DOCUMENT RESUME ED 359 700 AUTHOR Reichle, Joe; And Others … · DOCUMENT RESUME ED 359 700 EC 302...

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AUTHOR Reichle, Joe; And OthersTITLE Communication Intervention for Persons with Severe

and Profound Disabilities: An Overview.PUB DATE May 93NOTE 57p.; In: Kupper, Lisa, Ed. The National Symposium on

Effective Communication for Children and Youth withSevere Disabilities (2nd, McLean, Virginia, July10-12, 1992): Topic Papers, Reader's Guide &Videotape. p147-200. See EC 302 252.

PUB TYPE Viewpoints (Opinion/Position Papers, Essays, etc.)(120) Speeches/Conference Papers (150)

EDRS PRICE MF01/PC03 Plus Postage.DESCRIPTORS Agency Cooperation; Communication Aid: (for

Disabled); *Communication Skills; Delivery Systems;Early Intervention; Interaction Process Analysis;Interpersonal Communication; Intervention; *LanguageAcquisition; Pragmatics; *Severe Disabilities;*Severe Mental Retardation

IDENTIFIERS *Augmentative Alternative Communication

ABSTRACTThis paper examines issues in establishing an initial

social/communicative repertoire with individuals who have severe toprofound disabilities, with emphasis on intervention involving themost severely affected. The paper stresses the importance ofbeginning intervention efforts even before learners show intentionalbehavior and discrimination of environmental stimuli, and examinesthe importance of focusing on pragmatics and the interaction process.Increased availability of augmentative and alternative communicativeoptions is seen as increasing the potential for full inclusion ofpeople with severe disabilities in the mainstream. The paper alsodiscusses: communication as social behavior, intentionalcommunicative behavior, evaluating the efficiency of variouscommunicative forms, full utilization of naturally occurringinteractive contexts, teaching communicative forms and functions,modification of elements of environments to ensure communicativeattempts, collaborative service delivery, and addressing thedifferences and similarities between home and school. An appendixcompares taxonomies describing instrumental communicative intents.Attached are lists of 72 references, 13 books and monographs, 6products, 8 journals/newsletters, 6 organizations, and 47 federallyfunded projects. (DB)

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Reproductions supplied by EDRS are the best that can be madefrom the original document.

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Communication Intervention for Personswith Severe and Profound Disabilities:

An Overview

byJoe Reichle, Kathleen Feeley, and Susan Johnston

Department of Communication DisordersUniversity of Minnesota

U.S. DEPARTMENT OF EDUCATIONDetour of Educational Rsearcn and impmeemeni

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

Germs document nes been reprOduced asrecraeold Iron, the person or organdatfononginating it

C Minor changes nave been made to improvereproduction Quality

Pomts of rester), OPoniOnS stated on IhiSOOCument do not necessarily represent &boatOE RI position or pot.cy

This paper examines important issues in establishing an initial social 1 communicative repertoireamong individuals who have severe to profound disabilities.' The discussion is intended forinterventionists working primarily with individuals who have not yet displayed an overt interest in orwho are not yet able to discriminate among the environmental stimuli that surround them. Strategiesare also presented for working with individuals who display an interest in their environment but whouse highly idiosyncractic means to express themselves. A thorough review of communicative behaviorand communication interventions is presented.

INTRODUCTION

Thompson and Guess (1989) havedescribed learners with the most profounddisabilities as having characteristics thatinclude limited awareness, limitedresponse repertoires, no communicationsystems, and, often, medical complications.They go on to observe that teachers viewlearners with the most profound disabili-ties as a distinct group within a populationthat is generally viewed as having severeand multiple disabilities.

Unlike most learners who readilydemonstrate a propensity to voluntarily acton aspects of their environment or react

to the actions taken by others, personswith profound disabilities often do neither.Consequently, the task for the communica-tion interventionist often must begin withidentifying those stimuli that are apt toresult in a reaction from the learner. Inthose reactions lie the topographies thatthe interventionist can attempt to promptand shape into actions that may serve thelearner communicatively.

The focus of this paper is toexamine the establishment of an initialsocial/communicative repertoire amongindividuals who have severe to profounddisabilities. Our discussion will focus onindividuals who have not yet displayed an

1 This paper was prepared for and presented at the Second National Symposium on EffectiveCommunication for Children and Youth with Severe Disabilities, held July 10-12, 1992 in McLean,Virginia. The Symposium was supported through Grant No. H086B10002, a Cooperative Agreementbetween Interstate Research Associates, Inc., and the Office of Special Education Programs (OSEP)of the U.S. Department of Education. Preparation of this paper was supported in part by CooperativeAgreement No. H133B80048, awarded to the University of Minnesota by the National Institute onDisability and Rehabilitative Research (NIDRR). The opinions expressed herein do not necessarilyreflect the position or policy of either the U.S. Department of Education or NIDRR, and no officialendorsement should be inferred.

147

2 BEV uh Li

Reich le, Feeley, and Johnston

overt interest in or who are not yet able todiscriminate among the environmentalstimuli that surround them. Additionally,we will focus on individuals who havedisplayed an interest but are using highlyidiosyncratic strategies to expressthemselves.

According to the National JointCommittee for the Communicative Needsof Persons With Severe Disabilities (1992),current best practices in the establishmentand enhancement of communicationamong individuals with very severedisabilities should be based on six majortenets. These are that:

1. communication is social behavior;2. communication acts can be

produced in a variety of modes;3. appropriate communication

functions enable productive participationin interactions with others;

4. effective intervention must modifythe physical and social elements ofenvironments to ensure that the environ-ments invite, accept, and respond tocommunicative acts;

5. effective communication inter-vention must fully utilize naturallyoccurring interactive contexts; and

6. service delivery must involvefamily members working collaborativelywith a cadre of professionals andparaprofessionals.

This paper appears in L. Kiipper (Ed.),The Second National Symposium on Effec -Ulm Communication for Children and Youthwith Severe Disabilities: Topic papers,reader's guide & videotape. McLean, VA:Interstate Research Associates.

The discussion of communicationintervention in this paper will be framedto address these important tenets.

COMMUNICATION ASSOCIAL BEHAVIOR

The National Joint Committee forthe Communicative Needs of Persons withSevere Disabilities (1992) has definedcommunication as:

...any act by which one persongives to or receives from anotherperson information about thatperson's needs, desires, percep-tions, knowledge or affectivestates. Communication may beintentional or unintentional, mayinvolve conventional or unconven-tional signals, may take linguisticor nonlinguistic forms and mayoccur through spoken or othermodes. (p. 2)

This definition provides the starting placefor our examination of communicative actsand the social participation of individualswith severe disabilities. (See Appendix Ain this volume for the complete text of theNational Joint Committee's guidelines.)

Describing the Range of SocialParticipation Among Persons

with Severe Disabilities

Individuals with the most severecommunicative deficits are distributedacross a continuum of great breadth withrespect to their propensity to sociallyinteract. On one extreme are those indi-

148 3

Communication Intervention - Severe and Profound Disabilities

viduals with severe disabilities who arevery active socially. These individuals mayhave substantial behavioral repertoiresthat are aimed at obtaining/maintainingattention, obtaining desired activities, andescaping/avoiding undesired activities.For some of these individuals, the form ofthis social behavior will consist ofchallenging behaviors that may include,but not be limited to, tantrums, aggres-sion, property destruction, and self-injury(Durand, this volume; Reich le & Wacker,in press). Other individuals will have asignificant repertoire of social skills thatmay include the emission of an array ofgestures. These gestural repertoires mayrange from natural, readily understoodgestures (e.g., waving, pointing, or offeringa cup) to more idiosyncratic forms thatcan only be understood by individuals whoare intimately familiar with the learnerand who have learned to decipher thatperson's consistently-used, gesturalrepertoire. Still other individuals appearto have very little interest in engaging insocial interactions. Reich le, York, andEynon (1989) have referred to many ofthese individuals as appearing to bepassive participants in the milieu of socialenvironments. Plausible explanations forwhy these individuals have become passiveparticipants include: (a) they haveinteraction strategies, but they simplychoose not to use them; (b) they havelearned to refrain from social contact as aresult of learned helplessness (Seligman,1975); (c) social contact represents anaversive event, and this results in theactive avoidance of or escape from social

interactions; (d) they have limitations intheir ability to discriminate and react tosocial stimuli; or (e) they have limitationsin their ability to remain sufficiently alertto the social environment (Guess, Siegel-Causey, et al., 1990).

Operationalizing the Purposeand Flow of Early Social Exchanges

Interestingly, acquiring a propen-sity to socially interact does not appear torequire significant developmental prereq-uisites. Infants appear to attend to adultsvery shortly after birth. For example, thecaregiver's voice has been demonstrated toserve as a discriminative stimulus for afive week old infant's smiles (Wolff, 1963).Some regularly occurring events (e.g.,feedings) provide an opportunity for alearner to begin associating the presenceof familiar individuals with the delivery ofsocial attention, as well as both desiredand undesired objects/events. Still otherinstances of early social interactions seemless episodic and are geared to establish-ing and maintaining a proto-conversationbetween learner and teacher (or care-giver). In these instances, the learner mayor may not be interacting intentionally.Table 1 displays a variety of childbehaviors that are interpreted by adultlisteners as being socially responsive.These initial social overtures (even thoughnot yet intentional) have spawned aplethora of investigatory efforts todescribe early, expressed social intent andits influence on the environment.

149

4

Tab

le 1

Chi

ld B

ehav

iors

that

may

be

Int-

mpr

eted

as

Soci

ally

Res

pons

ive

by T

heir

Lis

tene

rs

Lea

rner

Beh

avio

r

As

mot

her

ente

rs th

e ro

om, h

er th

ree

wee

k ol

d in

fant

look

s at

her

and

sm

iles.

Upo

n dr

oppi

ng a

toy

from

his

hig

hcha

ir,

an e

ight

mon

th o

ld in

fant

rea

ches

for

the

toy

and

voca

lizes

.

Whe

n th

e bo

ttle

falls

fro

m h

is m

outh

,in

terr

uptin

g hi

s m

eal,

a tw

o w

eek

old

infa

nt b

egin

s to

cry

.

Thi

rty

min

utes

aft

er f

inis

hing

a b

ottle

, an

infa

nt s

tart

s to

cry

.

5

Car

egiv

er's

Per

cept

ion

ofth

e C

hild

's B

ehav

ior

Mot

her

inte

rpre

ts th

e in

fant

's s

mili

ng a

san

exp

ress

ion

of p

leas

ure

as a

res

ult o

fhi

s m

othe

r's a

rriv

al.

Bas

ed o

n th

is, t

hem

othe

r go

es to

the

child

'nd

begi

ns to

verb

ally

inte

ract

with

him

.

The

infa

nt's

fath

erin

terp

rets

thes

ebe

havi

ors

as a

req

uest

and

res

pond

s by

sayi

ng, "

OK

, Dad

dy w

ill g

et y

our

toy

for

you.

"

The

infa

nt's

cry

is p

erce

ived

by

his

mot

her

as a

req

uest

for

ass

ista

nce.

She

resp

onds

by

sayi

ng, "

OK

, I'll

get

you

rbo

ttle

for

you"

and

she

pla

ces

the

bottl

ein

his

mou

th,

Upo

n he

arin

g th

e cr

y, th

e m

othe

r go

es to

him

and

che

cks

his

diap

er. F

indi

ng th

edi

aper

wet

, she

per

ceiv

es th

e in

fant

'scr

ying

beh

avio

r as

a w

ay o

f co

mm

uni-

catin

g th

at h

e is

unc

omfo

rtab

le.

6

Act

ual O

ccur

renc

e

In a

ctua

lity,

infa

nts

at th

is a

ge d

o no

t yet

use

thei

r sm

iling

res

pons

e di

scri

min

i-tiv

ely

(Wol

ff, 1

963)

. For

exa

mpl

e, it

islik

ely

that

the

infa

ntw

ould

have

resp

onde

d in

the

sam

e m

anne

r if

ast

rang

er h

ad e

nter

ed th

e ro

om.

