Piaget Slide 1 Welcome. My name is Susan Bashinski. I am thrilled to have the opportunity to talk with you today about how learners with deaf-blindness develop symbolization ability. It's this skill about which we're going to talk today that really is central to a child, a young adult, any learner that has deaf-blindness in really moving from being what many people in the world would say non-communicative. I would challenge that, but a lot of people say, "Oh no, this learner doesn't have any communication." To helping facilitate that learner's skills to the point that they might be able to communicate using more conventional, usual communication. Being able to communicate more like the majority of people in the world do, or at least to help the learner communicate in a way that other people, including people unfamiliar with that child or young adult, might be able to understand. It's all about symbols. It's all about what symbols mean, what they are, how we learn to process and understand them. And I think in order to be able to really understand how this process develops in typical communication it's important to take a little bit of a quick look at the theories of Jean Piaget. Slide 2 And for those of you who are familiar with him, you're probably way ahead of where I'm going with this. For those of you who haven't heard of Jean Piaget, this is a very quick, five or ten minute introductory course to his theories, and in colleges and universities around the world they teach three and six credit-hour courses on Jean Piaget. So this is just like a teeny tiny dip into the bucket of his theories. But I think it's worth our time, because a learner's communicative competence is truly anchored in the motor, social, and cognitive achievements of the very first months of life. Piaget's theory is really a very solid, well-respected, evidence-based description of the sensorimotor achievements that occur during the first two years of life. So we want to look at just a few of the main tenants of this early developmental theory of Piaget. Slide 3 The entire key from the Piagetian perspective, the key to successful development of symbolic communication, or what could also be called language, is the notion of representational thinking, or the skills we refer to as representational thinking skills. There's a lot of big words in there and we may not all understand what they mean, so we're going to back up a little bit and look at this idea. When we talk about representational thinking we are referring to the ability to represent something in mind when it is not present in the here and now. The orange words that you're seeing on your screen explain it in a little bit of a different way that if you look at the professional literature in communication development you will hear about distancing in space and in time. So I want to give you a couple of examples about that. I think the easiest way for us to maybe wrap our heads around this notion of representational thinking is to put ourselves in the position of how that plays out in our own experience. When I say to you-- wherever you are now-- let's just assume that none of you are on a beach listening to the ocean waves. You might be in your living room, or your kitchen, or your classroom, a library, I don't know [laughter]. You are not on a beach. But if I say to you, "Think about the beach, or when was the last time you were at the beach?" We all might have somewhat individual interpretations of that, but we are able to represent in our minds a picture of moving water. Some of us would call them waves. Maybe some people would call them white caps. A lot of water coming into an area that's sandy. Maybe it's black sand. Maybe it's white sand. Maybe it's rough sand. But the notion is each of us is able to conjure up a mental image of a beach, even though none of us are at the beach right now, right here. So I'm merely using the beach example to say we're in a different space than the beach. We're in a different place than the beach. And we can all still hold that image in our minds because we have symbolic thinking skills. We have representational thinking skills. Another example to illustrate the time dimension is, even though right now-- let's just pick a time. Let's say that it's 1:15 in the afternoon. I could say to each of you, "What did you have for breakfast this morning?" And even though it is not the moment in time when you are sitting down, or standing up, rushing out the door to eat your breakfast, each of you could answer that question about what you had for breakfast this morning or maybe what you didn't have for breakfast this morning. And even though that's not right now in time at this moment of 1:15 you can hold in your mind an image of what you had. You can express and share with someone else what you had for breakfast this morning. That is a second dimension of distancing. We are able to use our language, our communication skills, to talk about something that is not present in the space where we are, and in the time where we are right now. We'll come back to this notion of distancing at the end of this talk this morning, but I wanted to plant that word, that seed of distancing because it really is central to the whole notion of helping the learners we teach, our own children, who have deaf-blindness learn to develop symbolization ability. And that's what this whole little talk is about, symbolization ability. The other major construct that I'd like to share with you or mention to you at this point in time that really does influence a learner's development of symbolization ability is how the learner, how your child has constructed object-based knowledge. And again that sounds kind of formal and I'm sorry I don't mean to do that, but it's what kind of experiences has your son, has your daughter, has the learner with whom you work, had experience, what kind of experiences, with objects and what have they done with those objects? For the Kansas Deaf-Blind Project, we have recorded another presentation on interaction with objects, and if you haven't taken a look at that you might want to do so. And even if you viewed or listened to that one previous to this presentation on symbolization, I really would encourage you after today's session to go back and listen to that one again. And maybe as you do, you would listen to it with a different filter or an additional filter that would help you know how helping a learner, helping your own child interact with objects would help promote the development of her symbolization skills. So that's kind of the basis for where we're going. Slide 4 In Piaget's theory, he has many, many constructs - a lot of things that I think influence our development of communication skills - but there are four notions, constructs, skills, about which Piaget wrote that he calls sensory motor precursors. And what he says these are-- they are precursors to communication development. And that's why they are important for us today. Notice, this word "precursor" might be new to somebody. "Precursor" is something that develops right alongside with or, possibly, a little bit in time before another skill, but it is very different than "prerequisite." I would guess that maybe some of you when you saw this screen, you went, "Oh, sensory motor prerequisites for communication development." And I really would like to say please erase that from your minds because in my belief - and I think it is well-grounded in the professional literature - there really are no prerequisites to communication development. If a child is alive, and breathing, and has someone with whom to participate, that's all you need to help promote that learner's communication development. There are no other prerequisites. But there are precursors, and these other skills that if we help promote, facilitate the development of these other skills while we're trying to begin to build a