MENTAL HANDICAP VOL. 13 JUNE 1985

However, the study suggests that elicited imitation plays an extremely small part in the “normal” language acquisition process.

Conclusion Despite several studies of spontaneous imitation in young

children, its role in language acquisition is still not clear. Children differ markedly in the extent to which they imitate spontaneously and it is possible that spontaneous imitation makes different contributions to the language acquisition process in different children. It is clear that it plays a much smaller part in language acquisition than has been claimed by the behaviourists. Even less is known about the role of elicited imitation in language acquisition, but there is reason to believe that it is of very little, if any, importance.

The next article will discuss the use of imitation in communication and language intervention.

References Bell, I. P. Communication and language in mental handicap: 1: Meaningful

terms. Ment. Hand., 1984a; 12: 1, 5-7. Bell, I. P. Communication and language in mental handicap: 3: The

Curriculum, Part 2. Ment. Hand., 1984b; 12:3, 119-122. Berry, P. B. Imitation of language: a psychololinguistic assessment

technique in severe subnormality. Unpubl. Ph.D Thesis. University of Manchester, 1973.

Berry, P. Imitation of language by mentally handicapped children: a language assessment technique. In Berry, P. (Ed.). Language and communicaiton in the mentally handicapped. London: Edward Arnold, 1976.

Bloom, L., Hood, L., Lightbown, P. Imitation in language development: if, when, and why. In Bloom, L. (Ed.). Readings in language development. New York: Wiley, 1978.

Bloom, L., Lahey, M. Languagedevelopment andlanguage disorders. New York: Wiley, 1978.

Bricker, W. A., Bricker, D. D. An early language training strategy. In Schiefelbusch, R. L., Lloyd, L. L. (Eds.). Language perspectives - acquisition, retardation and intervention. London: MacMillan, 1974.

Crystal, D. Child language, learning and linguistics. London: Edward Arnold, 1976.

Crystal, D. Workng with LARSP. London: Edward Arnold, 1979. de Villiers, P. A,, devilliers, J. G. Early language. London: FontandOpen,

1979. Folger, J., Chapman, R. A pragmatic analysis of spontaneous imitations. J.

Child. Lang., 1978; 5 1 , 25-38. Guess, D., Sailor, W., Baer, D. M. To teach language to retarded children.

In Schiefelbusch, R. L., Lloyd, L. L. (Eds.). Languageperspectives- acquisition, retardation and intervention. London: MacMillan, 1974.

Leeming, K., Swann, W., Coupe, J., Mittler, P. Teaching language and communication to the mentally handicapped. Schools Council Curriculum Bulletin 8. London: EvadMethuen Educational, 1979.

McConkey , R. Reinstating parental involvement in the development of communication skills. Child: Care, Health & Dev., 1979; 5, 17-27.

Miller, J. F. Assessing language production in children. London: Edward Arnold, 1981.

Miller, J. F., Yoder, D. E. An ontogenetic language teaching strategy for retarded children. In Schiefelbusch, R. L., Lloyd, L. L. (Eds.). Language perspectives - acqu , retardation and intervention. London: MacMillan, 1974.

Mittler,P. J. Language and communication. In Clarke, A. M., Clarke, A. D. B. (Eds.). Mental deficiency: the changing outlook. London: Methuen, 1974.

Ronda], J. A. Verbal imitation by Down syndrome and nonretarded children. Amer. J. Ment. Defic., 1980; 85:3, 318-321.

Ruder, K. F., Smith, M. D. Issues in language training. In Schiefelbusch, R. L., Lloyd, L. L. (Eds.). Language perspectives - acquisition, retardation and intervention. London: MacMillan, 1974.

Slobin, D. I. Psycholinguisrics. Glenview, Illinois: Scott, Foresman, 1974. Snow, C. E. The uses of imitation. J. Child. Lang., 1981; 8:1, 205-212. Taylor, J., Berry, P., Conn, P. A study of language learning through

imitation. In Berry, P. (Ed.). Language and communication in the mentally handicapped. London: Edward Arnold, 1976.