It is

not

unt

il af

te. a

ppro

xim

atel

y te

nm

onth

s of

age

that

infa

nts

use

aco

mbi

natio

n of

voc

aliz

atio

ns, g

estu

res,

and

eye

cont

act t

o co

nvey

req

uest

s.B

ased

on

this

, it

is p

roba

ble

that

the

infa

nt w

ould

hav

e em

itted

the

sam

ebe

havi

ors

had

the

fath

er n

ot b

een

pres

ent

(Bat

es e

t al.,

197

5; B

rune

r, 1

975)

.

At t

wo

wee

ks o

f ag

e, in

fant

s re

spon

dco

nsis

tent

ly to

an

inte

rrup

tion

of f

eedi

ngby

cry

ing.

Alth

ough

the

mot

her

was

pres

ent o

n th

is o

ccas

ion,

the

infa

nt w

ould

have

em

itted

the

sam

e re

spon

se h

ad s

hebe

en a

bsen

t (W

olff

, 196

9).

Alth

ough

the

mot

her

inte

rpre

ted

the

cry

asa

com

mun

icat

ive

resp

onse

,it

ispr

obab

le th

e di

aper

was

wet

long

bef

ore

the

cryi

ng b

ehav

ior

was

em

itted

(W

olff

,19

69).


Describing IntentionalCommunicative Behavior

The examples presented in thepreceding section suggest that parents andcaregivers readily interpret very youngchildren's production of discrete voluntarybehavior as communicative, even thoughthe actions may not have been emittedintentionally (see Halle, this volume).Most researchers agree that normallydeveloping infants become intentionalaround eight months of age. Wetherbyand Prizant (1990) described a number ofcriteria that may be useful in determiningthe point at which a learner is emittingdiscrete voluntary behavior with communi-cative intent. Criteria include:

1. alternating eye gaze between agoal and one's listener,

2. persistence in the production of abehavior until a goal has been met,

3. pauses between emissions(waiting for a response),

4. termination of a behavioralemission once a goal has been met, and

5. altering a behavior when it is notat first successful in procuring the goal.

Traditionally, communicationinterventionists have viewed intentionalbehavior as a precursor to communicativeinstruction. Increasingly, however,interventionists are attending less tospecific cognitive prerequisites tocommunication intervention. Rice (1983)stated that "there is a detectable sense offrustration regarding the elusiveness ofcognition and its role in language impair-ment and the remediation process" (p.347). An increasingly prevailing view isthat specific voluntary behaviors emitted

151

by the learner should be consequatedsystematically by the interventionist with adesired outcome that, over time, maycome to be associated with the voluntarybehavior produced. For example, loudvocalizing that occurs after a learner hasconsumed a beverage may be consequatedby a refill of beverage. Even though theinitial emissions of the vocalizations werenot intended for an audience, the learner,across consistently consequated responses,may come to learn that loud vocalizationsat mealtime tend to recruit offers of food.It is reasonable to assume that parents,caregivers, and teachers who (a) mostaccurately interpret the environmentalconditions that precipitate motor andvocal emissions and (b) consequatelearner emissions immediately may be themost efficient instructors of an initialcommunicative repertoire.

Currently, there are no availabledata to suggest that intentionalityrepresents a prerequisite for beginningcommunication instruction. At the sametime, however, it is important that theinterventionist place himself or herself in

position to discern the learner's initialemission of intentional behavior. At thispoint, increasing emphasis can be placedon shaping communicative productionsinto forms that will be more user-friendlyto the learner's listener.

Unfortunately, selecting initialcommunicative forms to teach is compli-cated by the limited repertoire of vocaland motor behavior that the learner bringsto the language learning task. Whetherthe goal of the interventionist's activities isto establish comprehension or productionof communicative behavior, it is impera-

7


tive that he or she identify discretevoluntary behavior emitted by the learnerthat can be shaped or prompted intosocially acceptable communicative forms.These forms may involve gestures,vocalizations, selection of graphicrepresentations, or a combination ofresponses within these modes.

COMMUNICATION ACTS CAN BEPRODUCED IN A VARIETY OF MODES

Guess, Siegel-Causey, et al. (1990)suggest that, once a learner with severe/profound disabilities emits intentionalbehavior, expansion of that individual'scommunicative repertoire is limited by thenumber of easily emitted, sociallyacceptable behaviors that can be shapedor prompted. Mirenda and Calculator(this volume) address the range of aug-mentative and alternative communicationsystems that can serve individuals withsevere disabilities. It is particularlyimportant that, prior to making decisionsabout establishing new communicationforms, the interventionist recognize anyexisting communication strategies emittedby the learner.

Identifying Learner Responses

Most learners engage in somediscrete voluntary behavior. Sometimes,movements associated with state changesbecome the initial forms that inter-ventionists attempt to establish asresponses to certain environmental events.For example, an interesting visualspectacle in the presence of a quiet butalert learner may result in increased body

movement. Conversely, a soft soundpresented to an alert and active learnermay result in a marked decrement inmovement. Initially, then, many learnerswith profound disabilities may displaygeneralized reactive responses to adults'social overtures.

A learner who has a limited reper-toire of voluntary responses presents aformidable challenge for locating func-tional actions that can be used communi-catively. Piche and Reich le (1991) havedescribed some characteristics of signalingresponse which the interventionist maywish to consider. They observe thatvoluntary responses already producedfrequently and that are part of a sociallyunacceptable repertoire should beavoided. Responses involving thecontrolled use of an undesired reflex ormovement pattern should also be avoided,if possible. Third, if possible, movementthat can be prompted should be selected.Finally, it is important to locate abehavior that, when produced, does notreadily fatigue the learner.

Once a learner's experience with aparticular social routine increases, he orshe may begin developing individualizedresponses that correspond to the particularroutine of interest. For example, when amother slowly produces a noise-makingtoy from behind her back, a child mayquiet. Once the toy is placed in thelearner's hand, he may come to learn thatit produces the most noise when shaken.If the learner finds this activity to beenjoyable, he may come to anticipate itsdelivery by engaging in the shaking actionjust prior to the item's arrival. This moreexplicit gesture, eventually used as a

1523


request, would provide the interventionistwith more explicit information about thelearner's preference than would a highlygeneral action such as smiling.

Deciding to Alteran Existing Repertoire

Communicative emissions mayinvolve natural gestures that will be quiteguessable to their communicative partner.Reich le, Halle, and Johnston (1993)suggest that establishing more sophis-ticated communicative forms for the sakeof making the learner's repertoire "moresophisticated" may not be warranted.However, shaping or replacing communi-cative emissions may be warranted insome instances. Included among these areinstances when: (a) the learner's com-municative productions are so idiosyn-cratic that they require the listener to befamiliar with their function in order to beunderstood; (b) the learner producescommunicative behavior that is easilyunderstood but socially unacceptable (e.g.,holding one's crotch to inform a communi-cative partner that one needs to go to thebathroom); or (c) the learner's communi-cative productions are harmful to thelearner or to others (e.g., aggression, self-injury, tantrums, property damage, etc.).

In all of the preceding examples,the interventionist must make decisionsabout how best to establish a beginningcommunication system and to what degree

will be integrated with the learner'sexisting communicative repertoire. Forlearners with a very limited communica-tive repertoire, there is a tendency forprofessionals to avoid having to make adecision about replacing an existing

153

communicative repertoire. We believethat replacing existing communicativeforms should be based on criteria thataddress the social acceptability andefficiency of the communicative forms thatthe learner produces at the outset ofintervention. The disadvantage to thisbelief is that the longer the interventionistwaits to replace an old form of behavior,the more difficult replacement maybecome. That is, the better maintainedand generalized a response, the moredifficult it may be to replace. In thefollowing section, we will considerintervention strategies that relate directlyto demonstrating the efficiency of a newcommunicative repertoire to the learner.

Considering the Efficiency ofCommunicative Forms

Typically, interventionists havepresumed that if learners are sufficientlymotivated to obtain an outcome, they willengage in communication even though theemission of conventional communicativebehavior requires substantial effort.Unfortunately, for some learners, the costof responding may be too great and mayoverride the reinforcing event or reactionfrom a partner, which will occur contin-gent on communicative emission. Evenwhen learners acquire a new communica-tive form, the inefficiency of this form mayresult in its failure to be maintained orgeneralized.

Recently, a number of investigatorshave become increasingly interested in theefficiency of communicative behavior be-ing established (Horner & Day, 1991;Mace & Roberts, in press; Reichle &Wacker, in press). Mace and Roberts (in


press) describe four criteria that addressthe relative efficiency of competingresponses that achieve the same outcome.These include: (a) the rate of reinforce-ment, (b) the immediacy of reinforcement,(c) the response effort, and (d) the qualityof reinforcement. For example, assumethat a learner currently requests a softdrink by standing beside the refrigeratorand tapping the door. An alternativecommunicative form might be to touch asymbol consisting of a miniaturized DietCoke logo that has been affixed to therefrigerator door. Briefly, we will applycriteria described by Mace and Roberts(in press) to this example.

Rate of Reinforcement

Suppose that a female learnerreceived the same reinforcer, Coca-Cola,regardless of whether she tapped therefrigerator or touched the product logo.That is, the learner's interventionistreinforced the new communicative behav-ior but also continued. to supply the sameconsequences for the emission of the oldbehavior. In this instance, no advantagewould be gained by using the new symbol.On the other hand, the rule could beapplied that tapping on the refrigeratorwould no longer result in obtainingCoca-Colas. By adding this contingency, aclear advantage would result for use of thenew logo. In other words, deciding not toreinforce the continued emission of thelearner's old behavior makes the advan-tage of engaging in the new behavior morediscriminable.

154

Immediacy of Reinforcement

When a learner uses more idio-syncratic behaviors to communicate, it isoften necessary for the listener to spend asignificant amount of time guessing whatit was that the learner wanted. Forexample, when a learner taps a refrig-erator, she might want a Coke, cheese, orany one of numerous other objects.Consequently, idiosyncratic requestingbehavior may delay the delivery of thedesired item. On the other hand, if thelearner touches an explicit symbolrepresenting the desired item, delays inobtaining the desired consequence may beminimized.

Response Effort

In our example, the effort requiredto emit the target response is virtuallyidentical for each of the two options. Ofcourse, as new product logos are added tothe array, the discriminative demand onthe learner correspondingly increases.Consequently, with learners who havesevere disabilities and clear boundaries ofthe response effort they are willing toexert, it is important to make the acqui-sition of other new symbols (competingstimuli) as error-free and effortless aspossible for the learner.

Quality of Reinforcement

Once the learner begins to touch alogo representing a desired beverage, shemay be apt to use it even though there isno refrigerator nearby. This, in turn, mayresult in some requests that are conse-

F)


quated by her listener providing somealternative beverage in place of therequested Diet Coke. If this occurs oftenenough, the learner may conclude thattarping the refrigerator obtains a betterquality of reinforcer.

Response Efficiency From theListener's Perspective

Thus far, we have considered theefficiency of communicative forms fromthe learner's perspective (e.g., rate ofreinforcement, immediacy of reinforce-ment, response effort, quality of rein-forcement). However, it is equallyimportant to consider the efficiency of alearner's communicative forms from thelistener's perspective.

Some communicative forms may berelatively efficient from the perspective ofthe learner but highly inefficient from theperspective of the listener. Often, thosewho spend a substantial amount of timewith a learner actually "learn" his or heridiosyncratic communication strategies.Although this may work well with theseindividuals, it may significantly limit thedegree to which the learner can communi-cate independently across a range ofcommunity environments. Assuming thatthe learner's idiosyncratic communicativestrategies are socially acceptable, it maybe most efficient for the learner to usethose strategies with familiar listeners butlearn more conventional communicativestrategies to use in other environments.

At first glance, the precedingsuggestion may seem somewhat compli-cated. However, many learners with veryidiosyncratic communication strategies

155

already use several different behaviors toachieve the same outcome. For example,if a parent tosses a package of dried fruitor pretzels near the learner and they arewithin her grasp, a probable responsewould be to pick up the treat and eat it.On the other hand, suppose the learnersees her mother give a package to a peer,but the mother does not offer a packageto the learner. This condition may belikely to result in a request for the treat.There is a growing literature thataddresses the most efficient interventionstrategies to use in establishing this"conditional" use of new communicativerepertoires (see Reich le, York, &Sigafoos, 1991).

