ED 395 445

AUTHORTITLEINSTITUTION

SPONS AGENCY

PUB DATECONTRACTNOTEAVAILABLE FROMPUB TYPEJOURNAL CIT

EDRS PRICEDESCRIPTORS

DOCUMENT RESUME

EC 304 840

Stremel, Kathleen; Wilson, Rebecca M.[Communication Interactions. Three Fact Sheets.]National Information Clearinghouse on Children WhoAre Deaf-Blind, Monmouth, OR.Special Education Programs (ED/OSERS), Washington,DC.

Aug 95H025U2000116p.DB-LINK, 345 N. Monmouth Ave., Monmouth, OR 97361.Guides Non-Classroom Use (055)DB-LINK, Ai% 1995

MF01/PC01 Plus Postage.Children; Communication (Thought Transfer);Communication Skills; *Deaf Blind; EvaluationMethods; *Expressive Language; IndividualizedPrograms; Interaction; *Interpersonal Communication;*Language Acquisition; *Nonverbal Communication;*Receptive Language; Skill Development

ABSTRACTThis document consists of three separately published

fact sheets (for parents and teachers of children who are deaf-blind)combined here because of the close relationship of their subjectmatter: (1) "Communication Interactions: It Takes Two," by KathleenStremel; (2) "Expressive Communication: How Children Send TheirMessages to You," by Kathleen Stremel; (3) "Receptive Communication:How Children Understand Your Messages to Them," by Rebecca M. Wilson.The first fact sheet defines communication; suggests ways to findopportunities for interactive communication; offers specificsuggestions for improving interactions (such as interacting often,allowing the child to participate in as many activities as possible,and providing examples for others); and gives an example. The secondfact sheet defines expressive communication, lists reasons.tocommunicate, explains use of a communication map to assess thechild's expressive communication, recognizes the progregsive natureof communication development in planning and individualized program,and presents guidelines for developing an effective communicationprogram. The third fact sheet defines receptive communication, offerstips for sending effective messages, and explains use of acommunication map to evaluate the child's current.receptive languageabilities and design a program for the child based on his/her hearingand vision, motor abilities, and cognitive abiliLies. Each fact sheetalso includes an annotated list of suggested resources. (DB)

************************************************************************ Reproductions supplied by EDRS are the bust that can be made

from the original document.***********************************************************************

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August 1995

COMMU-NICATION INTERACTIONS:

Acknowledgments

This fact sheet was adapted from one originally writtenby Kathleen Stremel and published and distributedwithin the state of Mississippi by the Mississippi State-wide Project for Individuals who are Deaf and Blind.

What is Communication?

Communication is the exchange of a message be-tween two or more people. Everyone communi-cates in many different ways and for manydifferent reasons.

Communication can be expressive or receptive.Children who are deaf-blind may never learn totalk. However, they can express themselves to you.They can receive the messages you send them.

Through communication, children can makechanges in their world. They can express theirwants and needs. They can make choices.

Through communication, you can teach your childto play, to learn about the world, to interact withyou, to do daily tasks, and to work.

Opportunities for InteractiveCommunication

take a look at the functional activities that occurat home or at school. For the younger child, these maybe eating, bathing, changing clothes, and playingwith a sister or brother. For an older child, these mayinclude swimming, cooking, and working. They allprovide opportunities to comramicate.

1. Ask the following questions:

How many different people interact with yourchild or your student in a day?How many interactions occur in teaching anactivity?

BEST COPY AVAILABLE

IT TAKES TWOWhat are the daily activities in which you in-teract with your child or student?How many opportunities to communicatewith you does the child have in different ac-tivities? None? One? Five? Ten?

2. Notice your child's actions during functionalactivities. For example

Functional Activity

EatingSwimmingDressing

.401,

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Ways Child MayCommunicate

Opens mouth for "more."Raises hand for "out."Touches yellow shirt.

In what ways is your child communicatingwith you?

4. Make sure every person who interacts withthe child knows how he or she receives andsends messages.

Each child will do this in unique ways. It is neces-sary to stop, watch the child, and read the message.

Does each person take time to watch and listento the child?

Are good records being kept so each caregiverknows what to expect?

Parents and teachers need to work together to dothe following:

Increase the opportunities the child has tocommunic .

Increase the different ways in which the childcommunicates.Increase the different reasons a child has tocommunicate.Increase the number of people, things, and ac-tivities the child communicates about.

2

TTY (800) 854-7013 DB-LINK

What Can You Do?

In the following material, we will use the name"Lee" to represent an infant, child, or young adultwho is deaf-blind. Think of Lee as your child, or asthe student in your classroom.

What can you do for Lee to increase his interactivecommunication?

1. Interact often with him. Give Lee a chance tounderstand what you are going to do before youdo it. Give Lee a chance to make a choice, or torequest "more."

2. Allow Lee to participate in activities as much aspossible.

3. Make sure Lee has a name sign. This may be thefirst initial of Lee's name to be worn on Lee'schest.

4. Make sure that you have a way to identifyyourself to him.

For Sister, her long braids.

For Dad, his beard.

For Mom, her rings.

For teacher, her short hair.5. Give Lee an opportunity to communicate with

you.

6. Always communicate to Lee what will happennext or where Lee is being taken before the activityor movement takes place.

7. Post an actual example of an interaction in yourclassroom; so that, everyone (peers, buddies, andall service providers) can follow this.

Page 2

An Example ofCommunication Interaction

for Lee:

Approach Lee slowly; let Lee smell or senseyour presence.

Use Lee's name sign.

Let Lee know your identification cue, as inMom's ring.

Let Lee know you are going to the car by let-ting Lee take or feel a set of keys.

Voice (800) 438-9376

Have Lee open or close the car door.

Let Lee buy something at the store.

Help Lee hand the money to the clerk if Leecan't do this by himself.

Let Lee know the activity is finished by put-ting the keys in a box or on a hook.

Communication is Worth theEffort

Learn the most effective ways to express yourmessages.

Listen and watch in order to receive messagesfrom your child.

Give your child practice in receiving and ex-pressing messages.

Make sure your child's Individual EducationPlan contains both receptive and expressivecommunication objectives.

Help your child WANT to communicate. Letyour child see that communication givespower.

