The Education and Training of the Mentally Retarded

Recent Advances

Adrian F. Ashman, Ronald S. Laura, Adrian F. Ashman, Ronald S. Laura

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429952036
• Edition: 1
• Topic: Education
• Subtopic: Education General

First published in 1985. The field of mental handicap is a broad one encompassing the interests of many professional groups. As a result, there is a need periodically to present wide-ranging reviews of advances in the field. This is the central aim of this volume.

Two chapters focus on the cognitive domain, and are especially pertinent in view of the recent release of the new Kaufman Assessment Battery for Children which uses Das's theoretical position as its foundation. Another contribution reviews the area of non-speech communication with those with special needs, a subject of much current interest and controversy. Other chapters focus on major issues such as maladaptive behaviour and deinstitionalization and use of new technology. The book is thus likely to be relevant to all those with an interest in advances in mental handicap research.

Chapter One

NONVERBAL COMMUNICATION SYSTEMS AND THEIR USE WITH MENTALLY RETARDED PEOPLE

A. Cooney

The wish to establish successful communication with handicapped people has led clinicians and teachers to consider the use of nonverbal systems. The statement: “If only he could speak”, has changed to “If only he could communicate”. As a result, the focus of communication programming for the severely handicapped has moved away from speech to include nonverbal (or augmentative) systems of communication.

Nonverbal systems can be classified into two broad groups:

1. Manual or unaided communication. These include systems which necessitate movement of the body (typically the arms and hands) but do not require access to equipment or devices separate from the body. Examples are sign language and systems, gestures, and pantomine (Grove, 1980; Kiernan, in press).
2. Graphic symbol or aided systems (two or three dimensional). Graphic symbol communication comprises systems such as Blissymbols (Bliss, 1965), rebuses or words and some type of external assistance, aid, or device such as paper, pencil, pictures, charts, communication boards or electronic devices (Lloyd & Karlan, 1982; Musselwhite & St. Louis, 1982).

Surveys conducted in the United States have provided data relating to the use of various nonspeech systems with mentally retarded clients and to signing programs in particular. Fristoe and Lloyd (1978), for instance, found that programs of sign instruction were the most common and Goodman, Wilson, and Bornstein (1978) speculated that in 1977 well over 10,000 clients were involved in sign programs and that this number was likely to increase. In the United Kingdom, several comprehensive surveys have shown similar trends to those found in the United States (Jones, Reid, & Kiernan, 1982; Kiernan, Reid, & Jones, 1979, 1983; Reid, Jones, & Kiernan, 1983).

Hospital and community schools in England, Wales and Scotland were the target of surveys conducted by the staff of the Thomas Coram Research Institute from 1978 to 1982. These schools provided education for pupils classified as severely and profoundly mentally retarded, physically handicapped, autistic, and those with speech defects. The schools reported the use of four main systems: Makaton, using signs from British Sign Language; Rebus Systems; Blissymbols; and the Paget-Gorman Sign System.

The final survey conducted by Reid and colleagues (Reid et al., 1983), confirmed the earlier established trend toward increased use of augmentative systems in special schools. The results indicated that there were 11,323 children using augmentative systems, of these, over 9,000 were involved in Makaton programs, 982 used Rebus Programs, 749 used Bliss Programs, and 424 were on Paget Gorman Sign System Programs.

Reid et al. (1983) estimated that one child in five in special schools covered in the survey used an augmentative communication system, 84% of the pupils used a sign system, and the remaining 16%, a symbol system. Having established a growth pattern in use of augmentative systems, the authors of the surveys in the United States and Great Britain highlighted the need for further empirical study into decision factors involved in the selection of a system, teaching methodology and functional usage of the system.

This chapter will focus on two general areas. First, I will discuss the literature which deals with the use and effectiveness of augmentative communication systems. Second, I will draw attention to the Makaton system which currently is being used in over eighty percent of schools in Great Britain (Reid et al., 1983). Makaton has received little coverage in the North American literature with the exceptions of these studies reported in Fristoe and Lloyd (1979, 1980) and Armfield (1982).

SELECTION OF CLIENTS

The most frequent reasons given by clinicians and teachers for the decision to implement an augmentative communication system are: (1) the failure of subjects to acquire intelligible speech (even after receiving systematic speech therapy); and (2) indications of frustration due to impaired communication (Bedwinek, 1983; Cooney & Knox, 1981; Creedon, 1973; Daniloff & Shafer, 1981; Faw, Reid, Schepis, Fitzgerald, & Welty, 1981; Lombardino, Willems, & MacDonald, 1981; Nietupski & Hamre-Nietupski, 1979; Oliver & Halle, 1982; Salisbury, Wambold, & Walter, 1978; Stremel-Campbell, Cantrell, & Halle, 1977; Wells, 1981). There are, however, several authors who have described assessment formats which would aid in the selection of clients who could benefit from instruction in the use of an augmentative system.