Usually, one assumes that establish-ing communicative behavior lessens theprobability of learned helplessness (Guess,Benson, & Siegel-Causey, 1985). How-ever, some vocabulary that may need tobe emitted in some settings to accessevents independently may foster helpless-ness if emitted in other settings. Forexample, at school a learner may have torequest something to drink. At home,however, the learner could simply go tothe refrigerator and select a beverage anytime he or she was thirsty. In this latterinstance, the emission of communicativebehavior actually results in the learnerbeing more dependent on others whoshare his or her environment. It isimportant that interventionists not onlytake great care in identifying a commu-nicative repertoire to teach, but also takecare to ensure that use of the communica-tive repertoire they are selecting willresult in greater rather than diminishedsocial independence for the learner.


The preceding discussion suggeststhat establishing a functional and efficientcommunicative repertoire is very difficultto accomplish if the interientionist designsand implements intervention procedures inthe absence of those environments inwhich the behavior is expected to beutilized, once acquired.

EFFECTIVE COMMUNICATIONINTERVENTION MUST FULLY

UTILIZE NATURALLY OCCURRINGINTERACTIVE CONTEXTS

The bulk of communication inter-vention programs developed for personswith severe disabilities during the 1970sused a didactic instructional format andfocused on establishing vocal modecommunication skills. This format oftenresulted in interventions that used anarrow range of teaching examples thatwere implemented outside the environ-ments in which the skills being taughtwere expected to be used. Typically,instruction was implemented by a singleinterventionist during episodes of massedteaching opportunities. Often, thesepractices resulted in establishingcommunicative repertoires that werepoorly maintained and not extensivelygeneralized.

As our knowledge of communica-tion intervention has grown, so, too, hasour fine tuning of the design of inter-vention formats. Within the past decade,increasing emphasis has been placed oninstructional strategies that providesufficient teaching examples under themost naturalistic circumstances possible.The challenge currently facing the

156

communication interventionist is toestablish discriminative and generalizeduse of a communicative repertoire withoutsacrificing the milieu of natural oppor-tunities to teach and stimulate language.In the discussion that follows, we willexplore best procedural practices thatattempt to address this challenge.

Identifying the Repertoireto be Taught

Describing a Range of CommunicativeFunctions

A number of investigators havedeveloped taxonomies to describeinstrumental communicative intents(Cirrin & Rowland, 1985; Dore, 1975;Wetherby & Prizant, 1992). Instrumentalintents describe why the learner produceda particular utterance, regardless of whereit occurred within the flow of an inter-action. Five taxonomies are compared inAttachment A, which appears immediatelyfollowing the references and resources atthe end of this article. This comparisonillustrates the similarities and differencesamong current descriptive strategies thatare used to describe communicative func-tions. These functions represent thebuilding blocks used in communicativeexcl-anges that comprise simple conversa-tions.

Distinguishing Between Pragmatic Functionsand Social Functions

Given the numerous descriptivetaxonomies available to the prospectiveinterventionist, describing the reason for

1 '2?ti


the production of any given utterancewould seem to be a relatively straight-forward proposition. However, we believeit is easy to misuse pragmatic taxonomiesto describe communicative forms ratherthan functions. For example, consider alearner who is grudgingly engaging inwork. Approximately one minute into thetask, the learner signals for "help." Hermother dutifully assists her with the firstchore. Several minutes later, the learneris again requesting assistance. After 10requests, her work has been completedwithout engaging in any work other thanrequesting assistance. Most pragmatictaxonomies would describe the learner'sbehavior as a series of "requests forassistance" or "requests for action," basedon the utterance form and the specificcontext in which it was emitted.

Alternatively, a functional assess-ment of the situation might suggest thatthe learner's communicative behaviorfunctioned to avoid or escape engagementin the activity. A request for assistance, insome instances, may serve as a strategy toaccess a highly preferred item (e.g.,obtaining assistance to unwrap a desiredpiece of candy). On other occasions,requests for assistance may be produced inan attempt to escape from an unpleasantchore. Unless the full range of relevantstimulus conditions is addressed duringintervention, the interventionist cannotconclude that the learner will generalizethe pragmatic function being taught acrossthe complete range of environmentalcircumstances in which the pragmaticfunction can be used. Reich le (1990b)reports instances in which teaching alearner to "request assistance" exclusively

157

in the presence of opportunities to escapeor avoid highly nonpreferred activitiesfailed to generalize to the use of "requestassistance" vocabulary to access desiredobjects and events (e.g., candy that thelearner needed help unwrapping). Reich le(1990b) also reports an instance in whicha learner with severe developmentaldisabilities was taught a general rejectinggesture ("no"). All of the identifiedteaching opportunities occurred when thelearner was offered a highly nonpreferredobject or event. Over time, the learnerused a rejecting utterance whenever anundesired item was offered. One of thisindividual's preferred activities wastraveling to a coffee shop on Saturdaymorning to partake of a beverage andsweet rolls. Generalization probesconducted in this setting demonstratedthat the reject gesture had generalized topreviously untrained and undesired break-fast items. For example, when offeredbacon or sausage (highly nonpreferreditems), the learner emitted his rejectingresponse. However, when offered refillsof juice (a highly preferred item) forwhich he had demonstrated satiation, thelearner failed to emit his newly-establishedrejecting utterance. As the interventionprocess proceeded, it became increasinglyclear that, inadvertently, the interven-tionists had taught the learner to use arejecting gesture across only a subset ofthe full range of important functionalopportunities for its use. Unless inter-ventionists match the pragmatic functionbeing taught with a full range of socialfunctions that the new utterance is expect-ed to serve, it may be very difficult to


establish a truly generalized communica-tive repertoire.

Describing General ConversationalFunctions

Generally speaking, during acommunicative exchange, three things canhappen. The interaction can be initiated,maintained, or terminated. In consideringfunctional social/communicative use, it iscritical that the interventionist considerestablishing instrumental communicativefunctions such as requesting, rejecting, andcommenting. Equally critical, however, isthe importance of considering how instru-mental communicative functions can beused across conversational functions (i.e.,initiate, maintain, and terminate). Table2 displays examples of interactions bet-ween instrumental communicative func-tions and conversational functions.

Describing early communicativebehavior can be particularly difficult in thecase of the idiosyncratic emissions ofindividuals with severe and profounddisabilities. Often, with beginningcommunicators, the interventionist's taskstarts with determining whether learnersalready understand that their vocal andgestural emissions can exert control overtheir environment.

Selecting a Functional CommunicativeRepertoire

Only recently have interventionistsbegun to grapple with developing strate-gies to derive the best and most efficientteaching examples to utilize in the inter-vention process. Recently, a package of

intervention logic referred to as generalcase instruction (Horner, McDonnell, &Bellamy, 1986; Homer, Sprague, &Wilcox, 1982) has received significantdiscussion as being relevant to theselection and organization of teachingexamples.

At the heart of the general caseapproach is the concept of stimulus con-trol. A general case approach is aimed athelping learners to make appropriate dis-criminations and respond to stimuli thatshare common features, and not respondto irrelevant features that may vary acrossstimuli and settings (Engelmann &Carnine, 1982). Implementing generalcase instruction requires careful adherenceto six basic steps, which include:(a) defining the instructional universe,(b) defining the range of relevant stimuliand response variation within that uni-verse, (c) selecting examples from theinstructional universe for use in teachingand probe testing, (d) sequencing teachingexamples, (e) teaching the examples, and(f) testing with non-trained probe ex-amples. In order to illustrate each ofthese steps, Attachment B outlines howeach of these would be operationalized inthe context of teaching a learner torequest a glass of milk by using a graphicsymbol representing "milk."

Following the guidelines of generalcase instruction ensures that generalizationis not a post-hoc consideration. Rather,the generalization process is consideredduring the development of interventionprocedures. Although general caseinstructional procedures have been widelyembraced in the special education litera-ture, they have received very limited

158 14

Table 2

Interaction Between Communicative Intentsand Stages of Communicative Exchanges

Initiate Maintain Terminate1

wcrc=a

1:4

H,,CD

oc)

A 6-year-oldsees a peer onthe playground.

A preschool childis watching hismother blowbubbles.

A learner haslost interestin playing withhis youngersibling.

o)

tig,CD

i--+,

He approachesthe peer andsays, "Warmplay?"

He says, "Do itagain."

He says,"Wouldn't youlike to watchcartoons now?"

Note: Adapted from Reichle, J., York, J., and Sigafoos, J. (1991). Implementingaugmentative and alternative communication: Strategies for learners with severedisabilities (p. 163). Baltimore: Paul H. Brookes. Copyright 1991 by Paul H. BrookesPublishing Company, Inc. Adapted with permission. (Available from Paul H.Brookes Publishing Company, P.O. Box 10624, Baltimore, MD 21285-0624.Telephone: 1-800-638-3775.)

15159

Reichle, Feeley, and Johnston

attention in the communication literature.Recently, a number of investigators(Halle, personal communication, May,1992; Reich le, Halle, & Johnston, 1993)have addressed its applicability tobeginning communication instruction.They are finding that, rather than beingprescriptive in terms of exact instructionaltechniques that must be used, a generalcase approach permits the interventionistgreat discretion in selecting specificintervention procedures.

Teaching Communicative Formsand Functions

Tannock and Girolametto (1992)have discussed the degree to which inter-vention strategies are learner-oriented(i.e., follow the learner's lead), interaction-promoting, or language-modeling.Learner-oriented components of communi-cation intervention seek to establishepisodes of joint involvement around thechild's immediate focus of attention.According to Tannock and Girolametto(1992), their success lies in:

...increasing the saliency of infor-mation in the child's physical andsocial environment; tuning itscomplexity to the child's currentlevel of functioning; providing thekind of input that the child canattend to, process, and assimilate

(p. 55).

Interactive models of interventionhave no specific communication topo-graphies as intervention targets. Addi-tionally, no didactic teaching methods are

160

used. Language-modeling techniques aredesigned to enable the child to recognizerelationships among content, form, anduse of language.

Although it is difficult to charac-terize any particular communication inter-vention program as adhering universally toone of these orientations, the latter(language-modeling) has been used mostextensively with persons with severecommunicative deficits and has the mostextensive empirical database. By far, themost empirical attention has been given tothose aspects of communicative interven-tion procedures focused on modeling lan-guage. Among the most ecologicallysensitive of these approaches has beenmilieu language intervention (Hart &Rogers-Warren, 1978).

Milieu Language Instruction: ALanguage-Modeling Approach

Hart (1985) described threeteaching strategies that encompass themilieu approach to language intervention.These strateiges are: mand-model, timedelay, and incidental teaching.

Mand-model instruction. During anepisode of mand-model instruction, theinterventionist places a variety of items ofpotential interest within range of thelearner. As the learner approaches thematerial, the interventionist initiates theinteraction by producing an utterance thatrequires the child's response. Forexample, in a requesting episode, theinterventionist might say, "What do youwant?" In a commenting episode, theinterventionist might ask, "What is that?"If the learner fails to produce the desired


response, the interventionist may followthe original utterance by producing amodel for the child to imitate (e.g.,"cookies," if the goal of the intervention isthe production of single-word utterances).When the learner responds, he or she ispraised socially and given access to thematerials. In order to benefit from;nand-model instruction, it is importantthat the learner be able to engage inimitation.

Once a learner participates in amand-modeling procedure, the interven-tionist is in a position to exert somecontrol over the frequency of communica-tive output. Unfortunately, because a highproportion of communicative emissions ispreceded by the interventionist's verbal-izations, spontaneous use of the learner'sburgeoning repertoire may not occurreadily.

Time-delay instruction. A time-delay instructional procedure is designedto transfer instructional control from theinterventionist's mands and models toother naturally occurring environmentalstimuli (Hart, 1985). A component of thetime-delay procedure includes an adult inclose proximity displaying a reinforcingstimuli. The adult remains quiet for abrief interval (Halle, 1982; Oliver &Halle, 1982), providing the learner with anopportunity to initiate the topic. If thelearner does not emit a response, theadult provides a model and again awaits aresponse. The learner is then providedwith the reinforcer, whether or not aresponse is elicited.

