AT in the Classroom: SETTing the Example for using Assistive Technology

Sometimes I take for granted what I have learned about assistive technology, so let me start out by sharing and defining it before diving into examples...

Assistive Technology (AT) is defined in the Individuals with Disabilities Education Act (IDEA) as any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability. It does not include medical devices that are implanted, such as cochlear implants.

As part of every Indvidualized Education Plan (IEP), Assistive Technology should be "considered" as part as the child's ability to have access to a Free and Appropriate Public Education (FAPE).

With all that in mind, in this alphabet soup of educational acronyms, how can parents, educators, and therapists search, select, and support children with complex needs?

Using the SETT Model, as developed by Joy Zabala who is a leader in Universal Design for Learning (UDL) concepts, it is recommended to look at four components: Student, Environment, Task and Tool.  First, you look at the Student: what are their strengths, needs, and motivating factors.  Then, look at the Envirnoment: where is the student going to be completing the task?  Third, name the Task: what does the student need to do or learn? Last is the Tools: how is this child going to access the task at hand, as independently as possible?

When I am working with students, I collaborate constantly with a group of amazing therapists and educators.  We try to look at all options from no tech to high tech. You don't want to jump to the iPad with ProLoQuo2Go if it's not going to work to the child's strengths and meet their needs.  Let me give you a few examples:

Example: 

The Student: A preschool student with significant physical and cognitive disabilities. S/he is able to reach, grab and release with both hands.  S/he is motivated by sensory exploration, food and music.  

The Environment: Student will be completing tasks in the OT room, the classroom, and academic specials like gym, art, and music.  

The Task: develop a means of communicating needs and wants.   

The Tools: 
No Tech: Incorporating the use of gestures, eye contact and vocalizations into activities

Low Tech Option- pictures, like Boardmaker, SymbolStix, or downloaded pictures from the internet.  

Mid Tech Option- voice output single switch with a picture indicating what it says or a swtich activated toy (available through specialty vendors such as Enable Mart  or Able Net or potentially Amazon).

High Tech Option- iPad with Cause and Effect music based play apps such as Inclusive Tech, with a switch and Blue tooth switch interface for the iPad such as the Pretorian APPlicator

During therapy sessions, I use them all.  The combination of all approaches supports intent, initiation, persistence, and communication needs through motivating play. This student must request a turn using a picture exchange to then activate the cause and effect switch based toy/app, indicate more wanted time on the swing, or use of the rice box.  Notice, I haven't attempted to start an alternative and augmentative communication (AAC) app.  S/he is not ready for it yet.  Maybe in the future, maybe not.  

Example 2.

The Student: Student with significant physical mobility challenges. S/he is very bright but has difficult time keeping up with his/her peers during class activities. S/he can type on average at the same speed his peers write; s/he can write single letters and numbers recognizably but large.

The Environment: regular education setting

The Task: S/he needs to be able to complete math, reading, and writing worksheets independently.

The Tools: 
No Tech: scribing, however this involves an adult or peer to do the work, and the student is dysarthric. Reliability of answers should be considered.

Low Tech: Use a Slant board, built up pencil, and strategic positioning (and repositioning) of materials

Mid Tech:Lap top already available in the classroom with shortcut to a word processing application and a printer

High Tech: iPad with a PDF translation app that takes a photo, turns it into a PDF on which the student can type or draw on, access to email and/or printer

The student uses a combination of all four, again. Now that the student has access to the tech, the need for the scribing is lessened.   Sometimes the child wants to write. So with strategic positioning and his built up pencil, s/he can fill in the blank or draw the lines. But when the writing is more than a few letters or numbers, he can complete his work on either the iPad or the computer.  Is it perfect? Is it up to UDL? No, because in theory, the means of his expressing his knowledge wasn't explored before creating the lesson.  But does it work and give him improved access right now?  Yes.  

Example 3.
The Student: Elementary student with decreased strength and endurance to upper extremities and absent lower body sesnsation.  Also wears glasses.  Enjoys reading and music, but has a hard time comprehending and expressing what she knows.  S/he hunts and pecks on the keyboard.
The Environment: The inclusion classroom
The Task: Reading assignments, comprehension
The Tools:
No Tech: Provide modified educational materials like multiple choice questions
Low Tech: Highlighting strips to visually narrow the area the student needs to which s/he needs to attend. Access to read-aloud accommodations on the ePublished version of the reading program
Mid Tech: Access to laptop with a text to speech app/extension (Read and Write for Google, Readability, etc)
High Tech: iPad with PDF translation app to enlarge the print on the screen and limit visual clutter.  If student has a print disability, may qualify for Bookshare account and could use Voice Dream app on the iPad as well.

