The Silent Partner? : Language, Interaction and Aided Communication [1 ed.] 9781907826788, 9781907826306

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The Silent Partner?

The Silent Partner? Language, Interaction and Aided Communication Martine M. Smith and Janice Murray (Editors)

J&R Press Ltd

© 2016 J&R Press Ltd All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, except under the terms of the Copyright Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, without the permission in writing of the Publisher. Requests to the Publisher should be addressed to J&R Press Ltd, Farley Heath Cottage, Albury, Guildford GU5 9EW, or emailed to [email protected]. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Library of Congress Cataloguing in Publication Data British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Cover design: Jim Wilkie. Cover image: Clive Watts/Shutterstock. (used under license from Shutterstock.com) Project management, typesetting and design: J&R Publishing Services Ltd, Guildford, Surrey, UK; www.jr-publishingservices.co.uk

Contents

Contributors 

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Foreword by Stephen von Tetzchner

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P art I Language learning in aided communication: Theoretical and empirical considerations 1

Introduction

2

Constructing a language in alternative forms

Stephen von Tetzchner and Kristine Stadskleiv

17

3

Operational demands and representational forms

Janice Murray, Helen Bell and Juliet Goldbart

35

4

S ymbolic representation and graphic symbol use: Insights from typical development

65



Martine M. Smith and Janice Murray

Ann Sutton

5

6

7

1

Syntax and morphology in aided language development

119

Narrative development and aided communication

141

Literacy learning and aided communication

159

Sally Clendon and Kate Anderson Gloria Soto and Renee Starowicz Annika Dahlgren Sandberg

Part II Language use in aided communication: Theoretical and empirical considerations 8 Co-construction, asymmetry and multimodality in children’s conversations

177

9 Time and timing in interactions involving individuals with ALS, their unimpaired partners and their speech generating devices

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Michael Clarke

Jeff Higginbotham, Katrina Fulcher and Jennifer Seale

The Silent Partner?

vi

10 Relevance in the context of multimodality and aided communication

229

11 Communication participation of adults who are lifelong aided communicators

247

12 “…this is not going to be like, you know, standard communication?” Naturally speaking adults using aided communication

269

13 Conclusion

289





Caroline Jagoe and Martine Smith

Lynsey Parrott

Martine Smith, Ellen McCague, Justyne O’Gara and Seana Sammon



Martine M. Smith and Janice Murray

Contributors Kate Anderson, College of Humanities and Social Sciences, Aukland, New Zealand Helen Bell, Manchester Metropolitan University, Manchester, UK Michael Clarke, University College London, UK Sally Clendon, College of Humanities and Social Sciences, Aukland, New Zealand Annika Dahlgren Sandberg, Gothenburg University, Sweden Katrina Fulcher, SUNY Fredonia, New York, USA Juliet Goldbart, Manchester Metropolitan University, Manchester, UK Jeff Higginbotham, University at Buffalo, Buffalo, New York, USA Caroline Jagoe, University of Dublin, Trinity College, Ireland Ellen McCague, University of Dublin, Trinity College, Ireland Janice Murray, Manchester Metropolitan University, Manchester, UK Martine M. Smith, University of Dublin, Trinity College, Ireland Justyne O’Gara, University of Dublin, Trinity College, Ireland Lynsey Parrott, University of St Mark & St John, Plymouth, UK Seana Sammon, University of Dublin, Trinity College, Ireland Jennifer Seale, University at Buffalo, Buffalo, New York, USA Gloria Soto, San Francisco State University, California, USA Kristine Stadskleiv, University of Oslo, Norway Renee Starowicz, University of California-Berkeley and San Francisco State University, California, USA Ann Sutton, University of Ottawa, Ontario, Canada Stephen von Tetzchner, University of Oslo, Norway

Foreword The present collection edited by Martine Smith and Janice Murray addresses a range of new and persistent issues in the field of augmentative and alternative communication, mainly but not exclusively related to aided language use and communication. The aim of the editors is to shed light on the aided language process itself. Although the field is coming of age, many issues related to this process are still unresolved or not even approached. The chapters apply different theoretical and methodological approaches, studying aided language in both typical and atypical aided language circumstances. In typical circumstances, there are aided communicators who are using communication aids as their main form of language in everyday interactions. In atypical circumstances, naturally speaking children and adults are using communication aids as part of an experiment or an attempt to simulate aided language interaction. Together, the circumstances included here represent three perspectives on the study of aided language processes. The first perspective addresses the use of communication aids as a first expressive language, as the acquisition of an alternative language mode. This is an atypical form of language development. Typical developments represent the ordinary range of abilities and skills. Atypical development always represents constraints and requires a narrower set of environmental conditions for optimal development than typical development. Atypicality does not have to imply abnormality, only that something is done in less common ways (von Tetzchner, in press). Due to the lack of a natural environment of aided communicators, the language environment and language experiences of aided communicators have to be planned and constructed and, unlike the environment of children who develop spoken language, many of these experiences are part of direct teaching. There are both similarities and differences between aided communication and natural speech but any form of language development represents an achievement. The use of communication aids always implies a lack of speech, and while the children are commonly termed “speech-impaired”, it is still an issue how the children’s achievements as aided language users should be reflected in how they are addressed (von Tetzchner & Basil, 2011). The present book mirrors the inherent contradiction between achievement and disability, as well as between communication for instruction and for other forms of communication. Such contradictions are reflected in chapters analyzing interactions involving aided communicators and chapters addressing aided language primarily as a communication mode in need of repair. The strong intervention perspective in the field is evident in that excerpts of aided conversations typically include a practitioner or an experimenter. The second perspective addresses the acquisition of aided language as a second language. This includes aided communicators who started using communication aids as a language prosthesis in adolescence or as adults due to acquired loss of articulatory and language skills. They include individuals with brain or muscle injury arising from

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accidents, or acute or progressive disease, including ASL and other motor diseases. The fact that they have been able to use spoken language in an ordinary manner implies that the linguistic basis differs from children developing aided language, and has a strong influence on the aided interaction process. Some individuals begin to use communication aids after a stroke or a physical accident leading to aphasia but may not really belong to this perspective, as they have lost many of the first language skills on which they must build the acquisition of a second language. The aided communicators described in this book thus constitute a variety of groups, differing in receptive language abilities, alternative language mode, vocabulary access, aided system, whether they operate the aid with codes to spoken messages or construct utterances based on graphic symbols; they differ in the systems used, and their speed and accuracy in navigating their aid. From a language point of view, pictorial symbols may be regarded as more “alternative” than letters, whose function is to reflect the spoken language (see de Saussure, 2011). In studies based on the two first perspectives, most interactions involve an aided communicator and a naturally speaking person. The literature on aided communication contains few descriptions of interactions between two or more aided communicators, and most of them include a naturally speaking mediator or interpreter. One suggestion presented here is that such interactions should not be described as one aided and one naturally speaking communicator but as an interactional unit where the participants have supplementary conversational roles. Problems achieving shared meaning may appear during any conversation. In both typical and atypical interactions, there is a need for reciprocal adjustments by the communication partners, but adaptations may not always be optimal in aided interactions. Similarly, in “foreigner talk” increasing voice loudness is a common characteristic, in spite of the fact that it is comprehension of a foreign language, not a hearing loss, that is the cause of the communication problem (Ferguson, 1981). In the present volume, there are many examples of problems in establishing shared meaning. They are not caused by the aided or the naturally speaking communicator alone, and thus not solved only by training one of them. It is a shared responsibility to make communication successful. The third perspective addresses the aided language process through experimental studies where naturally speaking children and adults “translate” spoken utterances into graphic utterances and simulate conversations involving aided communicators. These children and adults have limited experience and a small repertoire of aided language skills, in some ways similar to the acquisition of a pidgin language (Siegel, 1997), and the studies may be most relevant for understanding the early phases of acquiring aided communication as a second language mode. Presenting the aided communication of various user groups, as well as how naturally speaking children and adults use communication aids when simulating aided communication, gives a broader perspective than in most collections on aided communication. The volume addresses different aspects of conversations involving the use of communication aids, the difficulties and achievements of the different user groups, as well as the roles they fill, that is, role in the traditional sociological sense of the term, as a set of expectations related to the person in a particular function (Biddle, 1986). Still, the core function of the aid is to produce an utterance. This is usually not the

Foreword

only way of communicating, either for aided or for naturally speaking communicators: in face-to-face interaction utterances are typically supplemented by gaze, pointing, gestures, facial expression, etc. Individuals described as aided communicators may also use non-aided communication means like symbolic pointing. However, much communicative content is difficult to relay without language, and hence the language in aided communication is crucial and cannot easily be replaced by non-aided or nonverbal means. Aided language may have different forms: one may distinguish between (a) graphic symbols in their own right, whose meanings can be translated to spoken words of different languages, like spoken words and sentences are translated between languages; and (b) systems with symbols that represent spoken words and sentences, similar to how Chinese characters represent spoken words and orthographies represent speech sounds. Children developing aided communication as a mother tongue may start by using the first type, and individuals with acquired disorders the second. Homonymy (where one word form has several meanings) exists in most languages, is prominent in English, and is usually solved in the context; however, homonymy is more explicitly addressed in conversations with pictorial graphic symbols. One aspect of graphic symbol use is thus the often-literal interpretation which makes it more difficult for aided communicators to use language in a flexible way. The arbitrariness of the word form may be lost in metonymic-based pictorial symbol systems, and transparency may be a constraint rather than a support for meaning construction with graphic symbols (von Tetzchner, 2015). It is an underlying theme in several chapters that aided communication is not only a matter of form, the physical act of using a communication book or an electronic device with graphic symbols or letters as replacement or supplement to natural speech production. It is a “life form” in a Wittgensteinian sense (Wittgenstein, 1953), where construction and production of utterances, and the interactional and functional elements of the conversation, are both similar to and different from conversations involving naturally speaking communicators only. One important issue is identity as an aided communicator. The aid itself may facilitate an attribution of identity as belonging to a category of aid users, but there may be a weak uniting force. For one reason, aided communicators rarely communicate together: As a group, they are constructed in the eye of the communication partners. Moreover, rather than developing an emerging identity as a competent aided communicator, young aid users often have to prove themselves and, when difficulties arise, the status as competent aided communicator may easily be lost (see Smith et al., 2010). The chapters in the book afford new reflections on aided language and communication, and on the similarities and differences between users and how they use their communication aids. Each perspective provides interesting and valuable information but also reflects that there are still larger parts and many details of knowledge lacking. It is a complex picture that emerges from this book. Some core characteristics of aided communication and language may be abstracted from these different perspectives but the chapters also demonstrate the need for a coherent conception of aided communication. I believe the content of the book will inspire many new studies.

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References Biddle, B.J. (1986). Recent development in role theory. Annual Review of Sociology, 67–92. De Saussure, F. (2011). Course in General Linguistics. New York, NY: Columbia University Press. Ferguson, C.A. (1981). ‘Foreigner Talk’ as the name of a simplified register. International Journal of the Sociology of Language, 28, 9–18. Siegel, J. (1997). Using a pidgin language in formal education: Help or hindrance? Applied Linguistics, 18, 86–100. Smith, M., Murray, J., von Tetzchner, S., & Langan, P. (2010). A tale of transitions: The challenges of integrating speech synthesis in aided communication. In J. Mulennix & S. Stern (Eds), Computer Synthesized Speech Technologies: Tools for Aiding Impairment, pp. 234–256. Hershey, PA: IGI Global. von Tetzchner, S. (2015). The semiotics of aided language development. Cognitive Development, 36, 180–190. von Tetzchner, S. (in press). Child and Adolescence Psychology: Typical and Atypical Development. Hove, UK: Routledge. von Tetzchner, S., & Basil, C. (2011). Terminology and notation in written representations of conversations with augmentative and alternative communication. Augmentative and Alternative Communication, 27, 141–149. Wittgenstein, L. (1953). Philosophical Investigations. Oxford: Blackwell.

Part I L anguage learning in aided communication: Theoretical and empirical considerations

1 Introduction Martine M. Smith and Janice Murray

Aided communication refers to the use of communication tools that are external to the individual to “aid” co-construction of meaning in interactions with communication partners. In general, aided communication is introduced when, for whatever reason, a child or adult is unable to effectively use unaided modes of communication (e.g., speech, gesture, facial expression, vocalizations, etc.) to meet their communication needs. As noted by von Tetzchner and Stadskliev (this volume), interventions incorporating aided communication have a history stretching almost 50 years. Although much has changed since the first communication boards were described in the 1960s, the fundamental challenge such interventions seek to address (i.e., enabling individuals who experience significant difficulty in producing and/or interpreting intelligible spoken language to participate fully in communication interactions) remains unchanged. The purpose of this book is twofold: (a) to explore how, within communication interactions, aided communication resources are used and interpreted as individuals negotiate shared meanings; and (b)  to consider how the use of aided communication potentially influences and is influenced by the developmental path of children as they become enculturated into linguistic communities that are often unfamiliar with aided communication. Von Tetzchner and Martinsen (2000) proposed three different categories of use of augmentative and alternative communication. The particular interest in this volume is on what they term expressive use. Expressive use of aided communication refers to those situations where an individual can hear and understand spoken language but is unable to express or articulate with sufficient intelligibility to allow listeners to reliably infer communicative intent. In most instances, speech motor control difficulties are the primary cause of poor intelligibility, but it is not unusual for other difficulties to be present also. Although the chapters that follow here describe many different interaction situations and many different participants, in each case the participants referred to experience a discrepancy between what they can understand and what they are able to express using speech. In some instances, this discrepancy is contrived (see, for example, Chapter 4 by Sutton, focusing largely on children with no identified disabilities). In

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The Silent Partner?

others, the discrepancy is a consequence of a life-changing event, an acquired disability (see Higginbotham, Chapter 9, this volume). In many of the chapters, the focus is on children (e.g., Clarke; Clendon & Anderson; Dahlgren Sandberg; Soto & Starowicz; all this volume) or adults (Parrott, this volume) who were born with a disability and who require access to aided communication to support expressive communication for most if not all their lives.

Part I The book is divided into two main parts. Part I focuses on some of the puzzles, opportunities and challenges that arise when aided communication is introduced as children set out on a path of development, a path that incorporates physical, motor, sensory, cognitive and linguistic evolution on a grand scale. Renner (2003, p. 72) draws on the work of Vygotsky to suggest that the need to use aided communication represents a “developmental sidetrack”, an alternative route to development, one worthy of investigation in its own right. The developmental sidetracks afforded by aided communication are, as yet, not well understood. In Chapter 2, von Tetzchner and Stadskliev set the scene for much of the first part of this book, exploring some of the developmental demands and opportunities arising from the concurrent emergence of language and aided communication competence in young children. Their position is that learning to use aided communication represents an extraordinary form of language development, and that success in this enterprise is heavily influenced by a child’s language learning environments. They propose three basic requirements of environments that support aided language development. The first is that the environment (i.e., the communication partners within that environment) recognizes a child’s need for aided communication and provides aided solutions that match a child’s abilities. Second, the environment must be communicatively accessible. Studdert-Kennedy (1991) proposes that “language is not an object, or even a skill, that lies outside the child and has somehow to be acquired or internalized. Rather it is a mode of action into which the child grows…” (p. 10). Children learning to use aided communication can only grow into this mode of action if aided communication is available at all times and if opportunities to use aided communication are offered across environments and communication partners. Communicatively accessible environments ensure that the requisite mode of action is consistently available and accessible. Third, von Tetzchner and Stadskliev suggest that communication partners must be competent in incorporating aided communication into interactions in ways that are nuanced and tailored to each child’s skills and abilities, scaffolding and supporting aided language development. Mere provision of aided communication opportunities does not automatically yield a communicatively accessible environment. Unless communication partners are knowledgeable about the aided language form, can interpret conversation contributions expressed through aided communication, and are both willing and able to communicate in a manner that promotes a child’s communicative autonomy, communicative access remains elusive and the extent to which a child can demonstrate growth into the “mode of action” of aided language is constrained.

Introduction

Many other factors can constrain the extent to which children learning language using aided communication can demonstrate their knowledge, skills and competence. In Chapter 3 (Murray, Bell & Goldbart), the complex cognitive, motor and perceptual demands of using aided communication are explored. One of the themes of this chapter, the relationship between the multiple symbol forms experienced by children who use aided communication, is developed further in Chapter 4, where Sutton explores how children (with or without disabilities) develop an understanding of pictures, of pictures as symbols and of graphic symbols as communicative tools. Drawing from a wide body of research, she questions what we can and should infer about children’s symbolic and linguistic competence from their use of pictures or graphic symbols. As noted by Ninio and Snow (1996), one of the challenges children learning language must tackle is working out “how to formulate their social moves through language in a form interpretable by their interlocutors…” (p. 4). This challenge is greatly increased for children using aided communication. The form of their communication is inevitably different to the primary forms used by the majority of the communication partners with whom they interact. Chapters 4 to 6 of this volume focus on some of the critical interfaces between the forms of spoken language in which children are immersed and the forms of aided communication which they access in order to participate in interactions. In Chapter 4, Clendon and Anderson consider one point of intersection that has been the focus of some research attention: the impact of aided language use on the emergence of competence in spoken language structure, specifically in the domain of morphology. It has long been recognized that utterances produced using aided communication commonly lack aspects of structural organization, often characterized by a dominance of short or single-symbol utterances, with limited evidence of morphological inflections (Binger & Light, 2008; Blockberger & Johnston, 2003; Smith 2015; Sutton, Soto, & Blockberger, 2002). Conversely, it is also reported that the aided communication options provided to children learning language are often restricted in their potential to express output that reliably reflects a child’s developmental linguistic abilities (Blockberger & Johnston, 2003). Even if grammatical markers such as inflections are available, the meta-cognitive and meta-linguistic demands implicit in accessing and selecting such forms in aided communication often greatly exceed the developmental stage at which expression of such markers might be expected in spoken language. In this chapter, Clendon and Anderson review some of what is known about the emergence of morphological competence in children using aided communication, at least from an English-language perspective. Offering a new interpretation of the conundrum of pre-stored utterances, they draw analogies between the use of such utterances and the commonly reported “recycling” of phrases and words in spoken language. Gloria Soto and Renee Starowicz continue the theme of language development in aided communication, focusing on that quintessentially human activity, narrative construction and interpretation. Setting out the importance and the developmental emergence of narratives, they explore some of the features of narratives produced using aided communication and outline interventions that have focused on enhancing narrative skills in children using aided communication. Both narrative abilities and

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morphological competence are known to influence another aspect of language learning: the development of literacy skills. In the final chapter of Part I, Annika Dahlgren Sandberg reviews some of what we know about the specific challenges faced by children who require expressive use of aided communication in mastering yet another code for language: written orthographies. It seems reasonable to suggest that the factor that results in a need to use aided communication (i.e., a severe speech impairment) might create risk for literacy attainment, but many decades of research have indicated that this relationship is far from simple. Some of this complexity derives from the fact that reading and writing are learned skills. The learning environment and the available teaching supports are critical elements influencing the final outcome. Within those environments, it seems reasonable to suggest that aided communication may offer learning opportunities that are not always fully exploited.

Part II A constructivist perspective Part II of this volume shifts focus from the roles of aided communication in development to exploring instances of the “here-and-now” as interactions unfold. Communication can be modeled and construed in many different ways. In an information transmission model of communication, a meaning or message is sent by one participant in an interaction (a sender) and is received by another (the receiver), via a mutually accessible and intelligible channel of information (the signal) (Shannon & Weaver, 1949, as cited by Lloyd, Quist, & Windsor, 1990). Successful communication in this model implies that the meaning sent by the sender is received and retrieved by the receiver, so that successful transfer of information occurs. Anything that disrupts the integrity of the signal (for example excessive ambient noise, reduced speech motor control on the part of the speaker-sender, or reduced hearing on the part of the receiver) may compromise communicative success and disrupt the transmission of meaning. In this model, aided communication options, such as communication boards or speech output devices, seek to enhance the quality or change the channel of the signal, so that the sender’s message signals are boosted or modified to a point where they can be decoded by the receiver and the meaning can be retrieved (Lloyd et al., 1990). An alternative, constructivist perspective on communication is that meanings are not sent for processing from a sender to a receiver, but rather are co-constructed within interactions, where both participants seek to interpret each other’s meanings in a constant, active and dynamic process (e.g., Sperber & Wilson, 1988). In this model, the meaning of a given utterance does not reside in any one participant in an interaction, but rather is negotiated between interactants, as each participant seeks to infer the possible intended meaning of a speaker in producing a particular utterance. Such a model incorporates a view that decoding the linguistic meaning of an utterance is often insufficient as a guide to interpreting a speaker’s meaning. As suggested by Sperber and Wilson (1988) “communication is successful, not when hearers recognize the linguistic meaning of utterances, but when they infer the speaker’s ‘meaning’ from it” (p. 23).

Introduction

In this volume, constructivist models of communication underpin discussions across the chapters in Part II. There are a number of reasons for this perspective. One is that these models seem better situated to capture a common feature of interactions involving aided communication, namely repeated attempts by naturally speaking participants to gloss contributions offered in aided communication, in a way that is accepted by the other participant in the interaction as an interpretation of the intended meaning. Take, for example, the following extract from Brekke and von Tetzchner (2003, p. 185), where Sander, a young boy aged 6 years 8 months at the time of this interaction, was in dialogue with his teacher, using his picture book:

Extract 1.1 1 S: QUESTION 2 T: Question 3 S: BOOK 4 T: Book. Can you say more? 5 S: HOUSE 6 T: House 7 S: FINISHED ‘End of topic, turn to interpret’ 8 T: Is there a book you want? 9 S: ‘Yes’ (mouth movements) 10 T: Can you say which one it is? 11 S: (looks at project book) 12 T: Do you want your project book? 13 S: ‘Yes’ (mouth movements) 14 T: You said house, do you mean your home? 15 S: ‘No’ (mouth movements) 16 T: Do you mean the respite home? 17 S: ‘Yes’ (mouth movements) 18 T: Do you ask whether you can take the project book to the respite home? 19 S: ‘Yes’ (mouth movements) 20 T: Yes, of course, it is your book (gives Sander his copy) 21 S: ‘No’, ‘yes’, ‘no’, ‘yes’ (mouth movements). In this extract, it is clear that the teacher has successfully received and decoded a signal about a book and a house, but is unclear about the intended meaning. She first explicitly asks about meaning in lines 14 and 16 (do you mean your home? do you mean the respite home?), and then follows up with an implicit request for clarification as she tries to identify Sander’s intended link between the two decoded elements (project book

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and respite home) (line 18). While meaning negotiation is a hallmark feature of all conversations, this search for meaning may be qualitatively different, and particularly more explicit in interactions involving aided communication. The resources available in aided communication to disambiguate intended meanings often create increased potential for both ambiguity and mismatches between the interpretation of an utterance in aided communication and the intended meaning. A second advantage of a constructionist perspective in exploring interactions involving aided communication is that such a model places shared responsibility on all participants in an interaction in negotiating meaning. This frame broadens the discussion from a focus on individual “aided communicators” to the actions of all participants in interactions involving aided communication. Such a perspective also opens possibilities for exploring creativity and flexibility of participants in guiding interactions towards an agreed, acceptable meaning resolution. Finally, constructivist accounts focus on the process of meaning negotiation, rather than on the nature, quality or integrity of the channel or the signal. As such, they offer a way of avoiding the “killer D’s” of deficit, disability and diagnosis (Duncan, Miller & Sparks, 2011, p. 129), focusing instead on what is happening within an interaction as worthy of study in its own right. The title of this book reflects an underlying proposition: that in interactions involving aided communication, the aided communication component itself influences the interaction process, affecting all participants in the interaction. The presence of aided communication may extend participants’ focus beyond a triadic frame of “who we are as participants and what we are talking about”, to include how we are talking about what we are talking about. The question of how we are talking about what we are talking about is the main focus of the chapters in Part II.