Halle, Marshall, and Spradlin(1979.) demonstrated the effectiveness ofthe time-delay process with children who

had mental retardation. The interven-tionist delayed giving the learners theirfood trays during breakfast and lunch. Asa result, the learners' requests for lunchtrays increased and generalized acrosspeople and mealtimes. Thus, oncelearners take advantage of more subtleenvironmental cues, it may become in-creasingly likely that they, rather than theinterventionist, will begin to initiate theteaching opportunity.

Incidental teaching. This type ofteaching requires that the interventionistwait for the learner to choose a topic.The learner is then prompted to elaborateon the chosen topic and is supplied withappropriate models when needed. Theincidental teaching procedure differs fromthe mand-model procedure in that thelearner, rather than the interventionist,chooses the topic. For example, if alearner approaches an activity andcommunicates "want paint," the inter-ventionist responds by requesting languageelaborations (e.g., "What color of paintwould you like?"). If the learner does notrespond, the elaborated response may beprompted by the teacher. For example,the teacher may hold up the blue paintand say, "The color of this paint is

." If the learner still does notrespond, the appropriate response may bemodeled for the learner to imitate (i.e.,"blue paint"). When the learner providesa correct response, it is confirmed (i.e.,'That's right, this is blue paint"), and thechild is consequated with the reinforcingstimuli.

Although milieu language instruc-tion offers the distinct advantage ofcapitalizing on the same interactional


strategies that have been documented tooccur between parents and their normallydeveloping children, there are somelimitations of the model when applied tolearners with very severe disabilities.First, as it was originally presented,mand-model instruction is efficient whenrecipients engage in an imitative reper-toire. However, if a learner cannot act onan imitative model, the interventionistmust develop an intervention strategy toteach the learner to use the model.Secondly, there is a limited databaseavailable that addresses the generaliz-ability and maintenance of communicativeskills taught (Kaiser, Yoder, & Keetz,1992). Thirdly, the bulk of successfulapplications of milieu intervention hasfocused on populations that includedisadvantaged preschoolers, learners withspecific language delay, and learners withautism. Significantly less empiricaldemonstrations have been conducted withpersons who have more severe disabilities(Halle, Marshall, & Spradlin, 1979;Warren, Mc Quarter, & Rogers-Warren,1984).

Interactive-Based InterventionApproaches

With the increasing emphasis onconversation and interaction in beginningcommunicative exchanges, interactiveintervention strategies have becomeincreasingly popular among interven-tionists who do not want to focus onspecific forms of communicative behaviorto be taught. Although Tannock andGirolametto (1992) have observed that"...the precise mechanisms by which early

162

social interaction facilitates languagedevelopment are not known..." (p. 53),current research and best practice suggestthat particular aspects of the learner'scommunicative partner's behavior influ-ence the learner's acquisition of commu-nicative skills. Reich le, Halle, andJohnston (1993) summarize these aspectsas including:

1. the maintenance of jointattention (i.e., participants in theinteraction are attending to the sameaspect of the environment);

2. the contingent response to thechild's communicative effort (i.e., thepartner's response immediately followsand is related to the child's communicativeattempt);

3. the use of joint activity routines;4. the use of models and/or

expansions of learner utterances; and5. the modification of speech to

match the complexity of the child'scommunicative production.

A number of existing communica-tion curricula rely heavily on socialinteraction as the underpinning of thecommunication intervention process (e.g.,MacDonald, 1989). Consequently, addres-sing how learners with severe disabilitiescome to participate productively insocial/communicative exchanges warrantsdiscussion.

As mentioned earlier, socialexchanges between communicative part-ners can be initiated, maintained, orterminated. These three broad classesinteract with communicative functions thathave been described previously in thispaper. That is, a request can be used tofulfill each of the three conversational

13


functions, as depicted in Table 2. There islittle evidence suggesting that, once aspecific communicative function has beenacquired (e.g., rejecting, commenting), itgeneralizes across the conversationalboundaries of initiate, maintain, orterminate. Briefly, we will examine thethree conversational components as theyapply to the earliest phases of communi-cation intervention.

Maintaining communicative inter-actions. In order to react to andsubsequently maintain a social interaction,it is important that the learner be able toattend to referents that are being spokenabout by his or her listener. Additionally,it is important that the learner be able tocoordinate attention between his or herlistener and the referents of the inter-action. These competencies require thatthe learner exhibit a repertoire oforienting responses. Examples of theseresponses include joint focus, line ofregard, and following natural gesturaldirections.

In the context of a social exchange,joint focus refers to both participantsdirecting their attention simultaneously tothe same referent. At the most rudimen-tary level, visual and/or auditory locali-zation responses greatly facilitate estab-lishing joint focus. For example, if theinterventionist wishes to call a learner'sattention to an object, tapping the item orwalking over to the item will generallyresult in the learner's localization (Kaye,1976; Scaife & Bruner, 1975).

Line of regard occurs when thelearner's listener directs his or her gaze toa particular place; the learner may subse-quently look in the same direction of the

163

listener, even though there was no overtcue to do so. For example, while smilingat an infant, the mother looks out thewindow. Even though nothing may havehappened outside, learners older thanseveral months of age will demonstrate apropensity to follow their partner's gaze.Line of regard is viewed as a particularlyimportant advancement in ensuring thatlearners and their communicative partnersestablish joint focus on the objects orevents that are the focus of communicativeexchanges. Typically, learners who engagein line of regard require far less intrusiveprompts to visually sample their environ-ment than do learners who do not yetengage in this skill.

Sometimes, a communicative part-ner alters his or her focus of attention toa cluster of possible referents. Clarifyingwhich referent is the new focus of atten-tion may require pointing to the item orevent of interest. For example, whilereading a book with a child, parents maypoint to a particular aspect of the pagethey may wish their child to notice. Thisstrategy of focusing a child's attentionappears to be very effective at relativelyearly ages in normal developing children(Murphy & Messer, 1977). For individualswith the most severe communicative defi-cits, the pointing gesture represents animportant strategy that the interventionistcan use to focus a learner's attention wqh-out interrupting the flow of an interaction.

The behaviors that we have des-cribed thus far are aimed at teachirg thelearner to follow, anticipate, and partic-ipate in the flow of social routines.McLean and Snyder-McLean (1988) haveoutlined the characteristics of maximally


efficient social routines that focus on jointaction. They suggest that a routine musthave some unifying theme or purpose thatrequires both joint focus between thelearner and the listener and an exchangeof turns. To maximize the probability thateach team member acquires a role in thegame, actions should be based on apredictable sequence, with pauses thatpromote turn-taking. Routines must beones that can be implemented frequentlyacross time.

Once learners are particularlyactive in joint activity routines, steps canbe taken to identify those components ofthe listener's behavior which ensure thelearner's participation. Table 3 containsan example of how an interventionistmight isolate exactly which adult motorand vocal gestures result in a childrecognizing that he or she has an oppor-tunity to play a game of peek-a-boo. Inthis example, it is clear that the inter-ventionist's production of the spokenutterance "peek-a-boo" did not exert anycontrol over the learner's behavior.

Often, learners with more severedisabilities have difficulty learning tounderstand spoken words. Joint activityroutines may provide an opportunity forthe interventionist to determine thedegree to which the learner attends to thespoken utterances of his or her partner.The interventionist might select a routinethat involves the interventionist producingboth motor and vocal behavior. Duringthe initial phases of implementing thisroutine, motor and vocal behavior will bepaired. After extensive pairing, theinterventionist may choose to deliver thespoken cue just prior to the delivery of the

gestural cue. This would afford thelearner an opportunity to engage in adiscriminative voluntary behavior thatpreviously was under the control of only agestural cue. Across successful teachingopportunities, the interval between thedelivery of the verbal cue and the gesturalcue would be increased.

If the preceding strategy weresuccessful, it may still be unclear whetherthe learner actually understands thespoken word. Instead, the learner may beattending to prosodic aspects (i.e., pitch,loudness, duration) of the communicativepartner's utterance. For example, Reich le,Rettie, and Siegel (1986) reported thatsome preschoolers with Down syndromewere more apt to attend to aspects ofprosody (pitch, loudness, duration) than tothe specific segmental forms of utterances.The strategy just described could be usedto transfer instructional control from thepitch, duration, and loudness of another'sutterance to the actual word spoken. It isclear that children learn to attend to andutilize clusters of contextual cues that, asa package, serve as a discriminative stimu-lus for a social response. With learnerswho have very severe communication defi-cits, it may be very important to determinewhether they contingently act on socialstimuli. If they do, efforts can be made todetermine whether their partner's vocalbehavior is a salient aspect of thatdiscriminative stimulus. Once a learnerproduces contingent social responses tovocal stimuli, steps can be taken to teachhim or her to discriminate between wordsspoken by a communicative partner.

Initiating a communicative inter-action. Table 4 summarizes some circum-

164

20

Table 3

Determining Which Components of a "Peek-a-Boo" RoutineExert Stimulus Control Over a Learner's Response

Natural Occurrence Trial 1 Trial 2

Partner Behavior.

- approach child in typicalsetting

Partner Behavior:


Partner Behavior:


- smile - smile - smile

- raise hands to eyes andthen quickly pull handsaway from eyes

- raise hands to eyes andthen quickly pull handsaway from eyes

- say "peek-a-boo" - say "peek-a-boo"

Child Behavior.

- Put hands over own eyes

Child Behavior:

- no response

Child Behavior:

- put hands over owneyes

2165

Table 4

Circumstances That Occasion Communicative Initiations

Circumstance Example

Joining activities that are alreadyin progress

Tom Sawyer instills an interestamong his peers in painting a fence.

Beginning well-established routines

Upon receiving several cookies, alearner (taught that you can't eatyour snack unless all the children in thegroup have some) turns to a peer whodoesn't have any, offers her a cookie,and says, "Here."

Calling attention to novel eventsAt snacktime, when a child spills hismilk, a learner obtains the teacher'sattention to point out what hashappened.

Protesting the undesirable actionsof another

A waiter, assuming that a customer hasfinished her meal, attempts to removethe plate that still contains a smallamount of food. When this happens,the customer says, "I'm not done."

Note: From Reich le, J., York, J., and Sigafoos, J. (1991). Implementing augmentative andalternative communication: Strategies for learners with severe disabilities (p. 147).Baltimore: Paul H. Brookes. Copyright 1991 by Paul H. Brookes PublishingCompany, Inc. Reprinted with permission. (Available from Paul H. BrookesPublishing Company, P.O. Box 10624, Baltimore, MD 21285-0624. Telephone: 1 -800-638- 3775.)

166 22


stances that appear to occasion communi-cative initiations. Rarely has initiatingbeen the focus of early intervention effortswith persons having severe developmentaldisabilities. Usually, initiation isaddressed once the learner has acquired anew vocabulary but fails to use it in theabsence of overt prompts delivered by aninterventionist or communicative partner(Carr & Kologinsky, 1983; Char lop,Schreibman, & Thibodeau, 1985; Gobbi,Cipani, Hudson, & LaPenta-Neudeck,1986).

Within recent years, variables thatmay influence the likelihood of a learnerproducing a communicative initiation havebeen identified. For example, Carr andKologinsky (1983) demonstrated that, forsome learners to initiate an object request,the item had to be visible. They imple-mented procedures to ensure predictableconditions when the objects would beavailable but not visible. Their inter-vention resulted in an increase in thelearner's rate and variety of initiatedrequests. Other investigators includingChar lop, Schreibman, and Thibodeau(1985); Gobbi, Cipani, Hudson, andLaPenta-Neudeck (1986); and Halle, Baer,and Spradlin (1981) have reported thesuccessful use of procedures that incor-porated the use of ti:Lte-delay promptfading to establish communicative initi-ations.

