Standardized Tangible Symbols Ellen Trief,EdD

1. Standardized Tangible SymbolsEllen Trief,EdD

2. Primary Research Questions Will students with multiple disabilities and visual impairment benefit from the use of a universal set of tangible symbols for communication? Which student characteristics will be predictive of student mastery of tangible symbols?

3. The Settings Four schools in New York City • Lavelle School for the Blind • The Jewish Guild for the Blind • The Lighthouse • Helen Keller Services

4. Student Characteristics • Intentionality/Symbolism • Vision • Hearing • Ambulation • Play

5. Characteristics

6. Pre and Post Testing Speech and language pathologists from Hunter College administered the pre and post tests for the study under the direction of Dr. Paul Cascella. The symbols were used as pre and post test measures.

7. The Intervention Teachers and therapists chose at least 5 symbols which would be introduced to each child during the errorless learning phase. Two weeks of exposure to each of the five symbols at the beginning, during and at the end of each activity. Gradually built up to introducing more symbols during the seven months.

8. Training the Teachers and Therapists • A scripted task analysis was given to each teacher and therapist • A training session using video clips was done at each school prior to the intervention. • Follow-up visits were made to each site to ensure that the protocol was being consistently implemented (fidelity measure)

9. The Probe • After an activity was completed, the teacher/therapist showed a choice of two symbols to the child. • The symbols were presented on a board and the order of the symbols was changed over two or three trials • Data was recorded on simple data sheets.

10. What We Have Found • 44 of the 51 children enrolled in the study positively responded to the symbols when probed. Three showed no response and 5 yielded a 10% or less response. • The range of percentage correct during the probe phase of the study was 10.1%-92%.

11. Percentage of Correct Responses by Month

12. What We have Found So Far • The only significant difference across groups when we ran an ANOVA was ambulation. • Children who had some ambulatory skills learned more tangible symbols than those who were non-ambulatory. • The mean difference between the non-ambulatory and the ambulatory with assistance and ambulatory group was significant at the .05 level.

13. What Does This Mean? • Paul, Susan and I thought that level of communication development would be the strongest predictor in learning the tangible symbols, but in fact the only statistically significant predictor was mobility. • Vision, hearing and play showed no statistical significance in the acquisition of the symbols.

14. What We Have Learned • On the pre test and post test data the children in the study showed no significant gain in scores. • However, the post test was not given in context to the activity. • The children in the study had 6 months of practice with the symbols in context. • Unfamiliar people administered the pre and post tests.

15. What Does this Mean? • Outside and unfamiliar testing might not measure progress for this population. • Taking the task out of context and out of the natural environment during the actual activity made it difficult for the children to understand the question

16. Qualitative Analysis • Post Interviews of teachers (21) & speech therapists (8) • Teachers licensed in severe disabilities or visual impairment • Speech therapists licensed • All above had a Masters degree

17. Interview Questions • How do you feel tangible symbols helped the children in the study? • What do you see as a future direction in your classroom for the use of tangible symbols? • Do you feel that the symbols should be sent home to parents? • If so, How can we encourage the parents to use the symbols in their home? • Do you have any comments or suggestions for future use of the symbols?

18. Qualitative Analysis • Interviews videotaped in entirety • Fully transcribed • Coded using constant comparative (Glaser & Strauss, 1967) & word-by-word in vivo coding (Charmaz, 2006). • Major themes identified & all interview comments organized within 2nd document • 2nd document organized by themes & included in vivo • Counting of comments made within each theme • Second rater coded 1st document, making comments • Third document integrated coding, still within themes & with in vivo

19. Major Themes Identified • Student Learning Benefits • Attributions about Student Learning: Supports and Barriers (unsolicited by questions) • Adult Learning (also unsolicited by questions) • Future Directions-includes use in the home & suggestions for future interventions (in their classroom and beyond), and suggestions to improve the intervention

20. Benefits • Benefits Cited by Teachers & Therapists • Learned meaning of symbols • Improved behavior/socialization • Ancillary (unexpected) • Learning schedule/routine • Improved transitions • Express in new forms • Meet needs/wants • Making choices

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

22. Attributions: Supports • Attributions About Student Learning: Supports • Frequent opportunities to practice • Symbols selected were for highly preferred activities • Structured protocol • Customizing/individualizing select & naming of symbols • Cognitively more aware • Optimal alertness states are more frequent • Higher level of communication • Iconicity of symbols

23. Pairing with voice output communication devices (VOCD) • Tactually distinct symbols (from each other) • Adult consistency with protocol

24. Educator Comments about Supports • Educators often spoke about the importance of the intervention’s structure and opportunities for students to practice the use of the tangible symbols • “The student that I had the most progress with, was the student that I had every day, was seeing the symbols every day, over and over and over again.”

25. Attributions: Barriers • Attributions about Student Learning: Barriers • Early adult resistance • Physical & medical issues • Protocol-Probe (children not seeing the point) • Student Absenteeism • Tactile defensiveness • Behaviors with symbols (tossing, fiddling) • Frequent non-optimal alertness states • Irritability/moodiness

26. Lack of auditory feedback • Symbol size • Abstract symbols were not mastered (by some) • Child needs more time to learn symbols • Bilingualism • Reaching errors • Adult implementation errors

27. Adult Learning • Three educators initiated comments on their own learning • “I mean, in the beginning, I wasn’t sure about the whole thing. Because when you think about communication systems, you think about what’s the most relevant to each student individually. So, having this universal system, well, it seemed like a great idea. It kind of seemed like, how are these kids going to understand this if they don’t have any relationship to the symbol? But having gone through it, you know, and seeing some real progress, you know, I think it, for me, it seems like it is about consistency.”

28. Future Use • All 29 reported they would use tangible symbols in the future • Many wanted their current students to learn additional symbols • Lack of current student success did not deter teachers from using the symbols in the future • They talked about individualization-by selection of symbols from the set & thoughtful naming • Several talked about pairing with VOCDs (if the child already was a VOCD user)

29. All 29 agreed tangible symbols should be used in the home setting (“definitely,”“absolutely”... • “I definitely feel that the cues should be sent home so they’ll be carrying over and so that the student can use it in a naturalistic setting and so you’ll see more progress in the use of the tangible cues.” • Educators agreed that parents would need some preparation (observation in school, group & individual trainings, DVD…)

30. Suggestions for the Symbols & Intervention • Suggested additional tangible symbols • Duplicate sets were requested • Size & portability • Changes in use of the probe-less frequent • Additional training on indicating responses • Suggestions for ELLs-labeling in Spanish • Parent materials in their primary language

31. Respecting the Importance of Saliency • Select a tangible symbol from a universal or standardized set ONLY if that symbol is a good choice for that child (matches what is most salient to the child about a given activity or setting) • Universal sets do NOT replace the need to make some tangible symbols • Individualization also occurs by wise selection of a NAME for each symbol • Use the selected name (for each tangible symbols) consistently

32. Dissemination Efforts • Five articles were generated from this study. • The Development of a Universal Tangible Symbols System (JVIB, July, 2009) • The Selection of Tangible Symbols by Educators of Students with Multiple Disabilities and Visual Impairment (JVIB, August, 2010)

33. Dissemination Efforts • Comparing Parent and Teacher Ratings of the Frequency and Diversity of Communication among Children with Severe Disabilities (2012) • Article on quantitative findings regarding the benefits of tangible symbols to children who are visually impaired with multiple disabilities(May, 2013) • Teachers’ and therapists’ perceptions about the efficacy and future directions of a tangible symbols intervention (September, 2011)