Creativity, challenges and constructing identities Mike Clarke sets the scene for this part of the book, reviewing the contributions that both quantitative, distribution-focused analysis of conversational interactions, and qualitative Conversation Analysis techniques have made to enhancing our understanding of the structure, role and opportunities implicit in interactions involving aided communication. Reviewing a wide body of research, he explores how the asymmetry so often referred to in describing interactions involving aided communication, may be re-interpreted as a framework to support interaction success, guiding participants in their projections of upcoming turns to optimize the explicit relevance of upcoming contributions. Similarly, he revisits the oft-cited reliance on unaided modes in interactions, even where sophisticated aided communication options are available and accessible. Drawing on a range of data samples involving children who use aided communication, he illustrates the rich multimodal fabric of such interactions, highlighting the nuanced and sophisticated ways in which participants orient towards and attune to communication signals as they co-construct meanings in carefully managed timing sequences. He argues persuasively for consideration of aided communication components as the shared responsibility of all participants in

Introduction

interactions and the complexity he reveals through these analyses elegantly illustrates what he himself describes as the “diversity and brilliance” of such interactions. Jeff Higginbotham, Katrina Fulcher and Jennifer Seale continue the theme of exploring competence in the face of challenges, turning attention to the context of adults with acquired dysarthria and motor impairments interacting with conversation partners across a range of tasks. These authors explore the limitations that are often intrinsic to speech generating devices (SGDs) that have been developed from the perspective of a sender-receiver model of communication as outlined earlier. Such a model presumes that the roles of sender and receiver are relatively independent of each other. Higginbotham and his co-authors use the term grounding to describe the process whereby individuals within an interaction constantly strive to successfully achieve mutual understanding of each other’s communicative contributions, in a dynamic, reciprocal process of mutual influence. Focusing particularly on the timing challenges of co-coordinating conversational contributions involving aided communication, these authors highlight the explicit attempts that adults may make to address these challenges and minimize misunderstandings due to mis-timings or delays. Such strategies are not always successful and many of the interactions analyzed in this chapter highlight the cost of poor synchronization of conversational contributions. The authors reflect on how the design of SGDs may add to the synchronization challenges faced by adults using aided communication. Both this chapter and that by Clarke explore the creative solutions applied by participants in interactions involving aided communication as they try to arrive at a shared understanding of how each contribution is relevant and is to be interpreted. Jagoe and Smith (Chapter 10) continue this theme, applying a Relevance Theory lens to explore possible motivations in the selection of specific contributions offered through aided communication and how interaction partners interpret those contributions. A fundamental tenet of Relevance Theory (Sperber & Wilson, 1988) is that participants in an interaction are bound by a core responsibility to be relevant. Hearers are entitled to expect that speakers have produced the most relevant utterance that they are willing and able to produce at that time and in that context. The task for the hearer is to work out how a particular contribution is relevant to the ongoing interaction and to arrive at an interpretation of the contribution that is bounded by the requirement of relevance. In interactions involving aided communication, the potential for ambiguity is great, not only because of the nature of the tools available (including the vocabulary restrictions alluded to in Chapter 2), but also because the additional physical impairments that often accompany a need to use aided communication may impact on nonverbal communication cues and unaided communication modalities. Although all communication in face-to-face interaction is multimodal, the extent and importance of multimodality is more prominent in interactions where the aided communication tools themselves offer at least two visual stimuli (graphic symbols on a speech generating device and written text labels) and when selected, generate a synthetic speech signal. In their role as “speaker”, participants must make choices not only about how to encode contributions, but also how to let their communication partners know which aspects of which modalities are the ones to which they should direct their attention. In this chapter, Jagoe and Smith explore data drawn from interactions

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between an 8-year-old boy and his teacher, highlighting the creative solutions that can emerge as participants seek to arrive at a shared meaning. As under-specified units of meaning, graphic symbols offer potential for what has been termed “loose use” (Carston, 2002), where the hearer is expected to construct a non-literal ad hoc concept from a lexically encoded concept as part of the interpretative process. However, unless a hearer approaches the task of interpreting utterances with an openness to creative and loose use of graphic symbols, this strategy may not lead to success in meaning negotiation. In Chapter 11, Lynsey Parrott reviews co-constructed conversation involving aided communication with four adults, all of whom have used aided communication for many years. Taking a discourse analysis approach, the conversations are considered in terms of the balance between contributors, but also the strategies used to convey identity, personality, interaction leadership and ownership techniques, as part of the representations of self. As these interactions highlight, such interactions are unequivocally multimodal, where the aided system is one contributing aspect of the dialogue. Although many individuals who use aided communication have an acquired disability, such as those individuals described by Higginbotham et al. (this volume), relatively little is understood about how they accommodate to the requirement to change their communicative style, or how their communication partners adapt over time to the introduction of communication boards, voice output devices and changed access to gesture, facial expression and vocalization. Some of these issues are explored in Chapter 12 (Smith, McCague, O’Gara & Sammon), not with adults with acquired disabilities, but with students without disabilities who, over a six-week period developed communication boards for themselves and participated in video-recorded dyadic interactions, at times in the role of aided speaker and at times as natural speakers. In their reflections on the experience, a common theme that emerged was the perceived effort involved in both expressing and interpreting aided communication. Participants’ surprise at the degree of effort involved led them to make decisions about what kinds of things they were willing to discuss, how they structured their interactions and how those choices impacted on their presentation and perception of self as communication partners. Their reflections hint at the theme of identity constructed through communication revisiting some of the issues raised by Soto and Parrott, in earlier chapters.

Navigating the text In any edited textbook, a number of decisions must be made in the interest of coherence, uniformity and reducing the demands on the reader. Contributors to this volume were encouraged to include data within their chapters. In most chapters, particularly in Part II, these data are in the form of transcribed extracts of interactions between participants. On the whole, these extracts comply with the transcription conventions described by von Tetzchner and Basil (2011), as promoted by the AAC journal. These conventions are summarized in Appendix 1A, at the end of this chapter. Some of these conventions are applied across the text and not simply within transcribed extracts. For example, throughout the text, reproductions of utterances produced using natural speech are italicized (e.g., this represents an utterance produced using natural speech), while output generated using synthetic speech is enclosed within double quotation

Introduction

marks and is italicized (e.g., “this convention indicates an utterance produced using digitized speech”). Throughout the text, GRAPHIC SYMBOLS are identified through the use of upper case italicized font. There are many language representation forms potentially available for use by children and adults using aided communication and many different forms are included in the extracts across different chapters. These include spelling, orthographically represented whole words, a range of graphic symbol forms and Minspeak™ (Baker, 1982). No attempt has been made to provide a comprehensive or even representative overview of available systems. The focus throughout is on the communication interaction that emerges within the dialogue, and how this process is supported and shaped by the available tools. Additional notation conventions are required for some of the extracts, particularly those in Part II of this book, where fine-grained analysis is undertaken. In such instances, the specific notational conventions are summarized at the end of the relevant chapter. These conventions are in addition to those summarized in Appendix 1A and do not replace the latter. Some of the extracts presented in these chapters derive from an ongoing international project Becoming Aided Communicators (BAC), led by Stephen von Tetzchner in Norway. This multi-site project has contributors from over 16 countries and has generated a wealth of data that is now starting to offer new insights into the challenges, experiences and skills of children who are learning to use aided communication and those of their key communication partners (e.g., Stadskleiv et al., 2014). The full list of the participating researchers and some of the current publication output from this project is provided in Appendix 1B of this chapter. Extracts drawn from this project are identified in the relevant chapters by the insertion of a superscript BAC (e.g., Extract 1BAC). Other extracts unrelated to the BAC project are included in this volume, some of which are drawn from existing publications and some of which are original to the individual chapters. Although all the chapters in this book are focused on a shared phenomenon (the use of aided communication in interactions with partners who use natural speech), it is intended that each chapter can be read independently of others, if so desired. Chapters are therefore diverse in their structure and approach, with one chapter comprising a structured narrative review (Chapter 4), another describing a specific research project (Chapter 12) and yet others providing a synthesis of research (e.g., Chapters 2, 5–7) or drawing data from a range of research projects (e.g., Chapters 8– 10). While there are clear areas of overlapping interest (and at times these points are referenced within the text), contributors were encouraged to address what they saw as the key issues within the topic of the chapter, without reference to the other chapters. This decision means that at times there is a degree of repetition and of explanation of terminology – repetition that is necessary if the principle of allowing chapters to stand alone is given weight. For this reason also, references are included at the end of each chapter, rather than in a single bibliography at the end of the text. Throughout the book, extracts, tables and figures are numbered by chapter and sequence (i.e., the first table in Chapter 5 is numbered Table 5.1, etc.). The question of terminology is always somewhat fraught and the terms for describing

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aided communication and those who use it have varied over the past decades. In this text, aided communication refers to any communication that involves the use of tools that are external to the individual. Most commonly, this involves high-tech devices, referred to here as Speech Generating Devices (SGDs) or low-tech options such as communication boards. The term communication device or communication aid may refer to either a low-tech or a high-tech piece of equipment, although in general the word device is used in the context of technology.

Summary and conclusion The starting point for this book was a concern to explore the achievements of children and adults who use aided communication and a desire to focus on what can be considered the “third party” in interactions where aided communication is used – the aided component itself. While much has been written about communication devices, their design and organization, and about the extent to which devices are used and for what purposes, the focus here is on how introducing communication aids into interactions influences the communication that unfolds and the participants in that interaction in their roles as speakers and hearers. This focus is not unique to this text. There has already been interest in how the presence of a communication aid extends traditional frames of joint attention from dyadic to triadic in interactions between young children and adults (e.g., Benigno, Bennett, McCarthy, & Smith, 2011; Benigno & McCarthy, 2012; Smith, McCarthy, & Benigno, 2009). Echoes of this interest surface in Chapter 9, in the analysis by Higginbotham and colleagues of interactions between adults, and in Chapter 8, where Clarke analyzes interactions involving school-aged peers. What the chapters in this text share is a premise that when a communication aid is introduced into a communication situation, its presence changes the nature of the interaction and the roles of the participants in that interaction. Even when it is not actively used within the interaction, its silent presence exerts an influence – in much the same way that the presence of a third potential conversation participant may influence the dynamic of any interaction. The title of this text – The Silent Partner – has been chosen to focus attention not on a communication aid as an entity in itself, but on how interlocutors can draw an aided communication component into interaction partnerships and on how this silent partner role affords and shapes developmental opportunities over time and across a range of domains of language.

References Baker, B. (1982). Minspeak, a semantic compaction system that makes self-expression easier for communicatively disabled individuals. Byte, 7, 186–202. Benigno, J., Bennett, J., McCarthy, J., & Smith, J. L. (2011). Situational and psychosocial factors mediating coordinated joint attention with Augmentative and Alternative Communication systems with beginning communicators without disabilities. Augmentative and Alternative Communication, 27, 67–76. Doi:10.3109/07434618.2012.654191 Benigno, J., & McCarthy, J. (2012). Aided symbol-infused joint engagement. Child Development Perspectives, 6, 1810186.

Introduction

Binger, C., & Light, J. (2008). The morphology and syntax of individuals who use AAC: Research review and implications for effective practice. Augmentative and Alternative Communication, 24, 123–138. Doi:790496493 [pii] 10.1080/07434610701830587 Blockberger, S., & Johnston, J. (2003). Grammatical morphology acquisition by children with complex communication needs. Augmentative and Alternative Communication, 19, 207–221. Brekke, K.M., & von Tetzchner, S. (2003). Co-construction in graphic language development. In S. von Tetzchner & N. Grove (Eds), Augmentative and Alternative Communication: Developmental Issues (pp. 176–210). London: Whurr. Carston, R. (2002). Thought and Utterances: The Pragmatics of Explicit Communication. Oxford, UK: Blackwell Publishing. Duncan, B., Miller, S., & Sparks, J. (2011). The Heroic Client: A Revolutionary Way to Improve Effectiveness Through Client-directed, Outcome-informed Therapy. London: John Wiley & Sons. Lloyd, L., Quist, R., & Windsor, D. (1990). A proposed augmentative and alternative communication model. Augmentative and Alternative Communication, 6, 172–183. Ninio, A., & Snow, C. (1996). Pragmatic Development. Oxford, UK: Westview Press. Renner, G. (2003). The development of communication with alternative means from Vygotsky’s cultural-historical perspective. In S. von Tetzchner & N. Grove (Eds), Augmentative and Alternative Communication: Developmental Issues (pp. 67–82). London: Whurr. Smith, J.L., McCarthy, J., & Benigno, J. (2009). The effect of high-tech AAC system position on the joint attention of infants without disabilities. Augmentative and Alternative Communication, 25, 165–175. Doi:10.1080/07434610902972410 Smith, M. (2015). Language development of individuals who required aided communication: Reflections on state of the science and future research directions. Augmentative and Alternative Communication, 31, 215–233. Doi:10.3109/07434618.2015.1062553 Sperber, D., & Wilson, D. (1988). Relevance: Communication and Cognition. Cambridge, Mass: Harvard University Press. Stadskleiv, K., von Tetzchner, S., Batorowicz, B., van Balkom, H., Dahlgren Sandberg, A., & Renner, G. (2014). Investigating executive functions in children with severe speech and movement disorders using structured tasks. Frontiers in Psychology, 5, article 992, 1–14. Doi: 10.3389/fpsyg.2014.00992 Studdert-Kennedy, M. (1991). Language development from an evolutionary perspective. In N. Krasnegor, D. Rumbaugh, R. Schiefelbusch, & M. Studdert-Kennedy (Eds), Language Acquisition: Biological and Behavioral Determinants. Hillsdale, NJ: Erlbaum. Sutton, A., Soto, G., & Blockberger, S. (2002). Grammatical issues in graphic symbol communication. Augmentative and Alternative Communication, 18, 192–-204. Von Tetzchner, S., & Basil, C. (2011). Terminology and notation in written representations of conversations with Augmentative and Alternative Communication. Augmentative and Alternative Communication, 27, 141–149. Von Tetzchner, S., & Martinsen, H. (2000). Introduction to Augmentative and Alternative Communication (2nd ed.). London: Whurr.

Appendix 1a Transcription conventions The conventions below were originally proposed by Stephen von Tetzchner, and first appeared in print in the book, Augmentative and Alternative Communication:

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European Perspectives, co-authored by Stephen von Tetzchner and Mogens Hygum Jensen in 1996, and in the second edition in 2000, with subsequent discussion of the conventions in von Tetzchner and Basil (2011). 1. Naturally spoken elements are italicized. 2. “Words and sentences produced with digitized or synthesized speech” are italicized and placed in quotation marks. 3. MANUAL SIGNS are in capital letters. 4. GRAPHIC SIGNS and PICTURES are in capital letters and italicized. 5. Some manual signs or graphic symbols need more than one word in translation. When the gloss of a sign or symbol contains two or more words, these are hyphenated; for example, YOU-AND-ME or SIT-DOWN. 6. s-p-e-l-l-i-n-g is shown in lower case and underlined and has hyphens between letters. 7. ‘Interpretations or translations or meaning’ are used for interpretation of manual sign or graphic symbol utterances and appear in single quotation marks. This format is used when giving the meaning of facial expressions, gestures, pointing, etc.; for example, ‘yes’ (nodding) or ‘no’ (shaking the head). 8. { . . . } indicates simultaneous expressive forms; for example, speech and manual signs, or manual and graphic signs. For example, {GLAD I am glad} means that the manual sign GLAD is produced simultaneously with the spoken sentence I am glad. 9. Written whole words used for communication and which are selected as single units (e.g., on a word board) are underlined. From von Tetzchner, S., & Jensen, M.H. (1996). Augmentative and Alternative Communication: European Perspectives. (Table 0.1: Notations, p. 12). London: Whurr. See also von Tetzchner, S., & Basil, C. (2011). Terminology and notations in written representations of conversations with augmentative and alternative communication. Augmentative and Alternative Communication, 27, 141–149.

Appendix 1B Becoming Aided Communicators: Contributors and Publications Project Leader Stephen von Tetzchner Department of Psychology, University of Oslo, Norway

Principal Investigators (in alphabetical order) Maria Amelia Almeida, Federal University of São Carlos, Brazil Sue Balandin, Deakin University of Australia

Introduction

Carmen Basil, University of Barcelona, Spain Beata Batorowicz, McMaster University, Canada Sally Clendon, Massey University, New Zealand Marc Coronas, University of Barcelona, Spain Débora Deliberato, State University of S. Paulo, Julio de Mesquita Filho, Marilia campus, Brazil Margareta Jennische, Uppsala University, Sweden Kaisa Launonen, Helsinki University, Finland Elisabete Mendes, Escola Superior de Educação, Portalegre, Portugal Janice Murray, Manchester Metropolitan University, UK Leila Nunes, State University of Rio de Janeiro, Brazil Judith Oxley, University of Louisiana, Lafayette, USA Ana Peixto, Escola Superior de Tecnologia da Saúde do Instituto Politécnico do Porto, Portugal Gregor Renner, Catholic University, Freiburg, Germany Annika Dahlgren Sandberg, Gothenburg University, Sweden Martine Smith, University of Dublin, Trinity College, Ireland Emili Soro-Camats, University of Barcelona, Spain Gloria Soto, San Francisco State University, USA Kristine Stadskleiv, University of Oslo, Norway Lourdes Tavares, Instituto Politécnico do Porto, Portugal Hans van Balkom, Radboud University, The Netherlands Margje van der Schuit, Radboud University, The Netherlands Cátia C. Figueiredo Walter, State University of Rio de Janeiro, Brazil Ole Wriedt, Private practice, Aarhus, Denmark Chih-Kang Yang, National Dong Hwa University, Taiwan

BAC Publications Ahotupa, C. (2013). Monitapaustutkimus kommunikointikansiolla ilmaisevien lasten monimerkkisten ilmausten piirteistä [A multicase study of the features of multi-sign expressions of children who express themselves with a communication book]. Masters Thesis in logopedics, University of Helsinki. Airio, K. (2012). Graafisen viestinnän käyttäjien kielelliset ymmärtämisen taidot. Monitapaustutkimus PCS-merkkejä, bliss-symboleita ja kirjoittamista graafisena viestintäkeinona käyttävistä lapsista [Language comprehension skills of children who use graphic communication. A multicase study of children who use PCS, Bliss and writing as their graphic communication form]. Master Thesis in logopedics, University of Helsinki. Batorowicz, B. (2015). Social context, participation and goal-oriented communicative interaction of school-aged children with motor impairments who use augmentative and alternative communication: Voice and choice. PhD Thesis, McMaster University.

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Batorowicz, B., Campbell, F., von Tetzchner, S., King, G., & Missiuna, C. (2014). Social participation of school-aged children using communication aids: The views of children and parents. Augmentative and Alternative Communication, 30, 237–251. Doi: 10.3109/07434618.2014.940464 Batorowicz, B., Stadskleiv, K., & von Tetzchner, S. (2013). Acting on the physical world through aided communication. Presented at Regional Conference of the International Society for Early Intervention, Saint Petersburg, Russia, July 1–3, 2013. Batorowicz, B., Stadskleiv, K., & von Tetzchner, S. (2014). Participation of aided communicators in play with peers: Language for action. Presented at the 16th Biennial Conference of the International Society for Augmentative and Alternative Communication, Lisbon, Portugal, July 21–24, 2014. Batorowicz, B., Stadskleiv, K., von Tetzchner, S., & Missiuna, C. (2016, in press). Children who use communication aids instructing peer and adult partners during play-based activity. Augmentative and Alternative Communication. Deliberato, D., & von Tetzchner, S. (2016). Strategies used by Brazilian aided communicators in naming drawings using graphic symbols. Presented at the 17th Biennial Conference of the International Society for Augmentative and Alternative Communication, Toronto, Canada, August 8–11, 2016. Deliberato, D. & von Tetzchner, S. (2016). Young aided communicators narrating events from videos. Presented at the 17th Biennial Conference of the International Society for Augmentative and Alternative Communication, Toronto, Canada, August 8–11, 2016. Hämäläinen, E. (2010). Avusteisesti viestivien CP-vammaisten lasten ilmaisukyky ja apuvälineen rooli – äitien ja työntekijöiden näkemyksiä [Children with CP who use aided language: Expressive language and the role of AAC device. Mothers’ and professionals’ perceptions]. Master Thesis in logopedics, University of Helsinki. Launonen, K. (2016). Avusteisen kielen kehitys ja käyttötaidot [Aided language development and pragmatic skills]. Presented at Sillalla seminar, Helsinki, Finland, February 4–5, 2016. Mäkeläinen, K. (2009). Kirjoittamalla ilmaisevan lapsen kertomisen piirteet – Tapaustutkimus kirjaintaulua puhetta korvaavana keinona käyttävästä liikuntavammaisesta koululaisesta. [Narrative features of a child who expresses himself by writing – a case study of a severely motor disabled school-aged child who uses letter board as his AAC system]. Master Thesis in logopedics, University of Helsinki. Mäkinen, A. (2013). Monitapaustutkimus kommunikointikansiota viestinnässään käyttävien lasten kansioiden sanastoista ja kuvien nimeämisen keinoista [A multicase study of the expressive vocabularies and picture naming strategies of children who use a communication book in their communication]. Master Thesis in logopedics, University of Helsinki. Massaro, M., Stadskleiv, K., von Tetzchner, S., & Deliberato, D. (2015). Estrategias de comunicadores auxiliados na construcao de modelos fisicos. Presented at ISAAC VI Congresso Brasil, Saõ Paulo, June 11–12, 2015. Neuvonen, K. (2016). Kerro se kuvin [Tell it with graphic signs]. Presented at Sillalla seminar, Helsinki, Finland, February 4–5, 2016. Neuvonen, K., Launonen, K., & von Tetzchner, S. (2014). Partner strategies in conversations between aided and naturally speaking communicators. Presented at the 16th Biennial Conference of the International Society for Augmentative and Alternative Communication. Lisbon, Portugal, July 21–24, 2014. Nunes, L.R., Delgado, S.M.M., & Walter, C.C.F. (2011). O que dizem as familias e os profissionais sobre a comunicação alternativa. In L.R. Nunes, M. Pelosi & C.C.F. Walter (Eds), Compartilhando experiências: Ampliando a comunicação alternativa, Volume 1, pp. 41–55. Marilia, Brazil: Editora da Associação Brasileira de Pesquisadores em Educação Especial. Nunes, L.R., Walter, C.C.F., & Delgado, S.M.M. (2011). A comunicação alternativa na perspectiva das famílias, dos profissionais e dos próprios usuários. In Proceedings of the VI Congresso Brasileiro Multidisciplinar de Educaçao Especial. Londrina, Brazil: Editora da Universidade Estadual de Londrina.

Introduction

Nunes, L.R., Walter, C.C.F., & Delgado, S.M.M. (2012). A comunicação alternativa na perspectiva das famílias, dos profissionais e dos próprios usuários. In E.G. Mendes & M.A. Almeida (Eds), Dimensões pedagógicas nas práticas de inclusão escolar, Volume 2, pp. 399–419. Marilia, Brazil: Editora da Associação Brasileira de Pesquisadores em Educação Especial. Peluccio de Azevedo, V.A., Deliberato, D., & von Tetzchner, S. (2016). Communicative strategies of young aided communicators when describing visual scenes to different partners. Presented at the 17th Biennial Conference of the International Society for Augmentative and Alternative Communication, Toronto, Canada, August 8–11, 2016. Ruokonen, Anni (2012). Ikätoverin ja aikuisen viestinnän funktiot heidän viestiessään kansiota apuvälineenään käyttävän lapsen kanssa – monitapaustutkimus [Communicative functions of peers and adults when communicating with children who use a communication book as their aid – a multicase study]. Master Thesis in logopedics, University of Helsinki. Smith, M., Murray, J., & von Tetzchner, S. (2014). The tellability factor: Narratives in aided communication. Presented at the 16th Biennial Conference of the International Society for Augmentative and Alternative Communication. Lisbon, Portugal, July 21–24, 2014. Stadskleiv, K. (2013). Executive functioning and operational skills in aided communicators. Presented at the Third ISAAC Nordic Research Symposium, Oslo, Norway, April 18, 2014. Stadskleiv, K. (2014). Eksekutiv fungering hos barn med omfattende tale- og bevegelsesvansker [Executive functions in children with severe speech and motor impairment]. RHABU Regional fagkonferanse, Gardermoen, Norway, April 17–18, 2014. Stadskleiv, K. (2015). Eksekutiv fungering hos barn som bruker hjulpet kommunikasjon; implikasjoner for tiltak [Executive functioning in children who use communication aids: Implications for intervention]. Invited presentation at AKK konferens, Gothenburg, Sweden, April 18, 2015.  Stadskleiv, K., von Tetzchner, S., & Batorowicz, B. (2013). Assessing children who may need augmentative and alternative communication. Presented at Regional Conference of the International Society for Early Intervention, St Petersburg, Russia, July 1–3, 2013. Stadskleiv, K., von Tetzchner, S., & Batorowicz, B. (2014). Investigating executive functioning in aided communicators. Presented at the 16th Biennial Conference of the International Society for Augmentative and Alternative Communication. Lisbon, Portugal, July 21–24, 2014. Stadskleiv, K., von Tetzchner, S., Batorowicz, B., van Balkom, H., Dahlgren Sandberg, A., & Renner, G. (2014). Investigating executive functions in children with severe speech and movement disorders using structured tasks. Frontiers in Psychology, 5 (992). Doi: 10.3389/fpsyg.2014.00992 Toikka, Katri (2010). Kertomuksia kansiolla. Tapaustutkimus kommunikointikansiota käyttävän yhdeksänvuotiaan pojan kerronnasta ja kuvailusta. [Narratives with a communication book. A case study of narrations and descriptions with a communication book by a nine-year-old boy]. Master Thesis in logopedics, University of Helsinki. von Tetzchner, S., & Basil, C. (2011). Terminology and notation in written representations of conversations with augmentative and alternative communication. Augmentative and Alternative Communication, 27, 141–149. von Tetzchner, S., & Nunes, L.R. (2015). Pesquisa transcultural em comunicação alternativa: Justificativas, objetivo e metodologia. In R.Y.S. Chun, L. Reily & E.C. Moreira (Eds), Comunicação alternativa: Ocupando territórios, Volume 1, pp. 227–240. S. Carlos, Brazil: Marquezine & Manzini/ABPEE. von Tetzchner, S., & Stadskleiv, K. (2015). Utvikling av hjulpet kommunikasjon og kommunikativ problemløsning hos barn som bruker kommunikasjonshjelpemidler [Development of aided communication and communicative problem solving in children who use communication aids]. Presented at ISAAC Norge 12. National Conference, Sundvollen, Norway, April 13–15, 2015.