Chapman and Miller (1980) for instance, described a multi-faceted assessment to evaluate and compare the basic processes related to language acquisition and use: cognitive status, comprehension, production and use of language. Cognitive level is assessed commonly using the Uzgiris and Hunt (1975) Scales, informal observational assessment, and age level obtained for language comprehension, based on syntax and vocabulary. Language production is assessed for syntax, semantics and phonology. An assessment is made of the pragmatic use of language according to the levels of language functions and interaction patterns. A final assessment category exists for motor skills: gross, fine, and visual-motor. Where possible, age levels are determined for each of these domains, thus enabling a comparison and highlighting of areas of strength or weakness. This form of assessment differentiates between the child with communication delay relative to cognitive level and the child whose communication skills are comparable to cognitive level, but delayed relative to chronological level.

The importance of environmental considerations during the assessment of clients who are to be taught signing as an augmentative communication system has been stressed by several writers. How does the person interact with his environment? Lombardino et al. (1981) discussed four assessment criteria. The first is the assessment of language-related pre-verbal skills. Using a Piagetian (1962) framework they cited writers who have described the sensori-motor behaviors typically acquired by children prior to acquisition of speech. For example, Morehead and Morehead (1974) described attention, social imitation, receptive language and functional play as necessary prerequisites. In addition, Bruner (1978) examined social prerequisites of requesting, indicating and affiliating.

Intentional communication demonstrated by the use of gestures and/or vocalizations in sensori-motor Stage II has been considered as a prerequisite to symbolic communication (Bates, Benigni, Bretherton, Camaioni, & Volterra, 1977). Kahn (1975) referred to the importance of the development of representational skills in Stage VI, and Lombardino et al. stated that clients who function at cognitive levels lower than Stage V or Stage VI can be successfully taught signs to express basic semantic relations for early functional use. They argued that training low functioning individuals in sign-referent associations may facilitate a high level of cognitive functioning.

A second assessment criteria of Lombardino et al. concerns motor skills. Specifically, the client should be physically capable of making an intelligible approximation of a sign. If the signs can be interpreted by only a few familiar people, then an additional augmentative aid such as pictures or words should be introduced to assist intelligibility for the interpreter.

A third assessment criteria is also appropriate for the client who has difficulty imitating standard signs. An assessment is made of the semantic and communicative intentions expressed in the individual’s nonverbal communication. These natural gestures are used and shaped into a more systematic communication system.

Finally, Lombardino et al. assess clients’ oro-musculature status and as a consequence of this, the prognosis for speech. Such an evaluation enables the determination of the anticipated response mode - signs only, or signs plus speech. For some clients who communicate predominantly with signs, vocalizations may serve only as an attention getting device to indicate the beginning of signed communication. The authors acknowledged that some of the studies (Fulwiller & Fouts, 1976; Miller & Miller, 1973) demonstrated that, for some clients, vocalizations and speech appear to have been facilitated by inclusion in signing programs. Thus, focusing primarily on sign as the production mode will not preclude the possibility that speech will emerge as a by-product of manual communication.

The identification of children who are “at risk” for acquiring speech has been a major concern to some writers. The conditions that are likely to be a threat to the acquisition of speech were analyzed by Schiefelbusch (1980). For instance, a child might be considered “at risk” because of adverse environmental conditions. Ineffective interaction patterns between infants and their care givers may prejudice the development of communication, language, and speech. The infant gains experience in both the receptive and expressive functions of communication, language and speech by participating in play and socialization routines with adults, and children who are at risk may not evoke sufficient responsiveness from parents. This lack of responsiveness may lead to a failure on the part of the parents to heed the active social efforts of the infant.

Moreover, a child might be handicapped by biological conditions which might affect the reception or production of speech. Conditions such as hearing loss, brain damage, mental retardation, autism, or psychopathology are associated with difficulties in acquiring functional speech. Schiefelbusch described formal and informal assessment strategies for determining the presence and severity of some of the handicaps. He argued that early detection, early stimulation and the consideration of implementation of an augmentative communication system offer the best possibility for assisting in the development of functional language and communication. Schiefelbusch considered that the transition to symbolic representational skills was achieved through the action oriented play of children. The importance of an augmentative system may be that it provides a means for this transition.

