NCDB Products | Topical Publications - Deaf-Blindness

Expressive Communication

Acknowledgements

This publication was adapted from one originally written by Kathleen Stremel and published and distributed within the state of Mississippi by the Mississippi Statewide Project for Individuals who are Deaf and Blind.

February 2005 Revised

Purpose of This Fact Sheet

• Encourage parents and service providers to be more responsive to their child's current forms of communication.
• Discuss the reasons for and uses of expressive communication.
• Encourage parents and service providers to develop a "map" of their child's current and future expressive communication needs.
• Discuss the many forms that may be used for expressive communication.
• Discuss the progressive nature of communication development.

Present guidelines for designing an effective communication program.

What is Expressive Communication?

Expressive communication involves sending a message to another person(s) to (a) make something happen or (b) stop something that is already happening.

Children and youth who are deaf-blind are able to express themselves in many different ways. Parents, siblings, and service providers must be responsive to their varied forms of communication. In addition, they must notice and encourage opportunities for expressive communication.

Reasons to Communicate at 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 Communicate at a Later Age

Greet Someone; Make Social Comments

• Hi
• Bye
• Thank you

Make Offers

• Would you like some?
• Here, have some of mine.

Provide Comments

• Mine
• This is good
• The table is dirty

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 are deaf-blind may also use facial expressions, gestures, sign, communication boards, etc.

Communication Milestones

Put Your Child on the Map

We will use the name “Lee” to represent an infant, child, or young adult who is deaf-blind. Think of Lee as your child, or as the student in your classroom.

Initially, just like all moms and dads, Lee’s parents perceived Lee’s cries and movements as having meaning even though Lee was not purposefully communicate needs to anyone. People began to respond to Lee’s movements and facial gestures as if they were communication. Then, Lee began to understand that certain movements made certain things happen; Lee was beginning to have some control over the world. Later, Lee’s mom, dad, and teacher got together to figure out how Lee could communicate with more people and in new ways.

Communication Map

The Expressive Communication Map presented below 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 your child can be taught to communicate during the next year. (IEP Objectives)
3. determine the ways your child might be able to communicate in the future. (Visionary Planning)

As you look at the map in Figure 1, you will notice that, initially, the communication techniques are simple and concrete. As you move across the map you will see that the ways to communicate become more complex. Lee is able to use a number of different ways to communicate the same message. When Lee does this, Lee is showing “purposeful” communication behavior.

Parents and service providers should discuss the following:

• In how many different ways is the student currently communicating?
• What new ways could be taught during the year?
• What possible ways may be taught in the next five years?

You may fill in the areas with the color-coding that is shown, or you may make up your own. Parents should be given a copy and a copy should be placed with the child’s records. Too often, during periods of transition, the child’s communication system is not planned or maintained. When that occurs, valuable time may be wasted by (a) changing the child’s program when the current one is working, (b) trying to teach communication techniques that didn’t work in the past, or (c) teaching techniques the child already knows.

Text description of Expressive Communication Map

Communication by Recognition

Behaviors indicate an awareness that anther person is present.

Facial Expressions - These early forms may not be purposeful communication, but simple reactions that indicate pleasure or displeasure.

Examples

• Opens mouth for more.
• Turns head away.
• Smiles or grimaces.

Vocalizations - Early vocalizations may indicate pleasure or discomfort/distress. Parents may notice that when Lee is uncomfortable or not pleased, Lee’s vocalizations are louder, longer, and have different inflections than when Lee is happy.

Examples

• Cries to indicate discomfort.
• Makes soft "u" sound when rocked.
• Makes loud "a" sound when music goes off.
• Makes gentle "whee" sound when swinging.

Contingency Communication

These behaviors are purposeful but not used for intentional communication. However, they may be interpreted by others as being communicative. Lee learns that by can acting on the environment, Lee can cause an effect.

Body Movements - Lee may use large body movements or more specific body movements to express Lee’s wants. Initially, these may be used to protest or to request more. At this point, Lee is demonstrating anticipation that an activity will continue. Purposeful communication will continue only if other people respond to it.

