Never Too Early to Start – AT for Young Children

When should you start using AT? Can AT benefit very young children? What type of AT should be used?

When should you start using AT? Can AT benefit very young children? What type of AT should be used? At the Specialised ATC we have the privilege of working with Fong Ruo En, a bright six-year-old girl with cerebral palsy. She is currently under the early intervention programme at the Cerebral Palsy Alliance of Singapore (CPAS).

Ruo En uses a stroller and has limited use of her lower and upper limbs. While she has some gross motor movements, fine motor movements (e.g. finger movements) are difficult. She is also non-verbal and communicates primarily through vocalisations and gestures. Cognitively, however, Ruo En is just like any other six-year-old. She loves to joke, laugh, tease people and watch her favourite cartoon characters.

In following post we show how Ruo En uses AT and how it has enhanced her learning, participation, communication and independence. Her story is an example of how it is never too early to start using AT.



When Ruo En was first referred to us, it was clear that there was a lot that she wanted to say. She needed a vocabulary that was more than just single word choices, one that could help her make requests, comment and express opinions.

Ruo En limited motor movements made it difficult for her to directly access any communication device. She could not precisely point to the symbol that she wanted. A reliable access method would be a challenge. The team initially tried an ‘eye gaze’ system. This was tiring for Ruo En and she soon lost interest and motivation. The team reverted back to a ‘manual’, low-tech communication system using Partner Assisted Scanning. With  Partner Assisted Scanning her communication partner would be able to adjust the speed of scanning, which would not be possible with a device. So, there would more chances of successful selection. The PODD (Pragmatically Organised Dynamic Display) system was used as it was a well thought out language system that utilised symbols. The communication partner menu-ed through Ruo En’s choices and she used a head nod and vocalisation for ‘yes’ and shook her head for ‘no’.

Ruo En soon became proficient at using this manual system. It was then time to try Ruo En on a Speech Generating/Voice Output system. Ruo En already had an iPad. There are language/communication based Apps that can be downloaded into the iPad. The team trialled various options and decided to use a Bluetooth switch interface which is paired with her iPad App. Ruo En used the ‘Switch Control’ Accessibility option available in iOS 8. The team selected ‘Touch Chat 20 with Word Power” as her language App as it was systematic, well-organised and allowed Ruo En to have access to a large vocabulary.

To get Ruo En motivated to use her voice output AAC system, pre-formed sentences were programmed in her personal page, so she could easily initiate conversations. This included, “My name is Ruo En, and I am VERY smart!” Ruo En is now using her AAC system and is on her way to become Little Miss Chatterbox!

The next few posts will also explore the different types of solutions we tried and the challenges, pro and cons of using a mainstream device for AAC. Stay tuned!


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