DB-LINK345 N. Monmouth AveMonmouth, OR 97361Voice (800) 438-9376TTY: (800) 854-7013Fax: (503) 838-8150

CompuServe: 73324,2140Internet:lesliegDfsa.wosc.osshe.edu

DB-LINK (The National blormation Clearinghouse on Children Who Are Deaf-Blind) is funded through Cooperative Agreement No. I-1025U20001 by the U.S.Department of Education, OSERS, Special Education Programs. The oomions andpolicies expressed by thisjact sheet do not necessarily reftect those of DB-L1NK orthe U.S. Department of Education.

Communication Interactions

Voice (800) 438-9376 DB-LINK TIT (800) 854-7013

Additional Resources

Atwood, A., Clarkson, J., & Laba, C. (1994).Being in touch. Communication and otherissues in the lives of people who are deaf-blind. Washington, D.C., Gallaudet Univer-sity.

This book is aimed at interpreters, teachers, andother professionals who work with deaf-blindpeople. It provides basic information aboutdeaf-blindness and devotes a large section tointerpreting. The appendices cover organiza-tions, agencies, and schools servir$ deaf-blindpeople; training for teachers and interpreters;manual and braille alphabets; and charac-teristics of vision loss; recommendations forthose looking for more information.

Costello, M., Harlin, D., O'Donnell, N., &Ruzenski, S. (1992). Communication issuesfor individuals with dual sensory impair-ments. literature review. New York, HelenKeller National Center.

The purpose of this literature review is to deter-mine the state of the art of tactile methods ofsign communication for individuals with thecombined handicapping conditions of deafnessand blindness. Early intervention, interactivecommunication, non-symbolic communication,functional environments, cheremes, and iconic-ity are among the many terms defined and ex-plained in this general overview ofcommunication as it pertains to deaf-blind per-sons. Piece also includes an historical perspec-tive of service delivery, an etiological overviewof deaf-blindness and an evaluative commen-tary on the current status of instructional serv-ices. Includes suggestions for the use ofvideotapes as a teaching tool and has a 10-pagelist of sources at the end.

California Deaf-Blind Services (1992). Creat-ing a need to communicate. Fact Sheet. Cali-fornia Deaf-Blind Services.

Describes how to create a need to communicatein a deaf-blind person and thus increasinghis/her skills at communicating. Available inSpanish. Fact Sheet #019.

Meyers, L., & Lansky, P. (1992). Dancing cheekto cheek Nurturing beginning social. playand language interactions. Los Angeles,Blind Children's Center.

This booklet is based on the research findings ofa four-year study of ten babies with severe vis-ual impairment. 'They had differing diagnoses,resultin in varying degrees of cognitive andmotor disabilities. The goal of the research wasto find techniques that parents and babies can

use to successfully bypass some of the obstaclesto the development of social, play, and lan-guage skills that are the result of lack of vision.Includes listings of activities that did work andthose that did not.

McInnes, J., & Treffry, J. (1982). Deaf-blindinfants and children: A developmentalguide. Toronto, Buffalo: University ofToronto Press.

A reference guide for teachers, parents, andparaprofessionals working or living with chil-dren who are both deaf and blind. Providesday-to-day guidance and suggestions abouttechniques for assessing and for devising pro-grams. Good overviews on communication,motor development, perceptual development,and on orientation and mobility. Avail-able inSpanish.

Oregon Research Institute (1987). Getting intouch: communicating with a child who isdeaf-blind. Champagne, IL, Research Press.

Introduces teacher, staff, and parents to basicguidelines for communicating with childrenwho have vision and/or hearing impairmentsusing touch cues and object cues. The programstresses the importance of considering the de-gree of each child's sensory impairments andarranging an individualized communicationsystem based on the child's abilities and needs.

Anthony, T., Greeley, J., & Gleason, D. (1994).Guiding principles for interaction withyoung children who are deafblind. Revised.

Eight suggestions for successfully interactingwith young deafblind children. Suggestions forusing toys and types of toys to use are included.

Cushman, C., et al. (1992). Perkins activity andresource guide. A Handbook for Teachersand Parents of Students with Visual andMultiple Disabilities, Volumes I and II. Wa-tertown, MA, Perkins School for the Blind.

This is a two-volume handbook in loose-leafformat that is intended to be used as a resourcefor professionals in many disciplines, parents,and other caregivers who are working with chil-dren with visual and mi. ltiple disabilities. Itoffers general pidelines and resources to beused as a springboard for teaching and ad-dressing the wide range of educational needs ofthis student population. It includes a cassettetape of developmental music and songs.

Communication Interactions q Page 3

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Additional ResourcesHand in Hand Series

American Foundation for the Blind, Deaf-Blind Project

Mulholland, M., Welch, T. (1994) Hand inHand: It can be done! AFB Deaf-Blind Pro-ject National Consortium. New York: AFBPress.

This video provides a vigual introduction to theconcepts discussed throughout the 'Project ma-terials as well as a demonstration of its guidingprinciples. The ideas are presented through thevoices of parents, teachers, and service provid-ers of students who are deaf-blind. Based on thedevelopment of communication and inde-pendence the video includes information oncalendar boxes, touch cues, object cues, sightedguides, cane use, and the importance of pray. Aguide for use of the tape is included.

Prickett, J., Joffee, E., Welch, T., Huebner, K.(1995). Hand in Hand: Essentials of commu-nication and orientation and mobility foryour students who are deaf-blind: trainer'smanual. New York: AFB Press.

This component of the Hand in Hand materialsis intended to provide guidance for trainerswho are conducting workshops based on theinformation provided in all the project compo-nents. Part 1 provides an overview of the pro-ject, its materials, and the principles on which itwas based. It also includes special training con-siderations and some tips for working withadult learners. Part 2 offers suggestions forplanning training sessions and for using otherHand in Hand components. Part 3 providesspecific training suggestions for each module.Appendices contain sample forms.

Huebner, K., Prickett, J., Welch, T., Joffee, E.,(Eds.) (1995) Selected reprints and annotatedbibliography on working with students whoare deaf-blind. New York: AFB Press, 1995.

This is a collection of reprints and annotatedlistings. The articles included here were se-lected because of their particular value to class-room teachers working on their own. Articleswere chosen because they are relevant to theproject's focus on the topics of communicationand orientation and mobility; because they con-tain useful information, regardless of prevail-ing educational trends, about effective practicesin many settings and circumstances with stu-dents who are deaf-blind; and because theysupport other information in the project mate-rials. The articles are presented in two sections:print materials and audiovisual materials.