Relatively limited attention hasbeen given to efficient strategies toestablish communicative initiations duringthe earliest phases of the interventionprocess. This is a particularly important

167

need, given the overwhelming consensusthat persons with severe disabilities seemto more readily fill the role of responderthan initiator in social exchanges.

Terminating communicative inter-actions. Table 5 displays a range ofmotivations for terminating an interaction.There exists a propensity in the literatureto limit conversational terminating strate-gies to teaching examples in which thelearner is highly motivated to escape thepresentation of an undesired item or toescape an interaction that has becomeuninteresting. Unfortunately, theseinstances represent a narrowed samplingof the potential instances in which aconversational terminating function couldbe used. Recent research (e.g., Reich le,1990a) suggests that learners who aretaught to terminate an interaction whenpresented with highly nonpreferred itemsor events fail to generalize the use of theircommunicative strategy in the presence ofitems that are preferred but for which thelearners have entered a state of satiation.Typically, strategies used to terminateinteractions focus on identifying the mostnonpreferred situations as the interventionstimuli. However, many opportunities toemit communicative rejects may involveevents that are not particularly aversive tothe learner. We believe that, withlearners who exhibit the most severe dis-abilities, interventionists must carefullyselect a broad set of teaching examplesthat exemplify the full range of conditionsunder which a particular conversationalfunction is to be used.

Table 5

Circumstances That May Occasion Terminationof Communicative Interactions

Circumstance Example

Ending undesired interactionsA learner becomes bored participatingin a game of cards and says, "Let'sstop."

Concluding desirable interactionsin order to accommodate a schedule

When the bell rings in the schoolcafeteria, a learner may have toterminate her lunchtime interactionwith a peer in order to avoid beinglate to her next class.

Finishing pleasant interactions to takeadvantage of a more attractivealternative

A 7-year-old child may be content toplay with a 3-year-old child, providedno other playmates are available.However, the appearance of another7-year-old may result in theinteraction with the 3-year-old beingterminated.

Discontinuing pleasant interactionsdue to environmental disruptions

A learner who sees his little brotherfall off his bike may need toterminate a play activity in order torender assistance.

Note: From Reich le, J., York, J., and Sigafoos, J. (1991). Implementing augmentative andalternative communication: Strategies for learners with severe disabilities (p. 150).Ba14..irnore: Paul H. Brookes. Copyright 1991 by Paul H. Brookes PublishingCompany, Inc. Reprinted with permission. (Available from Paul H. BrookesPublishing Company, P.O. Box 10624, Baltimore, MD 21285-0624. Telephone: 1 -800-638- 3775.)

fioCommunication Intervention - Severe and Profound Disabilities

MODIFYING ELEMENTS OFENVIRONMENTS TO ENSURECOMMUNICATIVE ATTEMPTS

Although the goal of communica-tion intervention is for the learner toacquire the skills required to take advan-tage of natural communicative environ-ments, it may be difficult for learners withsevere and profound disabilities to takeadvantage of communicative opportunitieswithout some modification or rearrange-ment of the schedule of certain events.For learners who are served in regulareducational settings, some of the modifi-cations required may involve extensiveefforts to provide training, technicalassistance, and program ownership toregular educators.

Influence of the Learner's State

It is clear that learners vary intheir attentiveness to environmentalstimuli. Historically, the term behavioralstate has been used to refer to the variousbehavioral and physiological conditionsthrough which infants continuously pass(Wolff, 1959). Consider, for example, howbehavior state may affect an infant'sresponse to the presentation of a bottlefilled with milk. If an infant is crying andagitated, he may not immediately attendto the presentation of the bottle as astimulus and, therefore, not respondaccordingly (reach for the bottle and beginsucking). However, if an infant is awakeand relatively quiet, he is likely toimmediately attend to the bottle andinitiate the appropriate response. Becausethe behavior state of being awake, quiet,

Or:

169

and calm with minimal gross movementsinterferes the least with the ability toprocess various stimuli, it is posited that itis the optimal state for learning (PL'echtl,1974). Some general conclusions regard-ing behavior state that can be drawn fromnumerous investigations are presented inTable 6.

Behavior state in infants has beenexamined primarily among normallydeveloping infants (Prechtl, 1974; Wolff,1959, 1966). Colombo and Horowitz(1987) raised the intriguing question ofwhether the conclusions drawn from theinfant literature on behavior state condi-tions are applicable to older persons withsevere to profound disabilities who havedevelopmental ages similar to that ofinfants. Simeonsson, Huntington, andParse (1980) noted that determining thedegree to which behavior states in individ-uals with profound mental retardation arepredictable and regular may provideimportant information for the inter-ventionist.

To date, there is limited empiricalinformation on the behavior state charac-teristics of individuals ..with profounddisabilities (Guess, Mulligan-Ault, et al.,1988; Guess, Siegel-Causey, et al., 1990;Guess, Roberts, et al., 1991). Guess,Mulligan-Ault, et al. (1988) found that,among 21 students with severe to pro-found handicap,, the percentage of timespent in an awake-inactive-alert state(state more conducive to learning) rangedfrom 23.88 to 71.85, with a mean of 46%.Results from Guess, Siegel-Causey, et al.(1990) and Guess, Roberts, et al. (1991)suggest that: (a) sometimes it is possibleto predict that one particular behavior

Table 6

General Conclusions Regarding Behavior State in Infants

General Conclusions Reference

There is a succession of behavior Wolff (1959)patterns (states) that is similar in all Wolff (1966)normally developing infants.

Environmental variables (temperature, Wolff (1966)noise) can effect the duration and thestability of state cycles.

Infants with unstable state patterns inthe first weeks of life appear to be atrisk for later, rather severe medicalproblems.

Children recovering from brain injuryfollow a general pattern of recoverysimilar in many ways to the behavioralstate cycles of infants.

Premature infants, infants with Downsyndrome, and infants of mothers whoare alcohol-addicted have shownbehavioral state patterns that aredifferent from those of normallydeveloping infants.

Aberrations in state cycles are viewed assymptomatic of neurological disorgani-zation that might result in reducedopportunities to learn, as well asdiminished control over stimuli.

170

Tynan (1986)Thoman, Denenberg, Sievel, Zeidner,

and Becker (1981)

Thompson (1984)Bagnato and Neisworth (19F 3)

Prechtl (1974)

Horowitz (1980)Rainforth (1982)

26


state would follow another; (b) thereappear to be no temporal cycle patternsfor any of the subjects regarding any ofthe behavior state conditions; (c) there isa tendency to change from one behaviorstate to another in a relatively shortperiod of time (e.g., 21-32 seconds); and(d) there appear to be strong associationsbetween several behavior state conditionsand critical environmental variable combi-nations (e.g., deep sleep was associatedwith variable combinations that includedno interaction with the student and aprone or sidelying position).

These findings would suggest that itmay be particularly important to identifysetting variables that niay be associatedwith a critical "window" of interventionopportunity with learners who are in analert state for limited periods of time.Currently, there is a need to conductempirical investigations to determine theeffect that state conditions have on theindividuals who interact with students withprofound mental retardation and to identi-fy the environmental variables that mightalter the state conditions of theseindividuals.

COLLABORATIVE SERVICE DELIVERY

Ensuring That Professionals ClearlyUnderstand Their Roles and Are

Adequately Trained

Best practice in communicationintervention suggests that instructionshould occur in situations in which thebehavior is eventually expected to beproduced. With persons who have verysevere disabilities, we know that a

171

relatively large number of functionalteaching opportunities may be required toestablish new communicative behavior.Logistically speaking, communicationinterventionists must include parents,teachers, psychologists, teaching assistants,physical/occupational therapists, and ahost of other professionals who regularlycome in contact with the learner.Consequently, a tremendous level ofcollaboration across members of alearner's educational team is required ifqualitatively adequate instruction is tooccur.

In order to serve students inincreasingly inclusive settings, profes-sionals have begun to find it advantageousto reorganize service delivery to maximizethe use of a collaborative model of servicedelivery emphasizing integrated therapypractices (Rainforth, York, & Macdonald,1992). This emphasis on transdisciplinarycollaboration in serving children and youthin inclusive educational settings haspresented tremendous challenges to highereducation to alter its traditional discipline-specific preservice training.

Defining Collaborative Teams

Rainforth, York, and Macdonald(1992) have defined a collaborative teamas a group of members who labor togeth-er, with each team member contributinghis or her knowledge and skills and havingequal status as a member of the team.One hallmark of collaborative teams is atransdisciplinary approach to servicedelivery in which members of transdisc-iplinary teams:


1. share general discipline-specificinformation,

2. provide in-depth content back-ground for fellow team members, and

3. prepare their fellow teammembers to share in the implementationof what have traditionally been discipline-specific instructional objectives.

As a result of these practices,collaborative teams embrace the activeutilization of an integrated therapy model(Albano, Cox, York, & York, 1981;Giangreco, York, & York, 1989), in whichthe team as a whole identifies relativeenvironmental content in which to use alearner's emerging skills and focuses onstrategies to influence therapy objectivesin regular curricular areas. Implementingcollaborative teams and a correspondingintegrated therapy model requires care ifthe outcome is to be qualitativelyadequate (see Utley, this volume).

Advantages of a Collaborative Model ofService Delivery

Rainforth, York, and Macdonald(1992) describe a number of benefits of acollaborative transdisciplinary servicedelivery model. These benefits include:(a) increased instructional time forstudents with severe disabilities (Albano,1983; McCormick, Cooper, & Goldman,1979); (b) improved skill acquisition(Campbell, McInerney, & Cooper, 1984;Giangreco, 1986); (c) decreased passivecaregiving in regular educational envi-ronments; and (d) reduced conflictsamong team members (York & Rainforth,1987).

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Within the past several years, anumber of professional organizations (e.g.,the Division of Early Childhood, theAmerican Occupational Therapy Associa-tion, the Association for Persons WithSevere Handicaps, the American PhysicalTherapy Association, and the InternationalSociety of Augmentative and AlternativeCommunication) have endorsed policiespromoting collaborative teaming and anintegrated therapy model of servicedelivery. Each of these organizations hascited learning characteristics of studentswith severe disabilities, the benefits ofcollaboration, and existing legal mandatesand precedents as a strong foundation foradopting less discipline-specific servicedelivery.

Training for Collaboration

Establishing a successful inclusiveeducation for all students with disabilitieswill require overcoming two distinctly dif-ferent, yet highly interrelated challenges.On one hand, existing discipline-specificpreservice training does not allow suffi-cient modeling of a transdisciplinaryapproach to service delivery, which clearlyrepresents best practice. Correspondingly,preservice trainers do not collaboratesufficiently with service providers inapplied settings to develop the collabora-tion required to establish a continuum thatbridges pre-service and inservice activi-ties.

From a process perspective, pre-service providers appear to be failing tocarefully analyze the skills that will beneeded in the environments in which pro-fessionals perform, nor are they addressing

0 C'4_,


these skills via competencies in preservicetraining programs. We believe that highereducation preservice training must alsoadopt a strategy in which the training ofprofessionals becomes a collaborativeeffort with the public school communityand a transdisciplinary effort with academ-ic units within universities. In order toachieve this objective, it is important thatboth public schools and university preser-vice programs collaborate in a mannerthat is mutually beneficial. We believethat one reasonable approach to a mutual-ly beneficial relationship is the increasinginvolvement of public schools in preserviceinstruction and commensurate, increasinginvolvement of university preservice pro-grams in inservice activities of the publicschools.

