Standardized Tangible Standardized Tangible SymbolsSymbols

Ellen Trief,EdD Ellen Trief,EdD

Primary Research QuestionsPrimary Research Questions

Will students with multiple disabilities and visual Will students with multiple disabilities and visual impairment benefit from the use of a universal impairment benefit from the use of a universal set of tangible symbols for communication?set of tangible symbols for communication?

Which student characteristics will be predictive Which student characteristics will be predictive of student mastery of tangible symbols? of student mastery of tangible symbols?

The SettingsThe Settings

Four schools in New York CityFour schools in New York City

Lavelle School for the BlindLavelle School for the Blind

The Jewish Guild for the Blind The Jewish Guild for the Blind

The LighthouseThe Lighthouse

Helen Keller ServicesHelen Keller Services

Student Characteristics Student Characteristics

Intentionality/SymbolismIntentionality/Symbolism

VisionVision

Hearing Hearing

AmbulationAmbulation

PlayPlay

CharacteristicsCharacteristicsGender Ages English/

Bilingual

Vision Motor Hearing Play Sp.

Numbers in Each Category

Male=23

3-5.11 y.=16

English=26

TB=19 Ambul. =16

Funct.Hearing =25

Isolated=35

Vocal. =26

Female =21

6-11.11y=14

Bilingual=18*

VI= 18 Ambul.With assist. =8

With Hearing aid=1

Parallel=5

Non -vocal=18

12-20 y. =14

CVI=7 Non-Ambul.=18

Assoc. or Coop.4

Verbal< 5 words=4**

No Data available=2

No data available=18

Pre and Post TestingPre and Post Testing

Speech and language pathologists fromSpeech and language pathologists from

Hunter College administered the pre and Hunter College administered the pre and post tests for the study under the direction post tests for the study under the direction of Dr. Paul Cascella.of Dr. Paul Cascella.

The symbols were used as pre and post The symbols were used as pre and post test measures.test measures.

The InterventionThe Intervention

Teachers and therapists chose at least 5 Teachers and therapists chose at least 5 symbols which would be introduced to symbols which would be introduced to each child during the errorless learning each child during the errorless learning phase.phase.

Two weeks of exposure to each of the five Two weeks of exposure to each of the five symbols at the beginning, during and at symbols at the beginning, during and at the end of each activity.the end of each activity.

Gradually built up to introducing more Gradually built up to introducing more symbols during the seven months.symbols during the seven months.

Training the Teachers and Training the Teachers and TherapistsTherapists

A scripted task analysis was given to each A scripted task analysis was given to each teacher and therapistteacher and therapist

A training session using video clips was A training session using video clips was done at each school prior to the done at each school prior to the intervention.intervention.

Follow-up visits were made to each site to Follow-up visits were made to each site to ensure that the protocol was being ensure that the protocol was being consistently implemented (fidelity consistently implemented (fidelity measure)measure)

The ProbeThe Probe

After an activity was completed, the After an activity was completed, the teacher/therapist showed a choice of two teacher/therapist showed a choice of two symbols to the child.symbols to the child.

The symbols were presented on a board The symbols were presented on a board and the order of the symbols was changed and the order of the symbols was changed over two or three trials over two or three trials

Data was recorded on simple data sheets.Data was recorded on simple data sheets.

What We Have Found What We Have Found

44 of the 51 children enrolled in the study 44 of the 51 children enrolled in the study positively responded to the symbols when positively responded to the symbols when probed. Three showed no response and 5 probed. Three showed no response and 5 yielded a 10% or less response. yielded a 10% or less response.

The range of percentage correct during The range of percentage correct during the probe phase of the study was 10.1%-the probe phase of the study was 10.1%-92%.92%.

Percentage of Correct Percentage of Correct Responses by MonthResponses by Month

Oct. Nov. Dec. Jan. Feb. Mar. AprilTotal Trials 2,433 3,724 3,709 4,594 4,448 7,513 3,799# of correct responses 640 1,116 1,359 2,082 2,107 3,584 1,696% of correct responses 26% 30% 37% 45% 47% 48% 45%

What We have Found So FarWhat We have Found So Far

The only significant difference across groups The only significant difference across groups when we ran an ANOVA was ambulation. when we ran an ANOVA was ambulation.