Huebner, K., Prickett, J., Welch, T., Joffee, E.(Eds.) (1995) Hand in Hand : Essentials ofcommunication and orientation and mobil-ity for your students who are deaf-blind:Volume I. New York: MB Press.

This book is intended primarily for self-studyand in-service training. It is divided into, threesegments: Key Concepts, Communication, andOrientation and Mobility. Each of these seg-ments is, in turn, divided into 20 self-containedmodules which present essential informationabout deaf-blindness, how deaf-blindness af-fects learning, and how students who are deaf-blind can develop critical communication andO&M skills.

Huebner, K., Prickett, J. Welch, T., Joffee, E.(Eds.) (1995). Hand in Hand : Essentials ofcommunication and orientation and mobil-ity for your students who are deaf-blind:Volume II. New York: AFB Press.

Volume H is a follow-up to Volume I and con-tains four appendices as well as resource list-ings. Appendix A contains detailed medicalanci related information on vision and hearing.Appendix B discusses amplification systems in-cluding hearing aids, tactile aids, and cochlearimplants. Appendix C focuses on assessmentinstruments in the areas of communication andO&M. Appendix D discusses federal fundingfor services to children who are deaf-blind. Aglossary of terms follows the appendices. Theresource section includes organizations, agen-cies, books and periodicals, equipment and ma-terials and their distributors andmanufacturers.

The Hand in Hand series may be ordered fromthe American Foundation for the Blind, c/oAmerican Book Center, Dept. J, Brooklyn NavyYard, Building No. 3, Brooklyn, NY 11205 or bycalling (718) 8-52-9873.

The entire package of video and written mate-rials is available for $170.00 plus $7.50 for ship-ping. Call for pricing of individual components.

5

Page 4 Communication Interactions

DB The National InformationClearinghouse on Children Who Are

Deaf-Blind

EXPRESSIVE COMMUNICATIONHow Children Send Their Messages to You

Acknowledgements

This fact sheet was adapted from one originally writtenby Kathleen Stremel and published and distributedwithin the state of Mississippi by the Mississippi State-wide Project for Individuals who are Deaf and Blind.

Purpose Of This Flyer,Encourage parents and service providers to bemore responsive to their child's current formsof communication.

Discuss the reasons for and uses of expressivecommunication.Encourage parents and service providers todevelop a "map" of their child's current andfuture expressive communication needs.

Discuss the many forms that may be used forexpressive communication.

Discuss the progressive nature of communica-tion development.

Present guidelines for designing an effective com-munication program.

What Is ExpressiveCommunication?

Expressive communication involves sending amessage to another person(s) to (a) make some-thing happen or (b) stop something that is alreadyhappening.

Children and youth who are deaf-blind are able toexpress themselves in many different ways. Par-ents, siblings, and service providers must be re-sponsive to their varied forms of communication.In addition, they must notice and encourage oppor-tunities for expressive communication.

August 1995

Reasons To CommunicateAt An Early Age

Register Protest or Rejection"Don't touch me!""I don't like that!""I don't want another bite!""Stop doing that!""Gain Attention""Mama""Hey, here I am...look at me!""Come over here!"

Request Continuation"I want another bite.""More bouncing, please.""I need more work.""I want to play ball some more."

Make a Choice"I want chocolate milk." (not more food)"I'd like a hamburger." (not a drink)"I need a break from my work."

Reasons To CommunicateAt A Later Age

Greet Someone; Make Social Comments

"Bye.""Thank you."

Make Offers"Would you like some?""Here, have some of mine."

Provide Comments"Mine.""This is good.""The table is dirty."

Expressive Communication Fact SheetBEST COPY AVAILABLE

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Reply to a Previous Statement"Okay""Later."

Get More Information"What are we going to do?""Where are we going?""Where are we?""How do I do this?"

All of us express ourselves in hundreds of ways.The above examples used speech; children who aredeaf-blind may also use facial expressions, ges-tures, sign, communication boards, etc.

Communication MilestonesPut Your Child on the Map

We will use the name "Lee" to represent an infant,child, or young adult who is deaf-bEnd. Think ofLee as your child, or as the student in your class-room.

Initially, just like all moms and dads, Lee's parentsperceived Lee's cries and movements as havingmeaning even though Lee was not purposefullycommunicate needs to anyone. People began to re-spond to Lee's movements and facial gestures as ifthey were communication. Then, Lee began to un-derstand that certain movements made certainthings happen; Lee was beginning to have somecontrol over the world. Later, Lee's mom, dad, andteacher got together to figure out how Lee couldcommunicate with more people and in new ways.

Communication Map

The Expressive Communication Map presented be-low can be used as a guide to:1. determine the ways in which your child is

able to communicate with you right now.(Current)

2. determine the way or ways in which yourchild can be taught to communicate during thenext year. (IEP Objectives)

3. determine the ways your child might be ableto communicate in the future. (VisionaryPlanning)

As you look at the map in Figure 1, you will noticethat, initially, the communication techniques aresimple and concrete. As you move across the mapyou will see that the ways to communicate becomemore complex. Lee is able to use a number of differ-ent ways to communicate the same message. WhenLee does this, Lee is showing "purposeful" commu-nication behavior.

Parents and service providers should discuss thefollowing:

In how many different ways is the student cur-rently communicating?

What new ways could be taught during theyear?

What possible ways may be taught in the nextfive years?

You may fill in the areas with the color-coding thatis shown, or you may make up your own. Parents

Expressive Communication

Communication Contingency Instrumentalby Recognition Communication Communication

Facial Expressions

Use this color code tofill in appropriate areas.

Current Yellow1-year plan RedFuture Blue

Emerging SymbolicConventional Communication Symbolic

Communication (Adaptations) Communication

Vocalizations Touch PersonExtend Object Complex Gestures Manual Signs

Simple GesturesBody Movement Manipulate Person Miniature Objects Non-SpeechSymbols

ElectronicSystems

I Speech

Pointing Pictures/Drawings

Other TactualI Symbols

Calling Sw:tch Touch Object

1- Two SwitchCommunication

I---- _ __

Basic Communication <

-J

Communication isMore Complex

Figure 1 Communication Map

Page 2 Fact Sheet Expressive Communication

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should be given a copy and a copy should be placedwith the child's records. Too often, during periodsof transition, the child's communication system isnot planned or maintained. When that occurs,valuable time may be wasted by (a) changing thechild's program when the current one is working,(b) trying to teach communication techniques thatdidn't work in the past, or (c) teaching techniquesthe child already knows.

