perspectives in Education and Deafness

Yes, She Can! Language and a Student with Down Syndrome

In the fall of 1995, we began a comprehensive program for a kindergarten student with Down syndrome and a mixed moderate to severe sensorineural hearing loss. The combination of cognitive delay and hearing loss had impaired her acquisition of language so severely that, despite early intervention and intensive previous therapy, an effective communication system was nonexistent.

An educational team, consisting of an early childhood special education teacher and speech language pathologist, had become involved with this child when she was four months old. Assessments were conducted, and home interventions pursued. By 13 months, the child and family received home-based programming. When the child reached the age of three, she entered an early childhood special education program located in her local elementary school. During this time, language development lessons were presented to her and all the children in her group with minimal individual programming. She was the only child with a hearing loss, although the other children had speech and language delays. This approach-which included whole language and incidental exposure to language themes-did not increase her ability to use language. By the time she was four years old, the youngster was neither consistently localizing sound nor responding to her name.

A consistent approach and the addition of signs helped a young student with Down Syndrome and hearing loss to more than triple her vocabulary. Photo courtesy of Dennison and Gorman. Printed with permission.

At this point, the speech language pathologist (SLP) formulated localization of sound as a goal for individual therapy sessions, as a precursor to language development. In order to teach localization, various noisemakers and toys with sounds were used and the child was encouraged to turn to the sound of the source. For example, the SLP would carry a bell in her pocket. When she rang the bell, the child was encouraged to turn to the source of the sound. The SLP moved about the room, ringing the bell and praising the response of the child when she correctly located the sound.

When the child reached five years old, she was included in the mainstream kindergarten. Her expressive vocabulary continued to be limited to less than 20 words, making communication with peers and adults difficult. In order to communicate her needs and desires, she used inappropriate behaviors. She also displayed self-stimulating behaviors, such as using a spoon in repetitive horizontal movements.

Initially we undertook behavioral training using food, especially Jello, her favorite, as a primary reinforcer to enable her to learn to use a spoon in a more socially acceptable way. We incorporated the same stimulus-response-consequence programming with other items, pairing graphics with real items, allowing the child to use the graphic display to indicate her wants and needs. After a few sessions with the Jello and spoon, she was recalling and requesting these items through the use of graphic display only. A picture of the Jello was posted in the therapy room so that, on entering the room, she would have the opportunity to request her preferred item. Our student learned to express her preferences through the socially acceptable method of selection through graphic displays. The displays increased as the child learned the method. At first pictures were color photos of real objects; later they consisted of line drawings from a board builder program.

The child had progressed in language from less than 20 words at the beginning of kindergarten to 228 by the end of first grade.

Other desired items-such as chips and non-edibles-were introduced. These included activities such as playing with a ball and Playdough, and blowing bubbles. Graphics for the display board were accessed through the board builder computer program from Macintosh Mayer-Johnson Communication Board Builder. Signs were introduced for the displays. Before this, signs had been used inconsistently and only for basic needs. Most of her utterances continued to be in the therapy room; outside of the room, the majority of her interactions continued to be imitative and lacked any communicative intent. Still she was imitating vocal sounds, and becoming more interested both in graphic displays and in sign language. A core vocabulary list was developed. Each word was presented to her through graphic display, speech, and sign language. Activities were developed to demonstrate the meaning of words such as on, up, down, and stop, and she began producing these utterances in speech and sign. Rewards were no longer contingent on food and limited to praise, and she responded positively to "high fives!"

Efforts to learn language were not coordinated with the rest of the school. By the end of kindergarten her vocabulary reached 39 words, taken from a vocabulary list developed by the speech language pathologist.

What's in a Word?
Communication!

The child continued to manifest inappropriate behavior in her mainstream setting, and the team initially focused on devising a way for her to be successfully included in her mainstream classes. The team decided that the cause of the inappropriate behavior was poor communication skills. If she could express her needs and desires, perhaps her behavior would improve as well. Increasing her language skills became the team's primary focus. That spring we developed a plan. The following fall, as our student entered first grade, we put the plan in action. It included the following:

1. Pairing spoken words with the appropriate sign to teach vocabulary. Research and clinical experience have demonstrated that sign language can facilitate the acquisition of spoken language for children with Down syndrome (Kouri, 1989). Since our student had a hearing loss, the visual mode enhanced her speech and language development.