communication system for a particular child or young adult, the emergence of these precursors can facilitate the development of additional communication skills. One kind of feeds the other. So as early, early communication skills - about which we'll talk today - as those start to emerge, we will see changes in that learner's performance in regard to the four precursors you see on the screen right now and vice versa. So let's take a look at each one of these four sensory motor precursors from Piaget's theory. Let's look at them each individually. Slide 5 The first one is called object permanence, and the way that I would define this very simply is holding the image in one's mind. Again, in books, we could find formal definitions of object permanence that would go on for seven pages, and I just didn't think that'd be very kind to do to you today. So the reduced definition is holding the image in one's mind. At the bottom of the screen, there are two points for each of the precursors, and I tried to make these parallel as we go through. Object permanence is really central to search behavior that we, as parents and professionals who work with learners who are deaf/blind, we really want to promote the development of search behavior. And to be able to do that, we have to work toward the emergence of object permanence. The searching can be visual searching. If you would think for a minute of a typically developing youngster who's sitting in a high chair, and throws the spoon on the floor or knocks the spoon accidentally on the floor, and cries and cries because the spoon is gone but does nothing else, you might say, "Okay. We need to promote this idea of object permanence." If that same little child is a little bit older, has had a little more life experience and throws or knocks the spoon on the floor, and then looks over the side of the high chair tray to find the spoon or to see where the spoon went, "Okay. That's a signal. There's a visual search for what disappeared from visual view." Playing peekaboo with a blanket. If you play peekaboo with a young child or an older child who has some delayed development, and you, as a mom, are lying on the floor with your youngster who might be 12 months old, 14 months old, and you put a blanket over your head, and say, "Where's Mama?" or "Where's Daddy?" and nothing happens or your child begins to cry because your child thinks that you've disappeared, and now, the child is afraid or anxious. The child does not, at that point anyway, demonstrate the skill of object permanence. But if the child will giggle, or laugh, or make an attempt to move the blanket to whatever degree her motor skills will allow her to move the blanket and find you or if you move the blanket and then when you see your child's face, your child is beaming with a great, big smile, that's a signal that there is object permanence because that child knows you didn't fall off the earth once she couldn't see you anymore. That's a visual search behavior. For children who are totally blind or have a very, very significant vision loss, it would be difficult to relate to these examples. But there truly is very strong legitimate parallel that children who have no sight will tactilely search. If a child is playing with a toy on the floor, or interacting with some kind of a toy on the floor, an object, shoe - doesn't have to be a toy - and drops the shoe or the family dog runs through and moves the shoe, bumps the shoe out of your child's lap and the child cries because it's just plain gone, and the child doesn't have a clue what to do to find the shoe, that's a signal that, "Oh, we need to work on this search behavior. We need to do things to promote object permanence." But if your child wants the shoe gets knocked out of her lap or she drops the shoe and you'll see the hand come out to try to feel on the floor around like, "Where did the [inaudible] shoe go?" That's a search. That's a tactile search, and that is indicative that child has developed the construct of object permanence because as the final point on your screen right now says, "It's a cognizance." It's an awareness on a part of the learner, that whatever the object was, or the person, the mom or dad behind the blanket, continues to exist even when it is not directly within the sensory field. The first examples we're in, it's nonvisual field. The examples on the floor with the shoe, that's tactile field. It could be a search if a child had a beeper ball, and it turned itself off or something. They could search when the auditory signal was no longer being provided. We spend a little bit of time talking about object permanence. This is probably one of the most central sensory motor precursors to early communication development and is one that we can do a lot to facilitate. And through this one, I've tried to give you the structure that I'll use when I talk about the next three. Slide 6 So let's move onto the second one. The second sensory-motor precursor in the Piagetian theory is called means-ends understanding. A very simplistic, but I think, accurate definition is purposeful problem-solving. I'm confronted with something that I don't quite know what to make of it and I need some help here to solve this problem, or if I've developed means-ends skills, I can figure out how to solve the problem myself. Means-ends skills are related to the development of understanding of how we use tools. And this isn't literal, like use a hammer, use a screw driver [laughter]. It is using other people as tools to assist us to do things we can't do on our own. It's using other objects to assist us to reach, get to other things we can't get to using just our own bodies. An example would be if you're in your kitchen, or you're in your library, or your garage and there's something on a top shelf, and no matter how much you stretch up on your tip toes, you can't reach that doggone thing. So if you get out a stepping stool, put it in front of the cabinet, stand up on the stool, then you can easily reach whatever it is you need, you've used the tool of the stepping stool. You showed means-ends behavior because you figured out how to solve that problem. If you would have grabbed-- there we go. Gotten one of those grabbers to reach up and take something off an upper shelf, or if you would have picked up a stick to bat something, one of your children's toys is caught in a lower branch of a tree in your yard and you can't reach it and there's no stepping stool convenient out there, but there's another big stick so you get the stick to knock the toy out of the limb-- off of the limb you show means- ends behavior because you figured out how to solve that problem and get that thing knocked out of the tree. We see it in little children typically developing. If they'll walk, or waddle, or crawl, roll into the kitchen where they know their very favorite crackers are in an upper cabinet, and they'll stand on the floor and maybe put up an arm or cry because they can't reach the cabinet, but they have not developed the skill yet to be able to figure out, "I'll get the stepping stool out, or better yet, I'll open the drawers and I'll use the drawers as a set of steps to get to this thing that I want." It's the whole notion of how we use one thing to gain access to another. For children, young adults with deaf-blindness if they can't see they will use tactile cues to direct them to a location where something that they want is, or they may take a person and take momma-- grab daddy's pants leg and take daddy into the kitchen to get their favorite snack that they want. Or again, persons, objects. Use one thing, one person, to gain access to another thing. They quote, "Know how to figure it out." Slide 7 The third one, and this is the one that I'm guessing everybody has at least thought of before, the notion of cause and effect. Understanding of causality. I don't think we need any more