Children who had some ambulatory skills Children who had some ambulatory skills learned more tangible symbols than those who learned more tangible symbols than those who were non-ambulatory.were non-ambulatory.

The mean difference between the non-The mean difference between the non-ambulatory and the ambulatory with assistance ambulatory and the ambulatory with assistance and ambulatory group was significant at the .05 and ambulatory group was significant at the .05 level.level.

What Does This Mean?What Does This Mean?

Paul, Susan and I thought that level of Paul, Susan and I thought that level of communication development would be the communication development would be the strongest predictor in learning the tangible strongest predictor in learning the tangible symbols, but in fact the only statistically symbols, but in fact the only statistically significant predictor was mobility.significant predictor was mobility.

Vision, hearing and play showed no statistical Vision, hearing and play showed no statistical significance in the acquisition of the symbols.significance in the acquisition of the symbols.

What We Have LearnedWhat We Have Learned

On the pre test and post test data the children in On the pre test and post test data the children in the study showed no significant gain in scores.the study showed no significant gain in scores.

However, the post test was not given in context However, the post test was not given in context to the activity.to the activity.

The children in the study had 6 months of The children in the study had 6 months of practice with the symbols in context.practice with the symbols in context.

Unfamiliar people administered the pre and post Unfamiliar people administered the pre and post tests.tests.

What Does this Mean?What Does this Mean?

Outside and unfamiliar testing might not Outside and unfamiliar testing might not measure progress for this population.measure progress for this population.

Taking the task out of context and out of the Taking the task out of context and out of the natural environment during the actual activity natural environment during the actual activity made it difficult for the children to understand made it difficult for the children to understand the questionthe question

Qualitative AnalysisQualitative Analysis

Post Interviews of teachers (21) & speech Post Interviews of teachers (21) & speech therapists (8)therapists (8)

Teachers licensed in severe disabilities or Teachers licensed in severe disabilities or visual impairmentvisual impairment

Speech therapists licensedSpeech therapists licensed

All above had a Masters degreeAll above had a Masters degree

Interview QuestionsInterview Questions

How do you feel tangible symbols helped the How do you feel tangible symbols helped the children in the study?children in the study?

What do you see as a future direction in your What do you see as a future direction in your classroom for the use of tangible symbols?classroom for the use of tangible symbols?

Do you feel that the symbols should be sent Do you feel that the symbols should be sent home to parents?home to parents?

If so, How can we encourage the parents to use If so, How can we encourage the parents to use the symbols in their home? the symbols in their home?

Do you have any comments or suggestions for Do you have any comments or suggestions for future use of the symbols? future use of the symbols?

Qualitative AnalysisQualitative Analysis

Interviews videotaped in entiretyInterviews videotaped in entirety

Fully transcribedFully transcribed

Coded using constant comparative (Glaser & Strauss, Coded using constant comparative (Glaser & Strauss, 1967) & word-by-word in vivo coding (Charmaz, 2006).1967) & word-by-word in vivo coding (Charmaz, 2006).

Major themes identified & all interview comments Major themes identified & all interview comments organized within 2organized within 2ndnd document document

22ndnd document organized by themes & included in vivo document organized by themes & included in vivo

Counting of comments made within each themeCounting of comments made within each theme

Second rater coded 1Second rater coded 1stst document, making comments document, making comments

Third document integrated coding, still within themes & Third document integrated coding, still within themes & with in vivowith in vivo

Major Themes IdentifiedMajor Themes Identified

Student Learning BenefitsStudent Learning Benefits

Attributions about Student Learning: Supports Attributions about Student Learning: Supports and Barriers (unsolicited by questions)and Barriers (unsolicited by questions)

Adult Learning (also unsolicited by questions)Adult Learning (also unsolicited by questions)

Future Directions-includes use in the home & Future Directions-includes use in the home & suggestions for future interventions (in their suggestions for future interventions (in their classroom and beyond), and suggestions to classroom and beyond), and suggestions to improve the intervention improve the intervention