Teaching first Introduction

Results of a survey which examined the language abilities of the children in Melland School (Coupe, 1981) indicated that 28.4 per cent of the pupils were functioning below the one word imitation level. This agreed closely with the results of a similar study by Leeming, Swann, Coupe and Mittler (1979).

Examination of Melland School curriculum identified a sound and thorough instrument which emphasises the two separate elements of receptive and expressive language. However, for children at or below the one word imitation level, more emphasis could be placed on functional communication. At this stage of development aspects of language and communication are interrelated, and need to be viewed as a whole.

The development of communication According to Bates (1976) object

permanence and means-end relationships are necessary pre-requisite skills for communication with intent. She identifies a stage of key importance: the child generalises the use of means-end relationships and sets out to use an object to gain an adult’s attention or uses an adult to gain an object. The crucial stage of

meanings

Linda Barton Judith Coupe

SUMMARY. Various models of functional communication offer help in formulating curriculum content for pupils at the pre-one word and one word production level. However, for teachers of children with severe learning difficulties, these are often limited in practical application. One particular aspect of communication development is Teaching First Meanings, which in this article has been related directly to functional application and classroom practice. intentional communication is when the child sets a goal and is able to plan and apply appropriate means-end behaviours to attain it. Only after this will the child move on to develop language.

Halliday (1975) presents the notion of the functions of communication. He lays stress on the interpretation of the child’s meanings according to the contexts in which they are used. Bloom (1970, 1973) also takes this view but further argues that single word utterances refer to aspects of an event. She identifies two main categories of words used by young

children: substance words (loosely associated with an object, which later become the name for an object); and function words (which refer to functions a variety of objects may perform).

It was our intention to teach in a communicative context and make communication a natural process. Bloom’s notions of function and, substance words formed the basis of our teaching. The aim was to teach the discrimination and generalisation of concepts prior to words, based on two categories of meaning: “functions” and “events”.

LINDA BARTON is a Speech Therapist in South Manchester. JUDITH COUPE is Headmistress of Melland School, for children for severe learning difficulties, Manchester LEA.

@ 1985 British Institute of Mental Handicap 67

MENTAL HANDICAP VOL. 13 JUNE 1985

TABLE 1. Transcript of teaching session Sequence: A Meaning: Adult behaviour: Child behaviour: code

Sequence 1 Attention Teacher holds up car Demonstrated by adult

Teacher says “Car. . . look”, “look”, “look” Teacher puts car on floor Teacher says “Look”

Action Repetition Action

Teacher pushes car and says “Go” Teacher picks up car, holds up, says “Again” Teacher pushes car and says “Go”

One child says ‘‘& W -

Sequence2 Agent Teacher asks “Who wants it?” G v Christopher looks at car, points -- to self and vocalises - Teacher says “Good boy Chris”, gives him car

Attention Teacher says “Christopher”

Action Teacher says “Go”

Repetition

Action

Christopher takes car, puts it on floor

Christopher pushes

Christopher takes car and vocalises approximation to ‘‘Again“

G

W

G

- - Teacher picks up car and holds it up

Teacher reponds by saying “Again, good boy”

Teacher says “Go” and catches car

- Christopher pushes car -

Sequence3 Attention Teacher holds car

Agent Teacher asks “Who wants it?”

Teacher says “Good girl”, puts car in Natalie’s hand

Teacher retrieves car and says “Go”

Teacher picks up car, holds it in front of Natalie

Teacher responds “Again, good girl” Teacher puts car in Natalie’s hand

Teacher says “Good girl”, “Natalie, go”

Action

Repetition

Action

Natalie

Natalie vocalises and points to self (gesture)

Natalie drops car

Natalie prompted to push car

Natalie vocalises for more

--

Natalie prompted to hold car

Natalie Dushes car

L - vc

PG - V -

PG -

Sequence 4 Attention Teacher holds up car Martina l&s L

Agent Teacher asks “Who wants it?”