definition than that. This is related to purposeful, deliberate action. And there is another recording that you might choose to listen to at some point about the development of intentionality, which is very intimately linked with purposeful action. When we're talking about the earliest communication development, how symbolization skills emerge, how communicative intentionality emerges, the two of them really are intertwined. And if you listen to that presentation, you will say, doesn't Susan realize she talked about that before? But there is a lot of overlap and similarity, because the development of emerging symbolization can promote the emergence of intentionality, and vice versa. This whole idea of purposeful action is related to cause and effect. Some of you may have encountered this in schools, or if you are a parent, even working with your child at home, the school may have sent home some type of a big red switch or a big [inaudible] switch, and it's like, hit the switch to make the toy make its noise. Hit the switch to activate the shredder. Hit the switch to say, let me tell you a fact of the day. And if the child or the young adult has learned how to hit the switch to make that speak, but it is done purposefully, it's not randomly, oh, my arm bumped this, and the device spoke the phrase. Or that my paraprofessional, when the teacher says, is Susan here today?, that my paraprofessional takes my hand, takes my knee, and presses the switch with it to say, yep, I'm here. That's not a purposeful action on the part of the child. That's where you've got support for the child participating with a switch. But it's only when the child independently would activate the switch with an understanding of, oh, when I hit the switch and say, yep, I'm here today, teacher, teacher. That is purposeful action that shows I understand that the cause of my hitting that switch, touching that switch to activate it, gives the effect of communicating to my teacher that I know she wanted to know if I'm around and I'm letting her know that I am around. So by explanation, it's a cognizance, it's an awareness that one's own actions can impact other people, can impact other objects. Cause and effect, very important. Slide 8 So we've talked about object permanence, means-ends behavior, cause and effect or causality, and the fourth one - before we move into an examination of symbolization itself - is the notion of imitation. I think this is something that parents typically do so well with their children, definitely with their children who aren't challenged by deaf-blindness or other disabilities. Sometimes I think we lose sight of the fact we just need to play, and we just need to engage in imitative games with our children who have deaf-blindness. But that's really what this imitation thing is all about, copying a vocalization. It could just be an, "Ah!" If your child goes, "Uh!" you "Uh!" back. Your child goes, "Ah-a," "Ah-a" back, and you see if you can get the imitation going. Or your child-- sometimes to bump this up a level, you might go, "Uh-oh!" to see if your will go "Uh- oh!" or just go "Uh!" So you count numbers of vocalizations, and there's all kinds of ways we could scaffold this, but it's just the notion of copying or imitating another's vocalization. It can also be with gestures. Gesture could be a touch, a put out your hand, push something away. Sometimes we get the greatest success with our children with deaf-blindness by helping them learn to gesture to push away things they don't want, to push away things they don't like. Well, instead, if you're putting down in front of your child or your teenager who has deaf-blindness some particular thing to eat-- child doesn't like beets. So you're giving them beets, and they make a face, or do something that maybe idiosyncratically on their own unique way to say, "Mama, no! You know I don't like beets," so you just remove the beets. It's much more important to a child's development of these early, early communication skills to help. Take the child's hands, take some part of the child's body, and teach a rejection gesture, to prompt and prompt and prompt a rejection gesture so you can have your child saying, "I don't want the beets." Or if you're trying to brush the child's teeth, that's one thing they reject on their own, but. And rather than having them squirrel around in their chair and try to avoid you by turning their head, try to teach them a way to raise an arm to block their mouth or to push away dad's hand when dad's bringing the toothbrush toward their mouth. To teach a gesture - and it can be the person, mom or the dad, who's working with your child showing the child the gesture visually if he or she can see it, but if they can't, you can imitate the gesture through tactile modeling of that, and prompting to push away, to reject, a gesture. This notion of imitation is so critical to turn-taking. And turn-taking is another piece along with search behavior, tool use, understanding causality. Turn taking is really at the heart and soul of communicative interaction, because it takes two. There has to be reciprocal interaction - at least two people, maybe more - to exchange information. You communicate, I listen. I express, you listen. You express, I listen, back and forth, back and forth. But before this can happen in a true communication or speech, or manual sign, or tactile signing way, turn-taking has to happen motorically. Turn taking has to happen with other objects and just sounds. Some of you may have played that game with young children where - it's a hand game - you put down one hand and then the child puts down his little hand on top of yours. You take your second hand and put it on top, he puts his second hand, puts it on top, then you pull your hand out of the bottom. And you just keep making this stack of hands, alternating hands. Beautiful turn-taking activity that really does lay a foundation for communication development, and those are the kinds of things we do with our children who don't have disability, don't have challenges, that promotes their communication and we don't even know it. So this whole idea of imitation is an awareness of or attempting to reproduce another person's vocalization, which is speech sound - any sound, not words just sounds - or another person's gesture. Slide 9 With that said, that's the foundation. That's the framework within which we're operating. So we can now move into a more targeted examination of how symbolization develops. Because that was a topic, right? Symbolization ability. I do need to say, this is my disclaimer, different authors, different researchers in the field of special education, will talk about the number of stages through symbolization development. Susan Bruce, who's done a lot of work in this area, she's at Boston College, she talks about seven stages. Charity Rowland, another researcher at Oregon University, will talk about six or seven stages. Some other folks who've been at Kansas in the past, the McLeans will talk about six stages. I'm going to talk with you about three. Just because, you know, it's how many pieces into which we cut the pie. And I think the simplest way, yet a very robust way, to examine the emergence of symbolization ability, is just to talk about these three stages you'll see at the bottom of your screen right now. And the names aren't too sophisticated, so don't be scared away [laughter] by that. Non- symbolic, concrete symbolic, or what we'll call transitional, and abstract symbolic. Slide 10 So let's take a look at those. We will examine them in the order they were presented: nonsymbolic first, transitional second, and symbolic third. So you might say, "Where does this word nonsymbolic come from?" Again, I need to make you aware that there is not agreement in folks who work in special education in early communication development about what this first stage ought to be