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Communication Practices with Children Who are Deaf-Blind - Evidence Base Bibliography

Communication Practices with Children Who are Deaf-Blind - Evidence Base Bibliography

by National Consortium on Deaf-Blindness on Aug 31, 2013
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This is a partial list of materials on this topic available from the NCDB Catalog Database.  If you have additional questions, please contact us via email:

Updated 5/2015


ACC Intervention Using a VOCA for Deaf Children With Multiple Disabilities Who Received Cochlear Implantation --Lee, Youngmee; Jeong, Sung-Wook; Kim, Lee Suk. INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY, vol. 77, # 12, December 2013, pp. 2008-2013. (December 2013) OBJECTIVES:

The aim of this study was to examine the efficacy of a new habilitation approach, augmentative and alternative communication (AAC) intervention using a voice output communication aid (VOCA), in improving speech perception, speech production, receptive vocabulary skills, and communicative behaviors in children with cochlear implants (CIs) who had multiple disabilities.


Five children with mental retardation and/or cerebral palsy who had used CIs over two years were included in this study. Five children in the control group were matched to children who had AAC intervention on the basis of the type/severity of their additional disabilities and chronological age. They had limited oral communication skills after cochlear implantation because of their limited cognition and oromotor function. The children attended the AAC intervention with parents once a week for 6 months. We evaluated their performance using formal tests, including the monosyllabic word tests, the articulation test, and the receptive vocabulary test. We also assessed parent-child interactions. We analyzed the data using a one-group pretest and posttest design.


The mean scores of the formal tests performed in these children improved from 26% to 48% in the phoneme scores of the monosyllabic word tests, from 17% to 35% in the articulation test, and from 11 to 18.4 in the receptive vocabulary test after AAC intervention (all p<.05). Some children in the control group showed improvement in the speech perception, speech production, and receptive vocabulary tests for 6 months, but the differences did not achieve statistical significance (all p>.05). The frequency of spontaneous communicative behaviors (i.e., vocalization, gestures, and words) and imitative words significantly increased after AAC intervention (p<.05).


AAC intervention using a VOCA was very useful and effective on improving communicative skills in children with multiple disabilities who had very limited oral communication skills after cochlear implantation.


An Analysis of Communicative Functions of Teachers and Their Students Who Are Congenitally Deafblind --Bruce, Susan; Godbold, Emily; Naponelli-Gold, Sarah. RE:view, vol. 36, #2, Summer 2004, pp. 81-90. (2004) Communicative function is the way a communication partner perceives or interprets the meaning of a sender's message. This is different from "intent," which is the purpose held by the sender. Communicative functions typically acquired by young children include protesting, calling, showing an object, giving an object, answering, labeling, requesting an object, requesting an action, commenting on objects, and commenting on actions. This study analyzes and describes the communicative functions of 3 school-age deaf-blind students and their teachers. A detailed procedure was used to identify communicative functions by videotaping and transcribing interactions between the children and their teachers and communicative functions were coded. Interactions were videotaped both prior to and following a teacher in-service training on the functions of communication.


Analyzing Teacher/Child Interactions : What Makes Communication Successful? --Amaral, Isabel. DBI REVIEW, vol. 32, July-December 2003, pp. 12-18. (2003) The success of interactions between caregivers and learners with multiple disabilities depends largely on the ability of the caregiver to interpret and respond to the learner’s nonsymbolic forms of communication. This article describes a study that analyzed missed opportunities for communication (captured on video) between 2 children with multiple disabilities and their teachers and the results of an intervention process designed to reduce the number of missed opportunities. It found that teachers do leave many children’s behaviors unresponded to and that this number can be decreased through intervention.  The article includes an opinion scale that was used to analyze communicative behavior.


The Application of Werner and Kaplan's Concept of "Distancing" to Children Who Are Deaf-Blind --Bruce, Susan M. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS, vol. 99, #8, August 2005, pp. 464-477. (2005) This article discusses the application of Werner and Kaplan's concept of distancing and how it has shaped research and practice in deaf-blindness, including the theories of Jan van Dijk. Through the process of distancing, children develop an understanding of the differences between themselves and others, themselves and objects, and objects and representations. Adults can support progressive distancing in children who are congenitally deaf-blind by applying strategies such as the hand-under-hand exploration of objects, the selection of communication forms that are based on children's level of representation, the use of cues for recall that are based on children's experiences, and modeling of more complex play schemes. Distancing is essential to the development of communication, including the understanding of symbols.  Available in Spanish.


Applying the Diagnostic Intervention Model for Fostering Harmonious Interactions Between Deaf-Blind Children and Their Educators : A Case Study --Janssen, Marleen J.; Riksen-Walraven, J. Marianne; van Dijk, Jan P. M. American Foundation for the Blind Press. JOURNAL OF VISUAL IMPAIRMENT AND BLINDNESS, vol. 100, #2, February 2006, pp. 91-105. (2006) In an earlier article, the authors presented the Diagnostic Intervention Model for use as a guide in the design and conduct of interventions to foster harmonious interactions between children who are deaf-blind and their educators in various settings.  This current article demonstrates the use of the model in everyday practice and the effects of its application in a case study of one child. Single-subject design study. Available on the web:


Assessment of Prelinguistic Communication of Individuals with CHARGE --Bashinski, Susan M. ED.D. San Diego: Plural Publishing, Inc. CHARGE Syndrome, T.S. Hartshorne, M. A.Hefner, S.L.H.Davenport, J.W..Thelin (Eds.) (2011) Chapter 26 of this book addresses the assessment of prelinguistic communication with an understanding that the vast majority of young children with CHARGE will very likely demonstrate primarily prelinguistic skills at the time of their initial assessment and enrollment in an educational program.  Many of these children over time will become competent language users; a significant proportion of them, however, are likely to never develop symbolic communication abilities.  Therefore, this chapter addresses the identification of critical elements associated with prelinguistic communication, as well as robust strategies for assessing each of these elements.  It is essential knowledge for family members of individuals with CHARGE and the professionals who provide services for them. Publisher's web site:


BETS.  Is it Possible to Evoke Them, in Order to Facilitate the Communication Between the Congenital Deafblind Person and His Communication Partners --Bloeming, Kitty. 14th DbI World Conference on Deafblindness Conference Proceedings, September 25-30, 2007, Perth, Australia. (2007) This is text of a workshop presentation given at the 14th DbI World Conference on Deaf-Blindness.  This presentation discusses a study with the focus at expressions that are based on a Bodily Emotional Trace (BET). The main research question was:  Does knowledge about expressions that are based on a BET improve the communication between persons who are congenital deafblind and their communication partners?


Child-Guided Strategies : The van Dijk Approach to Assessment --Nelson, Catherine; van Dijk, Jan; Oster, Teresa; McDonnell, Andrea. Louisville, KY: American Printing House for the Blind, Inc. (2009) This guidebook describes the assessment of children who are deaf-blind using an approach developed by Dr. Jan van Dijk. Assessment techniques and general intervention strategies are provided for the following eight characteristics: behavioral state (state of arousal or alertness), orienting response (direction of attention to a stimulus), learning channels (sensory avenues children use to take in information), approach-withdrawal (what a child likes and dislikes), memory (processes that involve habituation, anticipation, and routine learning), social interactions, communication, and problem-solving. Videoclips of two children (ages 7 and 25 months) demonstrating the concepts described in the book are provided on a DVD. The book also describes how to write a summary of assessment findings and includes a sample assessment of an 18-year-old with multiple disabilities. Appendices contain parent interview questions, observation worksheets, and an assessment summary form.  The forms are also provided on a CD. Publisher's web site:


Children with Sensory Impairments --Silberman, Rosanne K.; Bruce. Susan M.; Nelson, Catherine. Baltimore: Paul H. Brookes Publishing Co. Educating Children with Multiple Disabilities: A Collaborative Approach, F.P. Orelove,  D. Sobsey and R. K. Silberman. (2004) Chapter 10  provides content on definitions, prevalence, etiologies, and the impact of vision and hearing loss on development and learning. Unique characteristics of students with sensory impairments and multiple disabilities, along with specific adaptations, accommodations, and instructional strategies are provided. This book is a widely used textbook for undergraduate and graduate education in special education and related fields. It is also useful for practicing special and general educators.  It emphasizes research-based guidance. Publisher's web site:


Come Here While I Say That: Can We Teach Deafblind Adults With Additional Disabilities to Attract Attention and Make Requests? --Mackintosh, Lucy. 14th DbI World Conference on Deafblindness Conference Proceedings, September 25-30, 2007, Perth, Australia. (2007) This is text of a workshop presentation given at the 14th DbI World Conference on Deaf-Blindness.  This presentation describes a study carried out into ways to equip people with sensory impairments and intellectual disabilities with the means to attract attention of communication partners before making requests.


Communication --Rodbroe, I; Souriau, J. Toronto: University of Toronto Press. A Guide to Planning and Support for Individuals Who Are Deafblind, McInnes, John M. (Ed.) (1999) This chapter focuses on communication of individuals who were born deaf-blind (congenitally deaf-blind) or who acquired the disability early in life (early adventitiously deaf-blind). It covers core strategies of intervention, frameworks for communicative events as well as cognitive and information processing problems in communicative development.  Available from: University of Toronto Press, Inc., (800) 565-9523, (416) 667-7832 (fax), 5201 Dufferin Street, North York, Ontario.  Email: Publisher's web site:


Communication and Language Development --Raanes, Eli. 14th DbI World Conference on Deafblindness Conference Proceedings, September 25-30, 2007, Perth, Australia. (2007) This is a brief summary of a workshop presentation given at the 14th DbI World Conference on Deaf-Blindness.  This presentation reports on findings in research on Norwegian tactual sign language.


Communication Development in Children who are Deaf-Blind : The Role of Grandparents in Family Centered Intervention --Shaw, Sherry L., Ed.D. Dissertation Presented for the Doctor of Education Degree - The University of Memphis, August 2001. (2001) The purpose of this study was to investigate the role of grandparents in the communication development of their grandchildren who are deaf-blind. The two-tiered study was conducted through the State Projects for children who are deaf-blind in Arkansas, Mississippi, and Tennessee with 143 parents and 80 grandparents.  The grandparents identified as most involved provided information about factors that influence their levels of involvement.  Results suggested that maternal grandmothers are more involved than other grandparents.  Analysis of similarities and differences between dominant cultural groups revealed maternal grandmothers were more involved in African American families than Anglo American families.  A needs analysis in areas of communication, nurturing, and school indicated the need for grandparents to be included in the child's communication plan.