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von Tetzchner, S., Almeida, M.A., Balandin, S., Basil, C., Batorowicz, B., Clendon, S., Coronas, M., Dahlgren Sandberg, A., Deliberato, D., Jennische, M., Larsson, M., Launonen, K., Mendes, E., Murray, J., Nunes, L., Oxley, J., Peixto, A., Renner, G., Smith, M., Soro-Camats, E., Soto, G., Stadskleiv, K., Tavares, L., van Balkom, H., van der Schuit, M., Walter, C.C.F., Wriedt, O., & Yang, C.-K. (2010). The system and aid histories of children developing aided communication. Presented at the 14th Biennial Conference of the International Society for Augmentative and Alternative Communication, Barcelona, Spain, July 24–29, 2010. von Tetzchner, S., Almeida, M., Balandin, S., Batorowicz, B., Basil, C., Clendon, S., Dahlgren Sandberg, A., Deliberato, D., Jennische, M., Launonen, K., Mendes, E., Murray, J., Nunes, L.R., Oxley, J., Renner, G., Smith, M., Soro-Camats, E., Soto, G., Tavares, L., van Balkom, H., Walter, C.C.F., Wriedt, O., & Yang, C.-K. (2012). Becoming an aided communicator. Presented at 15th Biennial International Society for Augmentative and Alternative Communication, Pittsburgh, USA, July 28–August 4, 2012. von Tetzchner, S., Almeida, M.A., Balandin, S., Basil, C., Batorowicz, B., Clendon, S., Coronas, M., Dahlgren Sandberg, A., Deliberato, D., Jennische, M., Launonen, K., Mendes, E., Murray, J., Nunes, L., Oxley, J., Peixto, A., Renner, G., Smith, M., Soro-Camats, E., Soto, G., Stadskleiv, K., Tavares, L., van Balkom, H., van der Schuit, M., Walter, C.C.F., Wriedt, O., & Yang, C.-K. (2014). The development of communicative problem solving in aided and naturally speaking communicators aged 5–15 years. Presented at the 16th Biennial Conference of the International Society for Augmentative and Alternative Communication. Lisbon, Portugal, July 21–24, 2014. von Tetzchner, S., Almeida, M.A., Batorowicz, B., Dahlgren Sandberg, A., Deliberato, D., Launonen, K., Murray, J., Nunes, L., Stadskleiv, K., & Walter, C.C.F. (2013). The development of communicative competence in aided communicators and naturally speaking children aged 5–15 years. Invited lecture, Federal University of Rio de Janiero, Brasil, November 21, 2013. von Tetzchner, S., Batorowicz, B., & Stadskleiv, K. (2013). Early intervention with augmentative and alternative communication. Presented at Regional Conference of the International Society for Early Intervention, St Petersburg, Russia, July 1–3, 2013. Walter, C.C.F., Nunes, L.R., & Delgado, S.M.M. (2010). Avaliação da linguagem receptiva de adolescentes usuárias de sistemas de comunicação alternativa. In E.G. Mendes & M.A. Almeida (Eds), Das margens ao centro: Perspectivas para as políticas e práticas educacionais no contexto da educação especial inclusiva, Volume 1, pp. 179–189. Araraquara, Brazil: Junqueira & Marin. Walter, C.C.F., Nunes, L.R. & von Tetzchner, S. (2015). Avaliação da linguagem expressiva de usuarios de comunicação alternativa. In R.Y.S. Chun, L. Reily & E.C. Moreira (Eds), Comunicação alternativa: Ocupando territórios, Volume 1, pp. 241–254. S. Carlos, Brazil: Marquezine & Manzini/ABPEE. Yang, C.K., Liao, Y.K., & Chung, L.C. (2012). The Final Report of the Establishment of an Aided Communication System for the 3–18-year-old Users’ Language Proficiency Rating Scale Project (Revised edition). Taipei City, Taiwan: Ministry of Education.

2 Constructing a language in alternative forms Stephen von Tetzchner and Kristine Stadskleiv

Constructing a language in alternative forms Through its nearly 50 years of history, intervention with individuals who use augmentative and alternative communication has changed. In the beginning, the provision of communication boards with graphic symbols seemed to be regarded as a sufficient basis for using aided language. Developmental processes were rarely discussed. There was a tendency to focus on ‘physical’ help, that is, on guiding a child to a communication form he or she could actually produce. It is now acknowledged that it may take a long time to establish a system whereby a child with a severe motor impairment can select and indicate a reasonable number of graphic symbols, but also for this group, intervention is not only a matter of providing a graphic system and a board or electronic aid. All aspects of the communication situation are affected by a slower rate of communication, a limited vocabulary and problems in initiating joint attention, conversations and new topics. For support to be functional, it must be adapted to these characteristics.

Language as social construction Language is both created and shared through the communicative activities of the members of a culture. Language development is the process by which children come to share their culture’s means of communication, mainly spoken and to some extent signed language. Although children no doubt have abilities that make language possible, language does not come ready-made. As a reply to Chomsky’s suggestion that a LAD (Language Acquisition Device) is what makes development of language possible, Bruner (1983) maintained that a LAD needs a LASS (Language Acquisition Support System). Children are active language investigators but cannot create language independently; they need a language-supportive environment. In the early phases of language development, children thus get help from more competent members of their cultural group, who engage them in the communicative interactions that contribute to the children’s development. The language environment

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is children’s main source of language practice (Nelson, 2007, 2014; Schaffer, 1989; Tomasello, 2003) and language development is influenced by the quality of the language environment (Hoff, 2006; Weisleder & Fernald, 2013). Children learn how linguistic expressions are used, in terms of their conventional use as well as in the creative production of new meanings. Wood, Bruner and Ross (1976) termed the support to children’s problem solving and development provided by parents and other adults as scaffolding, probably inspired by the tower-building task used in their study. Scaffolding is not teaching but represents an adaptation of help that supports the existing skills and abilities of the individual child during ordinary activities in such a way that promotes the development of new skills and abilities. The scaffolding strategies observed by Wood and associates included recruitment (getting the child interested in the task), reduction in degrees of freedom (limiting the actions needed by the child to finish the task), direction maintenance (keeping the child on the task), marking critical features (making the relevant features prominent), frustration control (reducing stress by solving the problem with a tutor), and demonstration (showing the role of some acts in the solving of the problem). It should be noted, however, that the concept of language scaffolding is based on the understanding that children actively seek to make sense of the physical and social world, and the underlying elements of scaffolding are co-construction, collaboration and guidance (Bruner, 1983). This means that children are not passively formed by social reinforcement as assumed by Skinner (1957); children are active problem-solvers in the language acquisition process. Children gradually internalize the communicative practices of their culture through observing and interacting with adults and more competent children, and through this also become able to externalize their feelings, ideas and wishes (Nelson, 2007). The notion of scaffolding is based on the assumption that adults are aware of when children need and do not need help. Adults for their part are active in supporting children’s learning and use of language. They direct and follow the child’s attention, and interact with the child and communicate about the child’s and other people’s activities. They make special adjustments to their language and produce child-directed speech or sign, characterized by short utterances, simple sentence structures and few grammatical errors (Holzrichter & Meier, 2000; Ratner, 2013). Adults also tend to use many questions when they interact with children, partly to keep the conversation going, but also to make the child attentive to relevant aspects of the situation. Repetition of what the child says is common, usually in an expanded form. For example, if the child says Daddy cup, the adult might say Yes, that’s Daddy’s cup or Daddy likes this cup. Expansions do not only affect grammatical form, but also link new words to the ones the child has already learned (Nelson, 2001; Nelson, Camarata, Welsh, Butkovsky, & Camarata, 1996). Scaffolding may also include arranging situations where particular features become prominent and where children may experience communicative challenges that they can only solve with some amount of help and guidance. Direct teaching is not usually part of language scaffolding, but explanations and explicit statements are common in non-educational activities. The transactional development of children’s active problem solving and adults’ assessment and sensitive help, guidance and support may be conceived of as a dynamic system of evolving competence (van Geert & Steenbeek, 2007).

Constructing a language in alternative forms

The development of aided language forms Some children are unable to speak or sign due to motor impairments, and they develop language produced with various forms of communication aids, aided language (von Tetzchner & Basil, 2011). When a graphic symbol system is used, it is because it supports the emergence of communication and language in children with atypical abilities (Branson & Demchak, 2009), usually because it is the only manner in which the children can express themselves. Children who are developing aided language – emergent aided communicators – constitute a heterogeneous group with different abilities and disabilities which influence the conceptual and social transactional processes involved in language development (Eddins, 1987; Gerber & Kraat, 1992; von Tetzchner, 2009; von Tetzchner & Grove, 2003). Learning to use communication aids is an extraordinary form of language development where the final goal is that the child is able to communicate with peers and adults about the same things and in the same situations as naturally speaking children. Children using aided communication follow a ‘side-track’ in cultural development, but a side-track that should lead to the development of normal, or at least optimal, language functioning (Renner, 2003). Varied language experience is in itself important for language development (Tomasello, 2003; Veneziano, 2005; von Tetzchner et al., 2008). This suggests also that aided language emerges best in varied circumstances, and it is therefore an explicit aim that children developing aided language should be engaged in all kinds of conversations. Young aided communicators have some additional challenges compared to naturally speaking children. First, while children who use natural speech have to learn the correspondence between a form and a concept or usage, that is, between signifier and signified (de Saussure, 1959), children using aided communication in addition have to learn the correspondences between spoken word forms and graphic symbols which are only partly overlapping. Utterances with graphic symbols are constructed differently and may not be processed and represented mentally in the same manner as speech, or as manual sign. Knowledge about the exact nature of this process is still limited, but as the language environments of aided communicators comprise mostly children and adults who use natural speech, a multi-modal representation of language in aided communicators seems likely. Multi-modal means that language is expressed in more than one modality, in this case, visual-graphic and articulatory-auditory. Aided communicators need to mentally represent both a set of potential meanings and a spoken word, and a graphic representation and the correspondence between the two, or rather how to ‘translate’ from one mode to another. Children using aided communication have to learn where in their communication aid each graphic symbol is located and the routes to get there, that is, how to navigate in their communication aid. The size of the graphic vocabulary they are offered is often limited. Nouns are often prioritized at the expense of function words and morphological markers (Oxley, 2015; Smith, 2015; Soto, 2015). When a spoken word does not have a reasonable lexical correspondence in the aid’s vocabulary store, the child has to express the intended meaning by combining lexical items from the aid’s vocabulary, or through strategic utterances (von Tetzchner & Martinsen, 1996). There

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may thus be a considerable difference between the automatic production of words and phrases by naturally speaking individuals and aided communicators’ construction of meaning by consciously searching for and selecting graphic symbols, and using them both as lexical referents and strategically to inform the partner’s interpretation and co-construction of the utterance. Producing longer utterances, even when simple, may also be challenging for individuals using aided communication, partly because it takes much longer than natural speech, but also because the most efficient order in the construction process might not correspond to the spoken word order. Many graphic utterances have a form that would not be grammatically correct in spoken language. It is not possible to automatize the creative construction of aided utterances, therefore the use of aided language may be more cognitively demanding (Bruno & Trembath, 2006; Stadskleiv, et al., 2014). Considering the challenges related to aided language use, the critical question is what it takes for children to learn to operate a communication aid and develop aided language. One basic requirement is a competent environment. Adults must have a repertoire of scaffolding strategies and be able to apply these in accordance with the abilities, skills and challenges of the child and the features of the communication system used by the child (von Tetzchner, 2009). To start with, the environment has to recognize the child’s need for aided communication and provide graphic symbols and a communication board or other equipment that can be tailored to the child’s needs. Secondly, the language environment has to be communicatively accessible to the child, that is, people in the child’s environment must recognize that the child must have access to aided language in all situations and with all communication partners. Thirdly, the communication partners must be able to support and scaffold the child in a manner that promotes and strengthens the child’s aided language development. There is limited knowledge about the language environment of young children who use aided communication, that is, how the use of graphic symbols emerges and changes over time, and it therefore follows that one needs to better understand how adults can best promote language development and use in children using communication aids (von Tetzchner & Grove, 2003).

Recognition of the need for aided language The first requirement is that the people in the environment must have knowledge about aided language possibilities, graphic systems and communication aids, and the competence to recognize both the child’s need for alternative means of language and that the alternative form should be a communication aid. In aided language, per definition the expressive language forms do not reside in the communicator, as with natural speech and manual signs, but exist in a physical form outside the body. Language forms are selected rather than produced (von Tetzchner & Martinsen, 2000). Aided language is typically chosen as the main form of communication mode for children with severe physical and motor impairments that preclude the use of speech and manual signs (Stadskleiv et al., 2014; von Tetzchner & Martinsen, 2000). Furthermore, even though

Constructing a language in alternative forms

the development and use of aided language represent challenges, if the possibilities offered by communication aids are not recognized, a child with a severe speech and movement disorder may not have any expressive means of communication at all. This is still the situation in many countries of the world. Realizing that a child must be given access to aided language is not as straightforward as it would appear to be. For example, it is well recognized that speech problems are frequent in children with cerebral palsy. Epidemiological studies indicate that approximately one third have severe speech problems or lack speech completely and the severity of speech impairment and motor impairment is highly correlated (Andersen, Mjøen, & Vik, 2010; Himmelmann, Lindh, & Hidecker, 2013). Still, studies in the UK and Norway have found that almost half of the children with cerebral palsy who need a communication aid did not have access to it (Andersen et al., 2010; Cockerill, Elbourne, Allen, Scrutton, Will, et al., 2013; Pennington, Virella, Mjøen, da Graça Andrada, Murray, Colver, et al., 2013) and a substantial proportion (16 percent) have to rely on eye gaze, body movements and vocalization to express themselves (Himmelmann et al., 2013). This also implies that the language environments of many children with cerebral palsy fail to support the children’s potential use of alternative means of communication and language. When the need for aided communication has been recognized, the next step is to find an appropriate graphic system and communication aid. There is a large diversity of communication aids and it is important to select the type of aid that is best suited to the child’s motor, cognitive and language functioning. However, epidemiological studies suggest that cognition is not always assessed, even in children with a known risk for cognitive impairments (Andersen, Irgens, Haagaas, Skranes, Meberg, & Vik, 2008; Stadskleiv, 2015). In studies, children with very different cognitive functioning are often grouped together. For example, many epidemiological studies report on children with IQs below 50 as a group (e.g., Beckung, White-Koning, Marcelli, McManus, Michelsen, et al., 2008), thereby making it impossible to discriminate between children with moderate, severe and profound intellectual impairment. Children with moderate intellectual impairment typically learn to speak in sentences if they have sufficient motor abilities (Lenneberg, 1967; Rondal & Edwards, 1997). Subsequently, if they do not have specific language disorders, motor impaired children in this group would belong to the expressive language group, who are characterized by a large gap between what they understand and what they can say (von Tetzchner & Martinsen, 2000), and would profit from being provided with a communication aid. Children with cerebral palsy are often classified on the Communication Function Classification System (CFCS) (Hidecker, Paneth, Rosenbaum, Kent, Lillie, Eulenberg, Chester, et al., 2011), a five-level scale where level I indicates the best functioning and level V indicates very limited success in communicating even with familiar communication partners. Himmelmann and associates (2013) found that 28 percent of children with cerebral palsy functioned on CFCS level V and that all of the children on this level were considered to have an IQ below 50. This implies that there are children with a moderate intellectual disability who have not been provided with a communication aid and who, perhaps for that reason, are unable to communicate successfully even with familiar partners.

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Making the environment communicatively accessible All children need a language-supportive environment to develop language. Children who develop spoken language are surrounded by a community of speakers (who sometimes speak more than one language). Members of this community are typically involved in diverse language environments, including the home, preschool, school and the neighbourhood, and many different communication partners, including both adults and peers. Their communicative access and entry into the language community are ensured through communicative interactions and ordinary scaffolding strategies (Bruner, 1983; Lock, 1978; Nelson, 2007). For young children using aided communication, a need for communicative access in a wide sense is not always recognized. Communication situations are often restricted and the number of communication partners may be limited. In one study, about 75 percent of the aided communicators had communication aids available only when at school (Cockerill et al., 2013), reflecting an environment with limited communicative access. For naturally speaking children, adults in the environment – including those who scaffold the children’s language development – are themselves naturally speaking communicators. For children using aided communication, the situation is very different. Their parents and teachers do not use graphic symbols for everyday communication; in fact, they hardly use them outside special training situations (Cockerill et al., 2013). Teachers are usually more competent in teaching than in using a communication aid for communicative purposes. Significant adults in the child’s environment typically have to learn to use the child’s communication form at the same time as they are supposed to be the main supporters of the child’s language development. In narrating the language development of Sander, a young aided communicator, Brekke and von Tetzchner (2003) describe how Sander’s teacher needed to learn Sander’s aided communication strategies, while Sander needed the interpretation and insight of the teacher as a guide to how his messages were understood by others. Both Sander and the teacher learned graphic communication in a way that is very different from both typical language development and ordinary school instruction. Children developing aided language need communication partners who are familiar with their communication aid and who support the children’s active use of aided language in all aspects of daily life. Although it is important that communication partners are equally sensitive to aided communicators’ use of supplementary, non-aided means of communication, limited availability of the aid or encouragement to use it outside training sessions tend to limit aided language experience. One consequence of limited support of aid use may be that communication mainly centres on the here and now (cf., Ferm, Ahlsen, & Bjorck-Åkesson, 2005). Communication outside the here and now will to a large extent require the use of linguistic signs, that is, lexical representations of words in one form or another (e.g., speech, sign or graphic symbols). In order to overcome this problem, communication partners may increase their use of yes/no questions. Such questions are useful in many situations and there are ways of making nuances in ‘yes’ and ‘no’ replies (Hörmeyer & Renner, 2013), but it gives the child little communicative responsibility and few initiation options. In the study mentioned above, Sander’s teacher taught the other children in the class to use Sander’s

Constructing a language in alternative forms

graphic systems, Pictograms (Maharaj, 1980) and Blissymbols (Bliss, 1965), and thereby made the school environment communicatively accessible. The children had shared aided language competence even if Sander was the more competent user. Provision of an aid without being guided to use it productively and creatively for different purposes may hinder the development of communication and language. Pinto and Gardner (2014) describe the communication interaction between 8-year-old Amy and her mother. Amy was using an iPad in assistive mode as she was unable to operate the device by herself. The mother pointed to symbols on the screen and asked Amy to indicate confirmation or rejection. The aid had synthetic speech output and each symbol produced a spoken sentence. There were no single words. For example, when the mother asked Amy what she wanted to do, one of the six symbols she was asked to choose between produced the sentence “I want to watch TV”. Amy was using both the graphic symbols with sentences and eye pointing at an object in the environment, but all the communicative interactions reported are about the mother’s attempt to find out what Amy wanted to do. A similar focus on choice-making is apparent in many studies of aided communication, including studies of individuals using aided communication who are not considered intellectually impaired (Basil & Cusine, 2015). Although choice-making is important for all children, and especially for children who have little independent control over the physical environment, choice-making comprises only a small part of children’s language use. Communication and language have many more functions than expressing needs and choosing activities. In fact, scaffolding the expression of needs that in most homes are fulfilled through everyday routines may have little communicative value compared to supporting dialogues with small talk, schoolwork and narratives. Early language intervention aimed at making the learner communicate choices may be useful but such interactions are not central in conversations between naturally speaking children and their parents. Moreover, choosing an activity represents only the beginning of an activity, and the result of focusing on choices may be a lack of language and language scaffolding during the activity. When an aided communicator has made a choice, the partner should encourage comments – or a topic change. Without this, there might not be so much more to talk about – except making new choices. A lack of variation in functions may impact negatively on a child’s development of utterance structure (Kilani-Schoch, Balciuniene, Korecky-Kröll, Laaha, & Dressler, 2009).

Scaffolding in aided language development Language scaffolding is naturally based on the asymmetry in language competence between young emergent language users and older children and adults in their environment. The asymmetry in competence between young children using aided communication and adult partners is usually both larger and smaller than for naturally speaking children and adults: larger because the adults are able to speak and smaller because they may have only marginally higher – and sometimes even lower – aided language competence than the young aided communicator. The limited experience and competence of most people in the environment may imply that children who develop aided language have a restricted input not only with regard to vocabulary and

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grammatical structure; they also have fewer communicative experiences, especially outside educational and other structured situations. Moreover, a true languagesupportive environment for aided communication should also include children in the environment with some aided language competence who thus to some extent share the communication form of the aided communicators (Brekke & von Tetzchner, 2003; von Tetzchner, Brekke, Sjøthun, & Grindheim, 2005). The lack of interaction with competent users of their own communication form is likely to have a negative influence on the language development of young children using aided communication. The lack of a community of users, or at least of people who are fluent in the children’s aided language form, may also mean that the children’s own productivity and linguistic exploration of the physical and social environment have a less prominent role than in typical language development. All children, both naturally speaking and aided communicators, start by producing single-word utterances (Brown, 1973; Veneziano, 2013). In spoken language, adults who scaffold children’s language development tend to produce multiple-word utterances but also to make adaptations in their language input, adaptations that are believed to support language development (Ratner, 2013). They maintain a correct use of grammar but reduce the complexity of the utterances and tend to choose vocabulary that makes the relations between the words in the utterance prominent and thus facilitate language learning (Hills, 2013). Some also hypothesize that informative ‘frames’, consisting of pairs of words that appear frequently together, may facilitate language learning (Cameron-Faulkner, Lieven, & Tomasello, 2003; Mintz, 2003). The situation is very different for young children using aided communication. The adults in their environment are often not familiar with producing even single-word utterances, let alone multiple-word utterances, with graphic symbols. This might be one reason that the phase with mainly one-word utterances seems to extend far longer in aided communication (Udwin & Yule, 1990; von Tetzchner & Martinsen, 1996). It has been suggested that the transition from single-word to multi-word utterances may require explicit training (Black, Waller, Turner, & Reiter, 2012) but the fact that some children who use communication aids spontaneously start to use multi-word utterances (Brekke & von Tetzchner, 2003; Hjelmqvist & Dahlgren Sandberg, 1996; von Tetzchner & Martinsen, 2000), implies that this is not always a necessity. It may rather be a consequence of being in a language environment that fails to afford the construction of longer utterances. The use of single-word utterances may also reflect the fact that commonly-used pictorial graphic systems do not seem to promote multiword utterances. Cognitive impairment may also contribute to the lack of multi-word utterances in some aided communicators, but it should be noted that many children with severe intellectual impairment who use natural speech nonetheless use sentences (Rosenberg & Abbeduto, 1993). Moreover, even children who are not regarded as intellectually impaired may use few sentences in aided communication output (Smith, 2003; von Tetzchner & Martinsen, 1996). Other capacities inherent in the child might also account for this delay, as large individual variance – even after receiving the same type of intervention training – is frequent (Bruno & Trembath, 2006). Tönsing and associates (2014) found that engaging children in storybook reading and using a matrix strategy to produce graphic symbol combinations was only successful for two

Constructing a language in alternative forms

of four children using aided communication in their study. It should be noted that no cognitive assessment was made in this study, and the two children who benefitted from the approach and produced symbol combinations scored higher on the Peabody Picture Vocabulary test (PPVT) (Dunn & Dunn, 2007) than the two children who did not profit from this training approach. To sum up, children using aided communication do not have access to a natural language environment of competent users who use the same language mode as themselves. Much of their language input comes through direct instruction and participation in educational activities of limited diversity, and where they have limited communicative responsibility. Interactions between adults using aided language and children developing this form of language are rare. In fact, most children using communication aids have never seen an adult aided communicator (von Tetzchner, Almeida, Balandin, Basil, Batorowicz, et al., 2010). Scaffolding corresponds to the principle of guided participation, that is, that children develop while participating actively in culturally valued activities with the guidance, support and challenge of children and adults who vary in skill and status.