called. Some people call it each of the four words you're seeing right now, prelinguistic, presymbolic. And then you see a pair of words that are almost the same except they say nonlinguistic and nonsymbolic. And you might say, "Susan, why don't you use prelinguistic or presymbolic," and that is a conscious choice on my part. I don't think it's a right or wrong thing, but to me it's connotation. And I think it's an important connotation. If we say prelinguistic, presymbolic, that says to me, okay, this level of communication development comes before some level of communication development that's going to come later. So this is okay, we're going to do this first, but we're going to move on into something that is later going to be linguistic or symbolic. And I don't think that connotation is appropriate. Because although it's all of our hope that every learner with deaf-blindness with whom we work to try to promote communication development, we all hope that that learner will move to some sort of symbolic communication system after a given number of months, after a given number of years. That's what we work toward. It's not always going to happen. Some of the learners on the Kansas Deaf-Blind Census will more than likely not ever develop symbolic or linguistic skills. And that's okay. Because even if that's true, there are so many things that we can do to improve that learner's communication, to change that learner's communication, to make that learner's communication more powerful. So don't go thinking it's a bad thing. And I think that if we use the prefixes pre-, prelinguistic, presymbolic, it gives folks, parents, other teachers, our colleagues in schools the notion well, we're doing this for right now, but something's going to come later, and we're going to move to the next stage, because pre- precedes something else that will follow. And that's just not true. So I don't like the connotation. I think it makes it seem like well, if we don't move pass pre-, sounds bad or something's wrong. I don't feel that way. So then we're left with nonlinguistic and nonsymbolic, and I could have lived with either one of those. But I think when you're talking about the development of symbolization ability, say what we mean. What we mean is it's not symbolic at the earliest levels of communication, so let's use that word, nonsymbolic. Slide 11 Symbolization. Definition of a symbol. Again, I do believe that each of you has a notion of what a symbol is. But to try to get us all on the same page and introduce three very important words that I'll be sharing and going back to for the remainder of this presentation, I want to review this really quickly if you'll indulge me for that. Definition of a symbol: One thing that stands for another. One thing that represents another. It could be the word computer, the spoken word when I say, "computer" that stands for the thing at which you're looking right now to view this PowerPoint. It could be the written letters C-O-M-P-U-T-E-R. Those are symbols that refer to that same thing. It could be ASL signs for C, finger spelling for C-O- M-P-U-T-E-R that stands for that same thing. It's spoken, written, doesn't matter. Some set of symbols that stands for another person, another thing, another activity. One thing stands for another. And that's what we're striving for. We want to get to the place with as many learners as we can that one thing can stand for another thing because that opens the world to allow us to communicate with distancing. But where we started to be able to communicate things that aren't right here, wherever here is for you, and to communicate about things that aren't right now. Things that are in this immediate moment in time. That's our goal. The other words that we need to agree upon are in orange on the screen. Referent, that's the object or the action that is going to be represented. So in the example with the symbols I was using, the referent is your computer itself. Representation is the manner in which you're having something stand for your computer. It could be the spoken word computer. The written word computer. The signed series of tactile finger spelling to represent computer. So the referent is the computer itself. The representation is the combination of symbols, things that are used to represent that object of your computer. Slide 12 So now we want to take a quick look at some of the vocabulary terms speech and language pathologists who talk about the development of symbolization ability don't always use the same terms. If you read anything in the professional literature about symbolization ability and how it emerges authors don't always use the same terms. Like I said, different people say, "Oh, there are five stages. No, there's seven. No, there's six. Bashinski here is telling us there's only three. There isn't a magic number. There's not an absolute number. As you're going to see in a few minutes, there's a continuum, and it's just how many pieces do we slice the continuum. But I think it's important that you be aware of this set of terms that appears on your screen now that are used by different folks in the field of communication development to describe this non- symbolic stage, or the non-symbolic-- the earliest point in communication development. Some folks will so, "Oh, this is primitive communication. This is idiosyncratic communication." I really like the notion of idiosyncratic. You'll see it show up again. It's the idea that individuals have behaviors, have signals, that are unique only to himself or herself. It's not a conventional way. It's not the way we all, say change the channel on the TV. One of my favorite examples is with a young man, I think he was 13 or 14 years old, and I was making a home visit, and he had deaf-blindness. And I was in the home, and all of a sudden, he was beating on the side of the TV set. And without missing a beat the parent got up, and walked over and got the remote, and changed the TV channel. And then the young man who was beating on the side of the TV was happy as a clam because that was his signal to say, "Hey, dad I don't want to watch what's on TV right now. I want you to change the channel for me." Well, those of us who are unfamiliar with that young man wouldn't have a clue what that behavior of beating on the TV means. That's what I used to do when my TV signal would go out and I wanted it to come back on. But that, because when that young man beat on the TV, as his family tried to play the game of 40 questions to figure out, "What is it that Todd could want?" They finally figured out when he beat on the TV and they changed the channel all is good. But none of us - the rest of us - use that particular behavior, beat on the side of the TV, to get the channel changed. That's an example of an idiosyncratic behavior. And I don't think anybody, after I told my story, I hope, nobody could say, "Well, that wasn't communicative." Because it certainly was communicative. Ask yourself, would it have been communicative to a babysitter that was staying with Todd for the very first time if mom and dad were so busy that when they left the house in a hurry that night they forgot to tell the babysitter, "Oh, if he beats on the TV it means change the channel?" Don't think so. The babysitter wouldn't have figured it out. Non-symbolic communication is also described as pre-intentional or perlocutionary. And I'd say, "What in the world is perlocutionary?" For this point in time, I would just say-- in the next two slides, you'll see other iterations of this word with locutionary on it. We really examine those-- the Kansas Deaf-Blind Project really examines those in a second presentation that is focused on the development of communicative intentionality, and so I'd refer you to that, and let's say, for now, let's focus on this notion of idiosyncratic, primitive, non-conventional descriptors for non-symbolic communication. Slide 