Communication Development in Young Children with Deaf-Blindness: : Literature Review III --Bullis, Michael  (Ed.) Monmouth, Oregon: Oregon State System of Higher Education, Teaching Research Division. (1987) Published as part of the Communication Skills Center for Young Children with Deaf-Blindness (funded from 1983-1988).  Each chapter includes a 15-20 page overview of a certain aspect of communication and then a review of the literature. Available from Teaching Research Publications, 345 N. Monmouth Ave., Monmouth, OR 97361, (503) 838-8800. Chapters: (1) Perspectives on Communication Assessment by Charity Rowland. (2) Tactual/Tactile Assessment by Patty A. Hart & Charles R. Spellman. (3) Visual Assessment by Pamela J. Cress. (4) Auditory Evaluation by Joseph E. Spradlin. (5) Elements of Nonsymbolic Communication and Early Interactional Processes by Ellin Siegel-Causey, Barbara Ernst, & Douglas Guess. (6) Mother-Child Interaction and the Development of Preverbal Communication by Madeline W. Appell. (7) Play, Cognition, and Communication by Joan Rich. (8) Development of Emergent Language by Kathleen Stremel-Campbell & Jimmie Matthews. (9) Contingency Intervention by Philip Schweigert. (10) Augmentative Communication Systems by Pamela Mathy-Laikko, Ann E. Ratcliff, Francisco Villarreul, & David E. Yoder.


Communication Development of Children with Visual Impairment and Deafblindness : A Synthesis of Intervention Research --Parker, Amy T.; Ivy, Sarah E. Elsevier. International Review of Research in Developmental Disabilities: Current Issues in the Education of Students with Visual Impairments. (vol.46) Deborah D. Hatton (Ed.) (2014) This chapter reports the results of a synthesis of research on educational interventions to improve early and emergent communication skills, both expressive and receptive, for children and youth with visual impairment and deafblindness, birth to 22 years of age. A search of electronic databases and recently published systematic reviews returned 34 articles published from January 2000 to August 2013 meeting inclusion criteria. Intervention studies focused primarily on communication partner training (n = 12), microswitch use (n = 10), or object symbol use (n = 7). The majority of researchers used experimental single-subject methods (n = 21, 62%) to examine efficacy of intervention to improve expressive communication skill. Results are discussed in terms of student characteristics, settings for intervention, critical procedural parameters, and targeted communication skills. Key conclusions for practitioners and researchers include individualizing interventions based on student preferences, ensuring the accessibility of materials and communication partners, implementing interventions within meaningful and naturalistic daily routines, training communication partners to be responsive, and designing and implementing high-quality research to identify evidence-based practices for communication interventions.  Contact the author(s) regarding availability of a copy of the chapter for individual research purposes. Publisher's web site:


Communication During Physical Activity for Youth who are Deafblind : Research to practice --Arndt, Katrina; Lieberman, Lauren J.; Pucci, Gina. Teaching Exceptional Children Plus Volume 1 (2004), Issue 2, Feature Article 1. (2004) Communication is a barrier to accessing physical activity and recreation for many people who are deafblind (Lieberman & MacVicar, 2003; Lieberman & Stuart, 2002). The purpose of this study was to observe effective communication strategies used during four physical activities for youth who are deafblind. Communication during physical activity was analyzed over two summers during a one-week sports camp with eight participants with four different modes of communication. Three themes emerged from the data collected: 1) the importance of allowing time for environmental exploration; 2) the individual and familiar people are essential resources; 3) conceptualizing activities as discrete or continuous emerged as a way of thinking about activity.

Available on the web:


Communication in Deafblind Adults with Usher Syndrome : Retrospective Observational Study --Figueiredo, Marilia Zannon de Andrade; Chiari, Brasillia Maria; Goulart, Barbara Niegia Garcia de. CODAS, vol. 25, #4, 2013, pp. 319-324. (February 2013) PURPOSE: To characterize the communication and the main mechanisms that facilitate interpersonal relationships of deafblind, especially in relation to communication and locomotion and the impact of these aspects on deafblindness.

METHODS: Report of a series of cases conducted from semi-structured interviews with questions relating to the functionality of communication, with Usher syndrome patients attended in a specialized clinic in a university service, in the year 2007. The sample consisted of 11 deafblind subjects, with Usher syndrome, aged between 20 and 57 years (mean age 43 years and SD=12.27), of which 7 (63.6%) were female. The responses were analyzed by qualitative-quantitative technique of the Discurso do Sujeito Coletivo (DSC).

RESULTS: All participants reported that visual and auditory symptoms began in childhood. Of the 11 interviewed, 6 reported that the disease has negatively affected their daily activities, 6 experienced difficulty at work, and 2 at leisure. Four reported that there was a change in family relationships, and 5 reported no change in the interaction with family and friends. In discourse analysis, almost 30% of respondents reported to use alternative forms of communication, 40% said move alone if the way is known before. Only 1 of 11 participants said they did not ask for help when needed.

CONCLUSION: Individuals diagnosed with Usher syndrome face challenging situations in daily activities, personal relationships, at work and at play. Alternative forms of communication are often used when verbal communication is not possible. The majority of respondents have independence of locomotion, or seeking ways to achieve it. Available on the web:


Communication in the Classroom for Children with Dual Sensory Impairments : Studies of Teacher and Child Behavior --Rowland, Charity. AAC AUGMENTATIVE AND ALTERNATIVE COMMUNICATION, vol. 6, #4, pp. 262-274. (1990) This paper reports the results of two studies on the communication-related behavior of children who are dual sensory impaired (deaf-blind) and their teachers.  In study #1, observations of an entire school day were made to determine overall rates of cues for communication provided by teachers to individual students and to analyze the activity context in which these cues were most likely to occur.  In study #2, 60-minute observations were conducted three times a month for an entire school year to assess the rates of communication provided by teachers and the rate of communication behavior produced by their students with dual sensory impairment in regular classroom programs.  The study helped to establish baseline rates of communication behavior and allowed an analysis of the relationship between the students' communicative behavior and their teachers' cues for communication.  Results of the two studies showed that the rate of cues for communication provided by teachers is relatively low, as is the rate of communication by their students.  These data reflects some of the difficulties associated with implementing a "milieu" approach to language training for students who have severe sensory impairments.  The need to provide teachers with better preservice and inservice training in the area of communication skills for students with multiple disabilities is discussed.


Communication in the Early Stage of Language Development in Children with CHARGE Syndrome --Peltokorpi, Sini; Huttunen, Kerttu. BRITISH JOURNAL OF VISUAL IMPAIRMENT, vol. 26, #1, 24-49. (2008) In this pilot study from Finland, communication in the early stage of language development in three one- to eight-year-old children with CHARGE syndrome was explored using video recorded free-play interaction sessions and a parental questionnaire. The children had varying degrees of visual impairment as a result of eye colobomas and hearing loss. Video recorded play sessions were the main method of data collection. Methods of analysis were modifications of the Tait Video Analysis and the Communicative Intention Inventory. The study found that the children mainly used gestures, but also vocalization and some signs.  The children used shared attention with their mothers most of the time, with initiations comprising almost half of their communicative expressions. Intentional communication covered 15% to 18% of the communicative acts.


Communication Instruction and Support Strategies for Young Adults Who Are Deaf-Blind --Goodall, deVergne; Everson, Jane M. Baltimore: Paul H. Brookes Publishing Co. Supporting Young Adults Who Are Deaf-Blind in Their Communities. Jane M. Everson (Ed.) (1995) Chapter 10 discusses the four components of communication: receptive skills, expressive skills, symbolic skills, and nonsymbolic skills. Guidelines are offered for communication instruction of young adults who are deaf-blind.


Communication Systems, Devices and Modes --Rowland, Charity; Schweigert, Philip; Prickett, Jeanne Glidden. New York: AFB Press. Hand in Hand, Essentials of Communication and Orientation and Mobility for Your Students Who Are Deaf-Blind, Volume I, K.M.Huebner, J.G. Prickett, T.R. Welch, and E. Joffee (Eds.) (1995) This chapter addresses the overall features of the communication modes, systems and devices that are often used by deaf-blind people along with the considerations involved in their selection  The book is available from: AFB Press, Customer Service, P.O. Box 1020, Sewickley, PA  15143.  Phone: 800-232-3044.  Fax: 412-741-0609.  Cost: $64.95 for the 2 volume set.  The complete series of Hand in Hand books and video are $169.95. Publisher's web site:


Comparing Parent and Teacher Ratings of Communication Among Children with Severe Disabilities and Visual Impairment/Blindness --Cascella, Paul W.; Trief, Ellen; Bruce, Susan M. COMMUNICATION DISORDERS QUARTIERLY, vol. 33, #4, AUGUST 2012, pp.249-251. (2012) Three trends emerged from independent parent and teacher ratings of receptive communication and expressive forms and functions among students with severe disabilities and visual impairment/blindness. Parents had higher ratings than teachers, receptive communication was rated the highest, and no skills occurred often. Implications are discussed for ecologically sensitive communication scales. (Contains 1 table.)


Comparison of Intervention Strategies for Facilitating Nonsymbolic Communication among Young Children with Multiple Disabilities --Siegel-Causey, Ellin. Monmouth, OR: Teaching Research Division, Oregon State System of Higher Education. Research on the Communication Development of Young Children with Deaf- Blindness, Michael Bullis (Ed.) (1989) This study tested propositions derived from Jan van Dijk's movement-based theory.  It was based on two assumptions: (1) communication is facilitated by primary caregivers who are nurturing and (2) there should be direct physical contact between the adult and child during early intervention.  The study examined the effects of movement intervention and passive intervention during social interaction.  The purpose was to ascertain whether there are differences between the effects of movement intervention and passive intervention in promoting nonsymbolic communication behaviors in young children with severe disabilities.  The participants were six children between three and five years of age who were identified as severely multiply handicapped and/or deaf-blind.  The study used a modified, alternating treatments design that was modified to provide intervention blocks (successive sessions of the same stimulation) rather than rapid alternation of intervention.  Overall, the results do not indicate that movement was effective in increasing behaviors among all children in the study. However, three participants showed a difference in their nonsymbolic behaviors during movement interaction.  The author notes that it is important to emphasize that research directed toward individuals with the most severe disabilities is not commonly done, nor are treatment effects easy to demonstrate.