2. Developing and administrating surveys of the vocabulary needed by everyone at school and home who had contact with the child. A total of 15 "vocabulary probes" were conducted by the end of the school year. A probe consisted of a piece of paper with the date, person's name or initials, and a return date, on which the individual could write any vocabulary that the child would need to interact in the environment or situation with that person. For example, the first grade teacher may have decided that words like "apple, eat, bus, sit, and line up" were important for the child because some of these words were from the child's thematic unit and others involved the understanding of direction.

3. Selecting appropriate signs. The SLP and teacher of the deaf and hard of hearing agreed on each sign. Signs were selected for ease of formation and internal logic either from the Signed English Dictionary or Signing Exact English,with semantic and syntactic markers omitted. Fingerspelling was avoided because the child's cognitive development was not advanced enough to enable comprehension. Occasionally mime was felt to communicate a word better than a formal sign. For example, when the occupational therapist needed the word "putty," we decided that the action of rolling something in the hand would be more effective than either a formal sign or fingerspelling the English word. Our discussion and agreement assured consistency of presentation.

4. Categorizing vocabulary and developing a database. The vocabulary obtained in the probes was categorized and put onto a database. At first, words were placed in categories, such as: people, places, social, objects, animals, clothes, foods, actions, descriptions, commands, questions, colors, body parts, and school routines. At the end of the school year, the list of words recorded had greatly expanded. As a consequence, the categories were revised for easier access and compilation. This reorganization meant the deletion of some of the categories and the creation of others.

The final spreadsheet contained the following categories: actions, places, social, objects, foods, holidays/seasons, animals/insects, people, weather, clothes, questions, body parts, colors, requests, word combinations, and descriptions. These categories proved more useful in developing sentences than categorization based on parts of speech. The spreadsheet also provided a tool for informal assessment of vocabulary inside and outside of the therapy room. Those people who had initially sent vocabulary were asked periodically to add to it. Additionally, they were asked to note the manner of the child's vocabulary use.

5. Distributing copies of the vocabulary tapes to the team members and individuals involved with the child. This included mainstream teachers, paraprofessionals, a special education teacher, an adaptive physical education teacher, an occupational therapist, and parents. As new information came in from the sign probes, new videotapes were produced-a total of six that year.

6. Issuing periodic reminders of the importance of verbal amplification and the use of signs. Professionals were continually encouraged both to make sure that the child's amplification was working and that they used signs with spoken words with the student so that the ultimate goal of oral communication could occur. The parents were also encouraged to make sure that the child used the amplification at home.

Look Ma!
The Vocabulary Grows!

We collected 350 words and, by the end of the year, 228 of them were used by the child. The child had progressed in language from less than 20 words at the beginning of kindergarten to 228 by the end of first grade. The majority of her utterances were in sign; 37% were signs matched with verbal utterances. Clearly the pairing of signs with verbal expression was encouraging the emergence of verbal attempts to communicate.

The change in format and involvement of people throughout the school and home were key strategies. It was a striking success for coordinated and consistent therapy, and showed what can happen when professionals in mainstream programs work together to assure the progress of individual children.

For many students with disabilities, it takes hundreds of inputs to develop even the smallest skills. When this is accomplished, however, it is no small feat-for those who achieve or for those who help them.

References

Chomsky, N. (1968). Language and the mind. New York: Harcourt, Brace World.

Derr, J. (1983). Signing vs. silence. Exceptional Parent, 13 (6), 49-53.

Birch, M. & J. (1991). The Communication Board Builder 3.0 [Computer software]. Solana Beach, CA: Mayer-Johnson Company.

Boorstein, H., Saulnier, K., & Hamilton, L. (1983). The Comprehensive Signed English Dictionary.

Washington, DC: Gallaudet University Press.

Gustason, G., Pfetzing, D., & Zawoklow, E. (1980). Signing Exact English. Rossmoor, CA: Modern Signs Press.

Kouri, T. (1989). How manual sign acquisition relates to the development of spoken language: A case

study. Language, Speech and Hearing Services in Schools, 20 (1), 50-62.

Kumin, L. (1994). Communication skills in children with Down syndrome. Rockville, MD: Woodbine House.

The Random House College Dictionary, Revised Edition. (1984). New York: Random House.