13 The middle stage, transitional. If it's nonsymbolic, symbolic, what's in the middle is that transition between those two. The stage is in, some of the literature, described as concrete symbolic. It says, "Okay. We're moving down this continuum. We're not there yet to fully symbolic communication, but it certainly has some connection to common sense." The notion of waving goodbye, or waving in our country, waving a hand, it's not explicit. It's not as unique as saying, "Hello," because it could also mean goodbye. It could also mean some version of, "Hey, I see you. Come here," or something. But if we see somebody waving, common sense tells us it either means hello, or goodbye, or something, or in a ballpark, we have a limited bounded area to try to interpret meaning. So by that example, you see that transitional communication is very conventional. The stage involves a whole lot of gesture, some vocalization. At this stage, behavior is very intentional. Kids do things on purpose. And there's the magic word that's a capital I-L-L-O, Illocutionary. Again, that's referenced in the presentation on intentionality, but it really connects to the transitional symbolization stage. So I didn't want to leave it off. Slide 14 And for the final stage of the development of symbolization skill, we just call it symbolic. That's the target. That's the goal. This is differentiated from the transitional stage in that the communication is now abstractly symbolic. This is the manner in which you and I are communicating. I'm speaking. You're listening. Everything I'm saying to you is symbolic. You are processing that as a symbolic communicator, understanding what I'm saying. Understanding the symbols of the print on your PowerPoint that you're viewing. Symbolic communication is the accepted practice for the native speaker of a language. Symbolic communication is referential. That means we use words. We use printed words. We use spoken words, we use sign language, we use tactile sign language, we use Braille to purposefully refer to ideas, objects, people, places. It's referential. It's intentionally communicative and there's that last stage of locutionary. Slide 15 In this chart, I tried to provide some key points about symbolization and I thought it might be helpful to see it in a chart where you could compare across. There's a ton of information on this one slide. So let's try to dissect it and take a little bit of a look at it. Again, the primary stages of symbolic ability are across the top. We've talked about those. Non-symbolic, transitional or symbolic. The second line of this chart, Piaget, the gentleman whose theory we examined at the beginning of this talk, he would roll over in his grave if he saw these ages associated with these stages. I want you to know, please, that Piaget did not put ages on any of the things, the concepts, the constructs, the skills he described. These are ages that I've drawn from a number of different authors in the literature. I didn't just make them up, but they are not absolute. And I struggled with whether I should share these or not, but I think it does give us some anchors by way of comparison to say, "Typically-developing children who aren't challenged by sensory loss, when do they move through these stages?" And I think it's that power that makes it worthwhile to include the stages. And as you'll see, kids are non-symbolic at the time they're born, and they usually move through and complete the non- symbolic stage of communication development at either eight or nine months of age. That's what eight/nine-- eight to nine months of age, they're finished with that. The transitional stage is a very short period of time; six months maximum is usually what people believe. It's when kids really start making connections, making associations. So from eight or nine months, depending on where the previous stage ended, until 12 to 15 months, kids have moved through this transitional stage. It could be as short as three months. And the symbolic stage, as I say, all of us are in the symbolic stage of communication development now, and we have been since we were 12 to 15 months old. You say, "Wow." So most of the stuff that we're examining today really has to do with what goes on in the first 12 to 15 months of life. And I think that's a sobering thought that all of these skills in typically-developing children are hooked up and functional for that child by a very, very young age. And it shows us the challenges we have to try to provide a variety of experiences that are rich enough to help our kids who have deaf/blindness move through these notions of object permanence, means-ends behavior, causality, imitation, knowing that one thing can stand for another thing and make it look more conventional, make it look more like the way everybody else does that thing or says that thing or signs that thing. It's a big challenge. If we look at the third row of the chart under non-symbolic, this repeats something I've said before, idiosyncratic gestures of vocalizations. Idiosyncratic; unique to that child. Think of the TV channel changer. Think as a parent, you could hear your baby's cry because that's what babies do between birth and eight to nine months of age; they do a lot of crying. But parents are able to differentiate, "That cry means I want you to come pick me up." "Oh, that cry means I'm hungry." "Oh, that cry means I'm poopy. I need my diaper changed." "That cry means I hurt." Those are idiosyncratic ways that your child is truly communicating with you through idiosyncratic vocalization. Crying is characterized as vocalization because it's sound; sound production. Going on down the first column on the left, context is very critical for parents, for teachers, for members of a school team working with a learner, to derive the meaning of the cries. Your child cries and you look at the clock and you go, "Wow, she hasn't had anything to eat three for hours," it's that contextual information about, "Oh, it's been three hours since she's been fed. She's probably hungry." That helps you tune-in to the fact that that particular means, "Feed me now, please." In a classroom situation, if there's a learner who's nine years old and the learner is kicking his leg in a certain way when he's in side-lying. And you watch, and the kick happens, and the kick happens, and the kick happens when he's in side-lying, but you don't notice that behavior in other times of the day. It could be a signal that says, "I'm sick to death of being in this contraption, will you please get me out of it?" Or it means, "I'm hurting now. I've been lying on my left side for 20 minutes and you need to move me." It's taking in the context of what time by the clock, what time of day, how long since medication, how long since placement in a particular position, whether it's an equipment position or not, who is socially around? Maybe it's a notion of-- you have a 14-year-old daughter who has a very best friend that comes in as a peer tutor in her class at school. And the way you've figured this out, the way the learner's teacher has figured this out, is that young lady is most animated, her facial expression seems happier, she smiles more, or her body is more animated-- she gets excited so she struggles with her head control because she's so excited, her muscle tone changes because she loves this friend that comes in as a peer tutor during fourth period. And so you're going to begin to say, "Oh, it's when Judy comes to work with this 14-year-old learner. And they are going to look at girly magazines or see what's going on with the boy bands that the 14-year-old gets animated, smiles, and gives these cues that are really behaviors that can be interpreted as communication behaviors, and that's where it all begins. That's where we begin to intercede to develop communication skills and to begin to stretch what the learners do to