The role of intervention in aided language development Given that there is no natural language environment of competent aided communicators, aided language development does not come naturally. Unlike children who use natural speech, children developing language using aided communication depend on the conscious, deliberate efforts of parents, teachers and other professionals. Aided language development is instructed and follows a planned rather than a ‘natural’ course. Because there is limited use of graphic communication in society and young children who use aided communication rarely meet individuals who use a graphic system, they need somebody to arrange appropriate conversations and explicit instruction to support and supplement the experience gained through planned conversations. One important question is whether the scaffolding and intervention usually given to young children developing aided communication is sufficient for promoting their optimal language development in their mode of communication. There are hardly any studies investigating what kind of instruction best supports the ability to construct graphic utterances, and thereby aided language usage and development. In interventions where individual training has a major role, the focus is often on form rather than on function, that is, on producing a response or avoiding an unwanted behaviour, rather than on promoting communicative intentions and goals (e.g., Bird, Dores, Moniz, & Robinson, 1989; Ganz, 2014; Sundberg, Endicott, & Eigenheer, 2000). In particular, the tradition of functional communication training based on Skinner’s theory of language development (e.g., Bondy & Frost, 2000; Mirenda, 1997) tends to be teacher-centred and focus on eliciting ‘communicative’ behaviour. Such approaches to intervention may be useful in skill training, but are less functional in promoting the development of communication and language competence. For example, children who use aided communication need to gain insight not only to the use of a graphic symbol, for example BALL, but also how this symbol relates to other graphic symbols, or what de Saussure (1959) calls paradigmatic meaning – the meaning of a graphic

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symbol or word in the meaning network constituted by the vocabulary. Such language knowledge is not easily achieved through special teaching in an isolated situation, but rather through guiding the child’s awareness of how the graphic symbol is understood and may be used by different people and thus how it may be used by the child in different settings. Incidentally, this form of scaffolding will also support generalization of language, which is considered a major problem in behaviour-oriented language intervention programmes (cf., Ganz, 2014; Ganz, Sigafoos, Simpson, & Cook, 2008). Expansion has been shown to be a useful scaffolding strategy in traditional language intervention (Nelson, 2001; Nelson et al., 1996). However, most adult expansions of utterances produced by young aided communicators are spoken interpretations of what the child has expressed, typically containing many words and phrases that are not readily available to the child. In order for expansion to function as scaffolding for a child using a communication aid, it is necessary to expand the child’s utterances with lexical items in the child’s communication aid. This implies that parents and teachers have to become proficient in using graphic symbols and know what vocabulary the child has available. Intervention based on the conceptual framework of the social constructivist tradition of Vygotsky (1962, 1978), represents a different approach than training based on applied behaviour analysis. One core premise is that communication and language can only develop through participation in social interaction. Intervention should help children develop the same usages of communication and language as other children, to express themselves and negotiate meaning in activities with joint engagement and social interaction. A passive communicative style may emerge in interactions involving aided communication, especially where young children need a long time to produce an aided utterance and have difficulties taking the floor. Scaffolding should support children in initiating interaction and engaging in authentic communication, that is, the expression of ideas, thoughts and narratives that originate in the children, for example in structured conversations (von Tetzchner & Martinsen, 2000). The focus should thus be on developing the child’s communication and language competence rather than increasing the frequency of certain communicative behaviours. It does not imply a system of rewards or reinforcers; communicative success (being understood) is more important than the instrumental success (obtaining or choosing something) often promoted in aided language intervention (e.g., Bondy & Frost, 2002; Mirenda, 1997). The aim is to guide and support children’s active communicative problem solving and engagement. Direct teaching may be an integrated part of the intervention but only as a way for the child to gain insights into utterance construction that are not readily obtained during ordinary interactions with partners who use natural speech. Book reading (typically with pictures) is a favoured activity for scaffolding language in both typical and atypical development. Liboiron and Soto (2006) describe seven intervention strategies used by a teacher when reading a picture book with an 11-year-old aided communicator: print reference (the teacher indexes information in the text), cloze procedure (the teacher says an unfinished utterance for the child to complete), expansion (the teacher repeats and expands the child’s utterance), binary code (the teacher gives the child a choice between two utterances), pointing/cueing (the teacher points to information in the text or the child’s communication aid), questions

Constructing a language in alternative forms

constituents (the teacher asks about information at a low level of semantic complexity) and questions comprehension (the teacher asks about information at a higher semantic complexity). In another study, the use of wh-questions, modelling and expansions were applied as scaffolding strategies in book reading (Bellon-Harn & Harn, 2008). Similar strategies with book reading have been reported to support word learning in children with typical development (Blewitt, Rump, Shealy, & Cook, 2009), and are also found in traditional teaching. The same scaffolding might also be applied when the child progresses to more advanced textbooks, both at home and in school, and when the child is constructing personal narratives (Solomon-Rice & Soto, 2011). However, these strategies are teacher-oriented rather than child-oriented, reflecting the relationship between the child and the adult in these studies. Moreover, in intervention with graphic communication systems, there is often an emphasis on routines (Ganz, 2014; Light, 1997; Stiebel, 1999). Repetitions may be without variation and hence do not provide any new information unless the utterance was not heard or seen the first time, unlike the variation strategies applied in scaffolding language development in children with typical development (von Tetzchner et al., 2008). The limited variation may be related to the size of the vocabulary and the difficulties children who use aided communication have in constructing specific messages. In the first years, and often for many later years, children using aided communication may have to rely on adults to express many of their own thoughts, or at least what the adults believe are their thoughts (Hjelmqvist & Dahlgren Sandberg, 1996; von Tetzchner & Martinsen, 1996). Parents and professionals are used to interpreting constructions expressed by children using aided communication and, with the exception of Blissymbol instruction (cf. Jennische & Zetterlund, 2015), little time seems to be spent on sorting out how to express particular meanings with the lexical items present in the child’s aid. Potential communication partners may not develop the competence in aided utterance construction that they need to guide the construction of complex and varied utterances in aided communication. Possibly as a result of limited relevant teaching and scaffolding, when children who use aided communication are asked to clarify what they mean, they tend to repeat the same utterance form, maybe the only one they are able to construct that could express a particular meaning. The answer to the question above (whether the strategies that are applied in promoting the construction of aided utterances and aided language development are sufficient), is probably ‘no’. There seems to be more focus on encouraging production of artificially constructed sentences that are as ‘natural’ as possible, rather than on constructing varied and complex meanings in aided communication.

Scaffolding the scaffolders For all children, the quality of scaffolding depends on the competencies of their communication partners. Descriptions of parents and other communication partners often focus on their shortcomings. Many are described as dominating communicative interactions, providing few opportunities for the child using aided communication to initiate conversations or switch topics, focusing on the communication aid rather than the content of the communication, or not giving enough time to formulate

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utterances using aided means (Broberg, Ferm, & Thunberg, 2012; Ferm et al., 2005; Kent-Walsh & McNaughton, 2005; Kent-Walsh, Binger, & Hasham, 2010; Pinto & Gardner, 2014). This is often used as a starting point for providing advice on how to interact with children who use aided communication by being sensitive to the child’s needs (e.g., Broberg et al., 2012), but there is less attention to the child’s communicative responsibility. The question is how to support the scaffolding of young children who need to use aided communication. Being a good scaffolder and communication partner of children developing aided language is more challenging than being a good scaffolder of children with typical development, simply because most adults are not as familiar with aided language as they are with speech. The scaffolders are therefore likely to need some scaffolding. A programme aimed at making parents better at scaffolding aided language should highlight the positive role parents typically play in their children’s life and make them aware of the fact that the child is using a communication aid – not primarily because the child does not speak although this is an underlying condition – but because it makes language development possible. It is noticeable that studies investigating the role of parents tend to emphasize the parents’ experience with the use of communication aids and less on strategies that may support language development, including intervention that may supplement the natural experiences of aided communicators (Mullican, 2012; Newton, Clarke, Donlan, Wright, Lister, & Cherguit, 2007). Challenges involved in accessing and acquiring a communication aid and the fact that many communication aids are under-utilized are important to document. However, many researchers’ questions seem to indicate a belief that the use or non-use of a communication aid is a choice that the parent can make. It is hardly conceivable that parents of children with typical development might be asked whether they believed it is a good idea for their child to speak. The use or non-use of a communication aid only represents a choice for parents if a child with little or no speech can use different forms of augmentative and alternative communication. For example, many children with autism are not motor impaired and do well with manual signs (von Tetzchner & Martinsen, 2000). Such research limitations may reflect a lack of knowledge about how one can support parents in becoming good communication partners, able to support their child’s development of aided language to a level where they can communicate together in a nuanced manner about any topic they wish. Research has pointed to a number of potential pitfalls, including failing to recognize a child’s need for a communication aid, asking only yes/no questions, relying on only a very limited repertoire of eye and hand gestures and vocalizations, teaching in all conversations, an exclusive focus on use of the communication aid, overlooking the child’s combined use of aided and unaided forms of communication, providing the child with an aided vocabulary that limits communicative possibilities, and so forth. These shortcomings can only be addressed if there is more focus on building parent competence interacting with and scaffolding successful use of aided communication.

Conclusion Most modern theories of language development regard participation in social interactions with more competent language users as a prerequisite for developing

Constructing a language in alternative forms

language. Social constructivist theories also emphasize the significance of scaffolding, that is, the support provided by more competent children and adults (e.g., Nelson, 1996, 2007; Tomasello, 1999, 2003; Vygotsky, 1962; Wood et al., 1976). In spite of the fact that behaviourism has little or no influence on current discussions of language development, the theoretical framework of Skinner (1957) has a strong influence on language intervention for children with disabilities (e.g., Ganz, 2014; Mirenda, 1997; Sigafoos, Doss, & Reichle, 1989). The framework of scaffolding has been used to conceptualize the learning that may take place in child–adult conversations through co-construction, collaboration and guidance. This is true also for conversations where the child uses aided communication, even if training and direct teaching may have a greater role in aided than in spoken language development. Aided language intervention may provide access to a functional means of constructing and sharing ideas with others, but limited awareness of co-construction may reduce the support provided by communication partners for language development of young children using aided communication. Moreover, scaffolding requires competence but professionals working with children who use aided language often lack the knowledge needed to create an environment that supports aided language development, as well as to guide or scaffold parents’ scaffolding techniques. Communicative access means that there are people who know and understand the aided language form, who can scaffold it in the acquisition period, and who are able and willing to communicate in a manner that gives the child communicative autonomy. Communicative access is as important as physical access for people with disabilities, but the provision of communicative access is still lagging behind developments in physical access. Research on typical language development tends to focus on the early years and on the importance of the child’s interaction with the parents and peers (e.g., Bloom & Tinker, 2001; Lock, 1980). Research on aided language development seems to focus more on the role of the teacher and the professional helper (e.g., Solomon-Rice & Soto, 2011; Tönsing et al., 2014) and the development that takes place after children have entered school (e.g., Newton et al., 2007). The emphasis is on formal training and specific interventions rather than on supporting communication in everyday situations and beyond making choices (e.g., Bruno & Trembath, 2006; Kent-Walsh & McNaughton, 2005; Pennington, 2009; Smith & Murray, 2011). There might be valid reasons for this focus, but such a focus might also reflect a view of aided communication, not as the child’s language but as some form of educational intervention. Future research may seek knowledge about how aided language conversations can be supported in everyday situations, in different places and involving different communication partners, reflecting a view of aided language as the true language of the child, with the consequences that this view has for development, availability and accessibility of aided language forms.

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3 O perational demands and representational forms Janice Murray, Helen Bell and Juliet Goldbart

Introduction Communication aids are a key intervention for children who cannot speak or who have limited speech intelligibility. The positive effects of using these communication systems include wellbeing, a sense of belonging, and educational attainment (Dada & Alant, 2009; Lund & Light, 2006, 2007a, 2007b; Schlosser & Lee, 2000). Children are introduced to aided communication systems for differing reasons. von Tetzchner and Martinsen (2000) summarized these reasons into three broad characteristic groupings: (i) children who may have age appropriate language comprehension but who need a means of expressive communication; (ii) children who may have delayed or limited language comprehension, as well as limited expressive intelligibility, and who may benefit from a system that augments their understanding of language and supports their expressive communication (Norbury, 2005); and (iii) children who use challenging methods of communication and who would benefit from an alternative method of communication. Reasons for introducing aided communication influence the identification of systems that have the potential to meet a child’s current and future needs (Beukelman & Mirenda, 2005). Indeed, limited research evidence is available to determine the characteristics and features of symbol communication aids and how these relate to successful use by a child (Baxter, Enderby, Evans, & Judge, 2012; Binger & Light, 2007, 2008; Blockberger & Sutton, 2003). Specifically, little is known about the impact of acquiring language knowledge through communication aid technologies on the educational and social experiences of these children (Parkes, McCullough, & Madden, 2010; Smith, 2015). There is limited research evidence to support our understanding of graphic language learning trajectories and how using aided communication systems may place differing

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demands on these children compared with their peers without disabilities (e.g., Binger & Light, 2008; Fallon, Light, & Achenbach, 2003; Murray & Goldbart, 2011; Smith, 2015). This chapter explores some key operational and representational features characteristic of aided communication systems. Gaining an understanding of the operational demands and representational forms of aided communication systems requires an exploration of the component parts of such technologies. Deconstructing the language representational systems/s installed and their organizational features will in turn support our understanding of the cognitive and linguistic demands underpinning effective use of an aided system. Identification of appropriate augmentative and alternative communication (AAC) systems requires the consideration of many things other than the equipment involved, especially when the children using it have additional physical or learning needs. By way of introduction, it may be useful to think of AAC systems as comprising four interconnected components: (i) the mode; (ii) the means of access; (iii) the language representational system; and (iv) the interaction strategies (Murray & Goldbart, 2009b). The mode of communication focuses on the platform used, often thought of as the aid. This may be in the form of lo-tech, light-tech or high-tech equipment; examples of these include a board made from cardboard, a single-hit voice output button switch and an electronic keyboard with screen and voice output. The means of access to the communication mode can be either direct or indirect. Direct access includes pointing to or pressing keys on a keyboard, or using eye-gaze to trigger keyboard access. Children with very severe physical involvement, however, may not be able to access the communication mode directly. In this instance, they could use an indirect approach: for example, using a scanning system involving one or two switches. The representational systems of AAC are many and vary in style and construction. In typical conversation we use spoken words to represent the meanings we want to convey. In aided communication, representational vocabulary sets are used to augment or replace speech attempts. These include written words or letters, photographs, line drawings, or a formalized set of graphic symbols such as Blissymbols (Bliss, 1965) or Picture Communication Symbols® (PCS) (Mayer-Johnson, Mayer-Watt, Cologne, & Bushen, 1993). In this chapter, formalized graphic language representations will be the focus. The interaction strategies children learn incidentally as typical speakers (for example for starting conversations, changing topics, and repairing misunderstandings) are often formalized for children who use AAC. Using an AAC system changes conversational dynamics. The development of AAC-aware interaction skills will support effective conversation with a range of communication partners (e.g., Drager & Light, 2010). The AAC technologies available offer an overwhelming array of operational and representational options. These include high-tech computer-based circuit boards housed in boxes of varying robustness and visual appeal, with varying output options including dynamic and static screen displays, along with digital speech output options and the potential for the technology to readily communicate with other electronic devices and systems, such as mobile phones or televisions. Access or input options are also evermore extensive and include eye-gaze, joystick, switch and other alternative keyboard configurations. Identification of appropriate vocabulary and its organization into a display

Operational demands and representational forms

introduces variance in operational and representational characteristics. Systems may be organized into taxonomic grid layouts over many screens, or set out as schemas, such as visual scene displays, or stylized iconic presentations such as Blissymbols (Bliss, 1965) or MinspeakTM (Baker, 1982; see also Drager, Light, Curran-Speltz, Fallon, & Jeffries, 2003; Drager, Light, Carlson, D’Silva, Larsson, Pitkin, & Stopper, 2004). These organizational characteristics place differing operational demands on the users’ mental representations and representational thinking skills (Vaughan van Hecke, Mundy, Block, Delgado, et al., 2012). Some graphic language representation systems have clearly-defined concepts represented through a finite number of symbolic elements (e.g., Blissymbolics). The user learns to construct the symbolic elements into meaningful units (often word units). These symbolic elements can be placed in a range of configurations allowing the user to convey different meanings, concepts or words. This type of graphic representation system has the potential to offer considerable communication flexibility but may be more challenging to learn in terms of the visual transparency of the symbolic elements. In other graphic language representation systems, there may be organizational and navigational rules that the user needs to learn in order to locate the appropriate item of vocabulary or communication phrase (e.g., Minspeak™ systems (Baker, 1982)). Minspeak™ is a system where vocabulary items are retrieved by combining specific symbols in predictable sequences. It utilizes high-tech platforms with computer software that supports user navigation by predicting symbol sequences and prompting the user to the most likely options. Other representational systems (e.g., Picture Communication Symbols® or PCS (Mayer-Johnson et al., 1993)) may be more flexible in their organizational options. PCS offers a range of picture symbols, many of which are highly transparent implying one readily recognizable meaning per picture symbol. This system offers greater organizational flexibility as it does not stipulate rules for the placement of picture symbols within a user’s communication system. By implication, this may mean that each user has a personalized configuration of picture symbols with potentially differing navigational routes of access to locate the same picture symbol. The relationship between component aspects of operational platforms and the types of language representation system used is complex. Awareness of the potential impact of these components on the child’s mental and physical actions and reactions will support our understanding of the demands of communication involving an aided system. The remainder of the chapter has been organized into two sections: operational demands and representational forms. Extracts of dialogue are presented in each section to support reflection on the complex interplay between operational demands and representational forms when interaction involves aided communication. Data examples presented throughout this discussion follow the transcription conventions described by von Tetzchner and Basil (2011) and all are drawn from the larger set of data collected as part of the BAC project, described earlier in the Introduction.

Operational demands: An overview This section considers the operational demands of aided communication with particular focus on the knowledge and skills required of the child, and at times their conversational partners, during interactions involving aided communication. As children will vary in

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their cognitive, linguistic, physical and sensory characteristics, the section specifically focuses on the executive resources required in preparing, retrieving and maintaining an aided communication interaction. The cognitive demands of aided communication concern children’s ability to plan for and execute an action in relation to the technological demands of the aided system, whilst simultaneously managing the conversational or language production demands of a specific interaction. Recent research in the field of AAC has shown an increased interest in the role of Executive Functioning (EF) skill and how it relates to aided communication use (e.g., Murray & Goldbart, 2011; Stadskleiv, von Tetzchner, Batorowicz, van Balkom, Dahlgren Sandberg, & Renner, 2014; Thistle & Wilkinson, 2013). Executive functions are the higher-order processes that enable us to plan, sequence, initiate, and sustain our behaviour towards a goal, incorporating feedback whilst making adjustments along the way. EFs enable us to plan, organize and develop strategies or rules, for example in solving problems (Baddeley, 1997; Denckla, 1996). In this discussion, the goal for the child using aided communication is to access the intended graphic representation to convey the intended message to their conversational partner. The specific aspects of EF considered here are attention control and memory.

Attention control Attention control collectively describes a number of emerging attention devices that, in typical development, move the infant from a point of ‘learning to’ to an ability to ‘learn from’. These phases of development are characterized by increasing efficiency in the execution of attention control devices, with a concomitant decrease in the overall cognitive resources allocated to the motor, spatial, representational and memory components of an interaction (Vaughan van Hecke et al., 2012). Three attention control devices are considered in brief here: sustained attention, selective attention and joint attention. Their potential impact on interactions involving aided communication are illuminated through examples of dialogue. In all extracts, the young people described as children using aided communication are using a high tech aid with Minspeak (TM) as their graphic language representation system. The system is described further in the chapter section on language representation, or for a more detailed account see Baker (1992).

Sustained attention Sustained attention appears to emerge in infancy and develop rapidly in early childhood from around 5–10 seconds at 3 months to a mature level in terms of duration by 18 months (Anderson, 2002). Studies exploring the emergence of sustained attention identify certain behaviours as indicators of attending. These include looking behaviour and associated head turning. Longer sustained attention does not necessarily imply greater ability, as shorter attention potentially implies quicker processing: shorter attention to novel stimuli is good, but increasing length of sustained attention is also good. From 18 months, executive attention emerges and develops until the mid-teens (Anderson, 2002). This executive function provides the child with mechanisms to control behaviour, allocate cognitive resources, evaluate behaviour progress, and direct activity with goals and plans. Interactions involving aided communication place particular demands on sustained attention. The goals of these interactions should resemble

Operational demands and representational forms

non-aided interactions, for example, to convey information in a mutually informative manner. However, the process of conveying and receiving information may look quite different to a non-aided interaction. In particular, interactions involving aided communication vary from non-aided interactions in terms of the sustained attention demands on both communication partners. For the child using aided communication there will be variance in the length of time it takes to produce an utterance. For the non-aided conversational partner there will be an increase in the length of time waiting for a message and potentially the time listening to an aided communication utterance. Finally, the time involved in verifying understanding of the messages transmitted place atypical demands on sustained attention. In addition to these factors, the looking behaviours normally associated with sustained attention may vary between interaction partners. For example, the child using aided communication has to move their visual attention between their partner/s and their communication system. Indeed, due to the operational demands of aided communication, in order to retrieve messages, the child using aided communication is likely to need to give atypical amounts of sustained (visual) attention to the aid rather than to their communication partner (Tomasello, 1999, Tomasello & Farrar, 1986). These sustained attention demands are demonstrated in Extract 3.1 from a threeway interaction involving aided communication between a boy aged 13, his friend and classmate and the researcher. The boy’s task is to describe a picture to his friend. He prefers using gesture combined with vocalizations, and offers good looking behaviours at such times. He opts to use his communication aid when gesture and vocalization are not understood. He uses his right index finger to access the squares on his aid directly. He has access to over 3000 words on his system but typically uses 500 items regularly. He finds sustained attention challenging when searching for useful messages on his communication aid, being easily distracted by options offered by the device. He also relies on adult communication partners to scaffold and co-construct messages. The friend has significant visual impairment, which makes his ability to attend to the multimodal components of the communication sequence more challenging. Consequently, the researcher offers several scaffolding bridges between the boys to support their sustained attention and successful message transmission. This requires considerable sustained attention from all parties and is a recognizable three-way interaction between a child who uses aided communication, a friend with additional communication challenges and an adult without communication challenges. Across this interaction, each partner’s sustained attention skills include visual, cognitive and physical components. The manipulation of these attention skills occurs with varying degrees of ability and success. The influence of sustained attention can be observed in the collaborative co-construction of the intended message, where aided communication is one component. Collective sustained attention is evident in the desire to arrive at an agreed message. Given the preferred communication strategies of each child, and the visual challenges for one child, this may have placed a different sustained attention demand on both children. Without the adult present, we have no way of knowing what this interaction would have looked like but scaffolding support from an adult is often reported in the AAC literature (e.g., Barker, Akaba, Brady & Thiemann-Bourque, 2013; Binger & Light, 2007; Dada & Alant, 2009; Smith, 2015; Trudeau, Sutton, Morford, Cote-Giroux, Pause, & Vallee, 2010).

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The Silent Partner?

40

Figure 3.1 A girl holding a mirror and looking into it (© Murray) Extract 3.1.

Extract 3.1BAC Key: A: child using aided communication, P: *friend*, R: researcher Picture: a girl holding a mirror and looking into it (Figure 3.1) Child (A) has produced the words ‘look’ and then ‘watch’ just prior to the following dialogue Dialogue length: 1 minute, 79 seconds Communication process 1

P

Is the girl watching TV?

2

A

“no” (shakes head)

3

A

4

R

5

A

6

A

“look”}

7

R

Right ok, so do you want *friend’s name* to ignore the word ‘watch’?

8

A

“yes” (nods head)

9

R

We’ll forget about the word ‘watch’[

10

A

{YES-YES “yes”}

Operational process

DELETE CHAR X 3 Hmmmmm Do you need both ‘watch’ and ‘look’, which is the better word do you think for this picture, hmmmm {SHEEP-MOON

Operational demands and representational forms

11

R

And think] about the word……

12

A

Look USES RIGHT INDEX FINGER AND CIRCLES HIS GLASSES

13

R

‘look’

14

P

Hermmm

15

A

*- (elbow catches icon button)

16

A

SPELL MODE X 2 {HOUSE-HOUSE

17

A

“house”}

18

R

[Is that….

19

A

20

R

21

A

22

A

“mum”}]

23

R

House?

24

P

ermmm

25

R

And your mum might use it, do you think girls use it more than boys?

26

A

“yes” (moves head) Boy USES RIGHT HAND TO BRUSH FRONT OF HAIR

27

R

Boys sometimes use it ok

28

A

Me POINTS AT SELF

28

R

You use it…… laughs

30

P

Laughs

31

R

And what do you do with it?

32

A

[USES RIGHT HAND TO BRUSH FRONT OF HAIR

33

R

What’s that word] that you do…….you?

34

A

USES RIGHT HAND AND POINTS AT GLASSES /loo/

35

R

Yeh well, can you say it with your talker, cause I think it’s easier for *friend* [to hear

36

A

37

A

41

WIPE-WIPE] Where you might have it, where you might have this thing is in [the {MOTHER-MOTHER

{SHEEP-MOON “look”}] Continues on next page

The Silent Partner?

42

38

R

Ok, so boys and girls and mums use them

39

P

Ermmmm

40

R

And they look into them

41

P

Mirror!!

42

R

Laughs…..did I give you a bit of a clue there?

43

R

Yeh

44

R

I did didn’t I

45

P

You did a mirror

46

R

Let’s see if you are right So who who looks into the mirror most in your family?

47

P

Laughs

48

A

Me (smiles and put head down)

Selective attention Selective attention is a phenomenon that incorporates the skills of sustained attention with the novelty or relevance of the stimulus (Anderson, 2002), with infants noticing novel components in their environment, selecting to pay greater attention to them. Attention is sustained whilst the infant considers this new experience. The capacity to focus on novel or relevant components in their environment is the beginning of the infant being able to control their attention behaviours to select one component over another (Anderson, 2002). This skill has importance far beyond infancy as it enables maintenance of focus on selected aspects of an action or, in this aided communication context, the relevant elements of the message being constructed. Cress (2002) suggests that children using aided communication have greater demands on their selective attention during an interaction as they have to elect to focus on their communication aid to locate and construct a graphic representation sequence, whilst also attempting to pay appropriate levels of attention to their communication partner. This type of interaction implies selective attention demands at an operational level, a language representation and construction level, and at a social engagement level. Developmental trajectories in selective attention have been reported (Tomasello, 1999). One example that has relevance to aided communication demands is a study by Shepp and colleagues (1987). These authors looked at the performance of children with typical development in three age groups (4-, 7- and 10-year-olds) when presented with a semantic judgement task involving complex pictures with several components to them. As a way of removing the language load in this task, it was first determined that the children understood the components that would be contained within the complex pictures. Using novel complex pictures, the children were instructed to select

Operational demands and representational forms

one component feature from each complex picture. They found that the youngest group struggled to independently review and selectively attend to one component of a visually complex picture. With cueing support, they were able to succeed in the task. They concluded that the younger children were processing the whole picture and responding to it as a gestalt, while the two older groups processed the salient information embedded in the picture and were able to de-select or ignore the irrelevant components of the picture, thereby completing the task independently. The following extract (Extract 3.2) has some resonance with the study by Shepp et al. in that the child, a boy aged 12, has been asked to describe a picture to his teacher. The teacher has not seen and cannot see the picture. To complete the activity successfully, the child needs to selectively attend to elements of the picture and describe them in a way that will enable the teacher to give a gloss of the whole picture. However, there are additional selective attention demands, as this boy uses a graphic symbol system which has a series of complex visual representations (MinspeakTM). Embedded within the symbols are semantic components which, if accessed in a particular symbol sequence, will generate appropriate clue words for his teacher. He has to selectively attend to the relevant components in order to sequence the symbols appropriately. He accesses his system using switch-scanning. As this slows down the rate of communication, this places an additional burden on his sustained attention skills. He is trying to describe a picture of an artist who is painting a chicken, whilst looking at an egg as inspiration for the painting. The extract is a salutary testament to the robust determination required by most children using aided communication to stay focused and selectively attend to the component parts of the communication task. The teacher attempts to quickly guess, based on minimal information from the child. The implications of this are not discussed here, as the focus for reflection are the selective attention demands being placed on the child.