Competencies for Teachers of Learners who are Deafblind --McLetchie, Barbara, A. B.; Riggio, Marianne. --Perkins National Deaf-Blind Training Project. Watertown, MA: Perkins National Deaf-Blind Training Project. (1997) Teachers of deafblind learners, in this case infants, children, and youth, must have specialized competencies in order to meet the complex and unique needs of their students.  Areas of knowledge delineated here are the outcome of a collaborative process involving university faculty and state deaf-blind project directors and are intended as a blueprint for personnel preparation programs in deafblindness.  Areas of competencies discussed: general knowledge about deafblindness; personal identity, relationships and self esteem; concept development; communication; hearing-vision; orientation and mobility; environment and materials; and professional issues. May be purchased for $5 from: Public Relations and Publications Department, Perkins School for the Blind, 175 N. Beacon St., Watertown MA  02472.  Phone: 617-972-7328.  Fax: 617-972-7334. Available in Spanish from DB-LINK. Publisher's web site:


Contact : Effects of an Intervention Program to Foster Harmonious Interactions Between Deaf-Blind Children and Their Educators --Janssen, Marleen J.; Riksen-Walraven, Marianne; Van Dijk, Jan P. M. JOURNAL OF VISUAL IMPAIRMENT AND BLINDNESS, vol. 97, #4, April 2003, pp.215-29. (2003) This study examined the effects of an intervention program to improve the quality of daily interaction between 6 congenitally deaf-blind children and their 14 educators (teachers, caregivers, and mothers).  With video analysis as the most important tool, the interaction coaches trained the educators to recognize their children's signals and attune their behaviors to the children's.  The intervention program tested here was developed based on the findings of two earlier studies.  The overall focus is the effect that harmonious interactions have on the process of communication. For two of the children, outcomes were measured using multiple baseline observations, weekly observations during the intervention, and subsequent follow-up observations. For the remaining 4 children, single prettest and posttest observations were conducted. Pretest-posttest design.


Creating a Communicating Environment --Pease, Laura. London: David Fulton Publishers. Teaching Children Who Are Deafblind: Contact, Communication, and Learning, C Clark, J. T. Eyre, L. Pease, S. Aitken and M.Buultjens (Eds.) (2002) This chapter covers effective teaching strategies for creating environments that promote learning. Staff learned to value and reinforce a whole range of communication strategies that are explored throughout this chapter. The population of children had changed with more children having profound or complex needs. Parents and educators can maek a significant difference by the quality of interventions and commitment to giving the deafblind child a degree of autonomy and control. Approaches to do so are outlined.


Developing Early Communication and Language --Crook, Carol; Miles, Barbara; Riggio, Marianne. Watertown, MA: Perkins School for the Blind. Remarkable Conversations: A Guide to Developing Meaningful Communication With Children and Young Adults Who Are Deafblind. Barbara Miles and Marianne Riggio (Eds.) (1999) This book chapter begins by outlining the major early stages of communication in children who are not disabled. It then provides detailed guidelines for how adults can create positive interactions that promote early communication development for children who are deaf-blind. Specific guidelines include responsiveness to a child's movements, use of touch cues, facilitating the use of hands to explore objects and people, facilitating taking turns, and inviting access to conversation using gestures, words, pictures, or objects used as symbols. Other topics include strategies for developing nonverbal, gestural communication (body movement, play with toys, outdoor play, play with sounds, creative play with "messy" and tactual materials, play with peers, and learning during natural daily activities); increasing a child's exposure to words; and developing oral language.


Developing Evidence-based Methods for Improving High Quality Interpersonal Communication with People who are Congenitally Deafblind --Martens, Marga; Janssen, Marleen. DBI REVIEW, #53, July 2014, pp. 58-61. (July 2014) Over the past six years research has been conducted in the Netherlands on communication and interactions with individuals with congenital deafblindness and early acquired deafblindness. This article focuses on a study building on the previous work by Janssen, Riksen-Walraven & van Dijk on harmonious interactions. It describes the Intervention Model of Affective Involvement (IMAI) and offers guidelines on how to foster affective involvement during interaction and communication between individuals with congenital deafblindness and their hearing/sighted communication partners. The underlying theory is presented.


The Development of a Universal Tangible Symbol System --Trief, Ellen; Bruce, Susan M.; Cascella, Paul W.; Ivy, Sarah. JOURNAL OF VISUAL IMPAIRMENT AND BLINDNESS, Vol. 103, #7, July 2009, pp. 425-430. (2009) The purpose of this study was to identify a set of standardized tangible symbols from which educational teams could select symbols for the children they serve. Tangible symbols are objects or partial objects with characteristics (e.g., shape, texture, and consistency) that can be used to refer to a person, place, object, activity, or concept. They are deemed an important form of communication for children with visual and additional impairments at the presymbolic level. This study surveyed 29 teachers and speech language pathologists about their use of tangible symbols. They were asked to identify the tangible symbols they already use, new activities and concepts they would like to have tangible symbols represent, and their preferences for tangible symbols for 28 referents that were identifed in a previous pilot study. A 14-member advisory board reviewed and discussed the results of the survey and suggested the symbols they thought were appropriate for each referent. The respondents identified 48 referents for which they already used or needed a tangible symbol and the advisory board identified an additional 9 referents.


Early Communication and Microtechnology : Instructional Sequence and Case Studies of Children with Severe Multiple Disabilities --Schweigert, Philip; Rowland, Charity. AAC AUGMENTATIVE AND ALTERNATIVE COMMUNICATION, vol. 8, December 1992, pp.273-286. (1992) Teachers and speech-language pathologists serving children who have dual sensory impairments combined with severe orthopedic impairments are often at a loss as to how to provide effective communication instruction. No systematic approach has been available to guide teachers through the intricacies of what is necessarily a difficult process. This paper describes the results of a 3-year investigation of the use of microtechnology to enable children with dual sensory impairments and severe orthopedic impairments to communicate. It presents an instructional sequence applicable to the wide variety of children who participated in the investigation. Some initially appeared to have no voluntary behavior at all, while others had some intentional motor behaviors that were not under any clear stimulus control or primitive but unreliable means of signaling such as gross vocalizations. By the end of the project, all of the children had shown an ability to learn and had acquired new communication skills. Three case studies are provided to illustrate the use of the instructional process.


Educating Students Who Are Deafblind --Prickett, Jeanne Glidden; Welch, Therese Rafalowski. Baltimore: Paul Brookes Publishing Co. Educating Students Who Have Visual Impairments with Other Disabilities, S. Z. Sacks and R. Silberman (eds.) (1998) The presence of a vision loss in combination with a hearing loss results in the distinct disability of deaflblindness.  Because this disability greatly compromises or eliminates easy access to information from the two distance senses, its impact is greatest on learning, communication, and social interaction. Chapter five examines the various forms of deafblindness.  Understanding these forms aids instructors in supporting the most appropriate communication options and instructional strategies for the unique needs and skills of individual students. Learning about deafblindness, especially through teaching or other involvement with students who are deafblind, brings about tremendous respect for the efforts required of and expended by these individuals daily in order to establish and maintain relationships with others in a complex world.


Effective Teaching and Learning --Hodges, Liz. London: David Fulton Publishers. Teaching Children Who Are Deafblind: Contact, Communication, and Learning, C Clark, J. T. Eyre, L. Pease, S. Aitken and M.Buultjens (Eds.) (2002) This chapter covers effective teaching and learning.  Children who cannot depend on their distance senses to provide reliable, undistorted and adequate information about their world learn less effectively. They do not easily learn incidentally from events around them. Their learning must be effectively arrangeed. Appropriate methods and techniques are offered within this chapter.


Effects of Motionese on Infant and Toddlers Visual Attention and Behavioral Responsiveness --Dunst, Carl J.; Gorman, Ellen; Hamby, Deborah W. CELL REVIEWS, vol. 5, #9, 2012. (2012) Findings from eight studies (12 samples) of infants and toddlers (N = 261) investigating the effects of adults use of motionese (modifying and simplifying gestures, actions, or signs when interacting with infants and toddlers) on child outcomes are reported. Results showed that child positive affect, visual attention, and behavior engagement were enhanced when the children experienced gestures and signing that included simplifications, exaggerations, repetitions, and was slower paced. Implications for practice are described. Available on the web: Publisher's web site:


Emergent Literacy Supports for Students Who Are Deaf-Blind or Have Visual and Multiple Impairments : A Multiple-case Study --McKenzie, Amy R. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS,  vol.103, #5, May 2009, pp.291-302. (2009) In this study, seven classrooms of students with deaf-blindness or visual and multiple impairments were observed to document the emergent literacy supports that were present including environmental characteristics, strategies, or activities. The findings revealed that the majority of classrooms used emergent literacy supports that were previously documented for students without disabilities. Implications for practice and suggestions for future research are discussed.


Emerging Evidence from Single-Subject Research in the Field of Deaf-Blindness --Parker, Amy T.; Davidson, Roseanna; Banda, Devender R. JVIB, November 2007, Volume 101, Number 11, pp. 690-700. (2007) Professionals in the field of deaf-blindness are challenged to use instructional practices that have been tested using experimental methodology. Single-subject design has been examined as a form of research that assists in substantiating practice. In a review of the literature, the authors identified 54 single-subject studies from 1969 to 2006 that provided emerging evidence for practitioners. Publisher's web site:


Enhancing Activity by Means of Tactile Symbols : A Study of a Heterogeneous Group of Pupils with Congenital Blindness, Intellectual Disability, and Autism Spectrum Disorder --Aasen, Gro; Naerland, Terje. JOURNAL FO INTELLECTUAL DISABILITIES, vol. 18, #1, January 2014, pp. 61-75. (2014) This study investigates responses to verbal versus tactile requests in children with congenital blindness, intellectual disability and autism spectrum disorder (ASD). Observation was conducted on two occasions. At T1, requests were given verbally, and at T2, tactile requests were given. All pupils perceived tactile symbols to be explicit requests to perform the act referred to by the symbols. The children seldom or never followed verbal requests. All children followed more tactile than verbal requests. Individual differences in verbal skills, motivations and the complexity of the activity are discussed. The availability of tactile symbols for individuals with congenital blindness, intellectual disability and ASD seems to increase their level of activity and their participation in school.