Communication by Recognition

Behaviors indicate an awareness that anther personis present.

Facial Expressions - These early forms may not bepurposeful communication, but simple reactionsthat indicate pleasure or displeasure.

ExamplesOpens mouth for more.Turns head away.Smiles or grimaces.

Vocalizations - Early vocalizations may indicatepleasure or discomfort/distress. Parents may no-tice that when Lee is uncomfortable or not pleased,Lee's vocalizations are louder, longer, and have dif-ferent inflections than when Lee is happy.

ExamplesCries to indicate discomfort.Makes soft "u" sound when rocked.Makes loud "a" sound when music goes off.Makes gentle "wee" sound when swinging.

Contingency CommunicationThese behaviors are purposeful but not used for in-tentional communication. However, they may beinterpreted by others as being communicative. Leelearns that by can acting on the environment, Leecan cause an effect

Body Movements Lee may use large body move-ments or more specific body movements to expressLee's wants. Initially, these may be used to protestor to request more. At this point, Lee is demonstrat-ing anticipation that an activity will continue. Pur-poseful communication will continue only if otherpeople respond to it.

ExamplesMoves body when person starts rocking Lee, then

stops.Moves body back when person starts giving a

back rub, then stops.Turns head away from disliked food.

Switch Activation (physical control) - Early assis-tive technology may include a switch that is con-nected to a tape recorder (for music), a fan, avibration pillow, or lights. This is not a communica-

tion response, but this may help teach Lee causeand effect. Lee may learn that if he makes a certainmovement, activating a switch, Lee can have somecontrol over the physical environment.

ExamplesTouches big yellow plate switch to turn on fan.Touches vibration pillow.Pulls strings on switch to turn on bright lights.

Switch Activation (social control) - If Lee is notable to get other people's attention by vocaliza-tions, physical touch, or going to them, Lee shouldbe taught other ways of calling or getting people'sattention. A switch may be hocked up to a tape re-corder that has a loop tape with a recorded mes-sage, "Come here, please." A simple buzzer mayalso serve as a calling device to get people's atten-tion.

ExamplesActivates a buzzing device in the workplace to in-

dicate, "Need help" or "Need more work."Presses a switch with a red satin heart that is con-

nected to a tape recorder that says, "Give me ahug."

Instrumental Communication

These behaviors are simple, non-symbolic behav-iors that are directed towards another person, withthe intent of causing the other pirson to act. Behav-iors can be directed at person or object, but notboth.

Touch Person- Lee will need to learn that things inLee's environment don't just happen. Other peoplecan control outcomes if Lee communicates withthem. If Lee has the motor ability to touch anotherperson to communicate, it is important to teach Leeto do so. In order to show that Lee has purposefulcommunication, Lee must look, turn to, or touchanother person to purposefully communicate tothat person. This can be done by eye gaze (if Lee hasenough vision to do this). It can be done by movingLee's body toward the other person or it can bedone by touching the other person. Initially, Leemay only touch you if you place your hand 1 / 2 to1 inch from Lee's hand. Then, you can begin tomove your hand away so Lee has to extend hishand farther in order to touch you.

ExamplesTouches Mom's hand to get another bite.Touches Dad's arm to get more tickling.Pushes brother 's face away to indicate, "Leave me

alone."

Manipulate Person - Once Lee can touch a person,Lee may begin to take the person's hand and moveit toward Lee or toward an object that Lee wants.We can help make this happen if we don't move ourhands immediately when Lee touches us. In this

i Expressive Communication Fact Sheet Page 3

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way, Lee will have to work a little bit harder tomake something happen (outcome).

ExamplesPulls Mom's hand (with the spoon) to Lee's

mouth.Pulls Dad's arm to Lee's tummy for more tickling.Pushes peer 's hand to open locker in the high

school.

Touch Object - We also want Lee to touch one (outof two or more) objects to request a choice. At first,we do not provide Lee with two "good" choices.We use an object Lee dislikes (a cool washcloth) andone Lee likes (oatmeal with cinnamon). This givesLee a reason to touch one object and not the other.Later, you can use two items, which Lee likes, toallow Lee to make choices. Lee may turn his cheekto touch the object if Lee does not have use of hisarms or hands. Lee may move his hand only aninch to touch the chosen object. A physical or occu-pational therapist may help determine the best mo-tor movement.

ExamplesTouches warm applesauce.Touches keys (to go riding) versus paper towel.Touches waistband to indicate "Go to bathroom."

Conventional Communication

The behaviors at this level are still non-symbolic.At this level Lee begins to coordinate the use of ob-jects and people.

Extend Objects - Lee will be able to extend objectsonly if Lee has the motor ability to do so. All chil-dren will not have this ability, and some objectscannot be extended. At first, Lee may extend theobject only a short distance. Gradually, Lee willlearn to extend it farther. Lee may also extend ob-jects to get something else in return.

ExamplesExtends cup to get more milk.Extends money holder for you to put in Lee's

"wages."Extends bowl for more popcorn.Extends lunch ticket to manager in cafeteria.

Simple Gestures - Simple gestures should be taughtbefore manual signs (if Lee has enough motor abil-ity). You and I use gestures to communicate everyday. Lee will continue to use simple gestures eventhough Lee may learn other complex ways to com-municate.

ExamplesWaITS "Hi"/"Bye."Gestures "Mine."Gestures "Eat."Gestures "Finished."

Puinting - Children without disabilities point topeople and objects before they learn to say theirfirst words. Often, their first words may be pairedwith pointing. We all point on occasion to commu-nicate something to somebody (especially in quietplaces, like church). Of course, Lee's ability topoint will depend on how well Lee is able to seeand how well Lee can use his fine motor skills.Many children who are deaf-blind will not be ableto use pointing as a way to communicate. How-ever, if Lee has enough vision to see large objects orlarge pictures and has good motor skills, we wantto teach Lee to point as a way to communicate.

ExamplesPoints to Daddy when he gets home from work.Points to a door to go outside.Points to a clock/watch with large numbers to

indicate, "Time to go to work."