Joint attention Joint attention is perceived as a more social or communicative aspect of attention, a triadic interplay where the child and the conversational partner jointly attend to the same referent. In a joint attention routine, the referent could be an inanimate object, a person or an unfolding event. Development of effective joint attention is critical to the emergence of more sophisticated communication behaviours, for example appropriate turn taking skills. The degree to which there is capacity to follow, initiate and maintain attentional focus is influenced by the skills and abilities of the child (Tomasello & Farrar, 1986). For example, reduced quantity and quality of joint attention behaviours have been observed in children with language delay (Markus, Mundy, Morales, Delgado, & Yale, 2000; Topbas, Mavis, & Erbas, 2003), and the existence of developmental disabilities, in particular physical disabilities, places limitations on a child’s capacity to initiate and sustain shared attention (Cress, 2004; Vaughan van Hecke et al., 2012). In the typical triadic definition of joint attention, disabilities such as physical impairments, hearing impairments and visual disturbances may affect the child’s capacity to recognize a partner’s attentional focus. Furthermore, Benigno and McCarthy (2012)

43

The Silent Partner?

44

Figure 3.2 An artist painting a chicken from an egg (still life) (© Murray) Extract 3.2.

Extract 3.2BAC Key: A: child using aided communication, T: teacher, R: researcher Picture: an artist painting a chicken from an egg (still life) (Figure 3.2) Dialogue length: 2 minutes, 81 seconds Communication process 1

A

2

A

3

A

4

T

A boy that looks horrible!

5

A

“no” (shakes his head)

“boy”} “look”} “oval”}

6

T

Or is he… is the boy looking at something horrible?

7

A

“no” (shakes his head)

8

T

It’s a shape

9

T

Oval…. Is he…. Is the boy looking in a mirror?

10

A

“no” (shakes his head)

11

T

Erm..is the boy, does he have an oval shaped body?

12

A

“no” (shakes his head)

Operational process {MOTHER-FIGHT {SHEEP-MOON {TEACHER-^CURRICULUM-^SHAPES

DYNAMIC STRIP (repeat)

Operational demands and representational forms

13

T

Is he looking through a window?

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A

“no” (shakes his head)

15

T

[Boy, look, oval

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R

have you] said enough? Can you think of a one more clue about what he’s doing maybe? Did you spot what he was doing?

17

A

18

A

19

T

is this something to do with an egg

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A

“yes” (upwards movement of body)

21

T

and a chicken?

22

A

“yes” (upwards movement of body)

23

T

Argh..has[

24

A

/bah/

“animal” “duck2”}

25

T

is there a chicken in the picture?]

26

A

“yes” (upwards movement of body)

27

T

Is there an egg in the picture?

28

A

“yes” (upwards movement of body)

29

T

Is the man eating the egg?

30

A

“no” (shakes his head)

31

T

Catching the egg?

32

A

33

T

Ermm Do you think the man is doing something?

34

A

“no” (shakes his head)

BACK-LLLCATEGORIES {SUN-LABEL^ALL ABOUT ME-^ECU CHOICE-*^ANIMALS -

DYNAMIC STRIP (repeat)

35

R

Ok….is it time to look?

36

A

“yes” (upwards movement of body)

37

T

Please can I? (laughter)

38

R

Yes you can

39

T

I’m dying to know Oooooh…..well done

40

A

/hmmm/ WHOLE BODY MOVING IN DELIGHT

41

T

So he’s painting, (laughs) he’s painting the chicken and looking at the egg Argh thank you good clues….oval very good

45

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The Silent Partner?

suggest an increased complexity in managing joint attention when using an aided communication system, proposing that adding this new dynamic results in a quadratic focus of child–aided communication system–partner–referent. They challenge the traditional definition of joint attention by introducing the aided system as an additional attention focus for both child and partner. This additional attentional focus (the aid) is itself a physically and cognitively demanding tool, which might impact on joint attention capacity of both communication partners. They conclude that joint attention routines involving aided communication place differing operational demands on the interaction partners, compared with non-aided joint attention routines. In the following extract (Extract 3.3), we have an opportunity to consider the joint attention behaviours involving aided communication. The activity involves the same 12-year-old child and adult as in the preceding extract. Here, the referent is an event: the child is describing a picture that he can see but the adult cannot see. Does this make the picture or the child’s description of the picture the focus of joint attention? With Benigno and McCarthy’s suggestion in mind, it is interesting to reflect upon the focus of joint attention throughout this interaction. It is intended to be the child’s description of the picture but is this the reality within the interaction? The challenge of determining the focus of joint attention is highlighted when you consider a number of things that are happening, for example: 1. The time taken to produce aided communication utterances (i.e., production of aided communication utterances is slower than typically spoken utterances – during this message construction time, what is the focus of joint attention?); 2. The use of multi-modal communication strategies (i.e., the child’s use of vocalization, gesture and looking behaviours – do these strategies enhance joint attention?); 3. The presence of the researcher (i.e., the child’s looking behaviour that makes the researcher a momentary focus of attention if noticed by the teacher – does this support joint attention to the task or bring in a new dimension that may be challenging for the teacher to comprehend?); and 4. The picture being described (i.e., the key referent and the goal of the interaction – as it can be seen by one conversational partner, in what way is it the focus of joint attention?). The effective use of all of these attention control devices offer a foundation from which the child using aided communication can plan for, maintain and shift focus during a conversation. The influence of attention control on aided communication use is far reaching.

Memory Another aspect of EF is memory. Memory skill and knowledge influences the operational success of aided communication. Like attention control, memory is an extensive area of research but an aspect of memory identified as part of EF is working memory (WM).

Operational demands and representational forms

47

Figure 3.3 A cat under an umbrella (© Murray) Extract 3.3.

Extract 3.3BAC Key: A: child using aided communication, T: teacher, R: researcher Picture: cat under umbrella (Figure 3.3) Dialogue length: 2 minutes, 41 seconds Communication process 1

A

{*-* “animal” [

2

T

It’s an animal

3

A

*“pet”} ]

4

T

A pet? Urm can you give me another clue?

5

A

{* “fun”}

6

T

It’s an animal, it’s a pet and it’s fun [Can I guess

7

A

{*-*-*-*-*-* “raining”}]

8

T

[Oh

9

A

/oarhah/

10

T

Now] is it a dog?

11

A

HAND RESTING ON HEAD /arr/ “no” (shakes head)

12

T

Is it a cat?

Operational process

Continues on next page

The Silent Partner?

48

13

A

“yes” (upwards movement of body) {*-*-*-*-* “yes” }

14

T

Yes, ooh right, anything else?

15

A

16

A

{ “raining”}

17

T

Raining, raining. Oh my goodness. A wet cat. Oh *A*(child’s name) where umm... Can you give me anything else?

18

A

“no” (shakes head looks in direction of R)

19

T

Where umm…Is it… raining, is it helping with the cat… to do something? What’s it helping?

20

A

“yes” (upward movement of body and smiles)

21

A

22

A

“dry”}

23

T

Dry[

24

T

Is it an umbrella?

25

A

26

A

“yes”}

27

T

Is the cat holding an umbrella?

28

A

29

A

“yes”}

30

R

Do you need to look now and see?

31

T

Ohh-Can I look? [I can……ooh excellent, well done, that’s brilliant well done *A* (child’s name)

32

A

“yes” (upwards movement on body)] “happy” (squeals in delight)

33

T

Those were really good clues, raining and dry

BACK PAGE- DELETE WORDS-WIPE {WHEELCHAIR-NEXT PAGE X 2-^WEATHER-UMBRELLA

BACK PAGE X 2- LLL CATEGORIES {DAN-OPPOSITES-UMBRELLA

{SUN-YES

WIPE ] {SUN-YES WIPE

Working memory In this section, we consider the operational demands of aided communication requiring effective and simultaneous working memory (WM) skills. An overview of

Operational demands and representational forms

the WM task for a child using aided communication starts with consideration of their aided communication system, which may have an extensive symbolically represented vocabulary, not all of which is visible at all times. The child must recall and maintain the target concepts whilst determining if they have a means of expressing these concepts within their aided system. They may need to navigate multiple layers of symbol storage whilst attempting to follow the most efficient navigational path, which may vary each time depending on the starting point of ongoing communication. As they aim for successful production of the desired word or phrase, they must locate the desired concepts on the relevant page whilst inhibiting any temptation to be distracted, for example, by alternative routes, or alternative concepts/graphic symbols or any desire by their communication partner to move on with the conversation. WM is the process of holding new visual or auditory information in mind as you retrieve older knowledge or procedures to apply to the new material. Working memory is not purely an executive function, but overlaps with the executive functions of attention and other types of memory (e.g., long-term memory) (Murray & Goldbart, 2011). During most conversations, children using aided communication have to retain new information in their heads (for example, the conversational context or their intended communication message), whilst drawing on older information (for example, the location of relevant graphic representations for the utterance they want to produce). Baddeley (2003, 2012) described one theoretical model of WM comprising three components: a central executive which allocates attention resources and makes storage decisions through the more recently identified episodic buffer; a phonological loop which responds to speech-based information via a temporary storage system and a sub-vocal rehearsal system; and a visuo-spatial sketchpad which integrates spatial, visual and possibly kinesthetic information. The existence of the phonological loop has been extensively researched in typically developing children. Age-related changes occur in the phonological loop, demonstrated by an ability to use articulatory rehearsal to recall spoken word-based stimuli (Baddeley & Andrade, 2000; Baddeley & Wilson, 1985; Ford & Silber, 1994; Friedman & Miyake, 2000; Gathercole & Pickering, 2000). Cowan (2001) reported changes in typical learners as the ability to rehearse and recall two to three items at 4 years, three to four items at 5 years, five items at age 11 and six items at 12 years. Hitch, Halliday, Dodd, and Littler (1989) reported that memory for spoken material was sensitive to word length in children aged 4 years and upwards, suggesting the longer the words the fewer words could be retained and rehearsed in their WM. In contrast to the role of the phonological loop, Baddeley (2012) more recently acknowledged that skills might differ when considering the function of the visuo-spatial sketchpad. Unnamed, visually presented material has a longer processing route, having to go through semantic processing before conversion to an articulatory form. Studies of the visuo-spatial sketchpad have been more limited than those of the phonological loop. Evidence suggests that, depending on the task, storage may be spatial, primarily visual or possibly motor and that competing demands reduce performance (Baddeley, 2003, 2012). For example, consider this situation for a child using aided communication: their vivid visualization of a familiar fairytale delivered by another person offering a verbal recitation, whilst they are simultaneously preparing (through aided means) an

49

The Silent Partner?

50

Figure 3.4 Ladders (© Murray) Extract 3.4.

Extract 3.4BAC Key: A: child using aided communication, P: peer, R: researcher Picture: ladders (Figure 3.4) Dialogue length: 1 minute, 68 seconds Communication process 1

A

2

A

3

A

4

A

5

A

6

A

7

A

8

A

9

A

Operational process WIPE WIPE

“you”} c-l-i-m-b “on”} “it”} “to get”} “something”} “you”} c-a-n-‘-t

{NAME-YOU SPELL MODE SPELL MODE {BRIDGE-HOBO {NAME-IT {TO-SHE {SCALES-IT {NAME-YOU SPELL MODE SPACEMAN SPELL MODE

Operational demands and representational forms

VIDEO-VIDEO (unintended sequence),

10

A

11

A

12

A

“you climb on it to get something you can’t reach”

13

P

Is it ladders?

14

A

“yeh”

“reach”}

{VIDEO-SHEEP-APPLE SPEAK ALL

expected commentary or response to be produced at the relevant point in the story. At the point of message composition, the graphic symbols on display would be the unnamed visual component. The competing demands of listening and constructing may challenge the successful processing of relevant information needed to convert the visual/spatial to the phonological system, impacting upon either the child’s story listening or utterance production skills. [These cognitive processes are described with recognition that there may be additional physical impairment challenges that further impact on performance.] In the field of AAC, as yet few studies have attempted to consider the demands of aided communication on working memory, though there are notable exceptions (Larsson & Dahlgren Sandberg, 2009; Murray & Goldbart, 2011; Stadskleiv et al., 2014; Thistle & Wilkinson, 2013). The extent of this research activity may be because one particular challenge for the field of aided communication research is that the majority of evidence from typically developing children is based on naturally spoken responses to investigation stimuli (see related discussion by Dahlgren Sandberg, this volume). The parameters of investigation considered thus far in AAC research have acknowledged and attempted to circumvent the need for natural speech responses from participants. These AAC studies focus on either the phonological loop or visuo-spatial components of WM, all offering exploratory comment on the influence of WM on the operational demands of aided communication. The emergence and presence of articulatory rehearsal skill in children using aided communication has been demonstrated (Larsson & Dahlgren Sandberg, 2009; Murray & Goldbart, 2011). Thistle and Wilkinson (2013) consider learning strategies (e.g., visual) and how they may play to WM strengths of certain users. For example, some children with a diagnosis of autism spectrum disorder may excel in certain WM tasks with a visual component. Stadskleiv et al. (2014) conclude that aided communication taxes the WM aspects of executive function more than typical (natural speech) communication strategies. In addition, they acknowledge that children using aided communication tend to have less experience of tasks that may support the development of enhanced EF skill, as suggested in the seminal work led by Bishop and Robson (1989). Extract 3.4 allows us to consider the young person’s ability to cope with the WM components of their message stream. Prior to the activity described in the transcript, the child using aided communication understood the task demands. She is 13 years old and directly accesses her high-tech system by pressing the keys required. The task requires her to describe a picture that she can see but her conversational partner has

51

52

The Silent Partner?

no knowledge of or sight of during the task. The production components allow us to consider a number of WM tools that she has to use to produce her intended utterance. These may include: 1. Deciding on the linguistic components of her response and internally rehearsing these as she completes other aspects of message generation; 2. Deciding which elements are available to her on her aided system; 3. Locating these from the novel starting position of message generation (i.e., which page of her system is she on when she starts to construct her message); 4. Element-by-element recall of a two-symbol sequence (which may also need to be internally rehearsed whilst located and activated), and her use of spelling sequences that place similar WM demands; and 5. All this whilst keeping track of where in the complete message sequence she is, to ensure the next most relevant element is sourced and selected. Whilst the picture description task may appear fairly straightforward (i.e., give your listener clues to identify that this is a picture of some ladders), this is a complex message generation operation for the child using aided communication compared with their typically developing peer using natural speech. It takes considerable time (note the time elements indicated in the transcript). Concluding this section, it seems that a highly skilled balancing act is required of children using aided communication. They must use EF skills with flexibility and synergy to get their message across using aided and unaided conversational techniques. These conversational techniques place differing demands on their EF resources. The child must simultaneously remain aware of their conversational partners’ needs and anticipate the next element of conversation in an attempt to keep the interaction going. The analogy of the iceberg comes to mind: what you see on the surface belies the realities that are present but hidden from view and therefore not always acknowledged or recognised.

Language representation: An overview Representational forms of communication are not limited to the field of AAC. Throughout history, symbolization has been used to convey coded messages to those who operated within cultures, societies and organizations to convey secret messages; this is specifically well documented within, for example, the Elizabethan era where tangible or graphic representational forms replaced the spoken word (Bruce-Mitford, 2008). In specific contexts, the symbolization stood for or represented something else (Beukelman & Mirenda, 2005). Understanding the symbolization required the sender and receiver to have shared recognition, and an agreed meaning of a representational form within a specific context of use. This shared understanding within a specific context of use is known as symbolism. The symbol may have one constant label but its meaning is open to interpretation according to the context of use (Bruce-Mitford, 2008). Symbolization is recognized as

Operational demands and representational forms

a coding label, whereas symbolism is recognized as the element of interpretation. The combination of these two concepts of symbolism and symbolization is notable in the stylized development of many graphic representation systems. The graphic representation typically used within the field of AAC may have a label or a name (symbolization) but actually be used to represent a range of notions depending on the context of use (symbolism). For example, symbolization offers a label, e.g., rose. Symbolism is open to be interpreted, e.g., the rose representing the following meanings: flower, affection, red, plant, beauty, and so forth. This next section explores the deconstruction of the graphic symbol in terms of symbolization and symbolism. We communicate in a range of contexts. For a child using aided communication, this makes the identification of relevant and functional language representation materials critical to their opportunities to contribute effectively within interactions across differing contexts. The vastness of this identification challenge is well documented (e.g., Bryen, Chung & Lever, 2010; Dada & Alant, 2009; Light, 1997; Wilkinson & Rosenquist, 2006). Identification and introduction of vocabulary may be influenced by the ease with which items can be visually represented (i.e., symbolization) or the flexibility of their use across multiple communication contexts (i.e., symbolism) (Binger & Light, 2007). The users’ current and anticipated needs and abilities bring differing components of the symbolization process into sharp focus, with consideration of what should be symbolized and why, leading to consideration of how we might symbolize (Beukelman & Mirenda, 2005; Schlosser & Lee, 2000). To explore the complexities of symbolism inferred in graphic language representations, one approach is to deconstruct the component parts, or the symbol elements, as a way of identifying which aspects of symbolization the user finds easy or more challenging to recognize, learn or use. Although developed considering children with typical development, Bloom and Lahey (1978) offer a useful frame of reference within which to describe the complexities of graphic symbol representation. They described three overlapping features of language and communication in terms of content, form and use. In brief, in spoken language, content considers meanings, including vocabulary knowledge, form considers word sequences and the word order relationships, whilst use considers the capacity to apply content and form knowledge in a flexible way according to the communication context. These content, form and use components readily apply to graphic symbol elements, specifically in terms of considering the ideas symbols may convey, the type of visual representations chosen and how this supports the user develop potential conversational strategies (schematically summarized in Table 3.1). The descriptions detailed below attempt to present a theoretical construction of the componential demands of graphic symbol representation. It is acknowledged that in reality there is an interplay between these components and a trade off in terms of the real-time communication demands on the child.

Content Analysis of language and communication content allows us to focus on the semantic aspects of graphic symbol representation subdivided here into (i) concepts, (ii) iconicity, and (iii) word classes.

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Table 3.1 Deconstructing graphic symbol elements. Content

Form

Use

Ideas

Concepts

Construction

Flexibility

Visual representation

Iconicity

Complexity

Purpose

Communication repertoire

Word classes

Organization

Retrieval

Concepts include the ability to assimilate and accommodate experiences, views and perspectives and are the building blocks of our knowledge and ideas (Aitchison, 2001; Blockberger & Sutton, 2003). Graphic symbol representations of concepts must be visually recognizable to the user (Bornman, Alant & Du Preez, 2009; Stephenson, 2009). The visual relationship between concept and representation is not a constant phenomenon, operating along a continuum from transparent to opaque iconicity. This continuum highlights that the symbolism within graphic representations may be at variance to the predetermined (symbolization) label assigned to the graphic symbol. This can be demonstrated with an example from the Minspeak™ representation package, ‘Language, Learning and Living’ (Jones, 1991). This was and still remains a popular symbol communication system in the UK. Take the symbolization labels for two icons SHEEP and DOG. When accessed in a sequence they speak the word ‘eat’. The sheep icon visually represents a sheep jumping over a barrier, whilst the dog icon is a dog tied to a post eating from a bowl. In the icon sequence, the sheep icon acts as an action classifier, whilst the dog icon specifies the action (in this instance ‘eat’ because the specific focus of semantic attention in the visual representation of the icon is the action of the dog: eat{ing}). In another example sequence, ZEBRA + SHEEP, the word ‘sheep’ would be produced. Here the zebra icon acts an animal classifier, with the sheep icon specifying the type of animal, i.e., ‘sheep’. Assuming that ‘eat’ and ‘sheep’ are the intended utterances, these examples suggest that the child is simultaneously recognizing the context specific concepts embedded within the iconic components of the graphic representations, and then manipulating these conceptual components by altering their sequential relationship to produce utterances from two differing word classes. What cannot be clear in this example is whether the symbolization labels (i.e., SHEEP, DOG, ZEBRA) have relevance to the child’s communication success (Light, 2003; Light, Wilkinson & Drager, 2008; Reichle & Drager, 2010). They are there for system organizational and representational classification and may have more relevance when considering these components, which will be revisited in the section under form. In the following example, the child demonstrates an ability to assimilate experiences and perspectives, moving between his internal concept knowledge and his knowledge of the concepts and content available within his graphic language representation system (Aitchison, 2001; Fallon et al., 2003; Mok & Kipka, 2009; Smith, 2006; Wilkinson & Rosenquist, 2006). The extract (Extract 3.5) involves a boy of 13 years participating in a guessing game with his teacher. He must describe a picture that his teacher cannot see, avoiding the key noun label ‘fruit’. The teacher does not know what is on the picture. The game is complete when they have an agreed understanding of the picture content. Finally, the picture is shared with the teacher.

Operational demands and representational forms

In this extract, this child demonstrates insight into the task requirements and the listener’s needs. He describes items in the picture in terms of their attributes (colours) and function (edible). These single word utterances demonstrate his concept knowledge, his awareness of the visual characteristics of the picture and their equivalent in his language representation system, and finally his awareness of differing words classes (i.e., adjectives and a verb), which he offers as semantic clues to support the listener. This performance suggests that he has learned these concepts and they have been made available to him in symbolized form, and that he is able to retrieve them from his aided system. However, as this guessing game is intended to be a co-construction activity relying on the conversational partner’s semantic knowledge, it is recognized that the use of the colour ‘orange’, which is also the name of a fruit, may have triggered this guess from the teacher and a more immediate successful conclusion. What we cannot be certain of is whether this was a strategic use of the word orange by the child who may have deliberately relied on the dual meaning of the word (i.e., adjective and noun) to support an appropriate guess. Leaving language content aside momentarily, we turn to language form. The form of a graphic symbol utterance will provide the lens for identification of its grammatical components in contrast to the production of semantically-related single message elements (as an example, see lines 1–19, Extract 3.5, e.g., the list of colours).

Form Analysis of language and communication form focuses on the grammar, or syntactic and morphological components of graphic symbol representation, further subdivided into (i) construction, (ii) complexity and (iii) organization. Aided language construction typically expects children using aided communication to learn to produce grammatical utterances that resemble the spoken language form of their environment. AAC research evidence suggests that production of fully grammatical utterances may be challenging for many children who can produce the content aspects of their utterances rather than their grammatical form (Murray & Goldbart, 2009a; Schlosser & Lee, 2000; Smith, 2015; Trudeau et al., 2010). Children using aided communication systems are operating bi-modally during any interaction. They are using the processing constructions of the spoken language within their environment and the processing constructions of their graphic symbol system. These do not always resemble each other in terms of their language form. There are two layers of organization: organization of an underlying spoken language form and an additional organizational layer of the access route required to map that spoken form onto their aided communication system. Some graphic symbol representations may vary in their position on the iconicity continuum by having different levels of complexity embedded within them. Such graphic systems may have sub-elements and a variety of semantic components, for example, Minspeak and Blissymbols (Binger & Light, 2008; Schlosser, 1997a, b; Trudeau et al., 2010) and consequently may at times break traditional rules of grammatical construction and organization, being more semantically primed to support the generation of themes of communication rather than producing grammatically correct utterances. Extract 3.6 is the start of a dialogue between two friends, both girls aged 13 years. One uses aided communication, the other natural speech. The picture being described is

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The Silent Partner?

56

Figure 3.5 Fruit in fruit bowl, many cut in half (© Murray) Extract 3.5.

Extract 3.5BAC Key: A: child using aided communication, T: teacher, R: researcher Picture: fruit in fruit bowl/many cut in half (Figure 3.5) Dialogue length: 2 minutes, 58 seconds 1

A

2

T

3

A

4

A

5

T

6

A

7

A

8

T

9

A

Communication process

Operational process

“yellow”}

{TEACHER-PAINTPOT-^COLOURS DYNAMIC STRIP

Yellow “pink”} “purple”}

{TEACHER-PAINTPOT-^COLOURS {TEACHER-PAINTPOT-^COLOURS DYNAMIC STRIP

Yellow, pink, purple “gold”}

{TEACHER-PAINTPOT-^COLOURS DYNAMIC STRIP

“orange”}

{TEACHER-PAINTPOT-^COLOURS DYNAMIC STRIP

Oh my goodness Ooh…umm,[ any more…. “eat”}]

{SHEEP-DOG WIPE

Operational demands and representational forms

10

T

It’s something that you eat and it’s all those colours? Is it an ice cream?

11

A

“no” (shakes head) “no”}

12

T

Any other clues?