Enhancing Sustained Interaction Between Children with Congenital Deaf-Blindness and Their Educators --Janssen, Marleen J.; Riksen-Walraven, J. Marianne; Van Dijk, Jan P.M.; Huisman, Mark; Ruijssenaars, Wied A.J.J.M. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS, vol. 106, #3, March 2012, pp. 177-183. (2012) The study presented within this article demonstrated the effects of the Diagnostic Intervention Model (DIM) on sustained interaction within a reciprocal three-turn structure (such as the educator-child-educator or the child-educator-child).  The authors reanalyzed observational data from the Contact effect study (Janssen et al) and looked at the duration of sustained interaction, the duration of the longest interaction sequence, and the mean number of turns in a sequence.  The results are evaluated and discussed.


Enhancing the Interactive Competence of Deafblind Children : Do Intervention Effects Endure? --Janssen, Marleen J.; Riksen-Walraven, J. Marianne; van Dijk, Jan P.M. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES, vol. 16, #1, March 2004, pp. 73-94. (2004) This single-subject design study replicated the results of a previous intervention study [Janssen et al, Journal of Developmental and Physical Disabilities, 14(1):87-108, 2002] that examined the effects of a training program designed to improve the quality of interactions between deaf-blind children and their educators. This present study was expanded to train educators to improve their responses to deaf-blind children's independent behaviors as well as interactive behaviors, and it included a follow-up phase. The study involved 16 professional educators working with four 7- to 11-year old children. The mean percentage of adequate educator responses was found to increase by 20.2% and remain above baseline during follow-up. Comparable effects were observed for the children. The percentage of appropriate interactive behaviors increased by 29.3% and the percentage of independent behaviors increased by 38.1% and remained well above the baseline level during follow-up.


Enhancing the Quality of Interaction Between Deafblind Children and Their Educators --Janssen, Marleen J.; Riksen-Walraven, J. Marianne; van Dijk, Jan P.M. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES, vol. 14, #1, March 2002, pp. 87-109. (2002) This single-subject design study examined the effects of an educator-oriented intervention program to improve the quality of the interactions between children who are deaf-blind and their teachers.  The study included four children, aged 6 through 9, and their 14 teachers.  The educators were trained to respond more adequately to a selected set of appropriate and inappropriate interactive child behaviors. In three of the four children, the mean percentage of appropriate interactive behaviors increased. The number of inappropriate child behaviors also decreased.


Environments That Encourage Communication --Crook, Carol; Miles, Barbara. Watertown, MA: Perkins School for the Blind. Remarkable Conversations: A Guide to Developing Meaningful Communication with Children and Young Adults Who Are Deafblind. Barbara Miles & Marianne Riggio (Eds.), pp. 76-93. (1999) This chapter includes information about the following characteristics of environments that encourage communication: respectful, responsive, mutually interactive, provide opportunities for choice-making, compensate for sensory losses by adapting physical and social circumstances (includes specifics about visual, auditory, and tactual modifications), provide opportunities for generalizing communication across settings, encourage a variety of communicative functions, provide a balance of structure and spontaneity, recognize the importance of mutual enjoyment.


Evidence-Based Communication Practices for Children with Visual Impairments and Additional Disabilities : An Examination of Single-Subject Design Studies --Parker, Amy T.; Grimmett, Eric S.; Summers, Sharon. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS, vol. 102, #9, September 2008, pp. 540-552. (2008) This review examines practices for building effective communication strategies for children with visual impairments, including those with additional disabilities, that have been tested by single-subject design methodology. It includes 30 studies, a number of which included children who are deaf-blind. The interventions tested in these studies were grouped into the following five categories: microswitch interventions (17 studies); multi-component partner training (6 studies); dual communication boards (4 studies); object symbols (2 studies); and adult-directed prompting (1 study).


Field Study of a Standardized Tangible Symbols System for Learners Who Are Visually Impaired and have Multiple Disabilities --Trief, Ellen; Cascella, Paul; Bruce,S. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS, VOL. 107, #3, May-June 2013, pp. 180-191. (2013) The study reported in this article tracked the learning rate of 43 children with mulitiple disabilities and visual impairments who had limited to no verbal language across seven months of classroom-based intervention using a standardized set of tangible symbols.


First steps of the deaf-blind child towards language --Dijk, Jan van. INTERNATIONAL JOURNAL FOR THE EDUCATION OF THE BLIND, v.15, no.3, May 1966, pp.112-114. (1966)


Forms and Functions in Communication --Miller, Emily King, M.A.; Swanson, Lori A., Ph.D.; Steele, Nancy M.Ed.; Thelin, Sara J., M.A.; Thelin, James, Ph.D. San Diego: Plural Publishing, Inc. CHARGE Syndrome, T.S. Hartshorne, M. A.Hefner, S.L.H.Davenport, J.W..Thelin (Eds.) (2011) Chapter 27 of this book addresses the communication skills in individuals with CHARGE syndrome.  Communication abilities in children with CHARGE syndrome greatly vary, but expressive communication skills in all of these children are delayed..  This chapter looks at the challenges in assessing communication skills, the communicative forms, functions and rate and a communicative analysis of individuals with CHARGE based on a series of studies at the University of Tennessee. Publisher's web site:


Fostering Harmonious Interactions in a Boy with Congenital Deaf-Blindness : A Single-Case Study --Janssen, Marleen J.; Riksen-Walraven, J. Marianne; van Dijk, Jan P.M.; Huisman, Mark; Ruijssenaars, A.J.J.M. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS, vol. 105, #8, August 2011, pp. 560-572. (2011) This article demonstrates the effectiveness of applying the Disagnostic Intervention Model for fostering harmonious interactions by describing a single-case study. Changes in the caregiver's turn-giving had substantial effects on the child's turn-taking, regulation of intensity, and approving and disapproving answers.The interaction effects were less clear for the child's initiatives


Functional Communication in Inclusive Settings for Students Who Are Deaf-Blind --Stremel, Kathleen; Schutz, Richard. Baltimore: Paul H. Brookes Publishing Co. Welcoming Students Who Are Deaf-Blind into Typical Classrooms - Facilitating School Participation, Learning, and Friendships. Norris G. Haring and Lyle T. Romer (Eds.). (1995) Chapter 10 provides some perspectives on and strategies for considering factors of an individual's social and physical environments to achieve a shared communication system.  This chapter also emphasizes a person-centered approach to the development and implementation of a functional communication system for students who are deaf-blind.


Functions of Unique and Conventional Gestures in Children who are Congenitally Deafblind --Bruce, Susan, Ph.D. 14th DbI World Conference on Deafblindness Conference Proceedings, September 25-30, 2007, Perth, Australia. (2007) This is text of a workshop presentation given at the 14th DbI World Conference on Deaf-Blindness.  This presentation describes the results of a research study on the functions of gestures expressed by seven children who are congenitally deafblind.


Gestures Expressed by Children Who Are Congenitally Deaf-Blind : Topography, Rate, and Function --Bruce, Susan M.; Mann, Allison; Jones, Chelsea; Gavin, Mary. JVIB, October 2007, Volume 101, Number 10, pp. 637-652. (2007) This descriptive study examined the topography, rate, and function of gestures expressed by seven children who are congenitally deaf-blind. Participants expressed a total of 44 conventional and idiosyncratic gestures. They expressed 6–13 communicative functions through gestures and 7 functions through a single type of gesture. They also expressed idiosyncratic gestures and used specific gestures for functions other than those that are typically associated with those gestures.


Impact of a Communication Intervention Model on Teachers' Practice with Children Who Are Congenitally Deaf-Blind --Bruce, Susan M. JOURNAL OF VISUAL IMPAIRMENT AND BLINDNESS, vol. 96, #3, March 2002, pp. 154-168. (2002) This article presents findings from a larger study on the thinking and practices of two teachers regarding communication intervention for students who are congenitally deaf-blind, prior to and following an in-service program with follow-up coaching. After they were instructed on the communication intervention model, teachers were able to plan and implement communication interventions that addressed the students' needs across all aspects of communication.  Includes complete descriptions of theory, methods, and examples of teacher statements about communication skills before and after the training.


The Impact of Congenital Deafblindness on the Struggle to Symbolism --Bruce, Susan M. INTERNATIONAL JOURNAL OF DISABILITY, DEVELOPMENT AND EDUCATION, vol. 52, #3, September 2005, pp. 233-251. (2005) Most children who are congenitally deafblind are severely delayed in their communication development and many will not achieve symbolic understanding and expression. This article discusses developmental markers cited in the research literature as predictive of or facilitative of the development of symbolism. These markers include the growth toward more abstract representations, the rate of intentional communication, joint attention to objects and others, achievement of abstract play, consonantal and interactive vocalizations, distal gesture, varied early vocabulary and categories, use of varied cues for recall, object permanence, 1:1 correspondence, cause-effect, discrimination skills, and imitation. The impact of congenital deafblindness on the achievement of these milestones, is presented, along with compensatory strategies to support the child's development.


Importance of Shared Communication Forms --Bruce, Susan M. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS, vol. 97, #2, February 2003, pp. 106-109. (2003) This study addresses the importance of shared communication forms among teachers and children who express themselves at presymbolic to early symbolic levels of communication.  It looks at two different classrooms with students who are deaf-blind and the forms of communication used between student and teachers.  Looks at how accessible communication was to the students.


Inclusion of Students Who Are Deaf-Blind : What Does the Future Hold? --Goetz, Lori. Baltimore: Paul H. Brookes Publishing Co. Welcoming Students Who Are Deaf-Blind into Typical Classrooms - Facilitating School Participation, Learning, and Friendships.  Norris G. Haring and Lyle T. Romer (Eds.). (1995) In Chapter 1 Goetz defines inclusion and then goes on to discuss the development of appropriate curriculum, utilization of special services, making the most of collaborative teaming and student social interaction.