Combination of all four.

Notice the trend?  There is no end-all, be-all answer to access needs because depending on the strengths, needs, environment, and task, the tools required will be different.  And it is always a work in progress as the demands of the schoolwork change.  The important thing to take out of this is that you need to ask the right WH questions.  Who? Where? What? and How? Because if you don't know the answer, you can consult with your team or request an Assistive Technology Evaluation from your local AT group, in accordance with your district policies and procedures.  If you're not sure, refer!  

If you want to learn more about SETT, UDL, CAST, AIM, or any of the other Assistive Technology acronyms, there are amazing free and at cost webinars available on-line through AbleNet University, CDT Institute, and AOTA .  And don't forget to make friends with your local AT program!  They can be an amazing resource.

Adventures in Assistive Technology: Adapting the Power Wheels

I had been dying to do this project for over a year, since I had first heard about the Go Baby Go through the University of Delaware.  It was an AH HA moment.  I could totally do that. Adapting a powered toy car so my kiddos could have access to play with their peers as well as build other skills such as switch use, or head and trunk strength, or language, upper extremity strength... you name it, I could justify it.  It is my magic, as an OT, ya know to justify ANYTHING!

So a few weeks ago I finally resparked the flame of innovation and started asking for donations of used power toys.  And to my joy, my nieces and nephews donated their John Deer truck because they weren't using it anymore and they wanted to help my kids.  There I was, John Deer in hand. Now to get the rest of the supplies.

Ratcheting PVC cutter
Cuts through pipe like buttah'

Switch. Check.  (ablenet.com)
PVC piping. Check.  (local neighborhood hardware store)
Nuts and Bolts. Check.  (local neighborhood hardware store)
Kill Switch. Check.  (amazon.com)
A husband to help me rewire. Check.

Once my Mr. Fix-It helped to rewire and solder the gas pedal to the switch, I got my Ratcheting PVC cutters out.  These are a necessary tool if you work with PVC.  Worth every penny.  I also got to steal Mr. Fix-Its Dremel tool and new Milwaukee Power Drill to perforate the holes in the piping and the truck to install the support frame.

Finishing touches included good ole pipe insulation,  duct tape to provide a softer support to the bracing, and industrial Velcro for a lap belt and shoulder support.  And voila, Pimp My Ride: John Deer Power Wheels edition was complete.

My son testing it out

When I envisioned the outcome, I primarily had my students with significant physical disabilities in mind, but the benefits of the project spread beyond that group.  Students with autism found it quite intriguing and motivating.  Those that were non-verbal, vocalized and expressed words such as "Cool!" "Go!" "4 by 4" and "Deer".  It gave others a chance for parallel play and structured communicative play by incorporating voice out put switches with phrases like "Do you want to go for a ride with me?" and "GO!"  Driving also encouraged bilateral hand use and intrinsic hand strengthening, as the children have to use push the switch while holding the steering wheel as they drive.  For my more involved students, I steer while they activate the switch.


Though not 100% complete, I still need to set a secondary switch for a right cheek activation site, this project is well on its way to fulfilling its purpose: increasing participation amongst children with multiple disabilities during free time play.  I actually wish that I had considered completing a research study on its effects on social participation.  Maybe next year....

Overall, I would consider this an advanced project due to the nature of adaptation and tools needed.  If I didn't have my husband's support, I don't think it would have made it out of my basement.  Also, there are a significant amount of obstacles.  First, logistics.  The size of the vehicle is big.  It's a two-seater.  And even though we removed the dump bed from the truck, it is still large to store (ask my co workers).  So if you are considering doing a project like this, you need to examine your storage capacity.  You also have to respect administration for your building.  I am lucky to work with educators and facility managers that don't mind my therapeutic antics.  Second, cost.  Though the power wheels was donated, I purchased most of the materials.  PVC is cheap; foam insulation is cheap; switches can be costly.  I completed this for under $50 but I had a lot of materials and tools already.  Third, overall understanding of positioning and access sites.  Position of the body is key to accessing life, including switches.  If a child is not supported appropriately and safely, the participation in motorized play will not be successful.