13

A

{“no”}

14

T

NO! All those colours, something that you eat… Can you repeat what you have told me…..yellow

15

A

16

A

17

A

18

A

19

A

20

T

21

A

{“no”}

“yes”} “yellow”} “purple”} “orange”}

{SUN-NOSMOKE

DYNAMIC STRIP

DYNAMIC STRIPWIPE {SUN-YES {TEACHER-PAINTPOT-^COLOURS {TEACHER-PAINTPOT-^COLOURS {TEACHER-PAINTPOT-^COLOURS

Ooh is it fruit? “yes”}

{SUN-YES

of an elephant holding some bananas with a horse on its back and a rooster balanced on the horse. This utterance demonstrates the atypical grammatical components that this (very competent) child using aided communication uses to generate the desired words using a Minspeak™ based system (for overlay examples see Jones, 1991), highlighting variance from a typical spoken utterance in terms of construction and complexity. A number of factors, including semantic classificatory reasons, may determine the choice of and organization of graphic representations (Light, 1997; Light, Wilkinson & Drager, 2008). This extract is a good example of the icon sequence strategies described in the previous section on Content (i.e., SHEEP, DOG, ZEBRA). The operational (construction) process is presented in the right-hand column of the extract. These constructions produce individual words; however, as a process of word construction it differs from the components of typically produced spoken utterances. Here, the child has to construct a sequence of semantically-linked icons relevant to the desired word/ message output, and then retain a sense of the construction sequence expected in a recognizable grammatical sentence. This demonstrates the bi-modal organizational levels of message construction required for every utterance produced. MinspeakTM

57

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58

Figure 3.6 An elephant, a horse and a rooster (© Murray) Extract 3.6.

Extract 3.6BAC Key: A: child using aided communication, P: Peer, R: researcher Picture: elephant/horse/rooster (Figure 3.6) Dialogue length: 7 minutes, 7 seconds

1

A

2

A

3

A

4

A

5 6

Communication process

Operational process

“it’s”}

{ELF-IT WIPE- WIPE

“there” “there’s”} “a”} “brown”}

{THELMA-YACHT + MONSTER {A-A { PAINT-MORE {BROWN

g-r-e-y

SPELL MODE SPACE MAN-

t-h-h i-n-g t-h-i-n-g

SPELL MODE DELETE CHAR SPACE MAN SPELL MODE

Operational demands and representational forms

7

A

8

-+“with”}

9

“bananas”} *-*

10

“and”}

11

“there” “there’s”}

12

“a”}

{BRIDGE-DANCE {APPLE-MOON +MONSTER {BRICKS –BRICKS {THELMA-YACHT MONSTER {A-A

13

“brown”}

PAINT-MORE {BROWN

14

t-h-i-i n-g

SPELL MODE DELETE CHAR SPACE MAN- SPELL MODE

15

16

“there there’s a brown thing there there’s a grey thing with bananas and there there’s a brown thing” P

SPEAK ALL

Is it a football?

is a particularly helpful system to demonstrate these constructions, and the complex and organizational demands involved. Many other symbol systems place equally recognizable demands on the user of aided communication. MinspeakTM is used here merely because the extracts cited include Minspeak users to illustrate the points made. Operational demands outlined in these sections on content and form allow consideration of the representational building blocks of aided language before moving on to thinking about how we use the aided language tools and strategies we have learned. The goal for the child is to acquire knowledge and understanding of what the graphic symbols look like, what they could represent and where they are located within the aided system, and how they may be combined to produce an utterance that is meaningful to their conversational partner. These production skills progress to use in a real communication context, in real time (Tomasello, 2003). This latter component is Bloom and Lahey’s (1978) description of language: Use.

Use Analysis of language and communication use is focused on the pragmatic utility of graphic representation, divided into (i) flexibility, (ii) purpose, and (iii) retrieval. The flexibility of a graphic system may be located within the components considered under Content and Form, or within the communication strategies of the child who uses AAC (Use). For example, a child may demonstrate the capacity to combine graphic symbol

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representations to offer creative communication ideas (e.g., Blissymbols) that may not use spoken language constructions. Alternatively, the flexibility within the system may mean that it offers the user capacity to develop linguistic complexity over time (McFadd & Wilkinson, 2010). Communication Use allows consideration of the features of multimodal communication within which the graphic representation system may be one modality. Use of multimodal communication strategies is dependent upon the purpose of communication and the range of communication modalities the person has a preference for using. Individuals may choose to use communication modalities other than their aided system, as the young man in Extract 3.1 did when he chose to use gesture to support his communication partner in guessing the item ‘mirror’. Revisiting this extract shows the child relying on the researcher to act as a communication broker for his friend who, due to visual impairment, could not readily see the communication gestures being used. Was this choice of communication modality indicative of strategic competence on the part of the child using aided communication, where he saw a purpose of the researcher as someone who could support effective message transmission (Light & McNaughton, 2014; Smith, 2015)? Alternatively, could it have been indicative of a challenge to his linguistic or operational competence, where he was uncertain how to retrieve the words from his aided system (Dietz et al., 2012; von Tetzchner & Martinsen, 2000)? This is difficult to determine. Applying Bloom and Lahey’s framework to aided language representations supports consideration of the differences in language learning and language use for the child using aided communication when compared to their typically developing peers. Aided communication use requires the user to perform a series of transformations between different frames of reference, which include focusing on the aided system and its navigational nuances, the conversational partner and their communication needs (social competence) as well as maintaining the conversational focus (strategic competence) (Light & McNaughton, 2014; Smith, 2015). The complexities of these transformations in real-time conversation and the demands these place on children using aided communication should not be underestimated.

Conclusion The operational demands of aided communication are far reaching. This includes consideration of the features of the equipment used, the graphic language representation system and its organization, the access method and the conversational interactions available to the child. In this chapter, we have contemplated operational knowledge and skill and the forms of symbolic representation. To do this meaningfully, we specifically considered the impact of EF skills and knowledge in relation to attention control devices and working memory capacities. Language representation was reviewed using the traditional linguistic lens of Content, Form and Use (Bloom & Lahey, 1978) as a framework to deconstruct the componential demands of graphic language representation codes. Executive functioning was reviewed in terms of planning, sustaining and maintaining goal-directed communication behaviours. In conclusion, the operational demands are high and the output gains may be less transparent. The representational features are variable. Language representational forms place differing demands on the communication

Operational demands and representational forms

skills of users, and can be deconstructed into the components that focus on semantics (content), grammar (form) and pragmatics (use). The purpose of the aided system for a child may prompt the identification of a particular language representation system (von Tetzchner & Martinsen, 2000). We have considered whom the symbolic referents are for and how the point of reference may change in conjunction with a consideration of how the referent changes during an interaction. We conclude that interactions involving aided communication are complex and vary according to individual partner needs and the context of aided communication use. Graphic symbol representation is complex, culture-bound, time-bound and experience-bound (Martin & Murray, 2010; Von Tetzchner, Almeida, Balandin, Basil, Batorowicz, et al., 2012). We suggest that greater consideration of the demands on executive functioning and language representation knowledge could enhance users’ achievement of aided communication competence and lead to greater independent communication success.

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Schlosser, R., & Lee, D. (2000). Promoting generalization and maintenance in augmentative and alternative communication: A meta-analysis of 20 years of effectiveness research. Augmentative and Alternative Communication, 16(4), 208–227. Schlosser, R. (1997a). Nomenclature of category levels in graphic symbols: Part1: Is a flower a flower a flower. Augmentative and Alternative Communication, 13(1), 4–13. Schlosser, R. (1997b). Nomenclature of category levels in graphic symbols: Part 2: Role of similarity in categorisation. Augmentative and Alternative Communication, 13(1), 14–29. Shepp, B., Barrett, S., & Kolbert, L. (1987). The development of selective attention: Holistic perception versus resource allocation. Journal of Experimental Child Psychology, 43(2), 159–180. Smith, M. (2006). Speech, language and aided communication: Connections and questions in a developmental context. Disability and Rehabilitation, 28, 151–157. Smith, M. (2015). Language development of individuals who require aided communication: Reflections on the state of the science and future research directions. Augmentative and Alternative Communication, 31, 215–233. Stadskleiv, K., von Tetzchner, S., Batorowicz, B., van Balkom, H., Dahlgren Sandberg, A., & Renner, G. (2014). Investigating executive functions in children with severe speech and movement disorders using structured tasks. Frontiers in Psychology, 5, 992. Doi: 10.3389/fpsyg.2014.00992 Stephenson, J. (2009). Iconicity in the development of picture skills: Typical development and implications for individuals with severe intellectual disabilities. Augmentative and Alternative Communication, 25(3), 187–201. Thistle, J., & Wilkinson, K. (2013). Working memory demands of aided augmentative and alternative communication for individuals with developmental disabilities. Augmentative and Alternative Communication, 29, 235–245. Tomasello, M. (1999). The Cultural Origins of Human Cognition. Cambridge, MA: Harvard University Press. Tomasello, M. (2003). Constructing a Language: A Usage-based Theory of Language Acquisition. London: Harvard University Press. Tomasello, M., & Farrar, M. (1986). Joint attention and early language. Child Development, 57, 1454–1463. Topbas, S., Mavis, I., & Erbas, D. (2003). Intentional communicative behaviour of Turkish-speaking children with normal and delayed language development. Child: Care, Health and Development, 29(5), 345–355. Trudeau, N., Sutton, A., Morford, J., Cote-Giroux, P., Pause, A., & Vallee, V. (2010). Strategies in construction and intervention of graphic symbol sequences by individuals who use AAC. Augmentative and Alternative Communication, 26(4), 299–312. Vaughan Van Hecke, A., Mundy, P., Block, J., Delgado, C., Parlade M., Pomarese, Y., & Hobson, J., (2012). Infant responding to joint attention, executive processes, and self-regulation in preschool children. Infant Behavior & Development, 35, 303–311. von Tetzchner, S., & Martinsen, H. (2000). Introduction to Augmentative and Alternative Communication, 2nd ed. London: Whurr. von Tetzchner, S., & Basil, C. (2011). Terminology and notation in written representations of conversations with augmentative and alternative communication. Augmentative and Alternative Communication, 27, 141–49. von Tetzchner, S., Almeida, M., Balandin, S., Basil, C., Batorowicz, B., Clendon, S., et al. (2012). The development of aided communicative competence: Communicative problem solving in children using aided communication and naturally speaking children aged 5–15 years. Presented at the 15th Biennial Conference of the International Society for Augmentative and Alternative Communication, 28 July–4 August 2012, Pittsburgh, USA. Wilkinson, K., & Rosenquist, C. (2006). Demonstration of a method for assessing semantic organization and category membership in individuals with ASD and receptive vocabulary limitations. Augmentative and Alternative Communication, 22(4), 242–257.

4 S ymbolic representation and graphic symbol use Insights from typical development

Ann Sutton

This chapter reports an exploration of the literature regarding graphic symbol use by children with typical development (TD) in light of the literature on development of symbolic representation. Discussions of aided communication often refer to some aspects of children’s symbolic representational skills (for example, Smith, 2015; Stephenson, 2009). However, it is possible that more may be learned by using the symbolic representation literature as a framework for examining use of graphic symbols in aided communication, particularly when going beyond early levels of relating to symbols. The goal of this chapter, therefore, is to examine performance of children with typical development on tasks involving the types of graphic symbols often provided on aided communication displays, in order to determine the level of symbolic representation that can be observed or inferred. The backdrop for this exploration is the literature on symbolic development in children with TD. There is clearly some correspondence and overlap between these two bodies of literature, particularly at early developmental stages: gaining entry into symbolic behaviour gives children access to language as well as the ability to use twodimensional depictions as symbols. However, their paths quickly diverge. In the AAC literature involving children with TD, there seems to be an implicit assumption that once children begin to talk, they are demonstrating symbolic behaviour that is sufficient to support the use of graphic symbols as a means for communicating. Scholars studying children’s symbolic development would likely nuance this conclusion. Once children begin to talk, they clearly demonstrate symbolic understanding because they are using arbitrary symbols (spoken words) to refer to aspects of their environment. However, attainment of full symbolic representation is not a unitary process: development differs across the subdomains of symbolic function (gesture, pretense, language, and visual symbols). Skills in one subdomain do not guarantee the same level of performance in another (Bialystok, 2000; Callaghan & Corbit, 2014). Further, symbolic development extends into the school years and involves several levels of representation prior to full attainment (Callaghan, 2013). Thus the ability to use arbitrary symbols (speaking)

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may be indicative of entry into the symbolic domain but cannot be interpreted as full symbolic competence. In this exploration of the literature of graphic symbol use, particular attention will be given to the evidence for levels of representation that may be uncovered in studies of children who are developing typically across a range of graphic symbol tasks.

The symbolic background There is a long history of interest in, and research on, symbolic representation within the field of child development in the domains of gesture, language, pretense, and material symbolic artefacts (visual symbols including scale models, maps, video, and pictures). Across domains, considerable attention has been given to the very early stages of development, that is, how young children gain entry to the symbolic function within that domain (e.g., Callaghan, Rochat, MacGillivray & MacLellan, 2004; Preissler & Carey, 2004; Salsa & Peralta de Mendoza, 2007). Ultimately, though, development in all domains leads to attainment of symbolic thought, that is, explicit awareness of and ability to contemplate relationships between symbols and their referents, and relationships among symbols within and across domains. It is children’s progress towards this accomplishment that is studied in the symbolic development literature.

What develops? Two recent articles (Callaghan, 2013; Callaghan & Corbit, 2014) provide extensive reviews and analysis of the theoretical foundations and research related to symbolic development. Three essential dimensions emerge from this literature. First, there are different levels of representation in the use of pictures as symbols (i.e., graphic symbols): development involves moving through these levels. At the level of association, children are aware that the symbol and its referent go together in some way, and they can demonstrate this association in their behaviour (e.g., pointing or looking at one when presented with the other). At the level of reference, the symbol can stand for its referent even when the latter is not present. The child is able to use the symbol as a source of information going beyond simple association with the referent. The level of representation, in contrast, is reserved for true understanding of the representational nature of graphic symbols: the nature or the relationship between the symbol and its referent and among symbols. At this level, symbols are objects of reflection. Second, progression through levels of representation is related to the notion of intent to represent. Symbolic nature is not inherent in a picture or graphic sign; it is the viewer’s interpretation of it that qualifies it as a symbol. The child comes to understand that others, as viewers, will interpret a symbol in the same way as he or she does, that is, with the intent to treat it as a symbol (Callaghan, 2013; Callaghan & Corbit, 2014). Third, progress in symbolic development is tied to the increasing explicitness of children’s understanding of the symbolic function of graphic symbols. Development involves a gradual shift from an implicit understanding, where children appreciate the symbol-referent association and view graphic symbols as a source of information, to an explicit understanding that symbols are available for conscious reflection. Children are not only able to act on the basis of the interpretation of the graphic symbol but also to reflect on what they do.

Graphic symbols and typically developing children

Infants seem to be aware of the similarity between corresponding objects and photographs of those objects. At five months, infants responded in a similar manner to objects and corresponding photographs but differently to a distinct object (DeLoache, Strauss & Maynard, 1979) and 9-month-olds treated pictures as if they were the actual objects represented (Pierroutsakos & DeLoache, 2003). Older toddlers (as early as 15 months) behaved differently towards objects and two-dimensional depictions (Preissler & Carey, 2004). The ability to associate a picture with an object (or word), that is, to make the link between the two when both are present, emerges perhaps as early as 18 months (Preissler & Carey, 2004, but see Callaghan et al., 2004). Regarding the referential function of pictures (i.e., the realization that a picture is a symbol that stands for something not present in the immediate environment), the age at which this function emerges differs across studies. The tasks varied across studies, which may partly explain the age discrepancies in the findings reported. Ganea, Pickard and DeLoache (2008) suggest an early emergence of the referential function (as early as 15 to 18 months). The children in their study learned a new word for a picture containing a highly iconic depiction of an object referent and then extended their understanding of the spoken word to the corresponding object. Simcock and DeLoache (2006) found that the referential function emerges later, across the 18- to 30-month age range. In their study, 18-month-olds were unable to associate pictures and referents; at 24 months, children were able to do so only if the pictures were highly iconic; by 30 months they were successful without the need for iconicity. Callaghan (2000) found that, even at 30 months, children needed favourable conditions in order to match graphic symbols with referents and were only successful on the task when the response options were highly distinctive, i.e., when the verbal labels for the symbols were available, and when there was a strong resemblance between symbol and pictured referent. The referential function seems to take some time to become stable. Initially, a close link between symbol and referent may be needed in order for children to perceive reference. Further, the relationship between symbol and referent may be asymmetrical in that the graphic symbol must accurately depict the reality. For example, Robinson, Nye and Thomas (1994) found that 3- to 4-year-olds had difficulty with the notion that a change in the referent might not be reflected in the picture. This was no longer an issue for the 4- to 5-year-olds, who were able to make the link between a picture and its referent even when the picture had been modified and no longer accurately depicted the referent.

Intent Some appreciation of intent can be observed in quite young children under certain circumstances. For example, in Salsa and Peralta de Mendoza (2007), children at 30 months used pictures referentially when it was made explicit that the symbol would be viewed with the intent to refer; at 36 months, children did not require this extra explicitness in order to use symbols referentially. Callaghan, Rochat and Corbit (2011) designed a task to explore referential intent. They created a pictorial version of a false-belief task, in which responding correctly requires explicit awareness that the viewer’s perspective differs from reality. Children had to recognize that what the

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viewer believed to be true could be different from what was depicted in the picture. Callaghan et al. found that 3-year-olds had little success with the task, but by 5 years of age, children’s responses demonstrated that they were able to identify the viewer’s representational intention, even when it differed from the real situation. Awareness of intent to represent continues to emerge over several years and may not be fully explicit until 9 or 10 years of age (Myers & Liben, 2008, 2012).

Explicitness Studies designed to tease out explicit understanding of the symbolic function of pictures seem to suggest that explicitness emerges during late preschool and early school-age years. For example, Thomas, Nye and Robinson (1994) explored whether 4-year-old children could disregard the way they usually used pictures, as standing in for referent, and treat the picture as an object. The ability to do so could be taken as an indication of the degree of explicitness of their understanding of pictures as symbols (graphic symbols). The children in this study were able to treat pictures as objects – rather than as referring to objects – only when explicit instructions and training were provided; without this high level of support, they interpreted the picture as referring to an object only (i.e., a symbol), not as an object. The children in a study by Zaitchik (1990) similarly had difficulty with a task requiring explicit understanding of symbols. Children aged 3, 4, and 5 years were asked to judge whether a photograph represented the same scene after something originally in the scene was moved without this change being made in the photograph. The children had little success on this task even with several modifications to the procedure to make the task easier. Eskritt and Olson (2012) used a task involving adequacy judgements, which require a high level of explicit awareness because the child must reflect on the characteristics of the production. When 5- to 6-year-olds were asked to judge ‘notations’ that could be considered as symbols in that they were made to represent objects, they recognized a ‘good’ symbol when they saw one, regardless of the quality of the symbols they produced themselves. These studies illustrate the increasing explicitness of children’s understanding of the symbolic function.

The role of language and social supports The role played by language in children’s symbolic development related to pictures is a recurring theme. Scholars acknowledge the difficulties in discriminating the potential impact of language on performance with pictures, but some studies have nonetheless attempted to do so. For example, Callaghan (2000) used a symbol-object matching task involving pairs of objects, some of which had the same name and others that had different names (e.g., two kinds of dogs versus a dog contrasted with another animal). Children’s performance differed depending on the verbal labels available for the graphic symbols presented. Children (2.5 to 3 years old) performed more poorly when the two objects had the same name, even when the similarity of the objects was controlled and despite the fact that the verbal labels were not used in the study. Bremner and Moore (1984) found that the performance of 5- and 6-year-old children on a drawing task was better if they knew the name of the object to be drawn. Naming the object before drawing led to better drawings by the 6-year-olds. Thus, language support does seem to enhance children’s performance on symbol tasks.

Graphic symbols and typically developing children

Social supports also contribute to children’s symbolic development. The term social support in this literature refers to opportunities for the child to observe experts (i.e., adults and older children) using graphic symbols in culturally appropriate ways. Exposure to adult use of pictures (for example, as part of a study protocol) influences performance on symbolic tasks involving pictures in young children. DeLoache, Peralta de Mendoza, and Anderson (1999) found that children were differentially sensitive to the particular demands of the task and to the amount of instruction they received. Three-year-old children could appreciate the relationship between a symbol and its referent only when adults provided “considerable contextual support” (p. 306) even if the symbols were highly iconic; 6-year-olds, in contrast, could perform the same task with essentially no training. Even very young children seem to be sensitive to adults’ behaviours with graphic symbols. In a study with infants aged 6, 9, 12, 15 and 18 months, adults modeled ‘contemplative’ or ‘manipulative’ attitudes towards pictures and objects (Callaghan et al., 2004). At around 12 months, the children were more likely to behave in the same way as adults with pictures than with objects. The authors interpret this as an indication of the role for social supports in behaviour with pictures; the effect of modelling may be less strong for objects because children are likely to have had more direct experience interacting with objects. DeLoache, Pierroutsakos, Uttal, Rosengren and Gottlieb (1998) also documented the resemblance of children’s behaviours with pictures to that of adults in a study of children aged 9, 15 and 19 months. The youngest children tended to treat photographs as if they were the objects depicted and showed a preference for real objects over photographs. However, by 19 months, the children were more likely to point to a photograph than try to manipulate it, in line with what adults typically do with photographs and objects. In cross-cultural research, the amount of exposure to graphic symbols and material artefacts in the child’s culture more generally (e.g., middle-class America compared to rural India and Peru) has had an impact on performance on graphic symbol tasks (Callaghan, 2000).

Summary The development of symbolic representation involves progression through at least three levels: association, reference and, finally, representation. Further, it involves increasing awareness that using a symbol entails intent on the part of the viewer to interpret the symbol as a representation. Throughout, understanding moves from being implicit to increasingly explicit and available for reflection. Language and social supports are influential during symbolic development. Language, itself a domain of symbolic functioning, provides a scaffold for functioning in another symbolic arena: graphic symbols. Social supports, that is, exposure to how adults behave with graphic symbols, provide guidance in how symbols can be used.

The aided communication foreground

In the field of aided communication, it is widely accepted that conducting studies with participants with typical development who do not themselves use aided communication systems for daily communication is a research strategy that can provide critical insights

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regarding theoretical constructs. There are, of course, limits in the degree to which findings from these studies can be applied to individuals who use aided communication to compensate for the limitations of their natural speech; nonetheless, this type of research has provided a rich source of information about several aspects of aided communication that would be difficult if not impossible to discover otherwise. In this tradition, the primary question addressed is the following: What evidence exists regarding level of symbolic development (association, reference, representation) in the AAC literature on graphic symbol use by children with typical development? This is a narrative review, an organized attempt to cover the research literature on graphic symbol use by children with typical development and to interpret it in light of symbolic representation development in children. Research articles written in English were identified by searching the major databases (Google Scholar, Scopus, Web of Science) using search terms AAC, graphic symbols, and children, and then eliminating studies if no children with typical development participated. One study was included as an exception, even though the participants had a disability (intellectual impairment) because the study was concerned with the use of graphic symbols by children whose daily communication was via speech. An initial reading of this literature led to three observations and decisions about what would be covered in the review. First, the notions of intent and explicitness from symbolic development are essentially not addressed in this body of literature. These concepts will therefore be mentioned when relevant, but not treated in a structured way. Second, it is important to be aware of the language and social supports available when considering the level of representation that could be revealed within the studies; these elements will be analyzed more systematically across the studies. Finally, it became evident that a different treatment would be required for studies of single symbols versus those involving symbol sequences. Studies of single symbols are far more frequent and correspond more closely (although not fully) to the symbolic development literature, which, for the most part, deals with single symbols only. They are more homogeneous in terms of level of symbolic representation they reveal, and will be discussed broadly, looking at trends across the studies. Studies of symbol sequences, on the other hand, are more challenging to construe in light of the symbolic development literature and require more detailed analysis in order to discern the level of symbolic representation that could potentially be involved. These studies will be discussed individually and in greater depth. .

Single symbols The studies of single symbols and children with typical development can be categorized primarily as exploring (a) characteristics of symbols (31 studies), in which children are asked to demonstrate in some way their understanding of the symbol; or (b) characteristics of displays (18 studies), in which children are asked to find particular symbols within the display arrangement put before them. In symbol characteristics studies, researchers generally tried to reduce the task demands so that task performance could be interpreted in terms of symbol understanding; in display characteristics studies, in contrast, researchers attempted to minimize symbol demands in order to be able to interpret task performance in terms of children’s ability to locate known

Graphic symbols and typically developing children

symbols within different display arrangements. This observation of minimal symbol demands could raise the question of whether display characteristics studies are relevant to a discussion of level of symbolic representation. However, graphic symbols are the stimuli in most of these studies and the participants have to relate to them in some way in order to perform the tasks they are asked to do. In fact, in many of the studies designed to explore display characteristics, the task presented to children involved a symbolic element (whether intentionally or not). The distinction between a symbolic study and a locating study thus may not be clear until the method has been examined in detail. In the interests of transparency and completeness, therefore, all identified display characteristics studies have been included. At the end of the display characteristics section, seven additional studies that examined memory span using graphic symbols will be discussed.

