The Use of Tangible Cues for Children with Multiple Disabilities and Visual Impairment

Many children with severe or multiple disabilities, including those with visual impairment, are limited in their ability to communicate. Communication is defined as how a person exchanges information about his or her desires, needs, knowledge, and perceptions with another person (Beukelman & Mirenda, 2005). Light (1997) defines communication as expressing one's needs and wants, developing social closeness, sharing information, and fulfilling social etiquette responsibilities. Communication can be verbal, written, or nonverbal, such as gestures or symbols. Young children typically communicate through gestures and vocalizations and then learn to speak words within the first year of life (Rowland & Schweigert, 2000). Children who have severe and multiple disabilities have difficulties in all aspects of communication. Augmentative and alternative communication often supplements or replaces verbal speech (Schlosser & Sigafoos, 2006). According to Beukelman and Mirenda (2005), augmentative and alternative communication attempts to compensate for limited verbal communication skills by integrating symbols, devices, techniques, and strategies to enhance or encourage communication. Augmentative and alternative communication includes "unaided modes" of communication, such as gestures, signs, and facial expressions, or "aided modes" ranging from the low tech--such as drawings and tangible symbols--to the high tech--such as speech-synthesized devices and laptop computers (Johnston, McDonnell, Nelson, & Magnavito, 2003). The most critical component for the successful use of an augmentative and alternative communication device is a child's willingness and acceptance to use it (Grassmann, 2002). In addition, a competent communication partner such as a teacher, parent, therapist, or caregiver is essential to provide the child with appropriate opportunities for taking turns, making choices, interacting socially, and expressing wants and needs to facilitate optimal communication (Kaiser, Hester, & McDuffie, 2001). According to Hetzroni (2003), the use of augmentative and alternative communication for students with significant intellectual disabilities helps to reduce problem behaviors such as biting, hitting, and having tantrums while increasing functional communication behaviors. In Hetzroni's study, the use of augmentative and alternative communication became part of the positive behavioral support plan. Rowland and Schweigert (1989) introduced the term tangible symbol, also known as tangible cues, to refer to three-dimensional tactile objects that can be manipulated easily and possess tangible qualities such as shape, texture, and consistency. Tangible symbols are typically used with children who have visual or dual sensory impairments and cognitive delays. They are real objects, miniature objects, and partial objects affixed to cards (see Figure 1). Symbols should be selected for the similarities of their tactile properties in relation to their referents, not for their visual similarities (Goldware & Silver, 1998). The response required when using a tangible symbol is pointing, touching, picking up, or, if possible, gazing in the direction of the symbol (Rowland & Schweigert, 2000). [FIGURE 1 OMITTED] In a study conducted by Rowland and Schweigert (2000) during a three-year period, 41 children with multiple disabilities--including those with significant cognitive delays, sensory impairment, and motor delays--were taught to use tangible symbols. The results indicated that the majority of these children learned to use tangible symbols as a means of communication. Some children went on to use more abstract symbols, such as pictures. Five of these children acquired speech along with the use of the symbols. The purpose of the study presented in this article was to introduce a communication system that uses tangible cues to all 48 of the preschool and lower school children at the Lavelle School for the Blind in the Bronx, New York, who met the criteria for the inter vention; these children had multiple disabilities, including visual impairment, and limited to no verbal skills. …