Increasing Communication in Children with Concurrent Vision and Hearing Loss --Brady, Nancy C.; Bashinski, Susan M. RESEARCH AND PRACTICE FOR PERSONS WITH SEVERE DISABILITIES, vol. 33, #1-2, pp. 59-70. (2008) Nine children with complex communication needs and concurrent vision and hearing losses participated in an intervention program aimed at increasing intentional pre-linguistic communication. The intervention constituted a pilot, descriptive study of an adapted version of prelinguistic milieu teaching (A-PMT). In A-PMT, natural gestures and vocalizations were targeted in child-focused, one-on-one activities conducted by a member of the project staff. Adaptations included using more physical prompts than in other forms of PMT and using means other than directed eye gaze to determine directionality of gestures. All nine participants increased their rates of initiated, intentional communication substantially during the course of intervention; in addition, each participant acquired new forms of natural gestures. Results were limited primarily to requests (as opposed to other communication functions). Discussion centers on how to promote more generalized communication developments in future implementations of the program.


Initiating Requests During Community-Based Vocational Training by Students With Mental Retardation and Sensory Impairments --Heller, Kathryn Wolff; Allgood, Margaret H.; Ware, Steven; Arnold, Susan E.; Castelle, Melanie D. RESEARCH IN DEVELOPMENT DISABILITIES, vol.17, #3, pp.173-184, 1996. (1996) Reports on a single-subject design study examining the effectiveness of teaching students with disabilities to request assistance during vocational training with the use of dual communication boards and gestures. Data was collected during baseline, intervention, and generalization phases. Students were able to initiate requests with 80% to 100% accuracy with the communication system at vocational sites.


Instruction and Assessment : How Students With Deaf-Blindness Fare in Large-Scale Alternate Assessments --White, Maria Thomas; Garrett, Brent; Kearns, Jacqueline Farmer; Grisham-Brown, Jennifer. RESEARCH AND PRACTICE FOR PERSONS WITH SEVERE DISABILITIES, vol. 28, #4, pp.205-213. (2003) The purpose of this article is to report the results from a study examining the relationship between educational experiences for students with deaf-blindness and large-scale alternate assessment outcomes. Individualized education plans (IEPs) and instructional practices for 24 students were observed for indicators of best practices for students with deaf-blindness and severe cognitive disabilities. Results indicate that students who had greater opportunities for developing communication and social skills also had better outcomes on a statewide large-scale assessment, yet there was no relationship between assessment outcomes and the quality of a student's IEP or overall instructional programming.


Interaction Between the Teacher and the Congenitally Deafblind Child --Vervloed, Mathijs P. J.; van Dijk, Rick J. M.; Knoors, Harry; van Dijk, Jan P. M. AMERICAN ANNALS OF THE DEAF, vol. 151, #3, pp. 336-344. (2006) This article describes a detailed case study that analyzed videotaped interactions between a teacher and a deafblind boy aged three years and four months.  The types and quality of  interactions that occurred during videotaped sessions of daily activities (bathing, dressing, and playing with favorite objects) are described.  The authors note that "empirical data on development, interaction, communication, and language in deafblind children is very rare," and propose that the method of analyzing interactions used for this study could be replicated and used in future research.


Interaction Coaching with Mothers of Children with Congenital Deaf-Blindness at Home : Applying the Diagnostic Intervention Model --Janssen, Marleen J.; Riksen-Walraven, J.; van Dijk, Jan P. M.; Ruijssenaars, Wied A. J. J. M. JOURNAL OF VISUAL IMPAIRMENT AND BLINDNESS, vol. 104, #1, January 2010, pp. 15-29. (2010) This article describes the application of the Diagnostic Intervention Model and its effects in two case studies of 3-year-old boys, Rolf and Ruud, using individual interaction coaching with their mothers. The purpose of the Diagnostic Intervention Model is to teach educators and caregivers to establish high quality ("harmonious") interactions with children who are deaf-blind. Positive effects were found for all the target categories in both cases, although an interaction that used materials appeared to be more complex.


The Intersection of the Development of Gestures and Intentionality --Crais, Elizabeth; Douglas, Diane Day; Campbell, Cheryl Cox. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH, vol. 47, #3, June 2004, pp. 678-694. (2004) This study examined the development of deictic and representational gestures in 12 typically developing children from 6 to 24 months of age. Gestures were categorized into J. Bruner's (1981) 3 broad (and 8 specific) communicative functions: behavior regulation (i.e., requesting objects, requesting actions, protesting), joint attention (i.e., commenting, requesting information), and social interaction (i.e., representational gestures, attention seeking, social games). Ongoing parental completion of researcher-created gesture recording forms and monthly researcher observational confirmation were used to capture the emergence and consistent use of targeted gestures. Within each specific functional category, a hierarchy of development was documented for the gestures and behaviors used to signal that intent. This study provides rich detail as to the order of emergence of common deictic and representational gestures and their relationship to other preceding and concomitant behaviors that children use to signal their intentions. Furthermore, the results document younger ages of emergence, in comparison with previous studies, for most of the targeted gestures and provide insight into the controversy in the literature regarding the relative emergence of declarative and imperative gestures.


Intervening on Affective Involvement and Expression of Emotions in an Adult with Congenital Deafblindness --Martens, Marga A.; Janssen, Marleen J.; Ruijssenaars, Wied A.J.J.M.; Huisman, Mark; Riksen-Walraven, J. Marianne. COMMUNICATION DISORDERS QUARTERLY, March 2014, pp. 1-10. (2014) This study examined the effects of a 20-week intervention to foster affective involvement during interaction and communication between an adult with congenital deafblindness (CDB) and his caregivers in a group home and a daytime activities center. Using a single-subject design, we examined whether the intervention increased affective involvement between the participant and his caregivers, and whether the participant’s positive emotions increased and his negative emotions decreased. In both settings, an increase in affective involvement and very positive emotions coincided with the onset of the intervention, with the clearest effects in the daytime activities center. Negative emotions decreased in the daytime activities center. During follow-up, affective involvement decreased in both settings but remained above baseline. The caregivers indicated that it was easier to share positive emotions than negative emotions. This study demonstrates that it is possible to foster affective involvement with an adult with CDB, both during interaction and communication.


Mother-Child Interactions: : A Foundation for Language Development --Seitz, Sue; Marcus, Sally. EXCEPTIONAL CHILDREN, vol. 42, #8, May 1976, pp.445-449. (1975) Interactions between the normally developing child and his parents are categorized by mutual responsiveness: each initiates and reciprocates communications.  When children's language development is delayed or impaired, this communication process may also become impaired, with parents unable to respond appropriately to confusing or reduced messages from the child. A methodology is presented for developing effective communications between such children and parents.  The approach is illustrated by the case history of a multiply handicapped, hearing impaired toddler and her parents.


A Movement-Based Approach to Language Development in Children Who are Deaf-Blind --Wheeler, Linda; Griffin, Harold C. AMERICAN ANNALS OF THE DEAF, Vol.142, #5, 1997, pp.387-390. (1997) Overview of the movement-based approach to language development in children who are deaf-blind. Describes utilizing the four coactive movement phases: resonance, coactive movement, nonrepresentation reference, and deferred imitation. Emphasizes the use of structure in the environment and the use of a hierarchy of media cues ranging from concrete to symbolic. Includes teaching strategies to use while implementing this approach.


Non-Verbal Deaf-Blind Child and His World : His Growth toward the World of Symbols --Dijk, Jan van. Watertown: Perkins School for the Blind. Developing Individually Appropriate Communication and Language Environments: Book A.  Nan Robbins (Ed.) (1983) This clipping is actually a short introductory piece titled "Deaf-Blindness Is Characterized by a Unique Way of Being" which is followed by the more complete explanation of the way motor skills are important to the development of communication skills in children who are deaf-blind.


Observing the Use of Tactile Schedules --Aasen, Gro; Naerland, Terje. JOURNAL OF INTELLECTUAL DISABILITIES, June 2014, pp. 1-22. (June 20, 2014) Children with congenital blindness and additional disabilities have increased difficulties in the educational setting. The authors explore the use of tactile schedules with seven children and study what are some basic conditions to ensure the schedules can be used independently. The role of the teacher is of utmost importance and discussed. Behaviors observed of the children being studied include communication gains and increased predictability.


Participating Children and Their Teams --Chen, Deborah; Downing, June; Minor, Lavada; Rodriguez-Gil, Gloria. Northridge: Department of Special Education, California State University, Northridge. Successful Adaptations for Learning to Use Touch Effectively: Interacting with Children who are Deaf-Blind or Visually Impaired and Have Additional Disabilities, pp. 7-11. (2005) This is a description of the research findings of Project SALUTE, which conducted a number of activities related to tactile learning in children who are deaf-blind.  One component of Project SALUTE involved research with four children in whom tactile strategies were identified, implemented, and evaluated.  Data analysis was based on videotaped observations over the course of the two years that the children were followed.  Findings included an increase in the use of appropriate tactile strategies by family members and service providers; a decrease in the use of hand-over-hand guidance by family members and service providers; an increase in positive and more active responses from children during interactions, including increased attention to the partner, increased frequency of responses to object queues and signs, and increased frequency of expressive communication; an increase in adults' expectation of a child's response as measured by an increase in "wait time" and using less support to prompt a response; and an increase in readability and elaboration of adults' interactions with children. Available on the web:


Preverbal Communication of the Blind Infants and Their Mothers --Rowland, Charity. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS, vol 78, #7 September 1984, pp 297-302. (1984) Analysis of filmed interactions between five mothers and their blind infants made at regular intervals over six months revealed that, although the frequency of the infants' vocalizations was within normal limits, the vocalizations did not follow normal patterns of responsiveness, and the mothers' responses were weak and inconsistent.


Professional Judgments of the Intentionality of  Communicative Acts --Carter, Mark; Iacono, Teresa. AUGMENTATIVE AND ALTERNATIVE COMMUNICATION, vol. 18, #3, September 2002, pp.177-191. (2002) The accuracy and reliability of professional's judgments of the communicative intentionality of acts and behavioral indicators associated with those acts were examined in this study.  Twenty special education teachers and 19 speech pathologists were asked to make judgments regarding the intentionality and the presence of behavioral indicators for videotaped segments of sequences of behavior for one normally developing child, two Down syndrome children, and three children with high support needs.  The clinical implications of the findings and directions for future research are suggested.