Teacher acknowledges, “Good girl, Martina” Teacher gives car to Martha

Teacher says “Go”

Teacher picks up car, places in Martina’s hand, asks “again?’’

Teacher picks up car, looks at Martina, says “good girl”

V - Martins vocalises

Action Martina takes car

Martins prompted to push it (gesture)

Martina with prompting pushes the car (gesture)

PG

PG

- -- Repetition

Action -

Sequences Attention Teacher shows car L

V

PGIW

Joseph I& - Joseph V J - Joseph prompted to point to self and spontaneously says,

Agent Teacher asks “Who wants it?”

Teacher repeats to Joseph, “Who wants a go?” -

“me”

Teacher touches his face, says “Good boy” Teacher gives Joseph the car Teacher says “Go”

Teacher retrieves car, says “Again”

Action

Repetition

Action Teacher says, “Go“

Teacher picks up car, says “Good boy”

.... - Joseph places the car on the floor and pushes - G -

5 Joseph retrieves the car and has a second quick go

Joseph takes car and pushes it G - - -

Sequenced Agent Emma calls out, “Me” W Teacher responds, “Good girl, Emma” (Teacher talks to scorer) Teacher gives Emma the car, says “Ready” Action

Emma holds car, says ‘‘Go”, then turn away from circle to push car

W

Teacher comments “Ooh” as car stops, then “Go and get it”

Teacher says “Again Emma, again, again”

Teacher says, “Go”, “Go, hurrah”

Emma goes to retrieve car, taking her time

Emma picks up car Repetition

Action Emma pushes car G

68 @ 1985 British Institute of Mental Handicap

MENTAL HANDICAP VOL. 13 JUNE 1985

Functions Functions express behaviours which are

common to a variety of objects, people, or events.

Existence. The child acknowledges that an object or an event exists by looking, touching, pointing, or naming. For example, when presented with a doll, child reaches and touches it.

Disappearance. The child indicates that an object that was present has disappeared, by look, gesture, vocalisation, or a word such as no, gone, or away. For example, when a toy car is pushed into a garage, child gestures with upturned hands.

Recurrence. The child requests a re- presentation of an object that existed but disappeared, or a repetition of an action that occurred, then stopped, either non- verbally - by a point, gesture, or vocalisation - or verbally - such as again, more: For example, a battery operated car is activated by adult. The child looks at the adult and vocalises to request a repetition of the action.

Nonexistence. The child indicates that an object does not exist where he expects it to be, either non-verbally - by a look, gesture, or vocalisation - or verbally such as no, gone, or the name of an object. For example, a child is given an empty biro and told to draw. Lack of results leads to showing of pen and “tuts”.

Events Events are single aspects of the

environment: the person or object that causes an action to happen; the object it happens to; and the action itself.

Agent. This is the person or object that causes an action to occur. The child can convey this by a gesture, vocalisation, or a word. For example, on presentation of a drink the child points to himself and says “me”.

Object. This is the object or person affected by an action. The child can convey this by a word or a gesture. For example, when shown a toothbrush, the child points to teeth and says “teeth”.

Action. This is any observable activity or change of state. The child can express this non-verbally by a gesture, or by a word such as up, go or jump. For example, when offered some pop-up-cones, the child says “go” and presses the lever.

Use of the meanings of functions and events

A child’s life revolves around sequences of communication and social interaction. These are repeated frequently and the child can come to anticipate them. The meanings of those situations can be taught using functions and events. Small, carefully selected clusters of meanings are first modelled and then taught in short

sequences to small groups of children. For example, to teach the meaning of

the sequence Existence, Disappearance, and Recurrence, three steps are necessary:

Step 1. Existence. The child’s attention is drawn to the object. Step 2. Disappearance. The object is made to disappear.