turn them into symbolic representations. And the way we know is the social context. Physical context, time, social context; all those things are very important. We wouldn't have a clue what those different behaviors that are idiosyncratic-- we wouldn't have a clue what they mean if we didn't look to context. And as we look to context, going on down to the last box in the far left-hand column, what really makes communication happen, what really makes communicative interaction happen in that situation is the partner, the adult, the other peer, the teacher aide, the mom, the brother, the teacher observes what's going on and says, "Okay, I get it. In this context, when this happens, the learner does this behavior. Bingo, we're going to interpret that behavior to mean, 'I really like Judy and I want to do things with her more often.' Or, '20 minutes is a little too long to be lying in this side-lying contraption,' because he starts to get pressure on his hip. Get him out of there after 18 minutes." Or we begin to say, "When he makes that foot-kicking motion, it's discomfort." It's, "Hey, get me out of here. I don't like this." The partner assigns the meaning. Those things are not symbolic to the learner yet, but by the partner looking at and isolating those behaviors that the learner makes and, repeatedly, the partner assigns meaning to those same behaviors, we are on our way and we can move with repeated associations, over time, consistent repeated associations over time, we can help move that learner into the transitional stage of development. One more point about this, as I said, if we're going to say the smiles and the animated body movement because, "I'm getting so excited, I can't control my head and can't control my trunk," everybody who works with that learner needs to make the same interpretation, it means, "Wow, I'm excited. I like this. This is pleasureful. I like Judy. Bring Judy on. Bring on Judy and her magazines. This is good." But if another person on a team says, "Oh, my goodness, she's getting too tired of sitting in her chair because her trunk control is lessening, it's coming apart, we need to schedule PT now," and interprets that when the learner's trunk starts wobbling, it's like, "Judy, you have to leave now. We have to do PT," you've got a dissonance because you've got a contradictory interpretation. Then if a third person comes in and says, "Oh, my goodness, the learner starts getting wobbly and we need to get her on the floor," or, "We need to feed her now because she's getting weak, she needs food," and so then every time the wobble starts, it's like, "Okay, Judy, you have to go back to your class now and we're going to feed the learner." I hope you can see how that's creating chaos because each of the three partners of the learner with deaf/blindness is attributing or assigning different meaning. So you have to have team communication, you have to have communication with families and everybody has to agree, "Ah, we really think she starts smiling and losing trunk control because she's so blasted excited, she loves looking at those magazines with Judy," and every single person has to interpret it the same way. And that's true for every behavior that the learner demonstrates in this non-symbolic stage. That's how we promote communication development with our typically-developing babies and we need to do the same thing with learners with deaf/blindness regardless of how old they are. So as you see with paired associations over time, you can move into the transitional stage, which is the middle column. It's very short. It could be as short as three months, maybe as many as six, but kids begin to make conventional gestures; putting their hand out with their palm up when they want somebody to hand them something, if they have that motor skill. If they have any functional vision left, to stare at somebody and then look at the object that they want somebody to hand to them. To make sounds that start to approximate words, like "Ah!" that can mean, "Hi." Or to make unhappy sounds when they're displeasured by something or uncomfortable with something. In this stage, there is some kind of naturally associated link, in a concrete way, there's some link with the referent. It's not just this random-- beating on the side of the TV could mean anything. There is some sort of natural association, like when you, as a teacher, might be lining up your class and some of the kids are getting their feeding machines or they're getting their sack lunches to get in line to go to the cafeteria, then you're going to see this demonstration of excitement from one of the young men in your class, one of the 17-year-old guys that doesn't have any organized set up communication, but he starts making a certain [inaudible] sound that is-- his could possibly be, "Oh, I'm hungry," and it comes out and the only time of the day you hear it is when you're getting in line for lunch. It's like, "Okay," the context is important, but it really makes sense because we're all headed for the cafeteria and there's a concrete link to that referent of, "I'm so glad I'm going to get something to eat now." At this stage, in the transitional stage, objects begin to become very, very critically important. We can start to introduce textures for kids who don't have vision, or three-dimensional objects, three-dimensional representations, and kids can begin to start to associate a piece of a chain link as, "Oh, wow, I get to go swing in the tire-swing on the playground." Or a piece of a strap that is like the strap on their backpack to say, "Oh, I get to get my backpack and go home now." And it's how we begin to use objects in calendar systems, in schedules; visual schedules, tactile schedules for kids to start to make concretely-linked reference to the ideas for which they stand. So we're starting to get conventional. It's moving along. It's not unique to one individual child. The partner in this transitional stage doesn't bear the complete burden of playing 40 questions or 200 questions or, "What in the world could that mean?" because there's some natural association. The far right-hand column of the chart, as I say, typically-developing kids will hit this stage sometimes as early as 12 months, usually by 15 months. For the rest of our lives, vocalizations are conventional. We start to hear true words. They may not be articulated exactly right. A kid may say, "Chee!" or "Cheese" because the zzz is really hard to say, but "Chee," that's very conventional. Word approximations, but that, again, it's just a matter of they don't have the motoric control to make the full sounds. Abstract reference; again, you start to see things about asking about grandma, if you're not at grandma's house or grandma's not around. Or the dog, "Where's the dog?" when the dog's not in the room with them. And start to move into two-dimensional representations. This is a little hard to think when a kid is 15-months-old, but this notion of symbolic-- this stage of symbolic communication ability lasts the majority of our lives. Traditional orthography refers to Braille, refers to print, refers to cursive writing, refers to Morse code, refers to just those traditional coded ways of representing ideas. So there's 16 tons of information on this chart. I hope it's not overwhelming, but I thought it might be nice to present it where you could look across and compare the stages. I think some summative comments might be helpful. If you look at the third line of the chart, "Idiosyncratic across to conventional," you'll see we could draw a line from left to right that says as we move through the stages of symbolization development, communication becomes more and more conventional. And it's a good summative statement, "Communication becomes more and more conventional." As we look at the next line following about context. Context is everything when trying to derive meaning