to be useful in the way it was planned to be used. Or using parts of the
material in a deep interview situation with a child’s surrounding network.
Another proposal for documenting communication situations for a child during
one day could be to ask the family (resource person or teacher) to bring a cam-
era for one day and take photos of interesting situations that day. The photos
could then be tagged with comments at the end of the day.
2.2 design ethnography
Design Ethnography is based on ethnography, a branch of anthropology that
uses various techniques and ways of thinking to understand modern human be-
haviors and cultures. The method is qualitative, meaning the research is focused
and capable of revealing a deep contextual understanding of what the users do
and why.

To get a better understanding for our users and the contexts that the children
use to be in during their daily life, we practiced design ethnography as a method
to perform deep user observations. Through these kind of observations, the
interaction designer tries to get as rich information as possible about the user,
the context, the user’s interaction with other persons and objects and within
and with the context and in consideration with the design challenge that you are
facing.

Image 5 . Photos taken during the user observations in Stockholm.

During the concentrated user studies we carried out in Stockholm Feb 2nd-6th,
our focus was to capture the variety of communication situations in different
contexts for children with special needs and try to define needs and problems in
relation to this. Focus has not been to distinguish behaviors and needs related to
a specific diagnosis, but rather to look at similarities for children with different
kinds of cognitive and communicative challenges.

We were privileged to observe a number of children in their daily activities both

Image 4 . Video documentation of an activity for children at the Habilitation in Nacka.
at a preschool called Hemmesta preschool, at two special schools called Hem-
mesta särskola and Skytteholmsskolan and during a group activity at the Habili-
tation in Nacka. In total we met a mixture of kids in the age of 5-12 years old in
several groups and classes, class teachers, speech therapists, drama pedagogues,
sports teachers, image therapists, habilitation pedagogues, psychologists, re-
source persons and a few parents.
 3. processing

When we returned to UID after this week, we all had a lot of impressions, pho-
tos, films, notes and questions. Each of us, Linda Bogren and Catharina Henje
from the Research Group and Ru Zarin and José Ledon, master degree students
in Interaction design, analyzed the material on his/hers own and made a content
inventory.
Image 5, 6 & 7 . Brousing and processing user observations.
Together we had some joint sessions were we discussed, analyzed and sorted
out our findings.

By printing out, nailing up and browsing photos of individual interesting stories

and situations from our observations, we could more easily share and discuss
the material and enhance the identification of recurrent patterns and common-
alities as well as specific themes, labeling the situations.
3.1 communication zones & substance
Within the Reggio Emilia approach, an educational philosophy focused on
preschool and primary education formulated in Reggio Emilia, Italy over the last
50 years, one regards the environment and the children’s group as important
pedagogues as the pedagogue him- or herself, when it comes to supporting the
child’s learning.

We used this as a model when sorting the information from the initial survey
and the user observations, identifying where and with whom communication
take part for our user group. We presuppose that the communication in all three Image10: Examples of groups that the children meet in their daily life.
surroundings is of importance for the child but may take different forms at dif-
ferent places and with different persons and may be of different importance and
priority for the child.

Image 11: Examples of individual persons that the children meet and have a relation with in their
daily life.
Image 8: The three surroundings that we relate to and were the children we met used to be in
their daily life

Summary
In a further study, it would be of interest to look deeper into the kind of com-
munication, the content and the priority degree due to the contexts. This to see
possibilities and constrains when evolving functions and interface in a future
communication tool.

Image 9: Examples of environments were the children we met used to be in their daily life
3.2 identified themes A. Communication
The following headlines are some of the significant themes that were identified From what we have seen at the different study visits, a multiple ways of com-
when processing the material from the design ethnography observations. Some munication is used in-between children and children and adults. From wordless
overlap each other more or less. The discoveries from our observation are here communication through shared visual experience, through pointing or physical
in some cases supplemented by material from interviews and literature. interaction as when a child grabs the adults hand or clothes to direct the per-
son or his or hers attention to what is needed (performative communication).
Or physical action as when a child just sat down (and refused to go further) at
A. Communication the same place every day, unable to communicate why this was such important
B. Interpretation place to stay.
C. Abstraction & Generalization
D. Social competence The communication can also appeared through physical objects as when a
E. Interests, Motivation & Reward child fetched an object (e g a toy or a video) to let the adult know what he/she
F. Visual feedback, Tangible objects & Reinforcement wanted as we heard and saw when visiting Stina Juhlin
G. Structure, Time & Transition
The verbal communication was sometimes aided by sign language, in Swedish
called TSS – Tecken Som Stöd (signs as support) or AKK – Alternativ Komplet-
terande Kommunikation (alternative complementary communication). The
verbal communication could also be supported by different images as photos,
PECS (Picture Exchange Communication System), PCS (Picture Communication
Symbols) and Pictogram.