Sea Choice Universal Kill Switch
Available through amazon.com

So if you are interested in researching a project like this, check out Cole Galloway and his team at the University of Delaware.  I downloaded their instructions, and then modified it to fit my needs.  For example, the kill switch they used is a single throw switch; my Mr. Fix It recommended the coil based like ones used on boats. Since it attaches to me while the children are driving, I don't have to worry about them driving off.  Go Baby Go project developers recently published new directions which are clearer and more organized.  And if you want to help me make another adapted car, you can visit my Donor's Choose site.

Special Thanks to Maddie and Patrick for donating their toy! Without it, my students would not be having nearly as much fun!

Back to School Tried and True

By this time of year, I am prepping to return to work and have found something that I cannot wait to use.  But honestly, this year, I can't wait to go back to my tried and true, my go-tos, my faves.

1. Music
People think I am nuts, but I sing everything. EVERYTHING becomes a song. Working with 3-5 years olds all day long will do that to you.  Almost each session incorporates something from Handwriting Without Tears Get Set for School album.  Kids love it.  I love it.  The songs address so many things from socialization, left/right discrimination, body awareness, language, pre-math concepts, I could go on and on.  In fact, the students even when they leave preschool, still expect to sing the Hello Song and do Tap, Tap, Tap.

My other top music pick incorporates technology.  Inclusive Technology's apps have such catchy tunes that I'll incorporate an app for my kiddos that need to work on cause and effect, assistive technology access learning, turn taking or counting.  The activities are great one on one or in groups.  I often will connect my iDevice to the Smartboard in the classrooms after our music and movement activity and before we move to the fine motor fun.  They just released two multi-songs apps that I might just splurge on, because I know I'll use them.

2. Scissors
I love cutting.  Put a tool in a child's hands and you can see their eyes and bodies hone in on the activity.  Snipping the paper strips or theraputty is, well, therapeutic.  Snipping through the resistance of the putty builds strength of the intrinsic hand muscles, while forcing bilateral hand skill development.  Adaptive scissors help to make it accessible to most, if not, all students, with the just-right assistance level.  And I started downloading or making play mats from Teachers Pay Teachers to support early math skills like one to one correspondence, number recognition and counting.

Scissor Assessment Kit from Achievement has a great variety of left and right adaptive scissors for just about any need or ability.

3. The Peanut Ball
I think I need to order about 5 more this year.  The peanut ball is such a great tool for core strengthening, balance, attention, and upper body strengthening, that its versatility equals its weight in gold.  Sit on it. Straddle it. Lay on your belly. Lay on your back. Throw it. Kick it. Carry it. Roll it. Do any of those while participating in an activity and the session gets even more bang for the buck.

4.  Theraputty
I  have been having so much fun adapting and creating activities using Fun and Function's variety of putties.  I heart the Animal Rescue Discovery Putty.  But over the year, the kiddos have lost most of my animals.  So I purchased the Emotions Putty which are totally cool.  It comes in Calm which is labeled as Soft. When cool, it is blue. When warmed up, it turns purple, like the old school mood rings.  It also comes in Energize which is labeled Firm.  It's this metallic glob of fun that reminds me of Terminator 2 when Robert Patrick oozes and molds into forms.  It is so mesmerizing that kids and adults alike will choose it.  The Putty Elements packs are a great addition. Because they are named Earth (green/ medium), Desert (red/ extra soft). Sun (yellow/soft ) and Sky (blue/extra firm) that along with science, it can support persistence and strength.  Note, it felt like their resistance did not match their labels; but that was ok.  For the ages with whom I work, I am less concerned with the resistance level than I am with engagement with a substance that will either challenge their sensory or fine motor needs.

Calm Emotions Putty

5. Dice
I am not just talking about the standard dot dice from the board games; I am talking about turning a couple of those random blocks you have laying around and creating new activities.  Roll picture/word dice to create silly sentence that not only address writing skills such as spacing, formation, and capitalization, but also supports language development and awareness.  Roll a move, dance a groove.  Easy way to add a movement break into an activity or the order to which a student completes an obstacle course.  Changing the way a learning center or activity is built, such as adding the playful component of dice, can change the attitude and engagement of a student learning a novel skill.

Foam Dice with Who? Where? Verbs? When? Boardmaker Pictures to prompt sentence expansion

Now that I have shared some of mine, what's in your back to school tool box?

If you want to be edutained….

