July 24, 2013

Choosing a Case for your AAC Device (with a Giveaway!)

This is part 3 of my series about choosing an AAC device. Click to read Part 1 (Apps vs Devices) and Part 2 (App Review).

If you choose a stand-alone device, chances are it comes with a built-in case. But if you choose a tablet with an AAC app as we did, you'll need to choose a case. In this post, I'll review three iPad cases. There are, of course, many many cases to choose from, and if you have a favorite, please do leave it in the comments.

When I looked into cases for our dedicated AAC iPad, I had several criteria for an ideal case.

First, it has to be durable. Of course, all cases have to protect, but because your AAC device will be coming with you everywhere, it is even more likely to be dropped, bumped, and generally treated more like sports equipment than a piece of expensive electronics.

Second, it has to be easy for the user to carry. Since many kids will be taking their devices to school, or even just around the house, it should have a carry handle and preferably a strap that will allow hands-free transportation.

Third, it should have a stand allowing the device to be upright on a table.

And finally, it should ideally amplify the sound loud enough to hear in a noisy environment like a restaurant.


Otterbox Defender
I have had an Otterbox Defender series case on "my" iPad since it became "our" (read: the kids') iPad.
Our iPad has survived many falls, throws, and even bites with this case. Food has been mashed on the screen, so I love that it has a built-in screen protector. Putting the case on the iPad does not require any screws, but connects well, and Moe has not ever gotten it off. The case separates into two parts, allowing the iPad to stand up in both landscape and portrait orientations, and Moe has no trouble (for better or worse) separating the two parts. Eventually (after well over a year), he did break the stand and the clips that hold the two parts together cracked. The Otterbox comes in many colors, and allows for easy distinction between devices if you have a non-AAC iPad in addition to the dedicated speech device. The case does not, however have a carry handle and is fairly bulky. It is moderately priced.

Stand in both portrait and landscape orientations
Built-in screen protector
Many colors
Replacement warranty

Clips and stand can break
No carry strap or handle

Cost: About $65 on Amazon.


This is the case that was recommended by our SLP and I see many kids carrying this case. It has a built-in handle and there are several accessories available, including a carry strap, wheelchair attachment, and bluetooth keyboard. It comes in two parts that separate and screw together. This ensures your child won't get the case off, but is also a pain if you have to open it. It has built-in speakers, making the case a little bulky, but also helps amplify the sound in noisier environments. The case comes in black or grey, but some customization via stickers or "skins" is available, which is nice for people who bring their device to school or a place where others may be using a device with the same case. (Our stickers are already starting to peel off.) There is also a nice slider that covers the home button, though Moe had no trouble figuring out how to open it.

There are a few issues with this case. The first is that the speakers need to be charged, so you have to plug two things in every night. The kickstand does not attach at the bottom to the case, so when you walk with it, it bounces against the case and is very annoying. You can put the case into the carry bag, but I got tired of taking the device in and out of the bag, which is a separate piece and likely to get lost. There is no built-in screen protector, so you need to use the kind that sticks on the screen. I don't think these protect as well, and they are hard to put on straight and without air bubbles. Finally, this case is very expensive. The case runs between $265-$345, depending on the accessories you choose.

Kickstand for standing upright on a table
Good amplification
Some customization
Lots of available accessories

Requires charging
No build-in screen protector
Sticker skins peel off easily

Cost: $265 standard, $345 bundle

GoNow case

GoNow for iPad and iPad Mini

The GoNow case is made by Attainment Company, which also makes the GoTalk NOW AAC app, and the GoTalk Express device. This case is light weight and seems to offer good protection, though does not include a screen protector. It comes in a silver color, has a built-in handle, and locations to attach a carry strap, though a strap is not included with the case. The case comes in two parts that must be screwed on, but the screws are attached to the case, so they don't get lost when taking the case apart. The case has a speaker which is designed to amplify the iPad sound acoustically, without electronics, so it doesn't need to be charged. There is also a switch on the front that magnetically locks and unlocks the device (though this doesn't work if you use your app in Guided Access mode, as I do). It does not have a kickstand, though I've been told one may be included in a future version. At $59, it is a relatively inexpensive option as well.

Relatively inexpensive
Acoustic amplification that doesn't require charging

No screen protector
No table stand

Cost: $59

We have stuck with the GoNow case, and with the addition of a stick-on screen protector and carry strap have found this to be a good option. I recently ordered a keyguard for the LAMP Words for Life App, which I think will be another nice addition. I highly recommend this case.

There are some other cool cases, including the Big Grips (reviewed by Adventures in Extreme Parenting) and the KidBox (which at under $20 could be an interesting option).


Attainment Company has offered to give away a GoNow case to one lucky winner! Just leave a comment below with your favorite iPad case. Contest will stay open through Monday and I will announce the winner on Tuesday!

(Update: The GoNow case is compatible with iPad 2 and later, as well as the iPad mini.)

July 18, 2013

Medication Update

Tenex is a teeny tiny round pill.
It is very difficult to cut it into a quarter dose.
My last post was about starting medication with Moe. I was not expecting any miracles, of course, but was anxiously anticipating some improved sleep. I hoped that the result would be a decrease in negative behaviors, anxiety and dysregulation.

We started him on Tenex, orignally developed as a blood pressure medication but commonly used for kids with ADHD and autism. The first week went well. Moe fell asleep fairly late, between 9-9:30, but was much less agitated while falling asleep. He slept consistently through the night, and woke around 7:00. This is not enough sleep for a six year old, but at least it seemed to be uninterrupted sleep.

We started with 0.25 mg then increased to 0.5mg (a half pill) before bed. We were worried about how we would give Moe the pill, but it is so small that we just put it on a small spoonful of yogurt or pudding and he swallowed it no problem. Since the first week went well, we added a 0.25mg daytime dose as well. This proved to be too much for Moe, and he was very sleepy during the day. He also started waking up at night.

We decided to add the 0.25mg to his nighttime dose, so he would be taking 0.75mg at night. We didn't see much difference in sleep. What we did see, with increasing intensity, was a dramatic uptick in aggressive behaviors. Moe was not himself. He was scratching and biting with no clear antecedent. At one point when I was in the kitchen, he ran at me from the back and bit me. Fortunately, he only got the back of my shirt. It was scary, and I owe a huge amount of gratitude to Moe's ABA team, who scheduled extra sessions to provide additional support. (And apologies to the amazing M who was met with tears of my own as I opened the door earlier this week.)

Moe can't tell us exactly how he was feeling, but it was clear he wasn't happy. Was he feeling dizzy, one of the possible side effects of the drug? Was he overly tired? Upset stomach? We don't know. What we do know is there was a clear correlation with the increase in the med with the increase in behaviors. On the advice of our psychiatrist, we reduced the medication back to 0.5mg two nights ago. The following day was much better, though not great. Last night, we took him off medication entirely. He didn't fall asleep, and we gave him melatonin, but the result was about the same: about 9.5 hours of sleep.

He had a great first part of the morning today, but has since been very dysregulated, with lots of tears. But he's been much less aggressive, and his behavior is more consistent with overtired Moe, than feeling really crappy and pissed off at the world Moe.

So now we have a decision to make. We could do nothing and go back to the status quo, which wasn't great but was at least a known quantity. We could try the next medication on the list, Intuniv. This is the same drug (guanfacine) as Tenex, but in a once-a-day slow release dose. Or we could switch to a new drug, likely Clonidine, which has some various dosing options.

This is how these things go, I am told: trial and error until we find the right thing. I am grateful that we are working with a responsive and knowledgable psychiatrist who has returned my calls every single day. I will keep the blog posted with how things continue to progress.


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