Schiefelbusch’s position, that an augmentative communication system should be considered for the child who is at risk of communication delay, is not accepted by all researchers. Shane and Bashir (1980), for instance, argued that augmentative systems should be used as a last resort, when intelligible speech has failed to develop. They presented a decision matrix of ten levels or functions. Progression through the matrix results in a decision to either elect, reject or delay the implementation of an augmentative communication system. Criteria are given for various factors including cognitive ability, oral reflex, language, motor skills, intelligibility, emotional condition, chronological age, previous therapy, imitation, and environmental influences. A decision to elect to use an augmentative system does not indicate which system is the most appropriate. However, the system might be one for which the expected outcome is to facilitate oral language production (Schaeffer, 1980), to augment communication (Cooney & Knox, 1981), to enhance oral speech intelligibility (Grinnell, Detamore, & Lippke, 1976), or some combination of the above. A decision to reject an augmentative system indicates that the implementation of an oral speech program is likely to be more successful. Finally, a decision to delay the use of an augmentative system indicates that such a program is inappropriate at the time, possibly because of lack of cognitive readiness or the need to study the effects of a different form of therapy.

The importance of determining cognitive levels, oro-musculature skills, language levels and usage, intelligibility, critical emotional factors and environmental conditions is taken up to some degree by other writers (Chapman & Miller, 1980; Kriegsmann, Gallaher, & Meyers, 1982; Lombardino et al., 1981; Musselwhite & St. Louis, 1982; Schiefelbusch, 1980). Shane and Bashir (1980), for example, placed importance on an additional factor, namely, the consideration of previous speech therapy. Has there been previous speech therapy? If so, was it appropriate? Was the progress too slow to enable effective communication or was it appropriately withheld? If the responses to these questions are negative, the advice is to begin or continue with speech therapy, and therefore to delay the implementation of an augmentative communication system. Such a decision suggests that the use of an augmentative system and speech therapy are mutually exclusive. This is an area over which there continues to be much discussion.

Augumentative communication systems, especially sign instruction programs have been used to promote speech skills. Grinnell et al. (1976) report the use of Manual English as a teaching strategy with trainable and educable mentally retarded adolescents to increase their productive use of speech, and to promote correct sequencing of speech in phrases and sentences. Walker and Armfield (1981) refer to the use of Makaton by speech therapists whose clients (of normal intelligence) have severe articulation or fluency problems. Makaton is used as a temporary means of communication to relieve excessive frustration while “speech” therapy is ongoing.

The question of the optimum timing for the introduction of an augmentative communication system is one that requires further investigation. Schiefelbusch (1980) and Morris (1981) have recommended that the beginnings of augmentative communication can be fostered in the young child who is “at risk” for achieving effective oral communication. The most important consideration is that the child learns to become an active participant in the communication interactions (le Prévost, 1983). Early vocalizations are encouraged. The parent, teacher, nurse or therapist reinforces and models the use of speech, gestures, signs or symbols.

SELECTION OF SYSTEMS

At first, the consideration of whether a client will be introduced to an aided or unaided system might appear to be a simple proposition. A major portion of the mental retardation literature refers to the implementation of manual communication systems, while the literature dealing with severe physical handicap refers to aided or symbol systems. The initial assessments for the client might indicate areas of skills and deficits which could then be used for determining the most appropriate system.

For some handicapped people there is no one system that is an exact “fit” for them. Throughout their life, different systems can serve different needs. A person might use vocalizations to attract attention, sign approximations to express basic ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Table of Contents
• List of Tables and Figures
• Acknowledgements
• Introduction
• 1. Nonverbal Communication Systems and Their Use with Mentally Retarded People
• 2. Behavioral Approaches to the Training of the Mentally Retarded
• 3. Developing Vocational and Prevocational Skills in the Severely and Profoundly Retarded
• 4. Drug-Behavior Interactions with Self-Injurious Behavior
• 5. Mental Retardation and Aggression: Epidemiologic Concerns, and Implications for Deinstitutionalization
• 6. Problem Solving and Planning: Two Sides of the Same Coin
• 7. Remedial Training for the Amelioration of Cognitive Deficit in Children
• 8. Computer Learning Systems for Mentally Retarded Persons: Interfacing Theory with Practice
• 9. Three Facets of Education and Training for the Retarded: Some Developments and Trends
• Subject Index
• Contributors