The MacGuyver of Assistive Technology herself, Dr. Therese Willkomm will be in Rhode Island in March to lead a great workshop.  I have had the pleasure of participating in Therese's workshops twice.  Her unique presentation style and ideas ignite creativity and practicality that will follow you to work and home immediately.  After her workshop, I visited my local Ace Hardware multiple times to get my hands on PVC piping and various other supplies to make a variety of assistive tech supports for my students.  And luckily, my husband has access to lots of companies who supply many of the materials she recommends.  So if you want to be edutained, consider contacting TechAccess to register for this make and take session with materials included!

Assistive Technology Solutions in Minutes – Using Ordinary Items to Create

Extraordinary Solutions – A Hands-On Make and Take Fabrication Workshop

March 28, 2014 8:30 am —3:30 pm

Learn how to make over 50 adaptations to accommodate someone who experiences a disability. This hands-on, interactive fabrication workshop will teach you how to make over 50 adaptations in 5 min. or less. These adaptations include assistive technology mounting solutions for a wheelchair, table, bed, car, crib, and other surfaces; adaptations to an iPAD; creating basic switches; and making solutions using various plastics. Each participant will fabricate: an iLean, BookiLean, SlantiLean, ScaniLean, SitiLean, FlipiLean, MouseiLe-

an, a battery interrupter; momentary switch; a Plate switch; a camera mount; and an adapted stylus. In addition, participants will learn how to heat and bend acrylic and cut PVC pipe.

Materials and Registration $180.00 

Contact TechACCESS to inquire about group discounts    

To register for any of our workshops visit our website: www.techaccess-ri.org 

The mission of TechACCESS of RI is to promote and support the independence and achievement of people with disabilities through the use of technology.

'Appy Hour Review: Inclusive Tech Apps Part 2

Welcome to Part 2 of Inclusive Tech 'Appy Hour Review.  This group of apps addresses slightly different tasks and skill development compared to the previous song based counting apps.  These apps are best for children with exceptional needs who are using cause and effect efficiently and you want to help them make more choices within their play or work on timing for switch activation.  Overall, if you find one app you like, chances are you will find others that help excite and engage the learners into persevering with the task.


Little Lost Penguin*
Cost: $2.99
Ease of Use: Available in a single switch or touch based mode, you must help the Little Lost Penguin cross six obstacles and feed him along the way. Honestly, I purchased and tried the app without knowing much about it.  I learned by trial and error what was expected (like the kids would have to do).  This app addresses problem solving skills because the player needs to figure out and wait to jump at just the right time.
Visuals: Of course the penguin is cute.  The visual are more complex than the previous cause and effect apps, but it is made to engage different skills for different learners.
Auditory: Gentle waves in the background, and swoopy jumping sounds accompany the penguin and help bring attention back to the task.
Engagement Factor: I swear it was inspired by Happy Feet.   Most of my students are not ready for this app quite yet but I am hoping as they grow, this app will support their needs.
Overall: This is a cute beginner app to bring the students to a new level of skill development, when they are ready. I give it 4 out of 5 Coffee Cups.

____________________________________________________________________________

Treasure Island*:
Cost: $2.99
Ease of Use: This app can be used as touch based, single switch, and two switch modes. Goal of the game is to find the treasure by scanning and selecting a square on the map.
Visuals: The map is presented as a grid of 9 squares. Once you touched a spot, a dark blue foot stamps on that section of the map.  I don't feel it is contrasting enough and wish I could modify the stamp in a different color at times. However, the benefit of the blue stamp is that is not overly distracting that the students do not perseverate on it.  You have to weigh your needs.
Auditory:Hopefully you children don't scare easily, sometimes the creepy skeletons will say boo and laugh at them. But generally the sound effects that accompany the squares are not too scary.
Engagement Factor: I have boys, work with a lot of boys, it was nice to have a pirate game! Once you find the treasure you get a song and dance from the pirate himself.  The map and location of the treasure changes slightly in each game so students can't memorize location.
Overall: This app can be used to develop step scanning skills. Scan, scan, scan, select. And its fun to go on a treasure hunt.  I give it 4 out of 5 Coffee Cups for the Arrgggghhhhh factor.
_____________________________________________________________________________

Shhh!:
Cost:$2.99
Ease of Use: This is a simple cause and effect app that can be play with touch base, single or two switch mode.  The tired old man is trying to sleep, and silly musicians keep interrupting him. Depending on the switch you activate, you will either open the door to disrupt the old man's sleep, or the old man will pop up and say "Shhhh!". 

Visuals: Simple black background helps to decrease visual stimuli.  Bright, clear, and animated images are  to watch.

