1. Emergent and Early Communication Learners with Deaf-Blindness Kansas Deaf-Blind Project April 9, 2010 Susan M. Bashinski

2. NATURAL GESTURES

3. WHY TEACH NATURAL GESTURES? Theoretical reasons: Developmentally occur prior to symbolic communication Thought to pave the way for symbolic communication Provide opportunities for linguistic input

4. WHY TEACH NATURAL GESTURES? Practical reasons: Readily understood by numerous partners No extra equipment is needed Can be used across many different contexts Evidence -base: easier to teach than some forms of symbolic communication

5. PRELINGUISTIC MILIEU TEACHING  Communication interactions occur within motivating, naturalistic teaching routines  Routines provide opportunities for a child to use natural gestures and vocalizations to greet, request, reject, comment in authentic contexts  Communication partner responds to a child’s communicative attempts in contingent ways  Primary targeted outcome is to increase a child’s rate of communication

6. ADAPTATIONS TO BASIC PMT STRATEGIES FOR CHILDREN WITH DB  Utilize augmented input strategies, including touch cues and object cues  Incorporate hand-under-hand strategies  Emphasize tactile and vestibular activities

7. ADAPTATIONS TO BASIC PMT STRATEGIES FOR CHILDREN WITH DB  Involve indication of directionality (of a communication act) through alternative orienting responses or whole body orientation--not just eye gaze  Incorporate environmental adaptations to facilitate the use of a child’s residual vision and hearing

8. PARTICIPANTS  12 children from NE Kansas / NW Missouri, recruited with assistance of the KS and MO state deaf-blind projects  Documented vision and hearing losses  3 to 7 years of age at study’s inception  Communicated at rate of less than one communicative act / minute  Communication skills at nonsymbolic level

9. RESEARCH REPLICATION  6 children from Indiana  Recruited through the Indiana Deafblind Services Project-staff of which provided all intervention sessions  Participants selected according to same criteria as applied in main study

10. KEY FINDINGS  Eleven children (main study group) and six children (replication group) completed intervention  ALL children (both groups) showed increases in rates of communication  Nine children (main study) and four children (replication) successfully achieved, or exceeded, exit criterion through initiations / responses  Two children (each group) exited intervention after 9 months (i.e., only participants who have significant motor challenges, in addition to other disabilities)

11. # COMMUNICATION ACTS / MIN. ParticipantBaselineEND: Intervention HOWA0.771.32 ROTL0.351.76 MANJ1.061.98 MACB0.732.07 HALD0.362.08 BROI0.411.99 LOCM0.922.11 OVZJ0.361.93 CAIE0.532.04

12. FINDINGS (continued…)  Increases in communication rate, for participants (n = 9) who do not also experience significant motor challenges, ranged from: 0.55 more CA / min. to 1.72 more CA / min. (25 to 77 more comm. acts in a 45 min session)  Average Increase in communication rate, for these participants, was 1.31 more CA / minute (59 more comm. acts in a 45 min session)

13. # COMMUNICATION ACTS / MIN DATA FROM REPLICATION SITE (INDIANA) ParticipantBaselineEND: Intervention BUCJ0.591.01 MINS0.831.80 COLD0.641.72 PRAB0.891.91

14. FINDINGS (continued…) REPLICATION SITE (INDIANA):  Increases in communication rate, for participants (n = 4) who do not also experience significant motor challenges, ranged from: 0.42 more CA / min. to 1.08 more CA / min. (19 to 49 more comm. acts in a 45 min session)  Average Increase in communication rate, for these participants, was 0.87 more CA / minute (approx. 40 more comm. acts in a 45 min session)

15. FINDINGS (continued…)  ALL children (in BOTH the main study group and the replication study group) demonstrated both an increased number and greater diversity in communication forms

16. FINDINGS (Participant nearest mean growth-main study group) Baseline FORMSEND: Intervention FORMS Push object away3 Baseline forms, PLUS: Drop itemExtend hand, palm up CryTake partner’s hand to… Give item to partner for help “High five” greeting Point Clap hands

17. EXPRESSIVE GESTURES EXTEND HAND, PALM UP (REQUEST)

18. EXPRESSIVE GESTURES TAKE PARTNER’S HAND (REQUEST)

19. EXPRESSIVE GESTURES TAP PARTNER’S HAND (REQUEST)

20. EXPRESSIVE GESTURES GIVE FOR HELP (REQUEST HELP)

21. EXPRESSIVE GESTURES POINT (COMMENT or INDICATE CHOICE)

22. EXPRESSIVE GESTURES EYE GAZE / CLOSE EYES (TERMINATE)

23. FINDINGS (continued…)  ALL children (in the main study group) demonstrated increased diversity in communication functions

24. FINDINGS (Participant nearest mean growth-main study group) Baseline FUNCTIONSEND: Intervention FUNCTIONS Protest2 Baseline functions, PLUS: RejectGreeting Request action / turn Request object Request attention Indicate choice Direct attention / Comment

25. EXPRESSIVE GESTURES GREET

26. EXPRESSIVE GESTURES REQUEST ACTION / TURN

27. EXPRESSIVE GESTURES REQUEST OBJECT

28. EXPRESSIVE GESTURES INDICATE CHOICE  Eye Gaze  Reach, w/ Eye Contact

29. EXPRESSIVE GESTURES REJECT / TERMINATE

30. SUMMARY OF KEY FINDINGS ADAPTED PMT was effective in increasing: Prelinguistic communication rate Diversity of individual learners’ nonsymbolic communication forms and functions--particularly for those learners who demonstrate good motor skills HOWEVER… Effects did NOT generalize to different contexts

31. ACKNOWLEDGEMENTS USDE grant award H324D0003-05 Co-Investigators: Dr. Nancy Brady, University of Kansas Ms. Karen Goehl, Indiana State University Teachers and families who allowed us to complete research in their classrooms and homes Gabe Holcombe, Jami Sweeney, Joan Houghton, Kate Nielsen, Samantha Irick