The federal mandates to serve chil-dren in the least restrictive environment,regardless of age or handicapping condi-tions, have created a critical need todevelop preservice training activities thatfocus on transdisciplinary intervention forchildren, particularly infants with disabil-ities and their families. Courtnage andSmith-Davis (1987) reported that, of the360 higher education institutions thatparticipated in their investigation, 48%offered absolutely no training in teamcollaboration. Rainfcrth (1985) conducteda nationwide survey of 53 university pro-grams in order to evaluate the degree ofinterd-partmental coordination in thepreservice preparation of students forwork with persons having severe disabil-ities. She reported only 3 instances of anytransdisciplinary pre-service activities.Results of this survey are particularlyalarming when one considers that, as these

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students complete their professionaltraining, they will be expected to workcollaboratively with other professionals inpublic schools. Rainforth's (1985) studysuggests that there are few instances inwhich higher education has met the chal-lenge of delivering content information ina manner that also teaches students thecollaborative skills that will be necessaryin applied school settings. Among themost frequently cited stumbling blocks tothe implementation of a collaborativemodel of personnel preparation are: (a)confusions regarding responsibilities, (b)absence of administrative support andstructure, and (c) turfism regarding theownership of courses within departments.The lack of preservice collaborationinevitably leads to a lack of collaborationamong professionals serving children inpublic schools (Campbell, 1987).Baumgart and Ferguson (1991) concludethat the collaborative process is "...judgedas valid and beneficial by parents andprofessionals (but) is not extensivelypracticed in either the service provider orthe preservice arena..." (pg. 319).

Baumgart and Ferguson (1991)have emphasized the importance of re-focusing university preservice instructionto place greater emphasis on team collab-oration and the use of on-site teamproblem-solving. In placing increasinglygreater emphasis on applied experiences,it will be increasingly necessary to ensurethat practica are not simply "practicinglabs" but, rather, collaborative instruc-tional settings in which the practicumstudent is given sufficient support toapproximate a more error-free (versustrial and error) learning environment.


Consequently, preservice students willrequire far greater support than theycurrently receive in most preservicetraining programs. In an existingenvironment of fiscal restraint in highereducation, it is clear that collaborativesupervision that involves the joint effort ofacademic faculty and practicing profes-sionals in the field must be provided. Ifthis is to occur, there must be clearadvantages for practicing professionals toprovide this engagement. There must alsobe active collaborative interaction betweenuniversity faculty/staff and service provid-ers to ensure that public school profes-sionals are in a position to provide astrong collaborative arrangement.

Giangreco and Putnam (1992) havedescribed a number of areas requiringcareful scrutiny. These areas relate to theprocesses of collateral teaming, integratedtherapy, and resulting inclusionary educa-tional practices. First, even though thereis a modest and growing database attestingto the value of an inclusionary model ofeducation, there is a need to quantitativelyand qualitatively examine the componentsof full inclusionary models on theacademic, social, and interpersonalrelationships that emerge in both childrenwith disabilities and their peers. Secondly,for students who receive inclusive educa-tion, there is a continuing need to createand validate innovative approaches thatensure intensive skill instruction that doesnot sacrifice regular classroom inclusionand the corresponding social experiences.Thirdly, there is a need to scrutinize bestpractices used in implementing overlap-ping curricular objectives, using inter-vention approaches (such as cooperativelearning) that, validated in regular

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education, have only just begun to receivesignificant attention as viable strategies forpersons with significant disabilities.Fourthly, there is a tremendous need toexamine collateral effects that theimplementation of individualized instruc-tional objectives may have on the learner'soverall ability to function in a regularschool environment. For example, asGiangreco and Putnam (1992) havepointed out, we have little empirical dataaddressing how learning a particular skill(e.g., playing with an age-appropriate toy)may be directly related to a differentpositive learner outcome (e.g., increasedoperative participation with a nondisabledpeer). If we are to make significantheadway in inclusive education, collateraleffects must come to be viewed as empiri-cally-predicted outcomes, rather than assome phenomenon that the interventionisthopes for after intervention.

Perhaps one of the most pressingareas for empirical scrutiny involvesidentifying and validating systems-changestrategies to assist professionals in workingcollaboratively toward successful inclusiveeducation for all individuals. Thisparticular area of scrutiny requires acareful coordination of researchers in theareas of policy and personnel preparation.

Including Peers inCommunication Intervention

Among even the most interactiveand incidental intervention strategies, thebulk of instructional opportunities occursin response to prompts or cues that havebeen teacher-arranged. A number ofinvestigators (see Goldstein & Kaczmarek,1992, for review) have suggested that a


variety of strategies can be directed atpeers of learners with severe disabilitiesto increase the probability that social/communicative interactions will occur.Goldstein and Kaczmarek (1992) suggestthat providing quality peer responsivenessto learners with disabilities may provide acontext more conducive to learning socialand communication skills. However, theyalso suggest that peer intervention is notwell suited to learning new skills. Thislatter observation presents formidablechallenges to interventionists and createsa clear need to merge data derived fromcommunication research with the empiri-cal literature addressing interventionstrategies to achieve inclusion.

Addressing the Differences andSimilarities Between Home and School

Traditionally, the assumption seemsto have been that communication skillsestablished at school would be useful athome and vice versa. Although it wouldmake the intervention process muchsimpler, this may not be the case. Forexample, if a learner wants a beverage athome, he may go to the refrigerator andget one. At school, however, obtaining abeverage may require a permission re-quest. The vocabulary and, to somedegree, the communicative functions mostapt to be expressed may differ tremen-dously across environments. Rather thanalways viewing skills taught in one settingas needing to be generalized across envi-ronments, interventionists may wish toconsider the environments as settingscalling for potentially different communi-cative responses. During the early phases

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of intervention, an important considerationmay be selecting some communicativeresponses that will be appropriate andfrequently used across settings. This maybe important to create a greater numberof acquisition opportunities. At the sametime, it may assist in the fostering ofteamwork among professionals andparents across settings.

SUMMARY

Traditionally, communication inter-ventionists focused on teaching a begin-ning repertoire of communicative behav-ior, once learners with severe to profounddisabilities had emitted intentionalbehavior. Increasingly, interventionists arerecognizing that valuable opportunitiesmay be lost if intervention does not beginat an earlier point. In part, interventionstrategies at increasingly earlier pointshave resulted from a prevailing changefrom semantically-focused interventionlogic to pragmatic, interaction-focusedintervention logic.

At the same time that interventioncontent has increasingly focused on prag-matics, there has been a wealth of infor-mation addressing the social functionsserved by repertoires of simple idiosyn-cratic (as well as socially unacceptable)behavior. The increasing availability ofaugmentative and alternative communica-tive options has provided an extensivearray of motorically simple strategies toexert significant control and influence overone's environment.

We have long since passed theneed to demonstrate that persons withsevere disabilities can be taught a reper-


toire of communicative functions. How-ever, we have not been as successful indemonstrating that the communicativebehavior taught is well maintained solelyin the presence of natural maintainingcontingencies. Nor have we adequatelydemonstrated that established repertoiresare sufficiently generalized.

Most recently, interventionists havebegun to focus on more efficient strategiesto use and on selecting the most criticalteaching instances to use. Additionally,interventionists are considering responseefficiency as an important variable indetermining the likelihood that a learnerwill choose to emit elements of his or hercommunicative repertoire.

There appears to be a consensusamong those who currently serve individ-uals with severe disabilities that inclusionrepresents an attainable objective forstudents with even the most severe disabil-ities. Unfortunately, it is not clear thateither special or regular educators arebeing adequately prepared to accomplishincluded placements. There remains asignificant need to recognize those aspectsof best practice which must be furtherexplored in regular education settings.What once were considered best practicemethods may not meet the test of socialvalidity and be considered best practicesin regular classrooms.

The vast majority of interventionresearch has selected a fairly narrowcommunicative form or function to teach.Increasingly, information on maintenanceand generalization is considered. How-ever, often the periods sampled post-acquisition are very modest. Among theplethora of available communication

intervention curricula, there are virtuallynone that have taken a learner from apoint of engaging in no intentionalcommunicative behavior to the establish-ment of an effusive repertoire of commu-nicative functions and correspondingvocabulary.

There is a critical need forlongitudinal efforts to validate curriculabeing developed for persons with severe toprofound disabilities. Although important,it is no longer sufficient to demonstratethat repertoires selected for instructionhave social validity at the point in timethey were implemented. Increasingly, it isimportant to address how initial interven-tion decisions influence later interventiondecisions. Only when this is scrutinizedsystematically will our intervention strate-gies become sufficiently streamlined.

To be able to express oneself haslong been viewed as a cherished right.Many individuals with severe to profounddisabilities have not been afforded thisright, although not maliciously. Fortu-nately, our ignorance regarding strategiesthat allow learners to take advantage ofopportunities is diminishing. Slowly, butpersistently, interventionists are movingtoward functional approaches that areassisting individuals with severe disabilitiesto exercise their right of free speech.

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Communication Intervention Severe and Profound Disabilities

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Joumals/Newsletters

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Closing the Gap. Bimonthly newspaper.Address correspondence to: Closing TheGap, P.O. Box 68, Henderson, MN 56044.Or call (612) 248-3294.

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183

Journal of Speech and Hearing Research(JSHR) (ISSN 0022-4685). Publishedbimonthly by the American Speech-Language-Hearing Association, 10801Rockville Pike, Rock;ille, MD20852-3279. Telephone: (301) 897-5700.

The Journal of the Association for Persons withSevere Handicaps (DASH) (ISSN 0274-9483). Published quarterly by TheAssociation for Persons with SevereHandicaps, 11201 Greenwood Avenue N.,Seattle, Washington 98133. Telephone:(206) 361-8870.

Mental Retardation. Send correspondence to:American Association on MentalRetardation, 1719 Kalorama Road N. W.,Washington D.C. 20009. Telephone: (202)387-1968.

Topics in Early Childhood Special Education.Address correspondence to: Pro-EdIncorporated, 8700 Shoal Creek Blvd.,Austin, TX 78758-6897. Telephone: (512)451-3246.


Organizations

American Speech-Language-HearingAssociation (ASHA), 10801 Rockville Pike,Rockville, Maryland 20852. Telephone: (301)897-5700.

Closing the Gap, P.O. Box 68, Henderson, MN56044. Telephone: (612) 248-3204.

International Society for Augmentative andAlternative Communication (ISAAC), 81Topham Cresent, Richmond Hill, Ontario,Canada L4C9E9.

The Association for Person with SevereHandicaps (TASH), 11201 Greenwood Avet. ueN., Seattle, Washington 98133. Telephone:(206) 361-8870.

The Arc (formerly the Association forRetarded Citizens), Arc NationalHeadquarters, 500 E. Border St. S-300,Arlington, TX 76010. Telephone: (817) 640-0204.

The Society for the Experimental Analysis ofBehavior, Inc., Business Manager, MaryLouise Wright, Dept. of Human Development,University of Kansas, Lawrence, KS 660452.

Partial Listing of ProjectsServing Children and Youths with Severe Disabilities

Funded by Office of Special Education Programs, U.S. Department of Education

Projects Focusing on Communication Intervention

Project LIFE (Lifelong Impact FromEducation)

Wayne FoxUniversity of Vermont449C Waterman BuildingBurlington, VT 05405(503) 838-8401

Project SAMSPaul AlbertoGeorgia State UniversityDepartment of Special EducationUniversity PlazaAtlanta, GA 30303(404) 651.2310

184

Enhancing Conversation Skills withAssistive Technology

V. Mark DurandUniversity at AlbanyOffice for Research, AD 2...81400 Washington AvenueAlbany, NY 12222(518) 442-4845

Functional Communication Training Usingan Augmentative Communication System

V. Mark DurandResearch Foundation of the StateUniversity of New YorkSUNYP.O. Box 9Albany, NY 12201(518) 442-4845

40


Teacher Work Groups - A Strategy forHelping Teachers Implement Best Practices

Dianne FergusonUniversity of Oregon1761 Alder StreetSTPEugene, OR 97403(503) 346-2491

The Effect of Tactile Aids on CommunicationSkills of Infants and Preschoolers withDeaf -Blindness

Barbara FranklinSan Francisco State University1600 Holloway AvenueSan Francisco, CA 94132(415) 338-1161

Communication and Social Skills Instructionfor Students with Sensory Impairmentsand Their Peers

Lori GoetzSan Francisco State University1600 Holloway AvenueSan Francisco, CA 94132(415) 338-1161

Validating Strategies that FacilitateSpontaneous Communication and ExtendPragmatic Functions for Learners withSevere Disabilities

Jim HalleUniversity of IllinoisDepartment of Special Education1310 S. Sixth StreetChampaign, IL 61820(217) 333-0260

Supporting Choice in the Lives of Studentswith Severe Disabilities

Robert HornerUniversity of OregonSpecialized Training Program135 Education BuildingEugene, OR 97403(503) 346-2462