TwolThree Choice Communication Systems - OnceLee is able to make a choice from two objects, wewant to increase the number of choices. As an ex-ample, Lee may do this by pushing a switch on athree-choice-light/buzzer device to express Lee'schoice of the three items or Lee may push one ofseveral switches that activate different messages ona tape recorder. If Lee is not able to make simplechoices with objects, a more expensive communica-tion system will probably not work either. No sys-tem can do magic.

ExamplesUses eye gaze to look at one of four objects vel-

croed to a plexiglass form.Touches one of three switches to get desired item

at lunch.Activates one of two switches to communicate

where Lee wants to go (miniature objects maybe velcroed to the switches; once Lee learns thatthese represent real objects or activities).

Emerging Symbolic Communication

At this level, the behaviors ihat are used to commu-nicate become gradually more abstract.

Complex Gestures - Once Lee is able to use a fewsimple gestures, then more gestures may be taught.Think of gestures that we all use occasionally.

ExamplesGestures, "Want."Gestures, "Put in here."Shrugs shoulders to indicate, "I don't know."Gestures, "Come."Shakes head, "No" or "Yes."

Miniature Objects - Once Lee has learned to asso-ciate object cues with people and activities in Lee'sreceptive communication program (see fact sheetReceptive Communication), Lee will be able to use

Page 4 Fact Sheet Expressive Communication

Voice (800) 438-9376 DB-LINK TTY (800) 854-7013

small objects that are associated with an activity asa way to express Lee's wants and needs.

ExamplesHands handle bar grip to PE. teacher to request

exercise bike.Presses button on a touch activated talking device

that has small objects glued to each of the but-tons.

Extends one of five small objects (velcroed on awheelchair tray) to the teacher to indicate whereLee wants to go.

Pictures and Line Drawings - Lee may have enoughvision (when Lee wears his glasses) to see picturesymbols (black drawings/Mayer-Johnson) eventhough Lee can't identify photographs. Line draw-ings are less expensive than miniature objects andtake less time to find. If Lee can see and understandthese, we can use them as we increase Lee's vocabu-lary

ExamplesSelects picture of swing to indicate, "I want to

swing."Presses a 3-Choice Switch with a picture of a

bucket indicating, "Need bucket to clean table incafeteria."

Points to a line drawing of a red square to indi-cate, "Put me on the red mat."

Symbolic Communication

Manual signs, written words, systems with braille,and speech words are true symbols. Lee must un-derstand that there is a 1-to-1 relationship betweenthe symbol and the obiect/person/ activity; thesymbol "stands for" cr "refers to" the real thing.This is very difficult for some children. If Lee hasenough cognitive abilities, Lee may be able to usan electronic system with speech output. Lee'ssymbol system may be large keyboard letters or abrailled keyboard, depending on Lee's vision, mo-tor and cognitive skills.

Some children may be taught multiple communica-tion methods concurrently. While one method is be-ing mastered, the next method can be introduced.

Communication DevelopmentIs Progressive

Parents and service providers need to consider thechild's vision, hearing, motor, and cognitive skills.They must also consider the child's age and withwhom the child will be communicating. It is impor-tant to remember that communication develop-ment is progressive. It may progress (a) from easyto hard, (b) from few ways to many, (c) from fewwants and needs to many, (d) from a few reasons tomany, and (e) with few people to many. How do we

10

determine the most effective and efficient expres-sive communication system for Lee?

Hearing and Vision Abilities

When was the onset of the vision or hearingloss?

Does Lee have the ability to hear (with hearingaids) and imitate some sounds?Can Lee see shadows or color?

Does Lee see objects well enough to reach outfor them?

Motor Abilities

Is Lee ambulatory?

Does Lee have full range of motion of his armsand hands, or is movement limited?

If Lee can't move his arms and legs, can Leemove his face from side to side?

Can Lee grasp objects?

Does Lee have the ability to extend his arm orto point?

Does Lee have a tray on his wheelchair for at-taching objects, switches, or electronic de-vices?

Cognitive Abilities

Does Lee seem to learn things quickly?

Does Lee indicate that he knows where he isgoing and what is about to happen?

Is Lee motivated to do things?

Does Lee try things again and again when Leeis learning new things?

Does Lee smile when he has accomplished atask?

Lee will not have to learn every form or waythat is presented above. You will need to con-sider Lee's vision, hearing, motor, and cogni-tive abilities and disabilities in order to (a)strengthen current communication, (b) de-velop new ways to communicate, and (c) planfor more efficient ways for Lee to communi-cate in the future.

REMEMBER .. The best communication results comefrom active teaching. Everyone in Lee's environ-nient must be responsive, consistent, and providemany different opportunities for communication.

Suggested ReadingRowland, C., & Schweigert, P. (1989). Image

symbol systems for individuals with multisensoryimpairments. Tucson: Communica tion SkillBuilders.

Expressive Communication Fact Sheet BEST CONAVAILABLE Page 5

TTY (800) 854-7013 DB-LINK Voice (800) 438-9376

Rowland, C., & Stremel-Campbell, K. (1987). Shareand share alike: Conventional gestures throughemergent language. In D. Guess, L. Goetz & K.Stremel-Cainpbell (Eds.), Innovative program de-sign for individuals with_glual sensory impair-ments (pp. 45-75). Baltimore: Paul H. Brookes.

Stremel, K., & Schutz, R. (in press): Functional com-munication in integrated settings for students whoare deaf-blind. In N. G. Haring & L. T. Romer(Eds.), Including students with deaf-blindness hitypical educational settings. Baltimore: Paul H.Brookes.

ResourcesAble Net, Inc. 1081 Tenth Avenue, S.E., Minneapolis,

MN 55414-1312; 800-322-0956.

Hope Catalog (1994). Hope Inc. 809 North 800 East,Logan, UT 84321: 801-757-9533.

Mayer-Johnson Company Non-Speech Communi-cation Products (1993). P. 0. Box 1579, SolanaBeach, CA 92075; 619-481-2489.

Prentke Romich, 1022 Heyl Road, Wooster Heights,OH 44691.

Toys for Special Children, Steve Kanor, 385 Warbur-ton Avenue, Hastings-on-Hudson, NY 10706; 914-478-9060.