Step 3. Recurrence. The object is made to reappear.

In this sequence the functions remain constant bu t the events can differ tremendously. This is important because the aim is to teach the meaning rather than the activity itself.

Example A. Existence. Jack in the box pops up. Disappearance. Jack in the box is pushed down and the lid is closed. Recurrence. Jack in the box is made to reappear.

Example B. Existence. Teddy is in front of the curtain. Disappearance. Teddy is made to disappear behind the curtain. Recurrence. Teddy reappears.

Example C. Existence. Child sits in a large cardboard box. Disappearance. The top is closed and child disappears. Recurrence. The lid is opened.

As progress is made, more complex sequences can be taught, for example Agent, Existence, Action, Recurrence, Action.

Step 1. Agent. Using words and gesture the adult asks “Who wants a turn?’. The child conveys the meaning that he wishes to be the agent. For example, the child points to himself and says “me”, or is physically prompted to point to himself.

Step 2. Existence. As the agent is given the object his attention, and that of other children in the group, is fmed on the object. For example, he is given a set of pop up cones, or a toy musical box is held up for him.

Step 3. Action. The agent causes an action to occur. For example, he presses the lever and the cones pop up,or he winds the handle or lifts the lid to create music.

Step 4. Recurrence. The action stops and the agent or others in the group request repetition. For example, as the cones are retrieved the agent gestures to press the lever, or when the music stops a child smiles and makes eye contact with the adult or the agent.

Step 5 . Action. As for Step 3.

Presentation Up to six pupils at or below the one word

level can be taught successfully using sequences of this kind. Preferably, one adult should teach, while a second records child behaviours, and sometimes assists with teaching. It is best for the children to sit with the adult(s) on the floor or on chairs in a circle so that they can all see what is happening and the adult(s) can control turn-taking. The children should

first observe the adult model, and then each other’s performances.

Adult(s) must intentionally exaggerate gesture, facial expression, and vocal intonation to present a strong model for imitation, and to maintain group interest and attention. Appropriate behaviour by a child should be rewarded socially. The sequence should be followed if possible ifa child deviates, bu t communicates something relevant. This should be acknowledged and rewarded.

Scoring child behaviour It is essential to record any indication

that a child is attending to or making use of the concepts being taught. Physical and verbal prompts and imitations as prompted behaviours should be noted. Gesture and eye-contact should be seen as desirable behaviours for children who have not reached a verbal level. Vocalisations and words (or approximations) used to convey appropriate meanings should be noted. Child behaviours can be scored by the following codes: L = Look; G = Gesture; V = Vocalisation; W = Appropriate word; P = Prompt.

A scoring system is important for measuring individual children’s progress in the frequency of response and spontaneous behaviours.

Example teaching session Five nursery aged children were taught

for relatively long sessions (30-60 minutes). Teaching style and control was important. Each session taught carefully selected sequences of meanings.

Table 1 is a transcript of a session where the sequence incorporated: attention - to the toy car; agent - who wants to make the car go; action - agent makes the car go; repetition - agent controls for action to be repeated; action - agent makes the car go.

Table 2 shows how the session is summarised for the purposes of scoring child behaviours.

The objects used varied with repetitions of the sequence and were organised before the session started. During the teaching session the same sequence was taught using a ball and skittles. Table 3 gives the behaviour scores.

The results indicate a marked increase in the children’s anticipation, attention span, and turntaking abilities.

Conclusion It is important for teachers to examine

ways in which children can initiate communication and exercise some control over classroom events. Opportunities should be created for “Function” and “Event” meanings to be experienced in a natural communication setting. Short sequences of meanings could be taught in contexts such as the Wendy house, water play, sand, creative work, construction toys, milk time, or even during toileting and washing. A more formal teaching

0 1985 British Institute of Mental Handicap 69

MENTAL HANDICAP VOL. 13 JUNE 1985

session should also occur at least once a day so that child behaviours can be recorded.