from the behavior of a learner who is non- symbolic. And as we move across from left to right-- we could draw an arrow from left to right to say, "Context becomes less and less critical as children's skills move down the continuum of symbolization development. Context is important, but its importance diminishes. The final line, the bottom line talks about partners. And as we move across the continuum of communication development, symbolization development, the responsibility of the partner, the role of the partner diminishes. The partner becomes less and less and less important as communication becomes more symbolic because I can talk to you, I don't even know you, you don't know me, we can talk to anyone, we can communicate with anyone who speaks the same language we do. Whereas Todd, the guy beating on the TV, he could only communicate with very, very familiar partners. So that would be a summary of this chart. This is a powerhouse chart. I think it's kind of the whole point we're trying to make with this presentation today. Slide 16 So let's see if we can wind this up. The sequence of symbolization development-- it's really important to understand that the development or the emergence of symbolization skills does not proceed in a single fashion in one direction. You start non=symbolic then you get transitional and you're symbolic and - boom - you're done. It really is influenced by the situations in which we find ourselves. I think we can all think of this. This story I tell my classes is, okay, I speak no French. But if I were going on a tour with a group of folks to Paris-- when I know I'm going to be going to Paris, I'm going to buy my French-English dictionary. And I'm going to look up the really important words, so I can ask directions and ask where the restrooms are and ask where I can drink of water. And I'm going to have that dictionary in my purse, and I'm going to stay with my tour group. And no matter what, I'm fine because I'm going to have an interpreter who can interpret for me. And I can communicate in a very symbolic fashion when I've learned how to say, "Where is the restroom, please?" But then as the day goes on, I lose my tour group, and I'm outside the Louvre, and I'm starting to get a little frantic. So I'm trying to look up in the dictionary, but I can't find the words to say, "Where did the tour bus go?" And I'm getting anxious, so I'm pantomiming. I'm trying to pantomime and point to things that are the same color that the tour bus was. And I'm trying to get the people to see if they talk English and they don't. Nobody does in this, my made-up story. So go with me here. So I'm trying to find things that are the blue and purple colors of my tour bus and saying, "The big bus with the wheels." And I'm doing charades and pantomiming, and I'm using conventional gestures, but my communication has slipped back into transitional. It's conventional, but I'm not using words and traditional orthographies to talk. And then somebody comes and steals my purse, and it's starting to get dark, and I don't have my dictionary. And I don't see anybody I know, and I can't find anybody that speaks English, so I sit down on the curb and I start to cry. And at that point, I've reverted back to my communication being non-symbolic because it's idiosyncratic and I might be doing whatever I do - picking on my fingernail or something - to say, "I am terrified here because I am lost, and I don't know where my tour bus went" and so on and so forth. Silly example but I try to use it to say we all go up and back, in familiar situations and foreign situations, if you've traveled to a place where the language is different. You don't speak the language. You've experienced this. Me, when I first moved to Carolina, I experienced this because the accent was so strong, I couldn't understand what my students were saying to me. So, again, as we adjust to different symbolic language forms, we slide up and down this continuum. But as native speakers of English, we operate the majority of the time in the symbolic stage, leading us to point number two. Although learners, all of us, demonstrate skills at multiple points along the continuum all the time, we describe a learner - we describe your son, your daughter, ourselves - by the descriptor where the majority of our skills are. Well, the majority of my skills are in the symbolic stage, so I would be a symbolic communicator. Slide 17 The levels of symbolization ability on this continuum are not differentiated by distinct boundaries. It's not like you're only in one stage. You have a smattering of skills. It's very blurry. We are understanding more and more about what happens in the transitional stage, but it's still a little bit of a mystery. Research continues. A shift from one stage of symbolization development doesn't occur overnight. Your daughter's not going to go to bed on Monday night non-symbolic and wake up Tuesday one week symbolic nor transitional. It doesn't happen that way. It's gradual. We use, again-- the level is described by a descriptor - bad sentence, I apologize - that corresponds with the majority of her symbolization skills. Slide 18 One other way that I think it's important to look at symbolization, before we wind this up-- again, the definition. Symbolization is a level of understanding that one thing, spoken, written, concrete, any kind of media, one thing represents or stands for something else. There are vocal things. Sound-based things. There are unaided things where we use our bodies. We make gestures. We use movements. We used aided things. That's when we use other devices - other stuff. The example I gave you with the switch to say, "I'm here, or here's the fact of the day." Slide 19 So I thought it might be useful for me to provide you with some examples. I have taken the three stages we've examined today, nonsymbolic, transitional, and symbolic, and I've taken those categories of type, or form, or mode of communication, vocal, sound based, unaided using just our bodies, aided using things outside our bodies, and put them generally into the classes where they would fall. So in nonsymbolic, kids use screaming, crying, babbling. Those things mean something. As it gets transitional, the vocal behaviors start to sound more like jargon. Our kids will start to vary the inflection with which they make sound. [inaudible]. We don't know words, we don't hear words, but the inflection changes. It's not just a high-pitched scream that doesn't change. And symbolic traditional speech, or voice output communication aid. If we look at unaided, ways that learners who have deaf-blindness communicate with us at a nonsymbolic level. It's their level of alertness. If they're dozing off. If they change their affect, their emotional state, from happy-go-lucky to crying to looking pained. It's the way they posture their bodies. It's the way they move their bodies. We need to start examining and searching. What could those things possibly mean? With what are they associated? Assign meaning to them, and everybody assign the same meaning, and treat them as communicative, and that will help the child move across the continuum of symbolization development. Things that start to look transitional, gestures, pointing, proximity, with your child coming to sit beside you or rolling over on the floor to get beside you. Facial expressions is a big one. Under symbolic, it's A-S-L, American Sign Language, tactile sign, finger spelling. And then the same thing we can do with the aided category, with nonsymbolic learners acting on people, pulling on your pants, slapping you, pinching you, acting on objects, beating on the side of the TV to say, change the channel. Transitional, textures start to be meaningful or can start to be meaningful with repeated association. Tangible symbols using three- dimensional objects. And then the symbolic again is textural codes, traditional