Additional ResourcesCalifornia Deaf-Blind Services, 1992. Communica-

tion : what is he trying to tell me? Fact Sheetsfrom California Deaf-Blind Services

A brief summary of the ways a deaf-blind childmay try to communicate is followed by a sug-gested continuum of steps for responding to thiscommunication behavior. Available in Spanish.Fielding, G., & Bullis, M., (ed). (1988). Communi-

cation development in young children with deaf-blindness: literature review. Monmouth, OR,Teaching Research Publications.

Published as part of the Communication SkillsCenter for Young Children with Deaf-Blindness.Each chapter includes a 15-20 page overview of acertain aspect of communication and then a re-view of the literature.

Hagood, L. (1994). Conversations without lan-guage: building quality interactions with chil-dren who are deaf-blind. p.s. NEWS HI, vol. vi,no. 3, July 1994, 5-13.

This article describes ways to involve the deaf-blind child, whose language skills are limited, inconversations. Has discussions on the importanceof developing conversation skills, then addressesfour specific problems/solutions in teachingthese sidll. Methods would work with parents,teachers, and other care givers. Article was in-spired by Dr. Jan van Dijk's presentation in SanAntonio, TX.

McFarland, S., Miles, B., Silberman, R., Riggio, M.,Smithdas, R, & Smithdas, M. (1994). Communi-cation with learners who are deaf-blind. SummerInstitute. Sands Point: Hunter College.

This program was offered through the PerkinsDeaf-Blind Training Project, a major goal of which

is to provide summer training to improve servicesfor learners who are deaf-blind. The course pro-vides a comprehensive analysis of the communi-cation needs of learners who are deaf-blind. Theimpact of dual sensory loss on communicationdevelopment, assessment procedures, and strate-gies to develop nonsymbolic and symbolic com-munication are addressed. Specificcommunication methodologies and a variety ofcommunication modes, including augmentativesystems, are presented.

Reyes, D. (1993). Access to context : a basic need fordeafblind people Deafblind education, July-De-cember 1993, 5-9.

This article explains what the author considers tobe the most serious difficulties faced by the deaf-blind within an environment which ' hears andsees." The piece also analyzes some of the re-sources available and some which need to be de-veloped with the aim of attaining an independentand integrated lifestyle. While developing themaximum use of the senses, mental ability andcommunication skills is deemed important, clar-ity of thought is seen by this author as the key tosuccessful independent living.

Stremel, K., Molden, V., Leister, C., Matthews, J.,Wilson, R., Goodall, deV., & Holston, J. (1990).Communication systems and routines: : a deci-sion-making process. University of SouthernMississippi

This manual was produced under grantG008730414 from OSER. The ultimate goal for chil-dren with any type of disability in the area of com-munication development is to assist the child,through social interactions and environmental ar-rangements, to be able to communicate in the mosteffective way possible, to a variety of people, and ina wide variety of social situations and environ-ments. The job of the interventionist is to move thechild and major interactor in that direction with theleast amount of "stalling." Knowing where to begin,the direction to take, anticipating some detoursalong the way, and knowing when we are there willbe based on a decision-making process. This manualcovers the teaching of communicative behaviors,receptive communication and expressive commu-nication, for children with vision, hearing and mator impairments via this decision-making process.Includes diagrams, charts, examples, ancian IFSP.

L7-7,71

DB-LINK345 N. Monmouth AveMonmouth, OR 97361Voice (800) 438-9376TTY: (800) 854-7013Fax: (503) 838-8150

CompuServe: 73324,2140Internet:leslieg@fsa.wosc.osshe.edu

DB-LINK (The National ligormation Clearinghouse on Children Who Are Dtuf-Blind) is funded through Cooperative Agreement No. H0251120001 by the U.S.Department of Education, OSERS, Special Education Programs. The opnnions andpolicies e4tressed by this_fact sheet do not necessarily reftect those of DB-LINK orthe U.S. Department of Erlucation.

iiPage 6 Fact Sheet Expressive Communication

DB The National InformationClearinghouse on Children Who Are

Deaf-Blind

August 1995

RECEPTIVE COMMUNICATIONHow Children Understand Your Messages

AcknowledgementsThis fact sheet was adapted from one originally writtenby Rebecca M. Wilson and published and distributedwithin the state of Mississippi by the Mississippi State-wide Project for Individuals who are Deaf and Blind.

Purpose Of This FlyerDescribe the special problems of communicat-ing with a child who is deaf-blind.

Give tips for sending messages that will pro-duce responses.

Encourage parents and service providers todevelop a "map" of the child's current and fu-ture receptive communication abilities.

Present specific cues that may "get through" tothe child.

Present questions to ask before designing aneffective communication program.

What Is ReceptiveCommunication?

Receptive communication is the process of receiv-ing and understanding a message. It is often diffi-cult to determine how a child who is deaf-blindreceives a message. Think about living in a worldwhere you cannot see or hear what is going onaround you. If we pay ciose attention to the waywe send our messages, we increase their chances ofbeing received.

4 I -1J. 4-

to Them

Tips For Sending EffectiveMessages

We will use the name Lee to represent an infant,child, or young adult who is deaf-blind. Think ofLee as your child, or as the student in your class-room.

Overall GuidelinesLet Lee know you are present. You mighttouch Lee's hand or shoulder.

Identify yourself to Lee, perhaps using yourring, watch, perfume, or hair.

Always let Lee know what is about to happen.For example, touch Lee's lip before giving abite of food.

Let Lee know he will be going somewhere.For instance, give Lee a set of keys to indicate"going for a ride."

Let Lee know when an activity is over. Use agesture or sign for "all gone" or "finished" or letLee help put the objects away.

Give Cues About the Expected Response

It is very difficult for individuals who are deaf-blind to understand how they should respond toyour communication. This is especially true whenthe child has limited understanding of speech cues.For example, when Lee is given a gesture or sign,"eat," Lee does not know if it is a command or aquestion. Possibly, Lee's teacher is teaching a newvocabulary word and wants Lee to imitate the sign.The following may help Lee understand what theresponse should be:

If you want Lee to answer, keep your hands incontact with Lee and wait.

If you are giving Lee a command, tap twice onhis shoulder.

Try (800) 854-713 DB-LINK Voice (800) 438-9376

If you are giving a comment or reinforcer, rubLee's shoulder.

If you want Lee to imitate you, tap twice on theLee's hand.

It is up to you to find a way for Lee to receive yourmessage. After that, you can expand Lee's under-standing to higher forms.