Promoting Interactions With Infants Who Have Complex Multiple Disabilities : Development and Field-Testing of the PLAI Curriculum --Chen, Deborah, PhD; Klein, Diane M., CCC-SLP, PhD; Haney, Michele, PhD. INFANTS AND YOUNG CHILDREN, vol. 20, #2, April-June 2007, pp149-162. (2007) This article describes primary outcomes of the development and field-testing of the curriculum "Promoting Learning Through Active Interaction" with 27 infants and their caregivers and early interventionists in 2 different states. The curriculum was designed to provide a systematic approach to supporting interactions with infants who have sensory impairments and complex multiple disabilities and who are at the preintentional level of communication. Participating infants had both a visual impairment and hearing loss and additional disabilities. Their families represented diverse socioeconomic, educational, and cultural backgrounds, and participating early interventionists varied widely in their qualifications. Results indicate that a diverse group of families used the strategies successfully and found them to be helpful in supporting their children's interactions and communication development. The article outlines key components of the curriculum and discusses evaluation data on the basis of caregiver feedback on use of strategies and analysis of videotaped observations on the caregivers' use of sensory cues with their infants.


Promoting Learning Through Active Interaction : A Guide to Early Communication with Young Children Who Have Multiple Disabilities --Klein, M. Diane, Ph.D.; Chen, Deborah, Ph.D.; Haney, Michele, Ph.D. Baltimore: Paul H. Brookes Publishing Co. (2000) The Promoting Learning Through Active Interaction (PLAI) curriculum is designed primarily for infants, preschoolers, and young children with severe or multiple disabilities (including deaf-blindness) who are not yet initiating symbolic communication and who have a limited repertoire of communicative behavior.  It can also be used with older children who have not yet developed intentional communication.  The curriculum consists of a Caregiver Interview to identify a child's current communication abilities and 5 modules: 1) Understanding Your Child's Cues; 2) Identifying Your Child's Preferences; 3) Establishing Predictable Routines; 4) Establishing Turn Taking; and 5) Encouraging Communicative Initiations.  The curriculum also contains handouts and recording sheets in both English and Spanish.  A video (Promoting Learning Through Active Interaction: An Instructional Video) is also available in English and Spanish.


Promoting Nontask-Related Communication at Vocational Sites --Heller, Kathryn Wolff; Allgood, Margaret H.; Davis, Bobby; Arnold, Susan E.; Castelle, Melanie D.; Taber, Teresa A. AUGMENTATIVE AND ALTERNATIVE COMMUNICATION, vol. 12, #3, September 1996, pp.169-178. (1996) This single-subject design study examined the effectiveness of using dual communication boards (one for the student and one for the communication partner) on increasing nontask-related communication between three students with mental retardation and deaf-blindness or deafness and coworkers at community-based vocational training sites. Issues for achieving a natural conversation, symbol selection, and vocabulary selection are discussed.  Reaction of communication partners was favorable.


Remarkable Conversations : Guide to developing meaningful communication with children and young adults who are deafblind --Miles, Barbara (Ed.); Riggio, Marianne (Ed.) Watertown, MA: Perkins School for the Blind. (1999) This book is a practical guide for teachers, family members and others who play a critical, direct role in the lives of children who are deafblind. Good communication is emphasized and illustrated with stories that are based on positive, real experiences. The beginning chapters lay the foundation for the development of instructional programs for children who are congenitally deafblind or who have become deafblind early in life. Later chapters look more specifically and sequentially at the nuts and bolts of providing meaningful experiences for these learners. The final chapters address some of the underlying issues that are fundamental to providing personalized educational services for infants, children, and young adults who are deafblind. The book is available from Perkins School for the Blind , 175 North Beacon Street, Watertown, MA 02472, Attn: Public Relations & Publications. Telephone: (617)972-7328; fax: (617)972-7334. The cost is $40.00.


Research Report : The Use of Tangible Cues for Children with Multiple Disabilities and Visual Impairment --Trief, Ellen. JVIB, October 2007, Volume 101, Number 10, pp.613-619. (2007) The purpose of the study presented in this article was to introduce a communication system that uses tangible cues to the preschool and lower school children at the Lavelle School for the Blind in the Bronx, New York, who met the criteria for the intervention. The 25 students selected as participants in this study ranged in age from 4 to 16 years and had multiple disabilities, including either total blindness or low vision, moderate to severe cognitive delays, motor impairments ranging from mild to severe, and significant language delays or no expressive language. Tangible cues were learned by 15 of the 25 students who participated in this study. The 10 children who were unable to learn this skill were the most severely delayed in cognitive, motor, and visual skills as measured by their psychological and educational evaluations. The use of tangible cues with a student with multiple disabilities and visual impairment can provide the student with a communication system to express his or her wants and needs, make choices, and understand simple tasks and routines. The selection for actually designing and making the tangible cues must be carefully considered, and the highest level of iconicity should be used to represent the object or activity for the student to make the connection.


Research to Practice: Steps for Supporting Communication During Physical Activity for People who are Deafblind --Arndt, Katrina; Lieberman, Lauren. 14th DbI World Conference on Deafblindness Conference Proceedings, September 25-30, 2007, Perth, Australia. (2007) This is a brief summary of a workshop presentation given at the 14th DbI World Conference on Deaf-Blindness.  This presentation describes a research to practice presentation reviewing ways to support communication during physical activity.


A Review of Intervention Studies Conducted with Individuals with Autism and Sensory Impairments --Banda, Devender R.; Griffin-Shirley, Nora; Okungu, Phoebe A.; Ogot, Orpa P.; Meeks, Melanie K. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS, vol. 108, #4, July-August 2014, pp. 299-309. (2014) Introduction: Recently, there has been heightened interest in individuals with autism and sensory impairments, and interventions that affect this population. To date, no reviews have analyzed intervention studies, and the present study adds to intervention research literature. Methods: Based on an electronic search, eight studies were included in the review. Results: The results indicated that four of the studies focused on communication skills, while the other four targeted problem behaviors. All participants made progress in communication and showed improvements in their behaviors. Discussion: Although positive results were seen in all participants, the studies suffer from methodological limitations. Thus, future research is needed to replicate studies as well as provide maintenance and generalization data. Implications for practitioners: Some suggestions are to include preference assessments prior to the development of intervention studies to create a modified picture exchange communication system with tangible objects or symbols.


A Review of Intervention Studies on Teaching AAC to Individuals who are Deaf and Blind --Sigafoos, Jeff; Didden, Robert; Schlosser, Ralf; Green, Vanessa; O’Reilly, Mark; Lancioni, Giulio. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES, February 2008, vol. 20, #1, pp71-99. (2008) We reviewed intervention studies on teaching augmentative and alternative communication (AAC) to deaf–blind individuals. Studies meeting pre-determined inclusion-exclusion criteria were identified through electronic databases and hand searching and were summarized in terms of: (a) participants, (b) AAC mode, (c) target skills, (d) intervention procedures, and (e) main findings. Certainty of evidence was assessed through critical appraisal of each study’s design and methodological rigor. Seventeen studies, comprising 103 participants, were identified. Most participants had combinations of developmental, physical, and sensory impairments. A range of AAC modes were taught, including textures, tangible objects, and line-drawn symbols. Basic requesting skills were the most common intervention targets and these were most often taught using well-established behavioral procedures (e.g., prompting, differential reinforcement). Positive outcomes were reported for 90% of participants, but the evidence for 11 of the 17 studies was inconclusive because of methodological weaknesses. Implications for clinical practice and future research are discussed.


The Role and Process of Literature Searching in the Preperation of a Research Synthesis --Lucas, Shannon M.; Cutspec, Patricia A. CENTERSCOPE, vol. 4, #3, August 2005, pp.1-26. (2005) The purpose of this article is to describe the role of the literature search in conducting practice-based research syntheses and to provide the reader with practical guidance on how to conduct a comprehensive literature search  A literature search is a systematic, in-depth investigation designed to identify that portion of the vast quantity of available research literature relevant to a specific endeavor.


Seeing the Possibilities with Video Phone Technology --Emerson, Judi, ABD; McDowell, Linda, Ph.D.; Bishop, John, Ph.D.; Hollingsworth, Toni, MS; Kershisnik, Paul. National Center for Technology Innovation. (April 2011) The University of Southern Mississippi, the Mississippi Deaf-Blind Project, and Sorenson Communications, Inc. teamed up to explore video phone communication potential for youth with deaf-blindess. A National Center for Technology Innovation 2010 Tech in the Works Competition award afforded the opportunity for the collaborative team to provide social interaction opportunities for students with deaf-blindness. This paper describes the study.


Selection of Communication Modes --Crook, Carol; Miles, Barbara; Riggio, Marianne. Watertown, MA: Perkins School for the Blind. Remarkable Conversations: A guide to Developing Meaningful Communication With Children and Young Adults Who Are Deafblind. Barbara Miles and Marianne Riggio (Eds.) (1999) This book chapter includes information about decisions on the most effective modes of communication to use with each student. Students who are deafblind will use multiple modes of communication.  Body language, movement, gestures, facial expressions, and sounds are usually part of the natural communication repertoire of all children who are deafblind. Speech, sign, fingerspelling, pictures, object symbols, print and/or braille for reading and writing--all of these conventional modes are additional choices for use with and individual who has both vision and hearing loss.


A Socio-Cognitive Approach to How Children with Deafblindness Understand Symbols --Hartmann, Elizabeth. INTERNATIONAL JOURNAL OF DIABILITY, DEVELOPMENT, AND EDUCATION, vol. 59, #2, June 2012, pp. 131-144. (June 2012) Children with congenital deafblindness are a population of learners who may need intervention in order to develop symbolic understanding. They experience a combination of vision and hearing impairments that can affect how they make sense of the world, develop relationships, and understand symbols. In this article, the author reviewed a socio-cognitive framework of symbolic understanding and suggested it as one way to organise the extant research on symbolic development of children with deafblindness. A socio-cognitive framework describes the development of children’s individual skills and how their abilities are supported by active participation in social and cultural experiences. Symbolic understanding is not an isolated cognitive skill, but rather a complex socio-cognitive developmental process that is intimately supported by meaningful interactions. A socio-cognitive framework may help teachers to support the symbolic understanding of school-aged children with deafblindness. Teachers of children with deafblindness can use the framework to understand their students’ individual socio-cognitive abilities and their social interactions. In other words, a socio-cognitive framework may support teachers of children with deafblindness to understand the abilities and environments that are critical to the development of symbolic understanding.