We have also seen the lack of common communication and communication tools
at the special school and the frustration this causes. Among the pedagogues and
the assistants we noticed the frustration because of the absence of individually
fitted tools and the problem with the school lacking money to buy adequate
aids.

We observed situations when adults tried to communicate with a child but

turned their head away from the child too quickly to be able to see his or hers
attempt to answer, and in one case, how sorry a boy became when not noticed
and misunderstood. And we also saw the happiness when a child was seen and
heard and understood.

One pedagogue told us that a challenge with some children is that they act and
communicate in different ways with different persons.
What se saw was that some children used speech and signs language for com-
munication in a higher degree with the surrounding adults than with other kids,
Image 12 . Photos from user observations and some of the Identified Themes.
both in classroom situations as in the playground. It seemed like they adapted
to the pedagogues expectations how to communicate in this more obvious way,
because even if they had quite a vocabulary, when communicating with each
others some kids used more of physical interaction to communicate that they
wanted something from each other.
When playing in the school yard during a lunch brake, we could see how a peda-
gogue consequently helped one of the kids in the communication with other
class-mates, helping the girl by telling her how to act and what to say to be able
to express her will, guiding the social interaction as well as the spoken communi-
cation.
What we experience is the definite need of finding each child’s’ individual level
and aid for communication.
C. Abstraction & Generalization
According to the pedagogues we met, both generalization and abstraction can
be of great difficulty, not least for children with autism spectrum disorders.
Another part of the disability is that these children more rarely ask for help. They
manage themselves and are satisfied with very little.
To learn and understand similarities is a keystone in the abstraction that takes
place in the construction of a language. At Kolbäckens habilitation they teach the
surrounding network how to step by step train functional communication. From
the basic in finding a way how to motivate the individual child and learn how to
imitate, to linguistic comprehension through understanding that an photo or an
image of an object is equivalent to the object and that you can ask for an object
by showing an image and so on.

B. Interpretation D. Social competence

Some children are quite transient in their communication. As an adult, you must In several group activities and games, at both the preschools, the special schools
be focused and observant for subtle signals, indicating that the child wants to and at the Nacka Habilitation group activity, components of training social com-
express something. Some pedagogues expressed that it sometimes is so difficult petence were included in the activities.
to understand what the child wants to express. “It’s so easy to misunderstand,
and you want so hard to grasp what they are trying to communicate, so you try
to interpret what they are saying and give them alternatives all the time.”

The special pedagogue Lena Nilsson at Kolbäckens Habilitation means that the
lack of language and communication also causes a lot of everyday worries. A dis-
order in the process of perceiving can cause difficulty in registering, organizing
and interpreting sensory impressions. The lack of communication makes it even
more difficult for the child to interpret hers or his own signals from the body as
to be aware of that you are thirsty, hungry or in need of taking a leak.