,

Communication MilestonesPut your child on the map

The communication map below may assist you indetermining the current ways Lee receives mes-sages. The map will also guide you as you focus onfuture ways to send your messages. Cues in thefirst segment are simple and concrete. They areusually given to the child through touch or in closeproximity to the child's body. As you move acrossthe map, the cues become more complex. As notedby the arrows, all cues are given with speech. Thissimultaneous use of multiple communicationmodes enhances Lee's ability to receive additionalinformation through sound and facial expressions.Brief explanations with examples of each type ofcue follow the map.

Natural Context Cues

Movement Cues

Touch Cues

Natural Context Cues - These occurrences happenfrequently during an activity or routine.

Examples:An alarm clock ringing.Running water in a tub.Putting a bib on a young child.Undoing a strap on a wheelchair.

Think about everyday routines. Look closely to seeif Lee is showing signs of anticipation of the naturalcontext cues. For example, Lee may open his mouthwhen sensing the bottle. Lee may wiggle when thewater is running.

Movement Cues or Tactile Gestures - These mo-tions actually move the child through a pattern thatis related to an activity.

Examples:Moving Lee's hand to mouth to eat.Moving Lee's arm up and down to play the drum.Swinging Lee's leg to kick the ball.

Receptive CommunicationAll cues given with speech

Object Cues

Use this color code to fill inappropriate areas.

Current Yellow1-year plan RedFuture Blue

Gesture Cues MiniatureObjects

AssociatedObjects

Pictures

LineDrawings

Other TangibleSymbols

Visual SignCues

Tactile SignCues

Speech

WrittenWords

Braille

Basic > Communication isMore ComplexCommunication

Figure 1 Communication Map

1. 3Page 2 1. , Receptive Communication

Voice (800) 438-9376 DB-LINK TTY (800) 854-713

Touch Cues - These signals get a simple messageacross to Lee. The cue is given by touching Lee'sbody in the area that is related to the message.

Examples:Touching Lee's lip to indicate, "Open your mouth

for food/drink."Touching Lee's shoulder to let Lee know someone

is there.Pulling on Lee's waistband to indicate time to

change diaper.

Object Cues - These real objects (miniature objectsor associated objects) allow Lee to gain more infor-mation.

Examples:Spoon = time to eat.Lifevest = time to swim.Keys = times to go.

Real objects are easy to recognize because they areactually used in an activity (diaper, coke can, keysetc.). Miniature objects or doll-sized repre-sentations of a real object also may be used; how-ever, vision abilities must be taken into account.The most difficult to understand may be the associ-ated objects or objects that stand for something else(clock for time, wheel for play truck, etc.).

Start by using just a few object cues that representactivities that occur very frequently or that Lee re-ally enjoys. Before the activity occurs give Lee theobject cue. Be consistent! After many times, noticeif Lee is anticipating the activity by getting excited,smiling, or smacking lips, indicating an under-standing of the activity. Then you may begin to addmore cues. Be sure that the school and home areusing the same cues and that everyone is present-ing them in the same way. Always consider visionwhen deciding what object cues to use. The size,texture and color may make a difference, as well aswhere the object is visually presented.

Gesture Cues - These body expressions are com-monly used to communicate. A child must havesome vision to see gesture cues.

Example:Waving good-bye.Holding out a cup for more drink.Shaking head for yes/no.

Picture Cues/Line Drawings/Other Tangible Sym-bols - These can be used to receive messages if thechild has adequate vision.

Example:

Drink Go Nap time Eat

Lee must understand that a picture stands for anobject, person, or activity. Also, Lee's visual skills

must be considered when determining the size of apicture or the need to use line drawings. There aremany other tangible symbol systems that can beused (Picsyms, Blissymbols, textured symbols,raised thermofax, photos, etc.)

Visual and Tactile Signs These symbols, expressedthrough manual signs, are based upon movement,placement, configuration, and directionality.

Due to the type and extent of the vision impair-ment, signing may need to be close to the child'Eface, directly in the center of Lee's visual field, or toone side. Gestures and signs must actually contactthe body of a child who has limited or no vision.Tactile modality may be used for a child who is to-tally blind, but who is cognitively able to under-stand the symbolic nature of sign language and/orfinger spelling. Signing and/or finger spelling isreceived by having the receiver place Lee's handsover the hands of the person sending the messagein order to feel the sign.

Speech - This mode should accompany all otherforms of communication. Even if Lee does not hearthe spoken word, Lee may receive informationfrom your facial gestures and expressions whenyou are speaking. Consult with a speech patholo-gist when developing a speech/language/commu-nication program.

Written Words/Braille These are used by indi-viduals who have the skills to understand symbolicwritten/brailled language. There are many types ofelectronic equipment that provide braille output.Consult with the vision specialists or other re-sources used by individuals who are blind.

Design a Program for YourChild

Parents and service providers must work togetherto consider the child's vision, hearing, motor, andcognitive skills. They must ask the following ques-tions to design and plan the most effective programfor the child.

Hearing & Vision

A communication system will not be effective if itis developed without use of prescribed adapta-tions. If Lee can benefit from grasses, hearing aids,or other adaptive equipment, Lee should use themat all times.

Q Is Lee totally deaf or does Lee have some usablehearing?

If Lee has an impairment, alternative forms of re-ceptive communication may include touch, ob-ject, sign, or other cues. These alternative formsalso depend on Lee's vision, motor, and cogni-tive abilities.

Receptive Communication .14BEST COPY AVAILABLE

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Q Is Lee totally blind or Does Lee have some usablevision?

Vision is the major source of information for anyindividual. Look for alternative ways to provideinformation, such as touch and object cues, largeprint/pictures/line drawing, braille and speech.Perhaps the pictures need to be black and whiteline drawings (without color or background)and/or held closer to the eyes than usual.

Motor AbilitiesQ What is the best position for Lee to use his vision,

hearing and/or touch efficiently?

Parents and various professionals must work to-gether to answer this question. The child withmotor disabilities must be able to receive infor-mation; therefore, parents and professionalsmust think of the best way to provide this infor-mation. If touch cues are used, remember to findthe parts of the body that will receive the mes-sages most effectively (touching the child's backmay set off a reflex. Try touching Lee's shoulder).Let us suppose Lee is Kind in his right eye, andthe physical therapist is working on graspingwith the right hand. The speech pathologist hasalso recommended the use of object cues for re-ceptive communication, and Lee's mom wouldlike a way to let Lee know he is going for a ridein the car.