orthographies, braille, any conventional coded system for language. Slide 20 I hope that from the information we've shared today, you can feel, maybe more comfortable with these assumptions than you might have if I'd had started with this, if I'd thrown this slide up first. But I think this is the base from which we all have to operate, that every single learner, every one of your children, every one of the learners in your class, every one of the 158 kids on the Kansas Deaf Blind census, they do communicate with us. It's up to us to figure out how, and what in the heck they're saying, but they do. Even if they're very, very primitive in their communication, non-symbolic, speech path, when I say, "Oh, he communicates like a three month old." Doesn't matter. Or the speech path probably wouldn't say that, the speech path would probably say, "Acts like a three month old." Bingo. I know how a three month old communicates. We'll start there. They do communicate with us. The onus is on us to figure it out, and to shape it and mold it, to move it across the symbolization continuum. Every single learner's communication skills can be improved, or altered. The reason I said, "or altered". It's a sad fact we don't like to talk about a lot, but there are some disability conditions associated with deaf blindness that involve a regression of skills. One example, Batten's disease, one example Usher Syndrome. Kids lose skills. And in those instances, we're not going to be able to consistently always improve or grow the learner's communication skills, but we not only can alter them, we must alter them. Because as children, young adults lose skills because of the progression of their disease, we have to give them different ways to communicate. We can't quit communication programming when they start to lose skills. We might have to back up, and instead of moving from non- symbolic, through transitional, to symbolic, we may have to more the other direction, and become more concrete. But we can change communication skills, and we have a responsibility to do that Slide 21 Things that you can do to try to facilitate the development of symbolization ability. Engage your child, engage the learners in your class, with experiences that involve action, movement, vestibular stimulation. Use all kinds of sensory exploration, including lots of touch. You can't neglect touch. For kids with deaf-blindness, many times if they're challenged by multiple disabilities we don't really have good ideas of what their vision and hearing skills are, unless we know they have none. And even then, sometimes I don't think we know that. Touch gets overlooked, and we have to teach touch, how to use touch. Your Kansas Deaf-Blind Project has another presentation on that topic if you would like to listen to that at some point. We want to find things, foods, objects, people, toys, activities that the learner prefers. Not what we prefer, what the learner, what your child, prefers. Do them. Do them every day. Do them several times a day. Play. One thing that is so interesting to me in the literature professionally-- and sometimes it's very legitimate. Kids with deaf-blindness can be very medically fragile in the first couple years of their life, and they don't get shaken and picked up and swirled around and turned around and piggy back ridden, and all these things that typically developing kids do. And we need to play. We need to use routines. Regularly use routines. Again, your Kansas Deaf-Blind Project has another presentation on that topic. You might want to take a look at it. Bottom line, the most important thing. If you have a child, if you are a teacher, if you are a teacher assistant with a learner with deaf-blindness who is not using symbolization, be responsive to that learner. Be responsive. The more responsive you can be-- so you interpret the movement wrong. The kid will let you know. We have to try. We have to do interpretation. We have to act like we understand meaning. And if we're wrong, then we guess again. Slide 22 Go back to where we started. The ability to represent something in mind when it is not present in the here and now, when it is not present in the current space and time, kids learn the notion of distancing. And that's what we're trying to teach when we're trying to teach symbolization. Slide 23 We can do this, we can do distancing, by infusing these-- these are just four examples. We can do tons of other things. But even if you don't have a detailed daily schedule, just do a now and later. We're going to do this right now. We're going to do this later. And finish box. And develop experience books. More about that. You can develop an interactive home-school journal to record some remnants or some information about daily events that will support what I like to call memory thinking. Then mum and dad, at home, can know that they went on a field trip to the art room at school today. It's very important when you're going to start to use 3-D objects, to mount the objects on some kind of [inaudible], or cardboard, heavy something, so that learners can distinguish when an object is a representation for something or when the object is the object itself. I know we ran through these really quickly but they're here for your use. I just wanted to put these up as a smattering of things we can do to promote the development of civilization. Slide 24 This is probably my favorite slide. If you want to promote the development of your son's or daughter's symbolization ability. Teaching teams, you want to promote the development of symbolization ability with kids who are non-symbolic. To teach expressive skills, to teach the learner to be expressive, you need to listen with your hands. Listen with your eyes. Listen with your heart. Don't listen only with your ears. Watch what they do. Feel with your hands when their muscle tone changes. Feel when their breathing pattern, their breathing rate, changes. To help build the learner's receptive skills or understanding of what you're communicating, talk with more than your mouth. Talk with objects, talk with your hands, talk with your touch, talk with your movement. That's the way we can help the kids to learn. Slide 25 There are a couple of references I would give you. The National Consortium on Deaf-Blindness. One of the best, in my opinion, written resources is by Susan Bruce. I mentioned her earlier. It's called The Path To Symbolism. It's available through this website. It's a Practice Perspectives publication from August 2008. Also, the University of Nevada website. Deaf-blind Project website in Nevada has great tips for home or school to help develop symbolic ability. And I would encourage you to take a look at those things. Slide 26 On this sheet, the reason I listed this first one, this is a resource that's available through the Kansas Deaf-Blind Project and it has, in a lot more detail, my personal take on how symbolization develops. Maybe you'd like to read that, maybe you wouldn't, that's fine too. The second one is another article by Susan Bruce that's a little more detailed than the practice perspectives to which I just referenced you about path to symbolism. This is a struggle to symbolism. It's a much more lengthy, scholarly article, but it's very good. And this whole notion of distancing, if that intrigues you and you're not familiar with that, the distancing information is from 1988 by Warner and Kaplan. It's a hard read but it's a really good read and it might be something that would interest you. And that concludes the information for today. I hope that this might make you view the communication attempts of the learners with whom you work, of your own children, in a different light. And if you have questions, I'm sure your Deaf-Blind Project staff would be happy to try to answer them for you. They have some great resources on this topic. And I really thank you for your attention today.