Examples

• Moves 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 assistive technology may include a switch that is connected to a tape recorder (for music), a fan, a vibration pillow, or lights. This is not a communication response, but this may help teach Lee cause and effect. Lee may learn that if he makes a certain movement, activating a switch, Lee can have some control over the physical environment.

Examples

• Touches 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 not able to get other people’s attention by vocalizations, physical touch, or going to them, Lee should be taught other ways of calling or getting people’s attention. A switch may be hooked up to a tape recorder that has a loop tape with a recorded message, “Come here, please.” A simple buzzer may also serve as a calling device to get people’s attention.

Examples

• Activates a buzzing device in the workplace to indicate, “Need help” or “Need more work.”
• Presses a switch with a red satin heart that is connected to a tape recorder that says, "Give me a hug."

Instrumental Communication

These behaviors are simple, non-symbolic behaviors that are directed towards another person, with the intent of causing the other person to act. Behaviors can be directed at person or object, but not both.

Touch Person - Lee will need to learn that things in Lee’s environment don’t just happen. Other people can control outcomes if Lee communicates with them. If Lee has the motor ability to touch another person to communicate, it is important to teach Lee to do so. In order to show that Lee has purposeful communication, Lee must look, turn to, or touch another person to purposefully communicate to that person. This can be done by eye gaze (if Lee has enough vision to do this). It can be done by moving Lee’s body toward the other person or it can be done by touching the other person. Initially, Lee may only touch you if you place your hand 1/2 to 1 inch from Lee’s hand. Then, you can begin to move your hand away so Lee has to extend his hand farther in order to touch you.

Examples

• Touches 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 move it toward Lee or toward an object that Lee wants. We can help make this happen if we don’t move our hands immediately when Lee touches us. In this way, Lee will have to work a little bit harder to make something happen (outcome).

Examples

• Pulls Dad's arm to Lee's tummy for more tickling.
• Pulls Mom's hand (with the spoon) to Lee's mouth.
• Pushes peer's hand to open locker in the high school.

Touch Object - We also want Lee to touch one (out of 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) and one Lee likes (oatmeal with cinnamon). This gives Lee a reason to touch one object and not the other. Later, you can use two items, which Lee likes, to allow Lee to make choices. Lee may turn his cheek to touch the object if Lee does not have use of his arms or hands. Lee may move his hand only an inch to touch the chosen object. A physical or occupational therapist may help determine the best motor movement.

Examples

• Touches 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 objects and people.

Extend Objects - Lee will be able to extend objects only if Lee has the motor ability to do so. All children will not have this ability, and some objects cannot be extended. At first, Lee may extend the object only a short distance. Gradually, Lee will learn to extend it farther. Lee may also extend objects to get something else in return.

Examples

• Extends 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 taught before manual signs (if Lee has enough motor ability). You and I use gestures to communicate every day. Lee will continue to use simple gestures even though Lee may learn other complex ways to communicate.

Examples

• Waves “Hi"/"Bye.”
• Gestures “Mine.”
• Gestures “Eat.”
• Gestures “Finished.”

Pointing - Children without disabilities point to people and objects before they learn to say their first words. Often, their first words may be paired with pointing. We all point on occasion to communicate something to somebody (especially in quiet places, like church). Of course, Lee’s ability to point will depend on how well Lee is able to see and how well Lee can use his fine motor skills. Many children who are deaf-blind will not be able to use pointing as a way to communicate. However, if Lee has enough vision to see large objects or large pictures and has good motor skills, we want to teach Lee to point as a way to communicate.

Examples

• Points 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."

Two/Three Choice Communication Systems - Once Lee is able to make a choice from two objects, we want to increase the number of choices. As an example, Lee may do this by pushing a switch on a three-choice-light/buzzer device to express Lee’s choice of the three items or Lee may push one of several switches that activate different messages on a tape recorder. If Lee is not able to make simple choices with objects, a more expensive communication system will probably not work either. No system can do magic.