For the adult to interpret the child’s signals right, verbalize them and move from
words to action, as to confirm that you have read the child’s needs, is not only a
way to formulate a language but also a way to help the child to interpret and un-
derstand hers or his own signals making it easier to express these in the future.
Image 13. A Social Story about what will Image 14. A aid for playing with your doll
happen when you go to the barber. - showing differnt alternative games you
can do with it..
It could be included in songs or games with turn taking and waiting for your turn
in a group activity, or games where you pose a question, asking somebody for
a thing or as “the fruit store game” during a snack brake where all the children
were sitting in a ring. First they got a real coin and then, one at time, they went
to the teacher in the middle and choose a fruit, asked for it and payed for it and
then went back to their place in the ring before enjoying the fruit.
Klara Mera had a lot of visual aids for training and preparing tasks in your daily
life. A social story can be a short explaining text or a series of images, telling how
to handle a situation or describing what to expect in a specific situation. This
text, reinforced with images, tells about what will happen when you go to the
barber.
Children with autism spectra disorders often have a shortage of Theory of mind
(T-O-M). It can be difficult for them to imagine things beyond the perceived, to
understand how, and even that, other people think, feel, are pretending or jok-
ing. It can be difficult to understand other peoples’ intention and to predict what
will happen. For these children, social stories are of great help, teaching the child
how to act and what to expect in a relation with other people and in specific
situations.
A deficiency in central coherence can mean that the child with an autistic chal-
lenge has an extremely good memory for details but at the same time a frag-
mented sensory integration with difficulty to generalize knowledge from one
situation to another, having narrow-minded interests and inability to vary the
games she or he plays. One kind of game can go well for a long time but is rarely
developed. Instead it is exchanged to another game. Stories can help them
understand what sequence that usually comes after another. Stories, images and
dolls can be a method for talking and treat a situation in a neutral way, without
exposing the particular child or his or hers situation.
E. Interests, Motivation & Reward
For the different children we met during the user study week in Stockholm;
we saw different attempts among the pedagogues to catch each individual’s
interests and motivation for supporting and encouraging the learning process.
For one child, the reward could be a verbal approval, for another it could be a
certain game, sing a song or watch a movie.
One boy we met was very fond of raspberries. For each task he performed at
school, he could collect an image of a raspberry and when he had gathered three
images he knew that he was allowed to go out to the kitchen and fetch half a
cup of frozen berries. Yummy! The reward system itself was a very lo-fi gadget,
made in plasticized paper. But it had taken some while for the pedagogues and
the family to frame the reward system for this child with Down syndrome, start-
ing with the instant treat to collecting abstract images and for the boy to wait
until the third image before collecting his desire.
Anneli Tisell at Hatten Förlag AB told about her work with developing the sound
for the application TeckenHatten, a children’s PC program for learning sign lan-
guage. The sound of a fart when something went wrong was such a misdirected
“reward” so instead of performing the tasks in a right way, the children using the
program really tried to fail – just to evoke the funny sound.
Anneli realized that she didn’t need to confirm or reinforce when something
goes wrong, only to strengthen succeeds.
All children are individuals, unlike each others, and therefore need different
strategies for capturing interests and gaining motivation as well as suiting pos-
sible systems for rewards.
F. Visual feedback, Tangible objects & Reinforcement
For all children at all preschools and schools visited, the teachers uses images,
photos, symbols, objects and signs to reinforce communication in one or an
another way. Lena Nilsson means that the eye-minded is so strong. “It is docu-
mented that images also trigger the linguistic development”, she tells us.
Often you see both text and image in combination. Signs as a support and
reinforcement to spoken language (TSS or AKK) are often used for children with
speech or language disorders.

One purpose of the articulated and visual feedback is also to strengthen the
child’s self conception and self esteem. Visa bild på studmatta
Using physical items and motions are other ways of enhancing memory by
involving other senses in your learning process as well as training fine and gross
motor-skills.

Image 17 & 18. Aids for visualizing time and the daily activities.

When you know that the time limit for one activity is reached, it can be easier
to switch to another. We also saw some examples in the schools how teachers
bridges over from one activity to another by singing a song or doing a physical
activity that actually led from one place with the first activity, to the next place
and next activity.
Image 15 & 16. The ordinary child book is
supported with tangible objects - the same
characters and utensiles that is mentioned
in the book.

G. Structure, Time & Transition

Structure is one of the three main cornerstones that Iréne Johansson stress as Image 19. Transition - walking
important when using her method to support children’s language development. on blocks from one activity, to
another.

All children are doing well from having a good structure in life, but children with
an autism spectra disorders depends entirely on the surrounding structure to
feel good and being able to act. To understand time and to switch from one
activity to another can also be very hard. One way of constructing structure and
making life more understandable is by visualizing time and showing what will
happen in the near future. There are a lot of lo-tech as well as more technologi-
cal devices that visualize time and duration as well as schedules for day activities
and weeks.
Summary
The themes and the observations made within the different areas as significant
to take into account in a continuous design process. They can serve as basis of
discussion when deciding what to focus on or including in a demand list for a
future product.
3.3 design opportunities
For us designers, an observed situation also serve as a starting points for design
opportunities. Some ideas appear already in situ, others when processing the
background material. To make the material easier to share, each of us chose
some observed situations that we found interesting, formulated them as “short
stories”, summed up with a formulated design opportunity in a sentence begin-
ning with “what if”.
Image 20 & 21. Some examples of the design opportunities that were formulated.
Summary
A good story about a user's experience can help people to see the problem
(or opportunity), motivate people to take action, and stick in people's memo-
ries long after we're gone. These short stories illustrate one way of processing,
selecting, visualizing and sharing a background material. It also shows how to
trigger and capture design opportunities from a material.
 4. previous experiences Picture based communication for
mobiles