Stimulating Intersubjective Communication in an Adult with Deafblindness : A Single-Case Experiment --Damen, Saskia; Janssen, Marleen J.; Huisman, Mark; Ruijssenaars, Wied A.J.J.M.; Schuengel, Carlo. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION, March 2014, pp.1-19. (March 2014) Sensory disabilities may limit a person's development of intersubjectivity, that is, the awareness of self and other, which develops in conjunction with interpersonal communication. This study used intersubjectivity theory to test a new intervention called the High Quality Communication (HQC) intervention for its effects on a young adult with congenital deafblindness and a developmental age between 1.5 and 4 years. Three of his social partners were trained to support attunement and meaning making with him through education and video feedback. This study measured seven observation categories at three layers of intersubjective development during a baseline and two intervention phases: dyadic interaction, shared emotion, referential communication, meaning negotiation, shared meaning, declarative communication, and shared past experience. The participant's use of conventional communication was included as an additional category. Effects were observed in all observation categories from the baseline through to the intervention phases. Further study of the effectiveness of the HQC intervention is recommended to test whether effects generalize across people and settings.


Tactile Learning Strategies for Children who are Deaf-Blind : Concerns and Considerations from Project SALUTE --Chen, Deborah, Ph.D.; Downing, June, Ph.D.; Rodriguez-Gil, Gloria, M.Ed. Monmouth, OR: Teaching Research Division. DEAF-BLIND PERSPECTIVES, vol. 8, #2, Winter 2000/2001, pp. 1-6. (2000/2001) Identifying effective tactile strategies for deaf-blind children who also have cognitive or physical disabilities is particularly challenging. Project SALUTE (Successful Adaptations for Learning to Use Touch Effectively), a federally funded model demonstration project, is addressing the need for a more informed approach to the use of these methods.  This article discusses key issues and concerns regarding the use of tactile strategies based on Project SALUTE's initial activities - a review of publications and input from focus groups.  The article outlines the literature and focus group findings which serve as the basis for the work of the remaining three years of Project SALUTE. Available on the web:


A Tactile-Proprioceptive Communication Aid for Users who are Deafblind --Kjambadkar, Vinitha; Folmer, Eelke. University of Nevada, Reno: Department of Computer Sciene and Engineering. This study is on the development of a low-cost bimanual communication device for users who are deafblind.  After testing the device with fourteen able-bodied users, one deafblind individual provided qualitative feedback using a case study. Available on the web:


Tactile Strategies for Children Who Have Visual Impairments and Multiple Disabilities : Promoting Communication and Learning Skills --Chen, Deborah; Downing, June E. New York: AFB Press. (2006) This book is designed to help service providers and family members learn to interact through touch with children who need tactile information to support their learning. The introduction includes a report of focus group findings and the results of research performed with four children during Project SALUTE, a model demonstration project funded by the U.S. Department of Education.  Other chapter topics include: the sense of touch, supporting interactions though touch, assessing tactile skills and planning interventions, focusing on tactile strategies, considering multiple communication options, adapting manual signs to meet a child's needs, selecting appropriate tactile strategies, and encouraging emergent literacy.  Cost: $39.95. Available from AFB Press. Phone: 800-232-3044. E-mail: There is a also companion video (or DVD) to this book called "Tactile Learning Strategies: Interacting with Children Who Have Visual Impairments and Multiple Disabilities."  The contents of the book and video reflect the activities of Project SALUTE, and this book is very similar to a manual published by California State University, Northridge, called "Successful Adaptations for Learning to Use Touch Effectively: Interacting with Children Who Are Deaf-Blind or Visually Impaired and have Additional Disabilities" by Chen, et al. Publisher's web site:


Talking the Language of the Hands to the Hands : The Importance of Hands for the Person Who is Deafblind --Miles, Barbara, M.Ed. Monmouth, OR: DB-LINK:National Information Clearinghouse on Children Who Are Deaf-Blind. (1999) It is important to understand what role the hands play in typical development, and in the development of children who are blind and children who are deaf. This publication will help educators, parents, and friends interact as skillfully as possible to facilitate the development of the hands of the person who is deafblind.  Available in Danish, German, Spanish, and Swedish. Available on the web: Publisher's web site:


Tangible Object Symbols : A Case Study with an Adult with Multiple Disabilities --Cascella, Paul W. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS, vol. 108, #3, May-June 2014, pp. 249-253. (May-June 2014) For special educators and speech-language pathologists who work among adults with multiple disabilities, tangible object symbols may be an appropriate avenue for communication enhancement. Many of these adults use presymbolic communicative actions (Cascella, 2005), and these symbols may enable them to transition from presymbolic into symbolic communication. Collateral evidence for this transition comes from promising results of tangible symbol applications among children who also have presymbolic communication actions (Parker, Banda, Davidson, & Liu-Gitz, 2010; Rowland & Schweigert, 2000; Sigafoos et al., 2008; Trief, Cascella, & Bruce, 2013). Yet, there is a paucity of research on tangible symbol treatments among adults.


Tangible Symbols : Symbolic Communication for Individuals with Multisensory Impairments --Rowland, Charity; Schweigert, Philip. AUGMENTATIVE AND ALTERNATIVE COMMUNICATION (AAC), vol. 5, #4, pp. 226-234. (1989) This article describes a study in which nine deaf-blind students who were not able to acquire abstract symbol systems were taught to use tangible symbols--manipulable symbols (objects or pictures) that bear a clear perceptual relationship to a referent.  Many individuals with multisensory impairments fail to bridge the gap between presymbolic communication and formal language systems such as speech or manual signs. A sequence of communication development that accommodates the use of tangible symbols is presented, as well as case studies illustrating the acquisition of tangible symbols by two students. Finally, data on the progress of the nine students in the study is presented.


Tangible Symbols as an AAC Option for Individuals with Developmental Disabilities : A Systematic Review of Intervention Studies --Roche, Laura; Sigafoos, Jeff; Lancioni, Giulo E.; O'Reilly, Mark F.; Green, Vanessa A.; Sutherland, Dean; Van Der Meer, Larah; Schlosser, Ralf W.; Marschik, Peter B.; Edrisinha, Chaturi D. AUGMENTATIVE AND ALTERNATIVE COMMUNICATION, vol. 30, #1, 2014, pp. 28-39. (2014) We reviewed nine studies evaluating the use of tangible symbols in AAC interventions for 129 individuals with developmental disabilities. Studies were summarized in terms of participants, tangible symbols used, communication functions/skills targeted for intervention, intervention procedures, evaluation designs, and main findings. Tangible symbols mainly consisted of three-dimensional whole objects or partial objects. Symbols were taught as requests for preferred objects/activities in five studies with additional communication functions (e.g., naming, choice making, protesting) also taught in three studies. One study focused on naming activities. With intervention, 54% (n = 70) of the participants, who ranged from 3 to 20 years of age, learned to use tangible symbols to communicate. However, these findings must be interpreted with caution due to pre-experimental or quasi-experimental designs in five of the nine studies. Overall, tangible symbols appear promising, but additional studies are needed to establish their relative merits as a communication mode for people with developmental disabilities.


Tangible Symbols, Tangible Outcomes --Rowland, Charity; Schweigert, Philip. AUGMENTATIVE AND ALTERNATIVE COMMUNICATION, vol. 16, #2, June 2000, pp. 61-78. (2000) This 3-year  study on the use of tangible symbols (objects and pictures) by 41 children with a variety severe and multiple disabilities was conducted to follow up on an earlier study by the authors that revealed the utility of tangible symbols for children who are deafblind.  The children all had combinations of the following major disabilities: mental retardation (9), developmental delay (32), vision impairment (23), hearing impairment (8), autism (9), orthopedic impairment (23), seizure disorder (8), and medical fragility (6).  Seven children had combined vision and hearing impairment plus additional disabilities. All were cognitively delayed. Of the 41 participants, only 6 failed to acquire tangible symbols, demonstrating their usefulness for children with a broad range of abilities.  A number of the participants progressed beyond tangible symbols and learned to use abstract symbol systems, including speech.  Data describing the progress of participants are presented.  Participants are grouped according to outcomes, and the characteristics of each group are discussed in terms of the communication skills of participants as they began intervention. A correction to 2 figures published in a later AAC issue (vol. 16, #3, p. 205) is appended to this article.


Teacher Preparation --McLetchie, Barbara A. B. Baltimore: Paul H. Brookes Publishing Co. Welcoming Students Who Are Deaf-Blind into Typical Classrooms - Facilitating School Participation, Learning, and Friendships. Norris G. Haring and Lyle T. Romer (Eds.). (1995) Chapter 5 sketches the history of educating individuals who are deaf-blind.  Then current issues in preparing personnel to work with infants, children, and youth who are deaf-blind is discussed.  These issues include the shortage of qualified personnel, geographic dispersion of the deaf-blind population, the need for standards, and the roles of teachers.  The chapter concludes with a vision of the future in the preparation of personnel who will have the tremendous responsibility of including learners who are deaf-blind as participants in their homes, schools, and communities.


Teachers' and Speech-Language Pathologists' Perceptions about a Tangible Symbols Intervention: Efficacy, Generalization, and Recommendations --Bruce, Susan M.; Trief, Ellen; Cascella, Paul W. AAC AUGMENTATIVE AND ALTERNATIVE COMMUNICATION, vol. 27, #3, September 2011, pp.172-182. (2011) Twenty-nine special education teachers (n=21) and speech-language pathologists (n=8) were interviewed about a tangible symbols intervention conducted with 51 children (3-21 years) with multiple disabilities and visual impairment. The intervention, which took place over a 7-month period, addressed the use of tangible symbols in the context of a structured protocol for implementing the daily schedule. These educators reported that students learned the meaning of symbols, exhibited improved behavior, and learned part or all of the daily routine, among other benefits. Supports and barriers to student learning (later coded as student characteristics or intervention characteristics) were discussed. Interviewees suggested improvements to the intervention and for generalization to the home setting, including labeling in the family's first language.