Studies of symbol characteristics The majority of symbol characteristics studies (see Table 4.1) involved preschoolaged participants (21); ten studies involved school-aged participants, including two that covered both age ranges (Jennische & Zetterlund, 2015; Musselwhite & Ruscello, 1984). Occasionally, the participants with typical development served as a control or comparison group for participants with disabilities (Huang & Chen, 2011). Twelve studies included a developmental aspect by comparing performance across different age groups (10), by including a group of adults as well as the child participants (Fuller, 1997), or both (Musselwhite & Ruscello, 1984). Most studies (23) were conducted in English-speaking environments; other languages were Northern Sotho, Afrikaans (2), Sepedi, Setswana, Swedish, Taiwanese and Thai. Two studies included children who were in bilingual environments (Da Fonte & Taber-Doughty, 2010) or who came from different cultural groups (Light, Worah, Drager, Bowker, et al., 2008) and were tested in English.

Role of language In all studies of symbol characteristics, researchers paid attention to the language that might support performance on symbol tasks. Several types of language support can be observed (see Table 4.1). First, researchers gave consideration to the words chosen as stimuli to be represented by symbols. Some restricted the vocabulary (for example, choosing object labels only or applying a developmental level); others purposefully included a variety of word types (e.g., semantic/syntactic categories); still others choose words based on the characteristics of the symbols to be used to represent those words in the study. In addition to selecting symbols for concepts that are likely to be known to the children, researchers also ensured that the children knew the spoken words corresponding to the symbols used in experimental tasks, thus allowing children to take advantage of their spoken language knowledge when approaching the symbol task. In some studies, an assumption about familiarity with the spoken words was made based on children’s age; in most studies, though, a vocabulary pretest or direct testing (identification and/ or naming) of the symbols was conducted prior to the experimental tasks involving symbols (see Table 4. 1).

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40 Blissymbols, 40 CyberGlyphs

16 PCS symbols corresponding to short phrases

93 Blissymbols

Alant et al., 2005 n = 50, (2 groups M = 10.82 yrs and M = 10.88 yrs; Northern Sotho)

Basson 2005 n = 46 (6;0-6;11; Afrikaans)

Bornman et al., 2009 n = 34 (M = 6;11; Setswana)

Clark, 1981 n = 36 (4.3 to 5.4 yrs; English)

association: symbol written and spoken word; maintenance after 7 and 30 days

Level of representation

look at a symbol and write down answers to the question: “When perceiving this symbol, what words, features or inherent characteristics of the symbol you think of?”

rate each symbol (3-point smiley face scale): how much it looks like the word it is intended to represent

association: symbol spoken word

likely involves association (produce written text about each graphic symbol)

symbolic element unclear but likely involves association

association: symbol point to symbol (array of 16) corresponding to word spoken word/phrase spoken by examiner

place each symbol on printed paragraph text on top of corresponding written word

Experimental task: child is asked to…

26 symbols from Carrier name each symbol as and Rebus systems, examiner pointed to it on Blissymbols, printed words a page

Champoobutr et al., 2013 64 PCS for “highn = 65 (10-51 years, frequency picturable words” not possible to separate out younger/older participants; Thai)

Symbols

Study author and participants

instructions for the questionnaire (verbal for younger participants, written for older participants)

training for task performance; repeated over 3 days (opportunity for learning)

thematic display (bedmaking context for symbols); effect of training examined: training = explanation of symbol meaning

symbols presented within context of a written paragraph (20 per paragraph); four testing times: after initial training, revision, 7 days, 30 days.

Social support

words (nouns, main verbs, learning trials prior to test prepositions) common to trial the three symbol systems; pretest to exclude children who could already read the printed target words; spoken word provided when child made error

difficult to discern whether the verbal label was given when the symbols were presented, but it appears that no spoken label was provided

all words believed to be known to the children (teacher report);

symbol named by examiner during testing; no verbal feedback provided for responses

stimuli were familiar words in school settings (nouns, verbs, adjectives, pronouns, prepositions); symbols were presented with picture and verbal description; understanding of referents included in training

Language support

Table 4.1 Summary of symbols, experimental task, representation level, and language and social supports in studies of symbol characteristics. Studies are identified by first author only in the table due to space considerations.

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16 PCS symbols: 4 symbols point to symbol (array of for each of 4 emotions 24) corresponding to the emotion evoked by a short spoken vignette

Deklerk et al., 2014 n = 90 (5-5:11; 44 Afrikaans, 46 Sepedi)

matching: photo – photo; object – object; association: photo - object, object - photo, spoken word - object

association: spoken word symbol or symbol - word; maintenance probe (5 symbols) 3 - 6 days later

reference? No direct stimulus presented for the symbol: does not appear that spoken label for emotion was given during testing.

demonstrate interest by looking; there may be association, but not required to perform task

association: word/phrase - symbol

objects were chosen because their spoken labels were known to be acquired early by children; children were pretested for knowing verbal label for objects; verbal label provided in one condition only

target words were all object labels; pretest of comprehension and production of target words; verbal label provided during testing

children had to be able to name the target emotions using spoken vignettes in a pretest

symbols and photos named by tester

verbal label given for each symbol during training and experimental task

orientation to each protocol using physical prompting to match object to object

pretests of ability to discriminate the symbols; training for the task

training provided for tasks; short scenarios used to provide context; differences between two linguistic-cultural groups; suggests perception of features of abstract concepts (emotions)

no training but behaviour (looking) within repertoire of the child

training trials for task requirements and familiarization with stimuli; context of thematic display (bedmaking)

* Dada 2013: participants had mild intellectual disability; all participants’ first language was other than English; testing was in English

point to, or select from an array, photo or object corresponding to stimulus; five protocols involving identity and non-identity matching and lower and higher order of representation (objects and photos), including one protocol using the verbal label of the photos

Franklin et al., 1996 12 target objects and n = 25 (26-41 mo; English) pictures of them (Experiment 1 only)

Table continues overleaf

name symbol or point to symbol when named (array of 15), depending on child’s assigned condition

Ecklund & Reichle, 1987 Blissymbols and Rebus symbols for 15 target n = 32 (38 - 65 mo; English; 16 in Bliss words condition and 16 in Rebus condition)

make a choice (array of 2 symbols or photos)

9 objects familiar to the child, PCS symbols and photographs of these objects

Da Fonte & TaberDoughty, 2010 n = 9; (3 each at 6 mo, 9 mo, 12 mo; English or bilingual)

find named symbol (array of 16) and cross it out

16 PCS symbols

Dada et al., 2013* n = 30 (12-15 years; English)

Graphic symbols and typically developing children 73

40 Blissymbols of high and low translucency and complexity

83 ALP Animated Graphic name the animated symbol association : symbol presented on the computer spoken word Symbols considered “not readily named” screen, with or without environmental sound, in response to the question “what’s this?”

47 Blissymbols, line drawings

10 high- and 10 lowpoint to symbol (array of translucency symbols from 4) named by the examiner Unlimiter Line Drawing Color set

Harmon et al., 2014 n= 46 (3;0-3;11; English)

Hetzroni & Lloyd, 2000 n = 72 (3-6 yrs; English)

Huang & Chen, 2011*% n = 20 (grade 1 to 6; Taiwanese); also matched group of 20 children with CP (no significant cognitive impairment in same grade range)

point to symbol when named (array of 9)

name each symbol appearing on a page in a booklet

association : spoken word - symbol

association: spoken word - symbol; maintenance testing 3 wks later

association: symbol – spoken label (called “drawing”); maintenance 1 wk later

association: spoken word - symbol

Fuller, 1997** n = 11 (54-66 mo.; English)

point to symbol when named by the examiner (array of 30)

30 Blissymbols judged to be low translucency and high complexity

Level of representation

Fuller & Lloyd, 1992 n = 20 (54-65 mo.; English)

Experimental task: child is asked to…

Symbols

Study author and participants

verbal label provided during the task

vocabulary used (tests and training story context) selected for ageappropriateness based on use in children’s stories and teacher judgment; verbal story accompanied by pictures that included symbols; the verbal label for each symbol provided multiple times during the task

all stimuli were verbs, taken from the MBCDI Words and Gestures

vocabulary typical of children of this age as judged by teachers

stimuli judged as appropriate for children of this age; verbal labels provided for all symbols prior to testing

Language support

symbol learning: 3 teaching sessions using direct instruction of 20 low-transparency symbols to demonstrate object-word-symbol correspondence

story context and active and passive training conditions, teaching of Blissymbol elements and compounds; effect of training on task performance

familiarization trial; training for the task

instructions for the task

instructions for the task

Social support

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Part II: name or describe (called “interpretation”) what the compound could mean (pretest); task repeated a second time after child had received all stimuli and explanations (post-test) Part III: Select Blisscharacters to represent spoken words that required compound symbols; say the meaning of the word constructed

Part I: 12 compound Bliss-words made up of Bliss-characters used in first part of study

Part II: 15 Bliss-characters representing single words

Table continues overleaf

concepts included known to be early developing; verbal label provided; child verbalizes own production

“frequently used in in children’s Blissvocabulary”, representing Bliss-character features; could be combined into compound symbols; not named prior to the task but verbal confirmation provided for child’s responses; could already name the Bliss-characters; no indication of what feedback (if any) given for responses

drawing activity assumed to be familiar to children; no obvious specific training provided

explanation of shape and meaning of Bliss-character provided for wrong responses extra explanation if requested; in Part III, same materials and general procedure used as in previous tasks, thus were very familiar

the auditory icons all instructions for task and appear software intended use of computer keyboard for children; include provided sounds made by “humans, animals, and inanimate objects” (p 1227) but not speech; no verbal labels provided for visual or auditory icons

**Fuller, 1997: this study also included a group of adults, n = 13 (18 - 30 yrs old) *%Huang, 2011: this study also included a matched group of 20 children with cerebral palsy (no significant cognitive impairment) in same grade range

10 PCS symbols and child’s (1) draw a named concept; association: spoken word Light et al., 2008 (2) name own drawing; (3) - self-generated “symbol”; n = 50 (3 - 6 yrs; 5 cultural own drawings name corresponding PCS symbol - spoken word groups tested in English) symbol

Part III: depending on type of response: association if named Bliss-characters; may be reference when integrated into a phrase or sentence

Part II: association (children named or described individual Bliss-characters); could be reference if two characters named as if an integrated symbol

Part I: name or describe Part I: association: symbol (called “interpretation”) – spoken word what he or she thinks the Bliss-character represented (pretest); task presented a second time after child had received all stimuli and explanations (post-test)

Part I: 15 Bliss-characters representing single words

Jennische & Zetterlund, 2015 n = 43 (14 at 3-3;11; 6 at 4-4;11; 8 at 5-5;11`7 at 7-7`11)

chose (using computer association : sound “icon” mouse) the visual icon - symbol (array of 9) corresponding to presented auditory icon

40 line drawings (“visual icons”) and 40 corresponding audible sounds (“auditory icons”); 66 additional visual icons

Jacko & Rosenthal, 1997 n = 24 (1st grade and 3rd grade; English)

Graphic symbols and typically developing children 75

24 custom symbols representing action words

45 PCS symbols, Blissymbols, Picsyms

Mineo et al., 2008 n = 93 (31 each at age 3, 4, 5 years; English)

Mizuko, 1987 n = 36 (29 - 44 mo; English)

Musselwhite & Ruscello, 30 Blissymbols, Picsyms, 1984%% Word subtest only Rebus n = 45 (12 at each of 3;0-3;11, 6;0-6;11, 9;0-9;11;English)

Symbols

Study author and participants

chose symbol (array of 3) corresponding to spoken word

choose a symbol (array of 4) corresponding to spoken word

select symbol (array of 4) corresponding to spoken word in 4 conditions: static line drawings, with disequilibrium or movement cues) or dynamic (animated or video)

Experimental task: child is asked to…

association : spoken word - symbol

association : spoken word - symbol

association : spoken word - symbol

Level of representation

introduction to the task; transparency task with no training followed by learning phase in which the correct response was provided when the child made an error

familiarization with software and task

Social support

stimulus words chosen verbal instructions for from high frequency task; 3 practice items word list and if included in all 3 symbol sets; Word subtest (30 items including nouns, verbs, adjectives, pronouns, prepositions, quantifiers, adverbs, auxiliaries, articles, and conjunctions); verbal labels provided during task.

words (nouns, verbs, descriptors) based on frequency rank in vocabulary of 1st grade children; verbs could not also be nouns (drink) or body parts (elbow)

pretest for receptive or expressive knowledge of vocabulary words used in study; verbal labels provided

Language support

76 The Silent Partner?

Table continues overleaf

24 compound Blissymbols point to symbol when (12 related and 12 named (array of 9) unrelated compounds) + 16 novel (untrained) compounds (8 for each condition)

Schlosser & Lloyd, 1993 n = 40 (36 - 60 mo.; English)

association: spoken word - symbol; retention probes 1-3 wks; generalization probes after 3rd and 6th teaching blocks and after retention probes

association: spoken word - symbol; spoken question - symbol answer; 7-day maintenance testing; generalization to untrained symbols

association : spoken word – symbol

vocabulary chosen from children’s story book and judged by preschool teachers as appropriate; spoken word – symbol relation demonstrated during training

symbols represented words usually known by young children but not likely guessable from form alone; equal representation of objects, actions, attributes; verbal label and explanation of symbol provided; child expected to name the symbols; symbols presented in a short narrative context

vocabulary chosen from among object names understood by 75% or 2-yr-olds (CDI) and validated for theme appropriateness by adult judges; pretest of 9 target items: matching spoken word - symbol; target symbols named during testing; verbal prompts and eliciting contexts including target word provided during testing; voice output on device

%%Musselwhite 1984 word subtest only: this study also included a group of adults

point to symbol (array of 12) named by the examiner or in response to question; (standard form and enhanced form)

24 Blissymbols

Raghavendra & Fristoe, 1995 n = 40 (3;0-3;11; English)

point to section of the scene (kitchen, bedroom, living room) displayed on the VSD and then to specific target item in response to eliciting question

15 vocabulary items incorporated into a Visual scene display

Olin et al., 2010 n = 23 (11 at 24-27 mo; 12 at 33-36 mo.; English)

vocabulary taught in context of story; six teaching blocks

training of symbols using either standard or enhanced Blissymbols; theme contexts to provide communicative purpose for use of symbols, including puppet who couldn’t talk and question-answer format; illustrations and narrative

elaborate social context to support use of symbols; familiarization session for use of visual scene; help character who needs computer to talk; direct instruction to perform steps of symbol section; up to 12 learning trials provided for each target symbol

Graphic symbols and typically developing children 77

32 PCS symbols, ALP Animated Graphic Symbols

32 ALP Animated Graphic (1) name symbol Symbols (transparency task); (2) point to symbol (array of 4) when named by examiner (identification task) in animated or static conditions

Schlosser et al., 2014 n =220 (71 at 3 yrs M = 41.56 mo., 79 at 4 yr M = 52.23 mo., 70 at 5 yrs M = 61.73 mo.; English)

Schlosser et al., 2012 n = 52 (16 at 3;0-3;10, 18 at 4;0-4;9, 18 at 4;10-5;8; English)

association: spoken word – symbol and symbol object; generalization to “untaught compounds of pretrained elements” (p. 229)

Level of representation

association : spoken word - symbol

association: symbol – (1) name symbol spoken word; spoken word (naming task); (2) point - symbol to symbol (array of 4) when named by examiner (identification task); different combinations of symbol set ([ALP or PCS), symbol format (animated or static), and word class (verbs or prepositions)

point to symbol(1) when named; and (2) as an answer to a question (array of 12)

36 Blissymbols (plus 12 more for generalization task)

Schlosser & Lloyd, 1997 n = 39 (47-70 mo.; English)

Experimental task: child is asked to…

Symbols

Study author and participants

24 verbs and 8 prepositions chosen from early emerging words; children’s ability to name the action and perform it when named were verified prior to testing; verbal instructions

24 verbs and 8 prepositions chosen from early emerging words; children’s ability to name the action and perform it when named were verified prior to testing; verbal instructions; spoken labels of symbols provided during task

words appropriate for preschoolers; verbal support higher in some of training conditions, including verbal explanation of the symbol and explicit link drawn with spoken word

Language support

familiarization with each type of symbol (animated/ static); instructions and demonstration of task with corrective feedback

familiarization with each type of symbol (animated/ static); instructions and demonstration of task with corrective feedback

Blissymbol elements and compounds were taught in one of three training conditions (paired-associate learning with referent-relevant comments, symbol explanations, and symbol explanations within a story-telling context)

Social support

78 The Silent Partner?

10 PCS symbols and 10 Developmentally Appropriate Symbols (DAS)

Worah et al., 2015 n = 40 (2;5 - 3;5; English)

association: spoken word - symbol

association: symbol word; generalization; retention and generalization assessment

touch target symbol (array association: spoken word of 10) when named (PCS - symbol or DAS)

16 symbols total from PCS, point to a symbol (array PICSYMS, and Makaton of 12) in response to a question when target emotion has been labeled

Visser et al., 2008 n = 26 (48 - 59 mo; English)

name symbol shown by examiner

18 Blissymbols (pictographic, ideographic, arbitrary) for learning and 18 for generalization

Shepherd & Haaf, 1995 n = 40 (20 at 6;0 - 6;11, 20 at 12;0 - 12;11; English)

words chosen were early emerging abstract concepts usually acquired by age 3; verbal label and corrective feedback provided during task

in pretest, child asked to name emotion elicited by vignette; emotion labeled in task items

words chosen from corpus familiar to 1st grade children; nouns, verbs, adjectives; verbal feedback provided; verbal label provided during task

familiarization with the symbols (name and explanation provided); training for task

pretesting served as familiarization

familiarization; two training conditions (paired-association and explanation of symbol components)

Graphic symbols and typically developing children 79

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Language support was also usually available to the children, both during the experimenter’s presentation of the task and while they responded. For example, the verbal label and the symbol were presented simultaneously or close together during the task, and verbal confirmation of symbols selected by the child during responses was usually given, either by the experimenter speaking the symbol label or by voice output provided by the technology used in the task.

Social supports As noted above, the notion of social supports in the symbolic development literature means exposure to expert use of symbols in culturally appropriate ways. There is little in the literature on children’s use of graphic symbols that corresponds directly to this concept (although it is more present in the intervention literature, e.g., Binger, MaguireMarshall & Kent-Walsh, 2011; King, Binger & Kent-Walsh, 2015). Nonetheless, certain elements of symbol-characteristics studies can be interpreted as a form of social support for the graphic symbols used, although not necessarily directly parallel to the types of social supports usually studied in the symbolic development literature. Symbol characteristics studies generally provided what could be considered as social support for tasks presented to children. The intent was to reduce possible effects of task requirements and to permit interpretation of the results in terms of symbol knowledge. Essentially, all studies incorporated ways of making sure that the children understood what was expected of them, such as familiarization or instructions for the task, or a pretest to ensure that children had the motor and/or cognitive skills required to perform experimental tasks (in addition to knowledge of corresponding spoken words, as noted above). Further, some studies: (a) provided additional training that could extend over several sessions prior to presenting experimental tasks; (b) incorporated other supportive elements such as a contrived context in which a character needs help to communicate; (c) provided a social scenario in a play setting; or (d) used a combination of these elements (see Table 4.1). These kinds of supports could be considered as similar to those provided in symbolic development studies (Callaghan & Rankin, 2002). In five studies, all involving Blissymbols, social supports and their effect on symbol task performance were directly examined (Hetzroni & Lloyd, 2000; Jennische & Zetterlund, 2015; Raghavendra & Fristoe, 1995; Schlosser & Lloyd, 1997: Shepherd, & Haaf, 1995; see Table 4.1). Social supports were manipulated in these studies by providing (a) training or no training or (b) different methods of training or teaching Blissymbols. Taken together, the findings of these studies suggest that providing increased social support (explanation of symbols versus no explanation; enhanced versus standard Blissymbols; story context versus no context; active versus passive training conditions) was beneficial for task performance. In general, though, the social supports for graphic symbol use that are viewed as important in the symbolic development literature were infrequently included in graphic symbol studies involving children with typical development. When elements believed to be supportive were incorporated, this was done primarily to encourage

Graphic symbols and typically developing children

task performance rather than to examine the potential role of social supports in demonstration of representational level.

Level of representation A judgement about the representational level elicited in a study is necessarily based on the symbols presented and the task that the child was asked to perform. Some of the symbol characteristics studies included more than one symbol set (9) while most (21) looked at symbols within a single symbol set differing along particular dimensions (e.g., high/low translucency or complexity; compounds/elements; animation cues). Two studies had somewhat different approaches. Franklin, Mirenda and Phillips (1996) explored several conditions involving different combinations of pictorial representations, including a matching condition as well as objects and spoken words. Light et al. (2008) asked children to produce graphic representations themselves, that is, create their own drawings and name them (see Table 4.1). There is some variability across the studies in the tasks used and how they were set up in each study; however, fundamentally, most experimental tasks involve: (a) selecting (i.e., pointing to) a symbol from an array (of varying sizes) when named by the examiner; (b) naming a symbol presented by the examiner; or (c) both (see Table 4.1). There are a few exceptions: children were asked to match a symbol with a printed word in a written text (Alant, Life, & Harty, 2005) or rate on a 3-point scale the resemblance of the symbol with the referent word (Bornman, Alant, & Du Preez, 2009). Da Fonte and Taber-Doughty (2010) observed the looking behaviour of infants when photographs and symbols of familiar objects were placed in view. Champoobutr, Potibal, Boriboon and Phantachat (2013) asked participants to write down what the symbol made them think of (i.e., not necessarily to provide a label for the symbol). Looking at these two elements (the symbols and the experimental tasks) across these studies, it is not surprising to find that most studies deal with the association level of representation: awareness of a link between a symbol and what it stands for when both the symbol and referent are present. In the last three studies, the nature of the task was somewhat different from this general pattern. The judgement task in Bornman et al. (2009) likely required understanding of the dual nature of pictures (as an object and as standing for something else). In Da Fonte and Taber-Doughty (2010), symbols and spoken words were both present, but association was not required to perform the task (preference for an object was inferred from eyegaze to one of two items in front of the child). The nature of the task in Champbootur et al. (2013) is not completely clear (see Table 4.1), but it seems likely that an association of the symbol with its referent would have been needed in order to respond adequately. About a quarter of the symbol characteristics studies included phases that could possibly reveal other levels of symbolic representation. Some studies (7) used a maintenance or retention phase in which the experimental association task(s) were presented to the children again after a period of time (usually a few days, up to a month) without repeating training (see Table 4.1). These tasks can be interpreted minimally as association tasks; however, they may reveal a more advanced level of representation. Success on the maintenance task could suggest that the child had formed a trace of

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the association relationship in order to be able to use it in the same way at a later time, without the social and language support initially provided. A more convincing demonstration of representation level beyond association is provided by studies that include a generalization phase. In four studies, all involving Blissymbols, the children were asked to identify (i.e., point to when named) symbols that were combinations of symbol components that had not been presented before during the study. It seems reasonable to interpret successful generalization performance as a reference level of symbolic representation: the children would have to go beyond the associations retained from the earlier training and experimental tasks and apply them in a new context or in new ways to different referents. Another study (DeKlerk, Dada, & Alant, 2014) may also suggest evidence of the reference level: children were asked to point to a symbol representing the emotion evoked by a short, spoken vignette. Although the emotions were named prior to the study, it does not appear that the spoken label for the emotion was given during the experimental task. Four of these studies that included a generalization phase are among those that examined the effect of training, mentioned above (Hetzroni & Lloyd, 2000; Raghavendra & Fristoe, 1985; Schlosser & Lloyd, 1997; Shepherd & Haaf, 1995). Thus there is a suggestion in the literature, although not yet well studied, that at least some aspects of training, (e.g., explanation of Blissymbol elements or short discourse contexts in the studies reviewed) may promote attainment of a higher level of symbolic representation.

Studies of display characteristics Most of the 19 display characteristics studies involved preschool-aged participants (17); three studies had school-aged participants, including two that covered both age ranges (Alant, Kolatsis & Lilienfeld, 2010; Hochstein, McDaniel, Nettleton, & Neufeld, 2003; see Table 4.2). The participants with typical development served as a control or comparison group for participants with disabilities in two studies (Hochstein et al., 2003; Wilkinson, Carlin, & Thistle, 2008). Five studies included a developmental aspect, four within the preschool age range and one with school-aged children (Wilkinson, O’Neill & McIlvane, 2014). All but one of the display characteristics studies were conducted in English-speaking environments (the exception being Robillard, MayerCrittenden, Roy-Charland, Minor-Coriveau, & Bélanger, 2013, in French). (As noted above, this observation about the language of the study may be partly a consequence of the language of publication of the studies included.)

Role of language Similar to the symbol-characteristic studies, most display-characteristic studies tended to provide considerable language support for the tasks. These supports included use of vocabulary that was known to be familiar to young children (e.g., by comparison with early language assessments); pretesting of comprehension and/or production of target words; naming of target words during practice sessions; and presentation of the spoken word with the target symbol within experimental tasks (see Table 4.2). Some studies, however, made a point of removing language support in order to isolate visual aspects of displays (Alant et al., 2010; Wilkinson, Carlin, & Jagaroo, 2006; Wilkinson et al., 2008; Wilkinson & Coombs, 2010; Wilkinson & Snell, 2011).