4.1 pictocontact
During 2008 and until March 2009, UID Research group carried out a project
called PICTOCONTACT in cooperation with The Swedish Post and Telecom Agency
(PTS) and The National Agency for Special Needs Education and Schools (SPSM).

In PICTOCONTACT, the users have been involved in the design development

throughout the whole project. The user group remained of people in the age of
16-30 y with a cognitive challenged on a level B , a few of them with very limited
spoken language.
Image 22. PICTOCONTACT - examples of interfaces for PC and mobile phone.

The overall objective with the project was to develop an Internet-based service,
which provided people with cognitive difficulties, and reading and writing ability
on a level B, to independently and remotely communicate and create a social
community with help of Pictogram.
Initial interviews were made with parents, teachers, resource persons and
special pedagogues to identify current needs, possible problems and functional
requirements. From this pre-study, the design department created an interface
for web and mobile phone which was tested for three months with 13 users and
their surrounding contacts before it was evaluated.
All tests with users must be well prepared. A test is more likely to succeed if it
is preceded of a pre-study with observations included, to better know how to
arrange the test itself. The test should be set up so the results can be interpreted
by those who are closest to the user, and with question that are possible for
these persons to answer.
The interpretation of a result can also be made in combination with observations
by the designers.

Summary
The experiences from this project show the importance of working in an intimate
contact with the people that are closest to the user, such as parents, assistants
or resource persons, teachers, etc.
One must take into account whether the person has an own language or not,
and adapt to each individual and situation.
It was hard to predict the outcome during the test period, it was much of trial
and error, and all through the project you have to be prepared on adapting as
the project progresses.
It took quite a while before some of the users learned how to use the new com-
munication tool, and in general, everyone, both users and surrounding network,
thought that three months was too short.

4.2 interaction design degree projects
The outcome from the Interaction Design degree projects made by José Ledon
and Rouien Zarin gives a lot of input according to user tests with cognitive chal-
lenged preschool children, touch screen based devices and the benefit of using
an eye tracking system.
JOSÈ LEDON
One of the user tests José Ledon carried out was with a 6 y old boy with Down
syndrome and autism spectra disorders. In this case he tried some applications
he had built for a Nokia5800 with a 3,2 inch wide touch screen(16:9).
One of the applications contained 15 small images placed on the area of 3.2
inches. The boy interacted with the interface in a spontaneously way and under-
stood intuitively how to press and interact with the small icons. Even though the
boys’ fine-motor skills were not the best, he had no problems with hitting the
small icons.
At the same user test, José Ledon tried the same application, now on an Eye
Tracking System from Tobii Technology model T-60. The application José Ledon
had designed contained both text and images. When touching one of the graphic
icons, a short movie-clip started were you can see the mouth of the boy’s
mother, reading the word that is shown in the graphics.
The feedback from the eye tracking device showed that the boy not only looked
at the images but also the text area. Animations were the most attracting. Com-
pared with other, nondisabled children in the same age, the boy focused and
moved his eyes in another way. His focused were some centimeters to the left or
the right of the objects that he interacted with on the screen. This could be due
to a vision problem, but also to the fact that it was very difficult to carry out the
calibration.
ROUIEN ZARIN
In the user tests Rouien Zarin carried out, he first tried a lot of animated flash
applications on a horizontal multi-touch screen together with some cognitive
challenged children. Most children interacted instantly and in collaboration with
the application. Some children became more dominant, taking the role of an
“advanced user” which made him try also with one child at time.
After some testing, the children also understood how to control the sound
driven application and seemed to enjoy the performance as well as the feedback
from the graphics.
At some points the computer couldn’t handle all incoming signals from all the
children’s input and totally slowed down. This is something to have in mind
when prototyping for user tests. Another reflection Rouien Zarin made was that
a touch screen does not support dragging, which most of the children had tried
to do.
Summery
From the tests performed with the eye tracking one can say that it is important
that the calibration is adjusted for the special user you are testing, to know that
you can rely on the findings and that you don’t lose valuable time and the child’s
attention in the beginning of a user test. But also that it is a perfect instrument
to use when evaluating the software you are about to design.
It was obvious that the children learned from each other’s when they interacted
simultaneously with the interface Rouien Zarin designed. There is also a big po-
tential in developing a sound driven application, and see how it could encourage
children to respond vocally, together in a group or single, and thus develop their
spoken phonetics and speech.
 And it seems though it is crucial that tools for training, enhancing and enabling
communication also are developed for really small children and children at a low
cognitive level.