PROBLEM: Since the vision is reduced on theright side, Lee may lose information when hegrasps the keys with his right hand.

SOLUTION: The physical therapist recommendsplacing Lee in a good seating position (with appro-priate support) and train Lee to turn his head to theright to increase his vision capacity by using his lefteye.

Cognitive AbilitiesQ Does Lee show interest in and recognize people,

objects or activities?

Notice if Lee is paying attention to what is goingon around him. For example, Lee may be lookingat or reaching for toys, smiling at people and/orfussing when hungry. Also, notice how Lee re-acts to certain people, objects, and activities. Forexample, Lee smiles when Dad comes homefrom work, gets excited when it is time to eatand/or cries when taken into the bathroom forbathtime. This information will be helpful inplanning routines to increase the child's commu-nication.

Q Does Lee understand that a picture, linedrawing, word, or sign represents a person,object or activity?

To use cues that are "symbolic.' such as pictures,line drawings, word, and/or signs, Lee must beable to associate a meaning with the symbol. Re-member, symbolic cues (picture of a tub, etc.) aremuch more difficult than environmental cuessuch as running water in tub to indicatebathtime.

ResourcesCoole , E. (1987). Getting in touch with a child who is

deaf-blind. [Videotape]. Research Press.

Musselwhite, C. R., & St. Louis, K. L. (1982). Communica-tion programming for the severely handicapped: Vocaland non-vocal strategies. San Diego: College4lill Press.

Reichle, J., York, J., & Sigafoos, J. (1991). Jmplementingaugmentative and alternative communication strategiesfor learners with sever disabilities. Baltimore: Paul H.Brooks.

Stremel, K., & Wilson, R. (1988) Providing services forJearners with severe handicaps;

Module for developing communication. Hattiesburg: TheUniversity of Southern Mississippi.

DB-LINK345 N. Monmouth AveMonmouth, OR 97361Voice (800) 438-9376TTY: (800) 854-7013Fax: (503) 838-8150

CompuServe: 73324,2140Internet:leslieg@fsa.wosc.osshe.edu

DB-LINK (The National hlormation Clearinghouse on Children Who Are Deaf-Blind) is funded through Cooperative Agreement No. H025U20001 by the U.S.Department of Education, OSERS, Special Education Programs. The optnions andpolicies egaressed by thisfact sheet cio not necessarily reffect those of ,DB-LINK orthe U.S. Department of Education.

Page 4 Receptive Communication

Voice (800) 438-9376 DB-LINK TTY (800) 85A-713

Additional Resources

Rowland, C., & Schweigert, P. (1993). Analyz-ing the communication environment to in-crease functional communication. JASH,vol. 18, no. 3, 161-176.

Many students with severe and multiple dis-ablilities demonstrate severe communicationimpairments. Efforts to improve communica-tion in these students often embrace a "naturalenvironment" or "milieu" approach, embeddingopportunities to commurucate within natural,functional activities across the entire scheduleof daily activities. In reality, functional activitiesdiffer greatly in the degree to which they fostercommunication. This article describes an envi-ronmental inventory designed to allow ateacher or speech-lanpage pathologist to ana-lyze the extent to which a specific activity en-courages functional communication for aparticular student. The inventory may be usedto compare different activities across the stu-dent's day or to track the improvement of spe-cific activities that initially may show littlecommunicative value for the student. Reliabil-ity and validity data for the inventory are pre-sented along with a case study of its use tomonitor and guide improvements in a func-tional activity to increase communication by ayoung child with multiple disabilities.

Cress, C. (1989). Augmentative communica-tion for children with deaf-blindness.Guidelines for decision-making. Mon-mouth, OR. Oregon State System of HigherEducation. Teaching Research Publications.

Published as part of the Communication SkillsCenter for young Children with Deaf-Blind-ness. Intended as a tool for rehabilitation per-sonnel, teachers, therapists, caretakers, andclients to assist in developing agumentativecommunication systems.

Downing, J. (1992). Communication interven-tion for individuals with dual sensory andintellectual impairments. McLean, VA. In-terstate Research Associates, Inc.

A summary of best practices for communicationintervention is presented with specific recom-mendations provided for the person who hasdifficulty receiving and processing auditoryand visual information. Recommendations forfuture intervention research and strategies areoffered.

Rowland, C., & Schweigert, P. (1990). Con-5truction and use Qf tangible symbols. Tuc-son, AZ. Communication Skill Builders.

This chapter demonstrates the construction anduse of tangible symbols. The program is forteachers, speech-language pathologists, othersupport staff, and parents who work with indi-viduals who have severe multiple sensory dis-abilities. Based on Jan van Dijx's work in theNetherlands with children who are deaf-blind,these techniques are also suitable for individu-als of all ages who have cognitive and/or othersevere communication deficits due to other dis-abilities.

Bailey, B. (1994). Developing textured commu-nication symbols for communication useLiving and learning together, vol. 1, no. 2,October 1994, 6-9.

The author explains what a textured symbol isand how the system works. Suggestions forcreating textured symbols are followed bytwelve guidelines for implementing a texturedsymbol system for communication with deaf-blind individuals.

io

Stremel-Campbell, K., & Wilson, R. (no date).Providing services for learners with severehandicaps. A module for developing com-munication. Hattiesburg, MS. Mississippi-University Affiliated Program; University ofSouthern Mississippi.

In looseleaf format, this volume is a series ofinservice training modules for developing com-munication, systematic instruction, data-baseddecision making, functional curricular content,and social integration. The content of the mod-ule emphasizes the early receptive and expres-sive communication skills that may beappropriate for learners with dual vision andhearing impairments. It contains a Trainer'sGuide and a Trainee Workbook.

Kiefer-O'Donnell, R. (1994). Supporting com-munication within replar routines: con-versing about life. Living and learningtogether, vol. 1, no. 2, October 1994, 1-4.

This article describes the communication needsof deaf-blind children and then continues on tolist the advantages of meeting those needs in aninclusive setting where the child's communica-tion has true meaning. Acknowledging thatsuch communication takes time to develop), Kie-fer-O'Donnell makes the case that the quality ofboth the communicative effort and the relation-ships between conversing partners will greatlyexceed the initial effort of learning to communi-cate in a new and perhaps unique way.

Receptive Communication Page 5