Teaching a Child with Multiple Disabilities to Use a Tactile Augmentative Communication Device --Mathy-Laikko, Pamela; Iacono, Teresa; Ratcliff, Ann; Villarruel, Fransisco; Yoder, David; Vanderheiden, Gregg. ACC AUGMENTATIVE AND ALTERNATIVE COMMUNICATION, vol. 5, #4, pp.249-256. (1989) A single case design was used in this study to determine the preferences for tactile surfaces of a child with multiple disabilities including deaf-blindness.  Within each session the child tended to depress a switch covered with a velveteen surface more frequently than switches covered with other textured surfaces. In a second phase of the study, the child's preferred surface was paired with a contingent response of social interaction from her caregiver. The child appeared to become more selective in her activation of the switch with her preferred surface, but did not increase her overall level of activation. Finally, it was found that the child switched to a high proportion of usage of a different surface when it, rather than the velveteen, was paired with the contingent social response. Single-subject design study. This was previously published as the following: Mathy -Laikko, et al. (1989).  Training a child with multihandicaps to use a tactile augmentative communication device.  In, Michael Bullis (Ed.), Research on the communication development of young children with deaf-blindness (pp. 87-103).  Monmouth, OR: Teaching Research Division, Oregon State System of Higher Education.


Teaching Strategies of the van Dijk Curricular Approach --MacFarland, S. Z. C. JOURNAL OF VISUAL IMPAIRMENT AND BLINDNESS, May-June 1995, pp. 222-228. (1995) The combined loss of vision and hearing affects the learning areas of communication, socialization, conceptualization, and movement.  The van Dijk curricular approach addresses these learning areas within the context of teaching children who are deaf-blind.  This article presents the major teaching strategies---including coactive movement, sequential memory, and symbolic communication---in implementing the approach.


Team Interaction Coaching with Educators of Adolescents Who Are Deaf-Blind : Applying the Diagnostic Intervention Model --Janssen, Marleen J.; Riksen-Walraven, J. Marianne; Van Dijk, Jan P. M.; Ruijssenaars, Wied A. J. J. M.; Vlaskamp, Carla. JVIB, November 2007, Volume 101, Number 11, pp. 677-689. (2007) In an earlier publication, we presented the Diagnostic Intervention Model, which can be used as a guide in the design and conduct of interventions to foster harmonious interactions between children who are deaf-blind and their educators. This article demonstrates the use of the model in everyday practice and the effects of its application in two case studies, using team interaction coaching. Implications for everyday practice are discussed. Publisher's web site:


Textured Communication Systems for Individuals with Severe Intellectual and Dual Sensory Impairments --Murray-Branch, Jamie; Udavari-Solner, Alice; Bailey, Brent. American Speech-Language-Hearing Association. LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS, vol.22, no. 1, January 1991, pp. 260-268. (1991) This article presents the development of textured communication systems for use by individuals with severe intellectual and dual sensory impairments for requesting and choice-making purposes. Includes case studies of two students that detail specific intervention strategies.  The use of textured symbols resulted in expanded expressive vocabularies and increased communicative effectiveness for both students.


Toward a Diagnostic Intervention Model for Fostering Harmonious Interactions Between Deaf-Blind Children and Their Educators --Janssen, Marleen J.; Riksen-Walraven, Marianne; Van Dijk, Jan P. M. JOURNAL OF VISUAL IMPAIRMENT AND BLINDNESS, vol. 97, #4, April 2003, pp.197-214. (2003) This article describes the Diagnostic Intervention Model, a training program to foster harmonious interactions and communication between deaf-blind children and their educators in various settings (e.g., school, group, home).  The model involves a cyclic process in which observations of interactions between deaf-blind children and their educators are used as a basis for the creation of intervention aims related to eight core categories of interactive behavior (initiatives, confirmations, answers, turns, attention, intensity, affective involvement, independent acting).  The article lays the groundwork for this by first discussing the significance of harmonious interactions in children's social and emotional development and the difficulties deaf-blind children and their educators face when attempting to develop such harmonious interactions.  It also includes a detailed review of previously developed intervention models and strategies that have focused on interaction and early communication with individuals who are deaf-blind.


Use of Dual Communication Boards at Vocational Sites by Students Who Are Deaf-Blind --Heller, K. W.; Allgood, M. H.; Ware, S. P.; Castelle, M. D. RE:VIEW, vol. XXVII, no. 4, Winter 1996, pp. 180-190. (1996) This article describes a single-subject design study done on the effectiveness of dual communication boards as receptive and expressive forms of communication with co-workers, supervisors and vocational trainers. Data was collected on (1) whether the three students in the original study continued to use dual communication boards effectively at community-based vocational sites; (2) whether the students in this study could use dual boards or single boards more effectively; and (3) how co-workers, supervisors, and vocational trainers preferred to communicate with the students who were deaf-blind.


Use of Dual Communication Boards with Students Who Are Deaf-Blind --Heller, K. W.; Ware, S.; Allgood, M. H.; Castelle, M. JOURNAL OF VISUAL IMPAIRMENT AND BLINDNESS, July-August 1994, pp. 368-376. (1994) This single-subject design study reported here examined the use of dual communication boards for teaching appropriate communication responses to three high school students who were deaf-blind.  It found that the students were able to use these boards with 100 percent accuracy in three communication routines in both school and community environments.


Use of Microswitch Technology to Facilitate Social Contingency Awareness as a Basis for Early Communication Skills --Schweigert, Philip. AAC AUGMENTATIVE AND ALTERNATIVE COMMUNICATION, vol. 5, #3, pp. 192-198. (1989) Individuals with vision and hearing impairments in combination with severe orthopedic impairments often fail to demonstrate any clear awareness of contingent relationships between their own behaviors and environmental outcomes.  Without contingency awareness, it is not possible to engage in intentional communicative behavior.  A single case design is presented involving a 7-year-old deaf-blind child with severe orthopedic impairments who demonstrated no contingency awareness.  The study was designed to examine the use of microswitch technology to facilitate awareness of social contingencies as a potential foundation for the development of intentional communicative behavior.  Results indicated that the child increased the targeted motor behavior (activating a microswitch) under conditions involving the delivery of social contingencies, but not under conditions involving the delivery of nonsocial contingencies.  Subsequent clinical applications are described to illustrate the direct impact of these findings on procedures for training the child's expressive and receptive communication skills. Single-subject design study.


Using a Single-Switch Voice Output Communication Aid to Increase Social Access for Children with Severe Disabilities in Inclusive Classrooms --Cosbey, Joanna Evans; Johnston, Susan. RESEARCH AND PRACTICE FOR PERSONS WITH SEVERE DISABILITIES, Summer 2006, Vol. 31, No. 2, pp. 144-156. (2006) Study conducted in which three children with severe multiple disabilities were taught to use a voice output communication aid (VOCA) to request preferred items or friends during play activities. The VOCA used in the study was a single switch device programmed with the phrase, “That looks fun. Can I play?” Data were collected regarding the number of times the children used the device during play activities, as well as the number of times the participants’ peers responded. The study’s results indicated that the students acquired communication skills while using the VOCA over the course of the intervention, as the device allowed them to successfully interact with their nondisabled peers. Implications for future research are discussed. This study was conducted by researchers at the Department of Special Education in Salt Lake City, Utah.


Using Action Plans to Support Communication Programming for Children Who Are Deafblind --Bruce, Susan M. RE: VIEW, vol. 39, #2, Summer 2007, pp. 71-83. (2007) The author describes the use of action plans to support 2 teachers' post-in-service implementation of communication strategies with 3 children who are deaf-blind. In the action plans, the teachers recorded changes in thinking and instructional practices under the 4 aspects of communication: form, function, content, and context. They also recorded their concerns about implementation and their requests for follow-up support. One teacher focused initially on forms of communication and later on context; the other teacher implemented practices across all 4 aspects, primarily because of the influence of regularly scheduled team meetings.


Using an Adapted Form of the Picture Exchange Communication System to Increase Independent Requesting in Deafblind Adults with Learning Disabilities --Bracken, Maeve; Rohrer, Nicole. RESEARCH IN DEVELOPMENTAL DISABILITIES, vol. 35, #2, February 2014, pp. 269-277. (February 2014) The current study assessed the effectiveness of an adapted form of the Picture Exchange Communication System (PECS) in increasing independent requesting in deafblind adults with learning disabilities. PECS cards were created to accommodate individual needs, including adaptations such as enlarging photographs and using swelled images which consisted of images created on raised line drawing paper. Training included up to Phase III of PECS and procedures ensuring generalizations across individuals and contexts were included. The effects of the intervention were evaluated using a multiple baseline design across participants. Results demonstrated an increase in independent requesting with each of the participants reaching mastery criterion. These results suggest that PECS, in combination with some minor adaptations, may be an effective communicative alternative for individuals who are deafblind and have learning impairments.


Using Tactile Strategies With Students Who Are Blind and Have Severe Disabilities --Downing, June E.; Chen, Deborah. TEACHING EXCEPTIONAL CHILDREN, vol. 36, #2, Nov/Dec 2003, pp56-60. (2003) Students who are blind and have severe disabilities need instructional materials that provide relevant tactile information.  This article describes specific tactile strategies to support the instruction of students who have severe and multiple disabilities and who do not learn visually.  It addresses issues for teachers to consider to help them become aware of how they can best interact with students through touch and describes tactile modeling, tactile mutual attention, characteristics of tactile learning, how to use tactile information to represent specific concepts, the importance of considering a student's degree of sensitivity to touch, and the need for a team approach to teaching.


Using the Communication Matrix to Assess Expressive Skills in Early Communicators --Rowland, Charity. COMMUNICATION DISORDERS QUARTERLY, vol. 32, #3, May 2011, pp..190-201. (2011) Many children born with severe and multiple disabilities have complex communication needs and may use no speech or only minimal speech to communicate. Meaningful assessment of their expressive skills to identify communication strengths along a developmental trajectory is an essential first step toward appropriate intervention. This article describes the foundations, structure, properties, and use of the Communication Matrix, an assessment instrument developed specifically to address the challenges of describing the expressive communication skills of children with severe and multiple disabilities. The widely used online version of this assessment tool collects data in an associated database. Sample data on children with specific disabilities generated by this database are presented to illustrate the clinical and research potential of this free assessment service.

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