But how should a communication tool be designed to promote speech in a func-

5. design development tional way and actually support social interaction?
challenges Since a few years back, the Habilitation in Umeå, as several others in Sweden,
is working with a behavioural intervention for young children with autism. They
Children with different kinds of autism have particularly difficulty with commu-
teach how to train functional communication step by step. On the basis of a
nication and social interaction, means Lena Nilsson at Kolbäckens Habilitation.
clear structure and finding the right way of motivating the individual child, they
Off course there is a wide range of individual differences, but it is common that
start with learning how to train the child how to imitate and then continue to
these children do not interact with other children and have a limited imagination
practice linguistic understanding through a range of examples. A good outcome
and ability to play imaginary games.
has been seen when starting at a low age, with a high intensity and with involve-
ment of the child’s whole network.
Deficiencies in communication skills for children with autism are particularly evi-
dent in the areas of joint attention and symbol use, says Gunilla Bohlin et al. in
The same base that the Swedish Habilitation Directors rely on, has for several
their report. These areas are also core areas for language development. Speech
years been practiced in the model for language development, Karlstadmetoden,
development is usually delayed, between one third and half of all children with
that the speech therapist Iréne Johansson has developed. This method is prac-
autism do not use speech in a functional way. Spoken language among children
ticed by families and their children with speech disorders, regardless diagnosis.
with autism before the age of five has also proved to be one of the strongest and
most reliable signs of a further positive development.
The model is grounded on children’s normal language development and the
three methodological ground stones includes that the training should:
The ability to communicate in a functional manner is crucial to how a person's
- start early, as soon as possible after the birth or as soon as the parents wants
life turn out. Even rudimentary communicative skills can mean a lot when it
- be continuously and repetitively performed
comes to interacting with the environment, general adaptation, inclusion and
- be structured, systematic and individually suited
quality of life. Even small improvements in communication skills may spell sig-
nificantly improved quality of life and fewer problem behaviors (Gunilla Bohlin et
In the design work with developing a strong and reliable tool for enhancing com-
al.).
munication and developing linguistic skills among children with speech disor-
ders, it would be of great benefit to rely on a ratified and well known model for
Every single step to support a cognitive challenged child’s communication skills is
language development. In the Nordic countries, Iréne Johansson is a guiding star
important. All these children can learn to read, write and speak – on their condi-
in this area, and has been so since the 1980’s.
tions. It will only take longer time and must be modified after each individual.
The key is that learning must be on their terms and based on every persons
The publishers Hatten Förlaget has done a great and inspiring graphic design
interests and curiosity.
work when they have developed the “Karlstadmodellen” into puppet characters,
children books and computer games. This illustrates how a trusted model for
A conclusion to be drawn from the observations is that conditions vary a lot
language stimulation can be made more accessible and tempting with help of
between individuals, which means that an open approach in the creation of an
graphic design and new technology.
application is needed to make it work for the broad audience.
There are other interesting influences telling about new ways of understanding
language. Gestures are shown to be critical both to linguistic and to cognitive
development. In Blackstone et al.’s paper, they also mention Tomasello’s “usage-
based” theory of acquisition as one of the most prominent accounts of language
acquisition today.
“The real thing is having fun” says Janice Light. She brought in teams of young
kids, posed a problem to them of a child who isn’t able to walk and talk and set
them loose to build an invention to help such a child. She has compared features
of winning toys and used modified participatory design methodology to inves-
tigate and assemble children’s preferences and priorities in the design of AAC
technologies.
Janice Light has also found that young children with developmental disabilities
(1-3 y) show substantial increases in vocabulary acquisition when provided with
access to dynamic display AAC technologies.
Barbro Svensson (speech and autism special pedagogue at the Habilitation in the
region Västra Götaland and member of Föreningen TalFör) means are the most
essential to ask yourself when you plan for, and carry out, communication train-
ing with a child:
- Where - in what context - does the child do justice to itself??
- With who communicates the child the best?
- Which activity and what interest captures the child's attention?
A user-centred approach in a design project is the only way to be sure that an
end-result will be successful for the users (including their network).
For a future project, where the aim is to develop a communication tool for cogni-
tive challenged children, we would recommend the design team to, from the
very beginning; establish a close contact with a group of children and their near-
est network. And along the project, plan for repeatedly implemented user-test
with ample time margins.