Auditory: If left alone, the musicians will play their instruments for about 15 seconds. But you can interrupt them by selecting the tired old man and he will tell them to SHHH!  There is no other extraneous noises, which is good to limit distractions.
Engagement Factor: The children really get a kick out of waking up the old man.  I swear that is an innate desire of most children.
Overall: Shhh! is fun and great way to explore the use of two switch mode.  5 out of 5 cups.

____________________________________________________________________________

Big Trucks:
Cost: $2.99

Ease of Use: This is a simple cause and effect app that can be play with touch base, single or two switch mode.  Interaction strictly makes the trucks make sounds and move on and off the screen. 

Visuals: Simple black background helps to decrease visual stimuli.  Bright clear truck images that have animation are pleasurable to watch.

Auditory: Each truck has a unique sound to go along its activation.

Engagement Factor:  Using the two switch activation, a child can build choice making.

Overall: This is a decent app for those with significant and complex needs.  It happened to flow with the preschool curriculum discussing stories like Goodnight, Construction Site. The students did appear to get less engaged after about 3-5 minutes, since they prefer the song based apps as previously reviewed.    I give it 3 out of 5 Coffee Cups.

_____________________________________________________________________________
Aunty Maggie's Recipe
Cost: $2.99
Ease of Use:This is a simple cause and effect app that can be play with touch base, single or two switch mode.
Visuals: You get to chose 1 kid from a field of 4 that you want to make into a monster. Touch the brightly colored potions to add as many as you want to the cauldron.  Then touch the goblet to have the child drink it.  The child turns into a colorful monster and does a dance.  After the dance the child returns to normal to start the process again.  There is a quick X to return to the field of 4 child select screen in case the player wants to change it up.
Auditory: The setting is a spooky house, so the crickets are chirping in the background, which after a while, I wanted the option to shut it off.  But when you select the potions or the cup, it has a pleasant and reinforcing sound that indicates the player made a choice.
Engagement Factor: I really like this game. My five year old (and even the 8 y.o.) really likes this game. This game is fun to develop choice making, reasoning skills, hypotheses in an engaging monstrous way. You can build on language skills by asking what color? What do you think is going to happen? How many potions do you want to use? Do you like or dislike your monster?
Overall:  You really can have a lot of fun differentiating to the goals specific to your child.  5 of 5 Coffee Cups.

_____________________________________________________________________________
The one thing I wish I could have access to is a quick exit to the app's home screen.  In most of the apps, you have to exit the app completely then reenter into the app.  I have talked with the developers but they have tried diligently to limit the visual distractions which is why they don't provide the quick out.  But they understood my concerns.  So whether or not you like or dislike an app, I urge you to share your feedback with the developers via app store reviews, emails, or blogs.  It takes feedback to make things the best for the intended users.

*apps with this star means I purchased it independently.  The others I received a code to download it for free.  My thoughts, as odd as they are at times, are my own and are not influenced by the company.

'Appy Hour Review: Inclusive Tech Switch Accessible Apps Part 1

Once I find an app I like, I tend to try the company's other apps to see how they may be beneficial to the children with whom I work.   Inclusive Technologies, based in the UK, has been a great find for my clientele.

The maker of Splat the Clowns has a plethora of switch accessible apps, so I figured I will do a compilation review of the ones that I have purchased, as well as the ones that I had received a code from the company to test drive.  Disclaimer, my thoughts, as odd as they are, are my own regardless of how I attained them :)

But because Inclusive Tech makes quite a few apps, most of which I love and use on a daily basis, I decided to do a 2 (or more) part 'Appy Hour to provide quick and concise reviews of their ease of use, visual, auditory, engagement factor, and overall thought.  And because I work some of the most amazing children with a variety of abilities and disabilities including Autism, Down's Syndrome, Developmental Delay, Cerebral Palsy, Visual Impairment, and Spina Bifida, I have had a chance to differentiate the use of these apps with really great results.  So here we go...