185

Training of Educators of Students withMultiple Disabilities that Include Auditoryand Visual Impairments: AFB Deaf-BlindProject

Kathleen HuebnerAmerican Foundation for the Blind15 West 16th StreetNew York, NY 10011(212) 620-2045

Personal Futures Planning for Individualswith Deaf-Blindness

Harold KleinertUniversity of Kentucky Research

Foundation114 Mineral Industries BuildingUniversity of KentuckyLexington, KY 40506-0051(606) 257-3045

Applications of Technology in the EarlyCommunication Training of Children withDeaf -Blindness

Harvey MarDevelopmental Disabilities CenterSt. Luke's-Roosevelt Hospital Center428 West 59th StreetNew York, NY 10019

Utilization of Innovative Practices inCommunication Treatment for Students withSevere Disabilities

James McLeanUniversity of KansasBureau of Child ResearchLawrence, KS 66045(316) 421-6550, ext. 1891

Utilization of Innovative PracticesCommunication Treatment Children withSevere/Multiple Disabilities

Charity RowlandOregon Research Institute425 S.E. 11th Ave.Portland, OR 97214(503) 232-9154


Validating Practices: Children withSevere Disabilities

George SingerOregon Research Institute1899 Willamette StreetSuite 2Eugene, OR 97401(503) 342-8445

A Comprehensive Model to Enhance theMaster and Functional Capabilities of Studentswith Multiple and Physical Disabilities

Jo-Ann SowersOregon Research Institute1899 Willamette StreetSuite 2Eugene, OR 97405(503) 232-9154

Enhancing the Effectiveness ofCommunicative Interactions

Robert StillmanCallier Center for Communication

DisordersUniversity of Texas at DallasCallier Center1966 Inwood RoadDallas, TX 75235(214) 905-3106

Facilitating Adaptations in Family-RoutineInteractions: For Infants/Young Children withDual Sensory Impairments and Their Families

Kathleen StremelUniversity of Southern MississippiDepartment of Special EducationSouthern Station Box 5115Hattiesburg, MS 39406-5115(601) 266-5135

186

An Integrated Parent-Teacher- RelatedService Team Approach to Communication:For Children with Dual Sensory Impairments

Kathleen StremelUniversity of Southern MississippiDepartment of Special EducationSouthern Station Box 5115Hattiesburg, MS 39406-5115(601) 266-5135

Innovative Applications of AssistiveTechnology for Students withSevere Disabilities

Barbara ThompsonUniversity of KansasDepartment of Special Education3001 DoleLawrence, KS 66045(913) 864-4954

Integrating Related Services into InstructionalObjectives

Bonnie UtleyUniversity of Pittsburgh5K01 Forbes QuandranglePittsburgh, PA 15260(412) 648-1998


Issues Related to Inclusion

Utilization of Best Practices in Transitionfor Students with Deaf-Blindness

Paul AlbertoGeorgia State UniversityDepartment of Special EducationUniversity PlazaAtlanta, GA 30303(404) 651-2310

Project Eyes and EarsDavid BurketDistrict of Columbia Public SchoolsWebster Administration Building10th & H Street NWWashington, D.C. 20001(202) 724-4018

Including Exceptions: A System for EducatingStudents with Dual Sensory Impairments andOther Extreme Disabilities in GeneralEducation Settings

Dianne FergusonUniversity of OregonSpecialized Training ProgramEugene, OR 97403-1235(503) 346-2491

Services for Children and Youth withDeaf - Blindness


Project LIFE (Lifelong Impact FromEducation)


187

Innovations for Educating Children with Deaf-Blindness in General Education Settings:Friends for Life

Norris HaringUniversity of WashingtonExperimental Education Unit WJ-10Seattle, WA 98195(206) 543-4011

Systematic Integrated Preschool Model forChildren with Severe Disabilities

Arlene AvenoUniversity of VirginiaCurry School of Education405 Emmet StreetCharlottesville, VA 22903-2495(804) 924-4778

Developing Social Relationships betweenStudents with Severe Intellectual Disabilitiesand Nondisabled Peers and Others

Lou BrownUniversity of WisconsinDepartment of RehabilitPion, Psychology

and Special EducationRoom 305432 North Murray StreetMadison, WI 53706(608) 262-2722

Kansas Project for the Utilization ofFull Inclusion: Innovations for Studentswith Severe Disabilities

Charles CampbellUniversity of Kansas1052 DoleLawrence/Douglas, KS 66045(316) 421-6550 ext. 1765

Regular Class Participation System: OngoingSupport for Students with Severe Disabilities

Dianne FergusonUniversity of OregonSpecialized Training Program135 Education BuildingEugene, OR 97403(503) 346-5311


Vermont Model for the Statewide Delivery ofQuality Comprehensive Special Education andRelated Services to Children

Wayne FoxUniversity of VermontCenter for Developmental Disabilities499C Waterman BuildingBurlington, VT 05405(802) 656-4031

Innovative Programs for Severely DisabledChildren

Sharon FreagonNorthern Illinois UniversityDepartment of Educational Psychology,

Counseling and Special EducationDeka lb, IL 60115(815) 753-0656

Innovations for Meeting Special Problems ofChildren with Severe Disabilities in theContext of Regular Education Settings

Doug GuessUniversity of KansasDepartment of Special Education3150 Haworth HallLawrence, KS 66045(913) 864-4954

Innovations for Meeting Special Problems ofChildren with Deaf - Blindness in the Contextof Regular Education Settings

Norris HaringUniversity of WashingtonExperimental Education UnitSeattle, WA 98195(206) 543-1000

Team Collaboration for School ImprovementEdwin HelmstetterWashington State UniversityDepartment of Education and Counselling

PsychologyPullman, WA 99164(509) 335-7016

Virginia Statewide Systems Change ProjectRachel JanneyCommonwealth of VirginiaDepartment of EducationP.O. Box 2020Richmond, VA 23284-2020(804) 367-8802

Integrated Social and Leisure Recreation forStudents with Severe Disabilities

William Kiernan or Sherril MoonChildren's Hospital Training and Research

Institute300 Langwood Ave., Gardner 4Boston, MA 02115(617) 735-6505

Application of Technology to EnhanceQuality of Life: A MultidisciplinaryConsortium Approach

Ian PumpianSan Diego State UniversityFoundation College of Education5300 Campanile DriveSan Diego, CA 92182-2462(619) 594-2462

Inclusive Education Project: A Building-BasedApproach to Developing Classroom and SchoolModels that Include Students with SevereDisabilities

Linda Davern or Pat RoganSyracuse UniversityDivision of Special Education and

RehabilitationSkytop Office BuildingSyracuse, NY 13244-2280(315) 443-1881(315) 443-9469

Innovative Programs in Severely DisabledChildren

Diane RyndakThe Research Foundation of SUNYState University College at Buffalo1300 Elmwood AvenueBuffalo, NY 14222-1095(716) 878-5216

188 d t-t


Using a Collaborative Problem SolvingStrategy to Facilitate the Mainstreamingof Students with Severe Disabilities

Christine SalisburyResearch Foundation of State University

of New York-BinghamtonDivision of EducationBinghamton, NY 13902-6000(607) 777-2727

Integrated Play GroupsAdriana SchulerSan Francisco State UniversityOffice of Research and Professional

Development1400 HollowaySan Francisco, CA 94132(415) 338-1919

Expanding Social Integration to Home andCommunity Settings

Phillip StrainAllegheny-Singer Research InstituteOffice for Resource Development320 East North AvenuePittsburgh, PA 15212-9986(412) 359-1600

1894 5

Membership in Home Schools for Studentswith Severe Disabilities

Terri VandercookUniversity of MinnesotaDepartment of Educational Psychology13 Pattee Hall150 Pillsbury HallMinneapolis, MN 55455(612) 624-4848

Preparing Regular Education Personnel toSupport Best Practices

Barbara WilcoxIndiana University ISDDCommunity Integration Resource Group2853 East Tenth StreetBloomington, IN 47408(812) 855-6508

Research Institute on Placement andIntegration of Children with Severe Disabilities

Wayne SailorSan Francisco State University Foundation1640 Holloway AvenueSan Francisco, CA(415) 338-1306

Attachment A

Taxonomies DescribingInstrumental Communicative Intents

1914G

Wet

herb

y &

Pri

zant

(198

9)

Com

men

t on

Obj

ect:

Act

s us

ed to

dire

ct a

noth

er's

atte

ntio

n to

an

entit

y.

Com

men

t on

Act

ion:

Act

sus

edto

dire

ctan

othe

r'sat

tent

ion

to a

n ev

ent.

et"

Atta

chm

ent A

Tax

onom

ies

Des

crib

ing

Inst

rum

enta

l Com

mun

icat

ive

Inte

nts

Cir

rin

& R

owla

nd(1

985)

Dire

ct A

ttent

ion

to O

bjec

t:D

irect

ion

oflis

tene

r'sat

tent

ion

to a

nex

tern

al,

obse

rvab

le r

efer

ent,

or s

ome

obje

ct id

entif

ied

by th

e ch

ild.

Thi

s in

clud

es th

e sp

eake

rta

king

not

ice

of a

n ob

ject

or

labe

ling

anob

ject

in

abse

nce

of a

req

uest

.

Dire

ct A

ttent

ion

to A

ctio

n:D

irect

ion

oflis

tene

r'sat

tent

ion

toan

ongo

ing

actio

nor

even

tin

the

envi

ronm

ent.

Foc

us m

ay b

eth

e m

ovem

ent o

r ac

tion

ofan

obj

ect r

athe

r th

an th

eob

ject

itse

lf. A

" co

mm

ent'

on

som

e on

goin

g ac

tivity

.

McL

ean

& S

nyde

r-M

cLea

n (1

991)

Req

uest

Atte

ntio

n to

Oth

er:

Beh

avio

r us

ed to

dire

ct th

eco

mm

unic

ativ

epa

rtne

r'sat

tent

ion

to s

ome

obje

ct,

pers

on(o

ther

than

self)

,ev

ent,

or s

tate

of a

ffairs

.

(Ref

er to

Req

uest

Atte

ntio

nto

Oth

er)

193

Cog

gins

& C

arpe

nter

(197

8)

Tra

nsfe

rrin

g:G

estu

res

inte

nded

to p

lace

an

obje

ctin

anot

her

pers

on's

poss

essi

on.

Dor

e(1

975)

Labe

ling:

Use

s w

ord

whi

leat

tend

ing

to o

bjec

t or

even

t.D

oes

not a

ddre

ss a

dult

orw

ait f

or r

espo

nse.

Wet

herb

y &

Pitn

ant

(198

9)

Sho

w O

ff:A

cts

used

toat

trac

t ano

ther

's a

ttent

ion

toon

esel

f.

Cal

l: A

cts

used

to g

ain

the

atte

ntio

n of

oth

ers,

usu

ally

toin

dica

te th

at a

com

mun

ica-

tive

act i

s to

follo

w.

Ack

now

ledg

emen

t:A

cts

used

to in

dica

te n

otic

e of

anot

her

pers

on's

pre

viou

sst

atem

ent o

r ut

tera

nce.

Cla

rific

atio

n: A

cts

used

tocl

arify

the

prev

ious

utte

ranc

e.

Req

uest

Obj

ect:

Act

s us

edto

dem

and

ade

sire

dta

ngib

le o

bjec

t.

Chi

n &

Row

land

(198

5)

Dire

ctA

ttent

ion

toS

elf:

Dire

ctio

nof

liste

ner's

atte

ntio

n to

the

child

as

age

nera

l atte

ntio

n-ge

tter

for

som

eun

spec

ified

soci

alpu

rpos

e.

Dire

ct A

ttent

ion

toC

omm

unic

atio

n: D

irect

ion

oflis

tene

r's a

ttent

ion

to s

elf a

sa

pref

ace

to a

noth

er c

om-

mun

icat

ive

beha

vior

that

follo

ws

imm

edia

tely

.