BenefitsBenefits

Benefits Cited by Teachers & TherapistsBenefits Cited by Teachers & Therapists– Learned meaning of symbolsLearned meaning of symbols– Improved behavior/socializationImproved behavior/socialization– Ancillary (unexpected)Ancillary (unexpected)– Learning schedule/routineLearning schedule/routine– Improved transitionsImproved transitions– Express in new formsExpress in new forms– Meet needs/wantsMeet needs/wants– Making choicesMaking choices

Educator Quotes on BenefitsEducator Quotes on Benefits

AllieAllie’’s behaviors went down and I think thats behaviors went down and I think that’’s what was s what was the biggest progress with her. At first she would yell, the biggest progress with her. At first she would yell, throw herself, tantrum. But once she learned, throw herself, tantrum. But once she learned, ““When I When I want to eat, all I have to do is touch that eat cue,want to eat, all I have to do is touch that eat cue,”” her her tantrums went down and the screaming went down. tantrums went down and the screaming went down. When she wanted to listen to her favorite music, all she When she wanted to listen to her favorite music, all she had to do was go and touch that music cue. With her, it had to do was go and touch that music cue. With her, it just minimized [the behaviors] and realizing, just minimized [the behaviors] and realizing, ““Hey, I can Hey, I can actually let them know what I want at this moment.actually let them know what I want at this moment.””

Attributions: SupportsAttributions: Supports

Attributions About Student Learning: SupportsAttributions About Student Learning: Supports– Frequent opportunities to practiceFrequent opportunities to practice– Symbols selected were for highly preferred activitiesSymbols selected were for highly preferred activities– Structured protocolStructured protocol– Customizing/individualizing select & naming of Customizing/individualizing select & naming of

symbolssymbols– Cognitively more awareCognitively more aware– Optimal alertness states are more frequentOptimal alertness states are more frequent– Higher level of communicationHigher level of communication– Iconicity of symbolsIconicity of symbols

– Pairing with voice output communication devices Pairing with voice output communication devices (VOCD)(VOCD)

– Tactually distinct symbols (from each other)Tactually distinct symbols (from each other)– Adult consistency with protocolAdult consistency with protocol

Educator Comments about Educator Comments about Supports Supports

Educators often spoke about the importance of Educators often spoke about the importance of the interventionthe intervention’’s structure and opportunities for s structure and opportunities for students to practice the use of the tangible students to practice the use of the tangible symbolssymbols

– ““The student that I had the most progress with, was The student that I had the most progress with, was the student that I had every day, was seeing the the student that I had every day, was seeing the symbols every day, over and over and over again.symbols every day, over and over and over again.””

Attributions: BarriersAttributions: Barriers

Attributions about Student Learning: BarriersAttributions about Student Learning: Barriers– Early adult resistanceEarly adult resistance– Physical & medical issuesPhysical & medical issues– Protocol-Probe (children not seeing the point)Protocol-Probe (children not seeing the point)– Student AbsenteeismStudent Absenteeism– Tactile defensivenessTactile defensiveness– Behaviors with symbols (tossing, fiddling)Behaviors with symbols (tossing, fiddling)– Frequent non-optimal alertness statesFrequent non-optimal alertness states– Irritability/moodinessIrritability/moodiness

– Lack of auditory feedbackLack of auditory feedback– Symbol sizeSymbol size– Abstract symbols were not mastered (by some)Abstract symbols were not mastered (by some)– Child needs more time to learn symbolsChild needs more time to learn symbols– BilingualismBilingualism– Reaching errorsReaching errors– Adult implementation errorsAdult implementation errors

Adult LearningAdult Learning

Three educators initiated comments on their own Three educators initiated comments on their own learninglearning– ““I mean, in the beginning, I wasnI mean, in the beginning, I wasn’’t sure about the t sure about the

whole thing. Because when you think about whole thing. Because when you think about communication systems, you think about whatcommunication systems, you think about what’’s the s the most relevant to each student individually. So, having most relevant to each student individually. So, having this universal system, well, it seemed like a great this universal system, well, it seemed like a great idea. It kind of seemed like, how are these kids going idea. It kind of seemed like, how are these kids going to understand this if they donto understand this if they don’’t have any relationship t have any relationship to the symbol? But having gone through it, you know, to the symbol? But having gone through it, you know, and seeing some real progress, you know, I think it, and seeing some real progress, you know, I think it, for me, it seems like it is about consistency.for me, it seems like it is about consistency.””