Examples

• Uses eye gaze to look at one of four objects velcroed 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 may be velcroed to the switches; once Lee learns that these represent real objects or activities).

Emerging Symbolic Communication

At this level, the behaviors that are used to communicate become gradually more abstract.

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

Examples

• Gestures, "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 associate object cues with people and activities in Lee’s receptive communication program (see fact sheet Receptive Communication), Lee will be able to use small objects that are associated with an activity as a way to express Lee’s wants and needs.

Examples

• Hands handle bar grip to P.E. teacher to request exercise bike.
• Presses button on a touch activated talking device that has small objects glued to each of the buttons.
• Extends one of five small objects (velcroed on a wheelchair tray) to the teacher to indicate where Lee wants to go.

Pictures and Line Drawings - Lee may have enough vision (when Lee wears his glasses) to see picture symbols (black drawings/Mayer-Johnson) even though Lee can’t identify photographs. Line drawings are less expensive than miniature objects and take less time to find. If Lee can see and understand these, we can use them as we increase Lee’s vocabulary.

Examples

• Selects 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 in cafeteria."
• Points to a line drawing of a red square to indicate, "Put me on the red mat."

Symbolic Communication

Manual signs, written words, systems with braille, and speech words are true symbols. Lee must understand that there is a 1-to-1 relationship between the symbol and the object/person/activity; the symbol “stands for” or “refers to” the real thing. This is very difficult for some children. If Lee has enough cognitive abilities, Lee may be able to use an electronic system with speech output. Lee’s symbol system may be large keyboard letters or a brailled keyboard, depending on Lee’s vision, motor and cognitive skills.

Some children may be taught multiple communication methods concurrently. While one method is being mastered, the next method can be introduced.

Communication Development is Progressive

Parents and service providers need to consider the child’s vision, hearing, motor, and cognitive skills. They must also consider the child’s age and with whom the child will be communicating. It is important to remember that communication development is progressive. It may progress (a) from easy to hard, (b) from few ways to many, (c) from few wants and needs to many, (d) from a few reasons to many, and (e) with few people to many. How do we determine the most effective and efficient expressive communication system for Lee?

Hearing and Vision Abilities

• When was the onset of the vision or hearing loss?
• Does Lee have the ability to hear (with hearing aids) and imitate some sounds?
• Can Lee see shadows or color?
• Does Lee see objects well enough to reach out for them?

Motor Abilities

• Is Lee ambulatory?
• Does Lee have full range of motion of his arms and hands, or is movement limited?
• If Lee can't move his arms and legs, can Lee move his face from side to side?
• Can Lee grasp objects?
• Does Lee have the ability to extend his arm or to point?
• Does Lee have a tray on his wheelchair for attaching objects, switches, or electronic devices?

Cognitive Abilities

• Does Lee seem to learn things quickly?
• Does Lee indicate that he knows where he is going and what is about to happen?
• Is Lee motivated to do things?
• Does Lee try things again and again when Lee is learning new things?
• Does Lee smile when he has accomplished a task?

Lee will not have to learn every form or way that is presented above. You will need to consider Lee’s vision, hearing, motor, and cognitive abilities and disabilities in order to (a) strengthen current communication, (b) develop new ways to communicate, and (c) plan for more efficient ways for Lee to communicate in the future.

REMEMBER. . . The best communication results come from active teaching. Everyone in Lee’s environment must be responsive, consistent, and provide many different opportunities for communication.

Suggested Reading

Rowland, C., & Schweigert, P. (1989). Tangible symbol systems for individuals with multisensory impairments. Tucson: Communication Skill Builders.

Rowland, C., & Stremel-Campbell, K. (1987). Share and share alike: Conventional gestures through emergent language. In D. Guess, L. Goetz & K. Stremel-Campbell (Eds.), Innovative program design for individuals with dual sensory impairments (pp. 45-75). Baltimore: Paul H. Brookes.