Ans

wer

. A c

omm

unic

ativ

ere

spon

se fr

om a

chi

ld to

are

ques

t for

info

rmat

ion

from

the

adul

tlis

tene

r.T

his

typi

cally

take

s th

e fo

rm o

fin

dica

ting

ach

oice

oran

swer

ing

a qu

estio

n.

Req

uest

Obj

ect:

See

ks th

ere

ceip

t of a

spe

cific

obj

ect

from

the

liste

ner

whe

re th

ech

ildaw

aits

are

spon

se.

The

obj

ect m

ay b

e ou

t of

reac

h du

e to

som

e ph

ysic

alba

rrie

r.

McL

ean

& S

nyde

r-M

cLea

n (1

991)

Req

uest

Atte

ntio

n to

Sel

f:B

ehav

ior

used

toat

trac

tat

tent

ion

to o

nese

lf. N

o ot

her

refe

rent

is in

dica

ted.

(Ref

er to

Req

uest

Atte

ntio

nto

Sel

f)

Req

uest

Obj

ect:

Beh

avio

rus

ed to

req

uest

an

obje

ct.

Inte

rest

is o

n th

e ob

ject

dosi

red.

194

Cog

gins

& C

arpe

nter

(197

8)

Sho

win

g O

ff:G

estu

res

orut

tera

nces

that

app

ear

to b

eus

ed to

attr

act a

ttent

ion.

(Ref

er to

Sho

win

g O

ff)

Ack

now

ledg

ing:

Ges

ture

sor

utte

ranc

esth

atpr

ovid

eno

tice

that

the

liste

ner's

prev

ious

utte

ranc

es w

ere

rece

ived

.

Ans

wer

ing:

Ges

ture

s or

utte

ranc

es fr

om th

e ch

ild in

resp

onse

to a

req

uest

for

info

rmat

ion

from

the

liste

ner.

Req

uest

Obj

ect:

Ges

ture

s or

utte

ranc

es th

at d

irect

the

liste

ner

topr

ovid

e so

me

obje

ct fo

r th

e ch

ild.

Dor

e(1

975)

Cal

ling:

Cal

ls a

dult'

s na

me

loud

ly a

nd a

wai

ts r

espo

nse.

Ans

wer

ing:

Ans

wer

s ad

ult's

ques

tion.

Add

ress

es a

dult.

Req

uest

ing:

Ask

s qu

estio

nw

itha

wor

d, s

omet

imes

acco

mpa

nyin

gge

stur

e.A

ddre

sses

adu

lt an

d aw

aits

resp

onse

.

o Wet

herb

y &

Per

mit

(198

9)

Req

uest

Act

ion:

Act

suse

d to

com

man

d an

othe

r to

car

ryou

t an

actio

n.

Req

uest

Info

rmat

ion:

Act

sus

ed to

see

k In

form

atio

n,ex

plan

atio

n, o

r cl

arifi

catio

nab

out a

n ob

ject

, eve

nt, o

rpr

evio

us u

ttera

nce.

Incl

udes

wh-

ques

tions

and

oth

erut

tera

nces

havi

ngth

ein

tona

tion

cont

our

ofan

inte

rrog

ativ

e.

Req

uest

Per

mis

sion

: Act

sus

edto

seek

anot

her's

cons

ent o

r ca

rry

out a

nac

tion;

invo

lves

the

child

carr

ying

out

or

wis

hing

toca

rry

out t

he a

ctio

n.

Req

uest

Soc

ial R

outin

e: A

cts

used

to c

omm

and

anot

hert

oco

mm

ence

orco

ntin

ueca

rryi

ng o

ut a

gam

e-lik

eso

cial

inte

ract

ion.

arrin

& R

owla

nd(1

985)

Req

uest

Act

ion:

See

ks th

epe

rfor

man

ce o

f an

actio

n by

the

liste

ner

whe

re th

e ch

ildaw

aits

a r

espo

nse.

The

child

may

spe

cify

the

actio

n(e

.g.,

'sit'

) or

the

child

'sim

med

iate

lypr

eced

ing

beha

vior

giv

e ev

iden

ce th

athe

rea

lizes

that

som

e ac

tion

isa

nece

ssar

y st

epto

obta

inin

g so

me

obje

ct (

e.g.

,si

gnal

ing

'hel

p* to

ope

n a

jar.

)

Req

uest

Info

rmat

ion:

See

ksin

form

atio

n,ap

prov

al,

orpe

rmis

sion

from

liste

ner,

whe

re th

e ch

ild a

wai

ts a

resp

onse

.T

his

incl

udes

dire

ctin

gth

elis

tner

topr

ovid

e sp

ecifi

c In

form

atio

nab

out a

n ob

ject

, act

ion

, or

loca

tion.

(Ref

er to

Req

uest

Info

rmat

ion)

(Ref

er to

Req

uest

Act

ion)

McL

ean

& S

nyde

r-M

cLea

n (1

991)

Req

uest

Inst

rum

enta

l Act

ion:

Beh

avio

r us

ed to

dire

ct a

com

mun

icat

ive

part

ner

toca

rry

out a

ctio

n fa

cilit

atin

gac

cess

to a

nob

ject

orat

tain

men

tof

ade

sire

def

fect

.

Req

uest

Info

rmat

ion/

Fee

dbac

k: B

ehav

ior

used

todi

rect

the

com

mun

icat

ive

part

ner

to p

rovi

dein

for-

mat

ion

abou

t an

obje

ct,

actio

n, o

r lo

catio

n; to

req

uest

appr

oval

/non

appr

oval

,pe

rmis

sion

, or

affir

mat

ion.

(Ref

er to

Req

uest

Info

rmat

ion/

Fee

dbac

k)

Req

uest

Non

inst

rum

enta

lA

ctio

n: B

ehav

ior

used

todi

rect

aco

mm

unic

ativ

epa

rtne

r's a

ctio

n. G

oal i

s to

inst

igat

eot

her's

actio

nsra

ther

than

to o

btai

n an

obje

ct o

r ef

fect

.

195

Cog

gin

& C

arpe

nter

(197

8)

Req

uest

ing

Act

ion:

Ges

ture

sor

utte

ranc

es th

at d

irect

the

liste

ner

to a

ct u

pon

som

eob

ject

in o

rder

to m

ake

itm

ove.

The

act

ion,

rat

her

than

the

obje

ct, i

s th

e fo

cus

of th

e ch

ild's

inte

rest

.

Req

uest

ing

Info

rmat

ion:

Ges

ture

s or

utte

ranc

es th

atdi

rect

the

liste

ner

to p

rovi

dein

form

atio

n ab

out a

n ob

ject

,ac

tion,

or

loca

tion.

Dor

e(1

975)

Req

uest

ing

Act

ion:

Wor

d or

voca

lizat

ion

ofte

n ac

con*

:-pa

nied

by

gest

ure

sign

alin

gde

man

d.A

ddre

sses

adu

ltaw

aits

res

pons

e.

Wet

herb

y &

Priz

ant

Cirr

in &

Row

land

(198

9)(1

985)

Pro

test

: Act

s us

ed t

) re

fuse

an u

ndes

ired

obje

ct o

r to

com

man

d an

othe

r to

cea

sean

und

esire

d ac

tion.

Gre

et: A

cts

used

to g

ain

anot

her's

atte

ntio

nto

indi

cate

notic

eof

thei

rpr

esen

ce,

orto

indi

cate

notic

e of

the

initi

atio

n or

term

inat

ion

of a

n in

tera

ctio

n.

McL

ean

& S

nyde

r-M

cLea

n (1

991)

liNue

st C

essa

tion/

Rel

ect/

Avo

id:

Beh

avio

r us

ed to

requ

est a

com

mun

icat

ive

part

ner

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ase

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desi

red

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n of

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das

hed

line

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inte

nt d

id n

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In th

at p

artic

ular

taxo

nom

y.

Gog

gins

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arpe

nter

(197

8)

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etin

g:G

estu

res

orut

tera

nces

sub

sequ

ent t

o a

pers

on's

entr

ance

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expr

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reco

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Dor

e(1

975)

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test

ing:

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ists

adu

lt's

actio

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ith w

ord

or c

ry.

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ress

esad

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reet

s ad

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reat

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eats

par

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aU o

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ttera

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ait

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of w

ord

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resp

onse

.

Not

e: F

rom

Rei

chle

. J ,

Hal

le, J

., &

Joh

nsto

n, S

. (13

93).

Dev

elop

ing

an in

itial

com

mun

icat

ive

repe

rtoi

re: A

pplic

atio

ns a

nd is

sues

for

pers

ons

with

sev

ere

disa

bilit

ies.

InA

.P. K

aise

r&

D.B

. Gra

y (E

ds.)

. (19

93).

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anci

ng c

hild

ren'

s co

mm

unic

atio

n: R

esea

rch

foun

datio

ns fo

r in

terv

entio

n (p

p. 1

10-1

14).

Bal

timor

e, M

D: P

aul H

. Bro

okes

Pub

lishi

ng C

ompa

ny. R

eprin

ted

with

per

mis

sion

. (A

vaila

ble

from

Pau

l H. B

rook

es P

ublis

hing

Com

pany

, P.O

. Box

106

24, B

altim

ore,

MD

212

85-0

624.

Tel

epho

ne: 1

-800

-638

-377

5.)

196


Attachment B

Illustrating the Six Steps of

General Case Instruction

197

5:5


Attachment BIllustrating the Six Steps of

General Case Instruction

1. Define instructional universe. It is during this step that the interventionist determinesall of the stimulus conditions in which it would be appropriate to emit the target response,as well as the stimulus conditions in which it is not appropriate to emit the target responsebut which might be easily confused with conditions in which the behavior should be emitted.

2. Define the range of relevant stimuli and response variation within that universe. Afterthe interventionist determine's the stimulus conditions that comprise the instructionaluniverse, it is necessary to determine the range of stimulus and response variability withinthat universe. In our example, the range of relevant stimuli variation would includevariability in the containers that the milk is presented (e.g., glasses, cups, cartons), as wellas variability hi the settings and the people present. The range of relevant responsevariation would include the variability in the responses that need to be performed (e.g.,response needed to access the symbol when the wallet is closed, response needed to accessthe symbol when the wallet is open).

3. Select examples from the instructional universe for use in teaching and probe testing.The interventionist selects positive teaching examples (members of the stimulus class thatshould elicit a target response), as well as negative teaching examples (members of theinstructional universe which should not elicit the target response) for use in teaching andin probe testing. In teaching a learner to request milk, the interventionist would delineatespecific situations where it is appropriate to request milk (e.g., in the presence of cartons,cups, glasses, milk), as well as situations where it is not appropriate to request milk (e.g.,when juice or soda is offered as the only available beverage).

4. Sequence teaching examples. The sequence in which positive and negative examplesare presented can effect the efficiency of instruction. One strategy might involve theinterventionist sequencing the teaching examples so that, at first, the positive and negativestrategies that are taught are maximally different (e.g., they share no relevantcharacteristics). Then, as the intervention progresses, the number of relevant characteristicsshared by the positive and negative examples increases until the examples are minimallydifferent (e.g., the negative examples share all but one of the relevant features that definethe stimulus class of positive examples). In our example, we might choose a carton of milkand a bottle of soda as our first positive and negative examples. Then, as the interventionprogresses, we might choose a clear glass of milk and a clear glass of orange juice.


5. Teach the examples. Teaching the positive and negative examples is accomplishedusing instructional techniques that represent current best practices (e.g., prompting,reinforcing appropriate responses, etc.). For our learners, we might choose to implementa stimulus prompting procedure where we gradually fade in the distractor symbol (e.g., thebottle of soda).

6. Test with non-trained probe examples. The interventionist is able to assessgeneralization by periodically conducting probe tests using stimuli that are not used in thecontext of intervention. Probe testing allows the interventionist to assess whether or not thelearner is responding appropriately across the range of stimulus and response variation. Forexample, on one occasion, we might select a cup of hot chocolate as a negative example.On another occasion, we might choose a juice box as a positive example.

200

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DOCUMENT RESUME ED 359 700 AUTHOR Reichle, Joe; And Others … · DOCUMENT RESUME ED 359 700 EC 302...

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