Five Swimming Sharks*

 Cost:$2.99
Ease of Use: Either in touch base mode or with switch interface, this app is very easy to use.  After setting up the Bluetooth switch interface, just enter the app, Switch Settings, click enable switch then x out. Easy peasey lemon squeezey.  This is single and 2 switch capable.  It has the song and 3 additional counting activities to the number 5.  I only wish that the third counting activity, counting in sets, had an easy exit besides exiting the app completely with the iPad's home button.
Visuals: Clear, bold colors accompany the words and numbers associated with the song and 3 counting games making it really good for early readers.  Not overly complicated for children with visual impairments.
Auditory:  I know the song is set to a tune from my childhood, but I cannot figure it out! Either way, it is consistent verse allows for easy learning.  Students and staff were shocked initially at the duck-eating shark but soon realized the humor in it.  And the british singer is pleasant to listen to.
Engagement Factor: The students are enamored with the cause and effect.  I have watched as my students learn wait, my turn, targeting, and counting.  I have printed and laminated the pictures of all of the apps so they can make choices, and they often will deliberately choose this one.
Overall: 5 out of 5 Coffee Cups.  This app can support early math and literacy concepts easily in the classroom and at home.   Click here for a youtube video posted by TecAssistive so you can have the song stuck in your head too.


Five Little Aliens:*
Cost: $2.99
Ease of Use:  This was the second app I had purchased and got my hooked onto Inclusive Tech, honestly.  This is a single switch capable app with a song and two additional counting activities.  Same set up as above.
Visuals: How can you not love the cute little green men?  Clear simple animation accompanied with the words and numbers and a not-complicated background makes it easy to watch.
Auditory: I can never get these songs out of the my head. Neither can the teachers or the students. It is an easy tune to recall with consistent verse and the same lovely british singer.
Engagement Factor: When I see children with the most severe and impaired motor coordination hit that switch over and over to continue the song or count along, I know they are learning, playing and showing others they are as well.
Overall: Overflowing 5 out of 5 Coffee Cups.  Everything about this app I adore, and so do the kids.

Five Little Rock Stars*:
Cost: $2.99
Ease of Use: Can be used with and without a switch.  See above, as I have noticed Inclusive Tech is consistent with their switch enabling process. This is a single switch capable app.  It has the song and 2 additional counting activities to the number 5.
Visuals: The background is duller than the animated rock stars so it helps to keep the attention without being overly distracting.  The songs and activities are accompanied by the words on bottom of the screen, and the number is on top.  Between each activation, this makes it easy to reinforce number recognition, early reading skills, and counting.
Auditory:  The tune is catchy. The song has a longer verse as compared to the other interactive song apps and I do wish it was shorter, but my students love it still.
Engagement Factor: I crack up that this is becoming some of my students' favorite song.  Some of my students with significant oral apraxia can clearly say "rock star" when requesting this app.
Overall: Simialr to Five Little Aliens and Five Swimming Sharks, Rock Stars provides a song and additional counting games for numbers 1 -5.  If the kids love it and they are learning, its a 4 5/6th out of 5 Coffee Cups.

I find it incredibly important to be in touch with the app developers because as a therapist and parent, I am one of the many on the front lines.  If there are things I like, love, or dislike greatly, I tell them, either in an email or a review.  I had reached out to Inclusive Tech to share some of my thoughts and the person to whom I was connected was thoughtful and thorough with his response.  I hope to see some of my suggestions in future apps or versions.  But whether or not that happens, IT appears to be a company with the children in mind and I look forward to seeing more of their developments.

Oh, and if anyone can tell me the names of the songs that these are based to I will thank you forever, it has been driving me nuts!

*indicates that I purchased this app

'Appy Hour: Splat the Clowns by Inclusive Technology

Given the nature and severity of the disabilities of many of the children with whom I work, I am continuously on the look out for engaging and accessible games.  So when I came across Inclusive Technology and the variety of cost friendly apps, I couldn't help but add them to my repertoire.

I need to state, not all apps are switch accessible.  But those that are switch accessible, can also be used with the standard touch interface.  Not to be too technical, but in order to use switch access, one must have access to a Blue tooth switch interface, like the Pretorian APPlicator.  It is the one that I currently use with my students.

Splat the Clowns was the first Inclusive Tech app I had purchased, for $2.99.  The idea is to press a switch or touch the screen to splat the clown face when it gets to the circle in the center of the screen.  Splat five clowns and the reward song comes on.  This app is great for building cause and effect play, targeting, timing, and visual tracking.  You can easily incorporate language concepts like wait, in, go, or turn taking social pragmatics if doing this as part of a group.  It's black background, simplistic and uncomplicated, make it a wonderful app for those with visual impairments, like cortical visual impairment, low vision, etc.  I have used this app with a students from preschoolers through 5th graders with a variety of abilities, from able bodied peers to those with the most challenging impairments; the result is still the same: Engaged and Happy Players.  Splat the clowns is a wonderful addition to the cause and effect play folder on any iPad.

Check out Splat the Clowns at the App Store.