Future UseFuture Use

All 29 reported they would use tangible symbols All 29 reported they would use tangible symbols in the futurein the future

Many wanted their current students to learn Many wanted their current students to learn additional symbolsadditional symbols

Lack of current student success did not deter Lack of current student success did not deter teachers from using the symbols in the futureteachers from using the symbols in the future

They talked about individualization-by selection They talked about individualization-by selection of symbols from the set & thoughtful namingof symbols from the set & thoughtful naming

Several talked about pairing with VOCDs (if the Several talked about pairing with VOCDs (if the child already was a VOCD user)child already was a VOCD user)

All 29 agreed tangible symbols should be All 29 agreed tangible symbols should be used in the home setting (used in the home setting (““definitely,definitely,”” ““absolutelyabsolutely””......– ““I definitely feel that the cues should be sent home so I definitely feel that the cues should be sent home so

theythey’’ll be carrying over and so that the student can ll be carrying over and so that the student can use it in a naturalistic setting and so youuse it in a naturalistic setting and so you’’ll see more ll see more progress in the use of the tangible cues.progress in the use of the tangible cues.””

Educators agreed that parents would need Educators agreed that parents would need some preparation (observation in school, some preparation (observation in school, group & individual trainings, DVD…)group & individual trainings, DVD…)

Suggestions for the Symbols & Suggestions for the Symbols & InterventionIntervention

Suggested additional tangible symbols Suggested additional tangible symbols

Duplicate sets were requestedDuplicate sets were requested

Size & portability Size & portability

Changes in use of the probe-less frequentChanges in use of the probe-less frequent

Additional training on indicating responsesAdditional training on indicating responses

Suggestions for ELLs-labeling in SpanishSuggestions for ELLs-labeling in Spanish

Parent materials in their primary languageParent materials in their primary language

Respecting the Importance of Respecting the Importance of SaliencySaliency

Select a tangible symbol from a universal or Select a tangible symbol from a universal or standardized set ONLY if that symbol is a good standardized set ONLY if that symbol is a good choice for that child (matches what is most choice for that child (matches what is most salient to the child about a given activity or salient to the child about a given activity or setting)setting)

Universal sets do NOT replace the need to make Universal sets do NOT replace the need to make some tangible symbolssome tangible symbols

Individualization also occurs by wise selection of Individualization also occurs by wise selection of a NAME for each symbola NAME for each symbol

Use the selected name (for each tangible Use the selected name (for each tangible symbols) consistentlysymbols) consistently

Dissemination EffortsDissemination Efforts

Five articles were generated from this Five articles were generated from this study.study.

– The Development of a Universal Tangible The Development of a Universal Tangible Symbols System (JVIB, July, 2009)Symbols System (JVIB, July, 2009)

– The Selection of Tangible Symbols by The Selection of Tangible Symbols by Educators of Students with Multiple Educators of Students with Multiple Disabilities and Visual Impairment (JVIB, Disabilities and Visual Impairment (JVIB, August, 2010)August, 2010)

Dissemination EffortsDissemination Efforts– Comparing Parent and Teacher Ratings of Comparing Parent and Teacher Ratings of

the Frequency and Diversity of the Frequency and Diversity of Communication among Children with Severe Communication among Children with Severe Disabilities (2012)Disabilities (2012)

– Article on quantitative findings regarding the Article on quantitative findings regarding the benefits of tangible symbols to children who benefits of tangible symbols to children who are visually impaired with multiple are visually impaired with multiple disabilities(May, 2013) disabilities(May, 2013)

– TeachersTeachers’’ and therapists and therapists’’ perceptions about perceptions about the efficacy and future directions of a tangible the efficacy and future directions of a tangible symbols intervention (September, 2011)symbols intervention (September, 2011)