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

Resouces

AbleNet, Inc. 1081 Tenth Avenue, S.E., Minneapolis, MN 55414-1312; 800-322-0956, fax 612-379-9143, customerservice@ablenet.com, http://www.ablenet.com/.

Hope Catalog. Hope Inc. 55 East 100 North, Ste 203, Logan, UT 84321-4648: tel/fax 435-752-9533, hope@n1.net.

Mayer-Johnson Company Non-Speech Communication Products. P. O. Box 1579, Solana Beach, CA 92075-7579; 619-550-0084, fax 619-550-0449, MayerJ@aol.com, http://www.mayerjohnson.com/.

Prentke Romich, 1022 Heyl Road, Wooster, OH 44691, 800-262-1933, fax 330-263-4829, info@prentrom.com, http://www.prentrom.com/.

Toys for Special Children, 385 Warburton Avenue, Hastings-on-Hudson, NY 10706; 800-832-8697, 914-478-0960, fax: 914-478-7030, customer_support@enablingdevices.com.

Additional Resources

California Deaf-Blind Services, 1992. Communication : what is he trying to tell me? Fact Sheets from California Deaf-Blind Services A brief summary of the ways a deaf-blind child may try to communicate is followed by a suggested continuum of steps for responding to this communication behavior. Available in Spanish.

Fielding, G., & Bullis, M., (ed). (1988). Communication development in young children with deaf-blindness: literature review. Monmouth, OR, Teaching Research Publications. Published as part of the Communication Skills Center for Young Children with Deaf-Blindness. Each chapter includes a 15-20 page overview of a certain aspect of communication and then a review of the literature.

Nelson, C. (1994). There’s more than one way to hold a conversation. Living and Learning Together, vol. 1, no.23, October 1994, 4–6. Nelson discusses the nature and importance of nonsymbolic communication for the deaf-blind child. She emphasizes the need for caregivers to recognize and respond to approach and withdrawal cues of the deaf-blind child. The importance of establishing a meaningful focus in any conversation to create a need for communication in the child is also stressed.

McFarland, S., Miles, B., Silberman, R., Riggio, M., Smithdas, R., & Smithdas, M. (1994). Communication with learners who are deaf-blind. Summer Institute. Sands Point: Hunter College. This program was offered through the Perkins Deaf-Blind Training Project, a major goal of which is to provide summer training to improve services for learners who are deaf-blind. The course provides a comprehensive analysis of the communication needs of learners who are deaf-blind. The impact of dual sensory loss on communication development, assessment procedures, and strategies to develop nonsymbolic and symbolic communication are addressed. Specific communication methodologies and a variety of communication modes, including augmentative systems, are presented.

Reyes, D. (1993). Access to context : a basic need for deafblind people Deafblind education, July-December 1993, 5-9.This article explains what the author considers to be the most serious difficulties faced by thedeafblind within an environment which "hears and sees." The piece also analyzes some of the resources available and some which need to be developed with the aim of attaining an independent and integrated lifestyle. While developing the maximum use of the senses, mental ability and communication skills is deemed important, clarity of thought is seen by this author as the key to successful independent living.

Stremel, K., Molden, V., Leister, C., Matthews, J., Wilson, R., Goodall, deV., & Holston, J. (1990). Communication systems and routines: a decision-making process. University of Southern MississippiThis manual was produced under grant GOO8730414 from OSER. The ultimate goal for children with any type of disability in the area of communication development is to assist the child, through social interactions and environmental arrangements, to be able to communicate in the most effective way possible, to a variety of people, and in a wide variety of social situations and environments. The job of the interventionist is to move the child and major interactor in that direction with the least amount of "stalling." Knowing where to begin, the direction to take, anticipating some detours along the way, and knowing when we are there will be based on a decision-making process. This manual covers the teaching of communicative behaviors, receptive communication and expressive communication, for children with vision, hearing and motor impairments via this decision-making process. Includes diagrams, charts, examples, and an IFSP.