AAC (Augmented and Alternative Communication) technologies are a broad, It would also be of importance to define what you would like to achieve or
integrated group of strategies, tools, and techniques from which an individual what you want to support with a future product as well as finding good ways to
with CCN (complex communication needs) may choose when communicating evaluate success in the developing work in relation to what you want to achieve,
anywhere, any time , and with anyone. either by network evaluations, logopedic tests, observations of positive changes
in social behaviour and interaction and so on.
When thinking about designing and improving AAC technologies, says Sarah
Blackstone et al., it is important to seek input from all relevant stake -holder
groups as family members, clinicians, teachers, educators, researchers, develop-
ers and manufacturers, knowing that they will not all view the world in the same
way. Though, the most important voices are often the hardest to hear, they say.
The most important in AAC research and practice is to involve and rely on the
individuals with the complex communication needs.

Participatory action research is mentioned as a widely recommended way to

involve individuals with complex communication needs in developing research
questions and designing methods (Blackstone, 2007).

In a project where the aim is to develop tools for for children with communica-
tion needs, we would like to pose the same questions to the design team that

Barab, S.A., et al. (2004) Critical Design Ethnography: Designing for Change. An-
thropology & Education Quarterly, Vol. 35, No. 2. pp. 254-268.
Blackstone, S. W., et al. (2007) Key principles underlying research and practice in
AAC. Augmented and Alternative Communication, 23:3, 191-203.
Bohlin, G., et al. (2004, revised 2006 and 2008) Mångsidiga intensiva insatser
för barn med autism i förskoleåldern. Report. Föreningen Sveriges Habilitering-
schefer. (Association for Swedish Habilitation Directors)
Bromark, G., Behandling av autism med beteendeterapeutisk intensivträning.
Habilitering för barn och vuxna i Uppsala län.
Fraser, S., & Gestwicki, C., (2001) Authentic Childhood: Experiencing Reggio
Emilia in the Classroom. Delmar Learning.
Johansson, I. (2007) Språkutveckling hos handikappade barn. Performativ kom-
munikation. Studentlitteratur, Lund.
Johansson, I. (1994) Language Development in Children with Special Needs.
Performative Communication. Jessica Kingsley Publisher, London and Bristol
Pennsylvania.
Ledon, J. (2009) Expressive Interactions. Communication Aid for Children with
Special Needs. Ma Interaction Design Degree Project report, Umeå Institute of
Design, Umeå University, Sweden.
6. references
Light, J. (Feb. 20, 2006). Technology Helps Disabled Kids Find Their Voice. Science
News. www.sciencedaily.com
Light, J. & Drager, K., (2007) AAC technologies for young children with complex
communication needs: State of the science and future research directions. Aug-
mented and Alternative Communication, 23:3, 204-216.
Light, J. et al. (2007) Children’s ideas for the design of AAC assistive technologies
for young children with complex communication needs. Augmented and Alterna-
tive Communication, 23:4, 274-287.
Söderbergh. R., et al. (2003) Från joller till läsning och skrivning. Kristianstads
Boktryckeri AB, Kristianstad.
Zarin, R. (2009) Trollskogen. A Framework for Enhancing Communication for Cog-
nitively Disabled Children. Ma Interaction Design Degree Project report, Umeå
Institute of Design, Umeå University, Sweden.
Föreningen TalFör, förening för Talpedagoger i Förskolan. http://hem.passagen.
se/talfor/
Umeå Institute of Design
Umeå University
SE - 906 29 Umeå
Sweden