References Bates, E. Language and Context: The Acquisition

of Pragmatics. New York: Academic Press, 1976.

Bloom, L. Language development: form and function in emerging grammars. Cambridge, Mass.: MIT Press, 1970.

Bloom, L. One Word at a Time. The Use of Single Word Utterances Before Syntax. The Hague: Mouton, 1973.

Coupe, J. Resultsofa Language SurveyatMelland School. Unpublished Report, 1981.

Halliday, M. A. K. Learning bow to mean: explorations in the development of language. London: Edward Arnold, 1975.

Leeming, K. , Swann, W., Coupe, J. Mittler, P. Teaching Language and communication to the mentally handicapped. Schools Council Curriculum Bulletin 8 . London: Evans Methuen Educational, 1979.

Reynell, J . K . Reynell Developmental Language Scales (rev. edn.). Windsor: NFEWNelson, 1977.

TABLE 2. Scoring - Seauence A: Car

Christopher Natalie Martina Joseph Emma

Attention L L L. L Agent GV VG V V PGW W Action G PG PG G WG Repetition W V Action G PG PG G G

TABLE 3. Scoring - Sequence B: Ball and skittles ~~

Christopher Natalie Martina Joseph Emma

Attenuon L L L L L

Agent W vw PGV W w

Repetition L PW L Action GV G PG G G

Note: The authors would be pleased to hear from anyone who wishes to apply thls approach or is developing a smlar framework of intervention.

Action W PG PG W PG

The law and mental handicap: 6. Consent to treatment

Mike Gunn

The issues surrounding treatment of people who are mentally handicapped are manifold. They concern not only a right to self-determination insofar as that is practically and legally possible, but also a right to receive appropriate treatment. The latter has not been recognised in England as such, but is a development of the interpretation of the Bill of Rights in America by the lower Federal courts’ which appears to be supported by the Supreme Court.2

The main concern of this article is with the right, if any, of a person who is mentally handicapped to decide what treatment and care to receive. There is very little directly relevant case-law, so the starting point is with general propositions.

Possible courses of action If the issue of wrongful treatment or care is to be raised in a

court of law, it will be raised as either a civil law or criminal law matter. If it is a civil law action, which is most likely, the person who is mentally handicapped, the plaintiff, will be seeking damages (or perhaps an injunction to stop treatment being continued) from members of staff and their employers, the defendants. If it is a criminal law action, this will be by means of a prosecution, probably of an individual member of staff. The result could be imprisonment, although a non-custodial sentence, if not a discharge, is more likely.)

Criminal cases are unlikely for a number of procedural reasons: legal aid is unavailable to the individual to pursue a

private prosecution; if it is not a private prosecution the poiice have to be convinced that a prosecution is appropriate; the complainant does not necessarily receive any financial benefit if successful; and the burden of proving the case is greater than in a civil law a ~ t i o n . ~ Civil law actions also have a major advantage for the plaintiff, in that the employing authority is usually “vicariously liable” for the actions of its employees and is thus financially responsible.’ Most members of staff are not insured against prosecution though doctors, for example, are.

There are two relevant civil law actions. The first is known as trespass to the person which, for present purposes, involves assault and battery.6 Any non-consensual contact with a person amounts to a trespass to the person. The second is negligence.’ The plaintiff succeeds here if he can establish that the defendant owed him a duty of care which has been carelessly broken. All health staff, inside and outside institutions, owe their patients a duty of care. That could be broken if consent is obtained by providing insufficient information. It is here, therefore, that the American concept of “informed consent” is relevant.* Thus the issue of consent is central to the entire question.

Consent Consent is a rational act of will by an individual. The person is

saying “Yes” to a form of treatment; not necessarily that he likes the idea of the treatment but that he realises the personal benefit

MIKE GUNN is a Lecturer in Law in the Department of Law, University of Nottingham,

University Park, Nottingham NG7 2RD. 70 @ 1985 British Institute of Mental Handicap