61 Dynasyms and line drawings

60 Minspeak Icon select sequences of sequences (30 for learning, Minspeak icons for target words (at least 2 selections 30 for generalization) per target) display with and without word prediction

Drager et al., 2004 n = 30 (3;0-3;11; English)

Drager et al., 2010 n = 20 (5;0-5;11; English)

Table continues overleaf

61 DynaSyms and line drawings

Drager et al., 2003 n = 30 (2;5-2;11; English)

Level of representation

Language support

locate target symbol (involving at least 2 selections) when main page is either grid–singlesymbol or contextual scene-screen-shot (array of 4 on main page and 15 on second page)

locate target symbol (involving at least 2 selections) on taxonomic or schematic grid (array of 15) or schematic scene display

association: word - symbol in sentence frame in play context; generalization: 30 new items, 2–4 days later

association: word - symbol association in sentence frame; generalization: with 18 new vocabulary items: 6 min free-play 2-3 days following test sessions

association: spoken word symbol (within a sentence frame); generalization: with 12 new vocabulary items (6 min free-play 2 wks later)

vocabulary (concrete and abstract words) chosen from list of words known by young children and compared to early language assessments; instructional prompt include verbal label of target; voice output by device upon symbol selection

vocabulary (concrete and abstract words) chosen from list of words known by young children and compared to early language assessments; instructional prompt include verbal label of target symbol; voice output by device upon symbol selection

vocabulary (concrete and abstract words) chosen from list of words known by young children and compared to early language assessments; instructional prompt include verbal label of target symbol; voice output by device upon symbol selection

locate (array of 6) symbol matching: picture - picture verbal labels not provided matching the stimulus in 3 (identical except colour) for symbols and shapes (focus on navigation) different colour conditions

18 PCS symbols, 18 arbitrary shapes

Alant et al., 2010 n = 60 (5;1-6;11; English)

Experimental task: child is asked to…

Symbols

Study author and participants

Table 4.2 Summary of symbols, experimental task, representation level and language and social supports in studies of display characteristics.

elaborate social play context (birthday party) and four learning sessions to support the symbol task; child asked to “help” a character to talk

elaborate social play context (birthday party) and four learning sessions to support the symbol task; child asked to “help” a character to talk

elaborate social play context (Birthday party) and 4 learning sessions to support the symbol task; child asked to “help” a character to talk

familiarisation with task

Social support

Graphic symbols and typically developing children 83

60 Dynasyms; Minspeak icons

Light et al., 2004 n = 80 (4;0 - 4;11; 5;0 5;11, 40 in each group; English) locate and select a symbol (or icon sequence) in response to eliciting context

association: spoken word – symbol; generalization: contextualized play targeting untaught words/ symbols (24 for 4-yr-olds; 30 for 5-yr-olds), 2 - 3 days later

locate and select symbols association : spoken word on display when named in – symbol single-level (array of 24) or dual-level (array of 8 for main page; array of 4 for vocabulary page), with or without category prompt.

32 PCS symbols

Hochstein et al., 2003* n = 8 (3 - 8yrs; English)

words (nouns, verbs, adjectives and interjections) chosen to include equal number of concrete and abstract concepts among frequently occurring words used by young children; instructional prompt incorporates verbal label of target symbol; voice output by device upon symbol selection

concrete and abstract nouns taken from word lists for young AAC users; verbal labels provided; voice output by device upon symbol selection

words chosen to include equal number of concrete and abstract concepts among frequently occurring words used by young children; verbal label provided as each symbol given to child

place the picture in association: spoken word relationship to other – symbol pictures on a 4 X 5 grid; verbally justify placements; rearrange as desired during testing.

Language support

pictures representing 42 vocabulary words

Level of representation

Fallon et al., 2003 n = 20 (4;0-5;11; English)

Experimental task: child is asked to… select symbol (array of 36) matching: symbol - symbol stimuli were object labels from CDI; symbol named using directed or groupduring practice sessions; item scanning voice output provided by device when symbol selected

Symbols

Dropik & Reichle, 2008 108 PCS symbols, 12 n = 13 (51-59 mo; English) targets plus others to create 3 arrays of 36

Study author and participants

elaborate social play context created (Birthday party); child asked to “help” a character to talk; learning sessions in which child was guided n how to find and select symbols

no specific training provided (intentionally)

practice of scanning techniques

Social support

84 The Silent Partner?

25 SymbolStix symbols

12 PCS symbols

9 target objects embedded in visual scenes

108 PCS symbols, 12 targets plus others to create 3 arrays of 36

Robillard et al., 2013 n = 65 (4;0 - 6;5; French)

Thistle et al., 2009 n = 30 (15 at 2;10 -3:11, 15 at 15 at 4:2 - 5;4; English)

Thompson et al., 2012 n = 20 (19 - 25 mo.; English)

White & Carney, 2010 n = 12 (48 - 60 mo.; English)

Table continues overleaf

3 PCS symbols

McCarthy et al., 2006 n = 20 (28 - 35 mo; English) association: spoken word – symbol

select a symbol (array of 36) using directed scanning and group item scanning upon visual presentation of target symbol

words were concrete nouns, chosen from early levels of receptive vocabulary tests, and judged to be known by children 4-6 yrs old; spoken label provided as part of task and by examiner upon symbol selection

children already knew the words to be used and were able to name the symbols prior to the study; verbal label of target provided during the task; voice output by device during the task

matching : symbol symbol

stimuli were object labels from CDI; target symbol named during practice sessions

vocabulary selected based on MBCDI data for 19-month-olds; comprehension pretest of target words (concrete objects names; syntactic objects of target verbs); voice output by device upon symbol selection

association: spoken word + words chosen to be symbol – symbol common fruits and vegetables; pretest of symbol naming and comprehension; verbal labels provided during task

locate and select target association: symbol symbol in two steps: (1) spoken word; touch the relevant scene retention: 2 wks later (embedded of nonembedded main page); (2) touch the target symbol on the second page

locate and select target symbol (array of 12) in 4 conditions manipulating foreground and background color

matching : symbol locate and select symbol matching the one shown symbol + spoken word and named; 3 or 4 levels of navigation required (arrays of 16)

select a symbol (array of 3) using traditional or enhanced scanning

orientation and practice of scanning techniques using display similar to experiment

familiarization with device; learning trials provided; social context: toy who needs help to talk

pretests familiarized the child with the symbols, the materials, and the procedure for the task

demonstration of use of device and software; navigation practice with 5 items

demonstration of scanning task only; training for task intentionally minimal

Graphic symbols and typically developing children 85

PCS symbols and nonreferential forms

36 PCS symbols

8 PCS symbols for emotions

8 PCS symbols for animals select symbol corresponding to animal photo (array of 16) in conditions with and without background color cues

Wilkinson et al., 2006 n = 16 (4;4 - 5;9; English)

Wilkinson et al., 2008** n = 16 (8 at 40 - 46 mo; 8 at 48 - 57 mo.; English

Wilkinson et al., 2011 n = 30 (3;8 - 6;1; English)

Wilkinson & Coombs, 2010 n = 10 (5 at 42 - 47 mo., 5 at 60 -66 mo.; English)

matching : symbol symbol

Level of representation targets were 16 clothing items; no auditory input during task

Language support

association : photo – symbol

association : photo – symbol

matching : symbol – symbol; association: spoken word –symbol

stimulus vocabulary likely to be known to young children; no verbal labels provided

no verbal labels provided with stimulus photos

familiarization with task and stimuli

instructions for task

vocabulary included familiarization and foods, clothing, and practice with each activities; pretest of condition comprehension and naming of symbols; verbal label provided with symbol stimulus

familiarization with task

training for task performance

Social support

**Wilkinson, Carlin and Thistle (2008) this study also included 10 children with Down Syndrome (106 mo. - 201 mo.)

*Hochstein et al., (2003): this study also included a matched group of 8 children with speech impairments and cerebral palsy

select symbol corresponding to emotion photo (array of 8) in conditions with and without color cues for the valence of the emotion (positive vs. negative). and in which the symbols were grouped according to valence or distributed randomly

select target symbol (array of 12) when similar-colour symbols clustered or distributed

select target symbol (array matching: symbol - symbol vocabulary assumed to be of 8) in same-color, guided (identical except colour) known to the children; no search, or unique-color verbal labels conditions

select symbol on display when similar-colour symbols clustered or distributed; gaze recorded by eye-tracking device

16 PCS symbols for clothing items

Wilkinson et al., 2014 n =14 (7 in each of 2 groups: 7 - 9yrs and 7 at 7 - 12yrs; English)

Experimental task: child is asked to…

Symbols

Study author and participants

86 The Silent Partner?

Graphic symbols and typically developing children

Social supports In general, it seems that social supports were less well developed in display characteristics studies than as noted above for symbol characteristics studies. Studies provided familiarization or instructions for task requirements, although two (Fallon, Light, & Achebach, 2003; McCarthy, Light, Drager, McNaughton, Grodzicki, et al., 2006) presented their tasks with no specific training in order to observe children’s behaviour on first exposure. Some studies did provide more extensive social supports, such as training, a social context, and/or a communication scenario (see Table 4.2). This variety largely corresponds to differences in researchers’ approaches to their study of display characteristics: within a communicative context (Drager, Light, Curran Speltz, Fallon & Jeffries, 2003; Drager, Light, Carlson, D’Silva, Larsson, Pitkin, & Stopper, 2004; Drager & Light, 2010; Light, Drager, McCarthy, Mellott, Millar, et al., 2004; Thompson, 2012) or in a decontextualized task (Alant et al., 2010; Dropik & Reichle, 2008). McCarthy et al. (2006) is an exception: no training was given, but the response expected was known to be within the children’s repertoires.

Level of representation Most display-characteristic studies (14/20) used only one type of pictorial representation (see Table 4.2). Although symbols were used as a means to explore the display characteristics of interest to the researchers rather than being the primary object of study, in contrast to the symbol characteristics studies, the children were nonetheless asked to make use of symbols in some way in the tasks presented. A few studies included more than one type of pictorial symbol in order to be able to address the display characteristic question of interest (for example, grid display organizations versus visual scene versus Minspeak icons, each of which requires a different type of symbol in addition to a different organization of the display (Drager et al., 2003, Drager et al., 2004, Drager & Light, 2010); or to compare performance with symbols and with arbitrary shapes, (Alant et al., 2010). One might expect that display characteristics studies would employ matching tasks (i.e., finding the same symbol in a given display arrangement) and this is the case for eight of these studies (see Table 4.2). In the other studies, participants were asked to find a symbol when it was presented with a different type of representation (usually a spoken word, sometimes a photograph), calling on at least some degree of association rather than matching alone. One study (Thompson, 2012) included a maintenance phase. Generalization was addressed in four studies that were conducted within the same line of research (Drager et al., 2003, Drager et al., 2004, Drager & Light, 2010; see Table 4.2). (In three of these studies, the generalization phase occurred several days after the first presentation of the experimental task(s), and thus could be considered to include a maintenance aspect as well, but the same experimental task was not re-presented to the children on the second occasion.) Interestingly, these are the same studies just mentioned, that included more than one type of pictorial symbol. There is a

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certain blending of symbols and displays in these studies that makes it difficult to tease out symbolic representation from symbol arrangement.

Studies of memory span with graphic symbols By their nature, studies of memory span involve a sequence of symbols rather than just one symbol; these studies are nonetheless discussed within this section on single symbols because the symbols are individual items in a list rather than intended as a single unit of meaning such as an utterance, in contrast to the symbol sequences that are the subject of the following section. Studies looking at memory span with graphic symbols included preschoolaged (4) or school-aged (3) children (see Table 4.3). In one study, the children with typical development served as a comparison group for children with cerebral palsy (Murray & Goldbart, 2011). Language and social supports are in general less well developed in these studies than in those noted in the preceding sections. All but one of the studies used common nouns as stimuli; the exception being Murray and Goldbart (2011), in which the stimuli were chosen primarily for their phonological characteristics and then paired with line drawings to represent the concepts (verbs and adjectives). A variety of symbol sets were used (for a description of these symbols, see Beukelman & Mirenda, 2013, Chapter 3): Blissymbols (1), Picsyms (2), PCS (3), Dynasyms (1) and custom line drawings (1). In five studies, children were asked to select (or point to) symbols corresponding to each of the items in the stimulus in the same order; three studies also required that the child place the symbols in the same arrangement on a grid as was presented in the stimulus (see Table 4.3). In one study (Murray & Goldbart, 2011), children were asked to use eyegaze on a frame (this was done in order to have comparable data across participant groups). All of these studies involved visual matching: matching symbols presented and symbols selected for the response. The number of symbols presented increased within each study and the maximum varied from three to up to 13. In all but one study (Peterson, Reichle, & Johnston, 2000), the stimulus symbol sequence was removed before the child began to respond. Two studies also incorporated the spoken labels of the symbol stimuli as well as the visual matching task, because of the research questions addressed in the study. Swim (2014) found that memory span performance was better with the spoken label (along with the visual symbol). In general, studies of memory span provide evidence of matching abilities but are not informative about higher levels of symbolic representation. The memory requirement (removal of the stimulus symbol sequence prior to responding) can be interpreted as retention, but since these tasks do not appear to involve the meaning of the symbols, it is difficult to interpret the findings as reflecting a representational level.

Summary Taken together, studies of single symbols provide ample evidence of association. Some of the studies targeted matching, a lower level of representational functioning used in studies to establish a progression towards association (Franklin et al., 1996) or to

Graphic symbols and typically developing children

89

Table 4.3 Summary of symbols, experimental task, representation level, and language and social supports in studies of memory span using graphic symbols. Study author and participants

Symbols

Experimental task: child is asked to…

Level of representation

Language support

Social support

Mizuko et al., 1991 n = 20 (M = 54 mo; English)

Blissymbols or Picsyms; 10 sequences at each length (2 or 3 items)

select each item (2 or 3) presented on the stimulus plate (5 sec.) in the same order, using direct selection or circular scanning

matching to non-permanent stimulus sequence

symbols not labeled

task and response conditions (direct or circular scanning) explained

Mizuko et al., 1994 n = 22 (M = 55 mo.; English)

Picsyms; arrays of 10, 20, 30 40 symbols

select each item (2) presented on the stimulus plate (5 sec.) in the same order, using direct selection or row-column scanning

matching to non-permanent stimulus sequence

symbols not labeled

task and response conditions (direct or row-column scanning) explained; 2 practice items

Murray & Goldbart, 2011* n = 30 (3;0 - 6:01; English)

18 pictures (3 sets of 6 that differed based on spoken word characteristics: control words, long words, phonologically similar)

select (on eyegaze frame) each item in stimulus (up to 6) in same order; silent and spoken presentation conditions

matching to non-permanent stimulus sequence; association in one condition?

pictures named as they were placed on response board on each trial

training and practice for eyegaze response and for task performance

Petersen et al., 2000 40 Dynasyms n = 12 (32-50 mos.; English)

select each of 2 items presented in the visual stimulus card (5 sec.) in the same order, using linear or row-column scanning (array of 40)

symbol pair - symbol sequence (max 2) copy (stimulus remained visible)

vocabulary chosen to be familiar to 2- to 4-yr-old children; semantically related symbol pairs symbols (e.g., farm-pig, car-key); verbal labels provided during practice if needed

practice of scanning techniques, including verbal and physical prompting

Swim 2014 296-307 PCS n = 19 (8;4 - 10;9; symbols English); association: symbol – spoken word

select each item in stimulus (up to 13) and place (drag and drop) on 4X4 grid in same location and in same order as shown in stimulus

matching to non-permanent stimulus sequence; association: symbol – spoken word

spoken label provided by device as each symbol appeared in stimulus

training and verbal instructions for task performance

Wagner & Jackson, 2006 n =120 (40 each at M = 6yrs, M = 7 yrs, M = 9 yrs; English)

20 (2 practice, 18 test) randomly chosen sequences of PCS symbols (max 10 symbols)

place symbol cards on a fixed grid to recreate sequence presented, using direct selection (drag and drop) or visual linear scanning

symbol-symbol; increasing number of symbols

all stimuli composed of common nouns; correspondence with CDI; children knew verbal labels for symbols used; verbal feedback provided in practice trials; no verbal input provided once test trials started

familiarized with and practiced selection technique

Wagner & Shaffer 2015 n = 112 (35 at 1st grade, 7 yrs; 37 at 3rd grade, 9 yrs; 40 at 5th grade, 11 yrs)

307 PCS for common nouns (203 targets and 104 distractors)

recreate a display of symbols by placing (drag and drop) individual symbols in the response display in the same order as originally presented; number of symbols increased over trials up to 13

symbol – symbol matching with delay: some level of association likely required for individual symbols

Nouns as stimuli because “frequently used in cognitive science and developmental studies” and “represent concrete concepts” (p. 28); pilot study confirmed children in this age range correctly pointed to over 90% of symbols chosen as stimuli

training and practice provided; stickers given as reinforcement

*Murray (2011): also included a group of 30 children with cerebral palsy (3:01–6:01)

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Table 4.4 Summary of representation levels elicited in studies of symbol characteristics and of display characteristics. Study

Representation level Matching

Association

Retention

Alant et al., 2005

X

X

Basson, 2005

X

Bornman et al., 2009

X*

Champoobutr et al., 2013

X**

Clark, 1981

X

Dada et al., 2013

X

Generalization

Da Fonte & Taber-Doughty, 2010%% DeKlerk et al., 2014&&

X&&

Ecklund & Reichle,1987

Studies of Symbol Characteristics

Franklin et al., 1996

X X

X

X

Fuller, 1997

X

Fuller & Lloyd, 1992

X

Harmon et al., 2014

X

Heztroni & Lloyd, 2000

X

Huang & Chen, 2011

X

Jacko & Rosenthal, 1997

X

Jennische & Zetterland, 2015

X

Light et al., 2008

X

Mineo et al., 2008

X

Mizuko, 1987

X

Musselwhite & Ruscello, 1984

X

Olin et al., 2010

X

Raaghavendra & Fristoe, 1995

X

Schlosser et al., 2014

X

Schlosser et al., 2012

X

Schlosser & Lloyd, 1993

X

Schlosser & Lloyd, 1997

X

Shepherd & Haaf, 1995

X

Visser et al., 2008

X

Worah et al., 2015

X

X

X

X

X

X

X X

X

X

Graphic symbols and typically developing children

Study

Representation level Matching

Association

Retention

Generalization

Drager & Light, 2010

X

X

X

Drager et al., 2004

X

X

Drager et al., 2003

X

X

Alant et al., 2010

Studies of Display Characteristics

Dropik & Reichle, 2008

X

X

Fallon et al., 2003

X

Hochstein et al., 2003

X

Light et al., 2004

X

McCarthy et al., 2006

X

Robillard et al., 2013

X

Thistle & Wilkinson, 2009

X

Thompson, 2012

X

White & Carney, 2010

X

Wilkinson et al., 2006

X

Wilkinson et al., 2008

X

Wilkinson & Coombs, 2010 Wilkinson et al., 2014 Wilkinson & Snell, 2011

X

X

X X

X X

* Bornman (2009): asked for judgement of similarity of symbol and word referent: likely calls on understanding of dual nature of picture ** Champoobutr (2013): exact nature of the task is not clear, but it seems that an association of the symbol with its referent would be needed to respond. Da Fonte & Taber-Doughty (2010): symbols and spoken words both present, but association not required to perform task.

%%

&&DeKlerk (2014): symbol used in response to spoken vignette in which the spoken word for the emotion was not pro

minimize the symbol demands in order to focus on another aspect, as in most studies of display characteristics and memory span. Table 4.4 summarizes the level of representation that can be inferred from the studies of single symbols reviewed. The levels included do not strictly follow those used in the symbolic development literature, but are levels that are relevant for graphic symbols in AAC and can be viewed as a progression of maturity of representational understanding.

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Symbol sequences There are fewer studies of use of symbol sequences by children with typical development, but there is much food for thought here. On initial consideration, the fact that sequences of symbols are involved could be taken to suggest that the symbolic level is that of representation (relationships among the symbols); however, this conclusion would be premature. Each of the studies in this section will be examined for evidence of the level that can be attributed to the children based on their performance on the tasks that were presented in the studies. This section is organized in a somewhat chronological order. Studies that were based on the same or overlapping data sets are grouped together.

Smith (1996) The goal of Smith’s (1996) study was to elicit sequences of symbols. Five children, aged 3;5 to 4;7, participated in weekly sessions over a period of 10 weeks, during which they were exposed to a variety of activities involving graphic symbols. Fifty-three PCS symbols chosen for the activities were displayed on a communication board for each child. The symbols were introduced to the children. (This introduction is not explicitly described in the paper, but likely involved naming the symbol and asking the child to do the same.) The adults modelled use of the symbols (i.e., pointed to the symbols on the display while talking) during activities in a play context. Opportunities were provided for the children to use the symbols during the activities. With the intent to provide a social context in which use of the symbol display would be appropriate, a Bird puppet was introduced to the children and was put in charge of the activities. The puppet was described as being able to see well but not to hear because he didn’t have ears. The children were told that they needed to use the symbols in order to communicate with him (“explain messages using picture boards”, p. 122). The social support for symbolic use of the graphic symbols (PCS, in this case) is rather extensive in this study and includes the increased presence of symbols in the environment during the study sessions, the attention given to them during activities, and the pretence of their importance in communicating with the puppet. It is not clear, however, to what extent the children actually observed the adults using the symbols themselves in the ways that the children were meant to use them, that is, whether the children would perceive this use as a culturally appropriate way to engage with graphic symbols. Language support was also present. Spoken language was fully available to support the children’s understanding and use of the graphic symbols. The symbol display did not incorporate voice output, but the adults supplied verbal labels for the symbols the children pointed to. Verbal instructions were provided for activities, and all participants interacted verbally throughout the study. Following the 10-week intervention period, the children were presented with a task designed to elicit utterances constructed of graphic symbols. The material for the task included an array of four pictures that depicted similar events with slight differences in content, designed to require, or at least encourage, the child to communicate sufficient

Graphic symbols and typically developing children

information to allow the puppet to distinguish the target from the rest of the array. The PCS display of 53 symbols was also present. Following the examiner’s verbal instructions, the child first formulated a spoken utterance to describe the target picture (thus providing an oral target for his or her symbol utterance), and then was asked to construct a graphic symbol utterance to convey that message to the Bird puppet. The data were first analyzed based on the symbols indicated by the child in each turn, that is, in between any spoken feedback by the adult. One child, Una, was essentially unable to perform the task using symbols, although she had no difficulty describing the target picture in speech. As Smith (1996) reports, her behaviour suggested that she did not distinguish the PCS symbols from other environmental pictures. She was able to give a verbal label for the symbols but might do so during the middle of an activity that was unrelated to the symbol she named. The other four children, after producing full sentences in their spoken descriptions, overwhelmingly pointed to single symbols in their responses on the experimental task, even though these symbol responses would not be adequate for distinguishing the target picture from the other pictures in the array. Only the two oldest children pointed to two or more symbols in a substantial proportion (more than 25%) of responses (see Figure 4.1). It is not possible to determine from the data whether these responses were adequate in uniquely identifying the target picture. The data were subsequently reanalyzed in light of the observation that some graphic symbols, even though indicated in separate child turns, were more appropriately interpreted as contributing to the same utterance, based on the child’s and partner’s verbal and non-verbal behaviours accompanying the symbols (somewhat analogous to

Figure 4.1 N  umber of responses containing one, two, or more symbols in the original analysis and the reanalysis for each child. Data from Smith (1996).

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the concept of ‘successive single word utterances’ in early child speech). This reanalysis (called a ‘vertical’ analysis) led to a more even distribution of utterance lengths in PCS responses for all four children, but the shift of what were considered singlesymbol utterances in the original analysis to becoming part of longer utterances in the reanalysis was different across the children. Although the proportion of utterances originally classified as single symbol that remained so in the reanalysis was relatively similar across the children (between 36 and 47%), the number of longer utterances changed in different ways. For Oisin and Natalie, the number of 2-symbol utterances tripled (from three in the original analysis to 10 in the new one) whereas there was little change for Olwen and James (15 and 17 for Olwen; eight and nine for James). These observations can be interpreted as suggesting that Olwen and James were able, at least to a certain extent, to point spontaneously to two symbols for a single picture, and the vertical analysis served to increase the number of longer (i.e., three or more) symbol sequences they used. Oisin used primarily single symbols, some of which could be interpreted as contributing to a sequence of two symbols. There was little change in the number of longer utterances (three or more symbols) in the reanalysis (increase of zero or one). For Natalie, there was an increase in number of utterances containing two symbols, as noted above, and containing three or more symbols. The even distribution of utterance lengths in James’ data is interesting. Could this be interpreted to suggest the possibility that his choice of number of symbols in his response was more intentional, in contrast to the other children who used a preponderance of shorter responses overall? The contrast of James with Oisin, who used about the same number of utterances in total but a different pattern of number of symbols in each response, suggests that these differences may be important, although not explainable on the basis of these data alone. Taking into consideration the visual material presented for the task, the most straightforward interpretation of the findings is that the children’s performance on this task indicated the level of association. The children were able to point to a symbol related to one of the pictures in the array of four. Even when it is possible to consider some of these single symbols as contributing to the same description (as in the reanalysis), it is likely that these symbols were being used to indicate particular elements of the picture; in other words, the symbols were associated with the picture elements since the pictures were still present while the children constructed their responses. What may be hinted at in these data is the possibility of a progression from a global association with the picture (single-symbol responses that remain so in the reanalysis) to some finer distinctions being made, that is, more than one symbol associated with elements of the picture. Nonetheless, the data from Smith (1996) seem most closely aligned with the level of association.

Sutton and Morford (1998) Sutton and Morford asked 32 children (aged 5;9–12;7) in four groups (6, 8, 10 and 12 years) to point to graphic symbols on a display (20 symbols) to describe to a second experimenter what was seen in a video clip. There were 24 live-action video clips, in which one of two agents (a man or a woman) performed an action on an object, comparable to a subject-verb-object (SVO) word order in speech. Social support consisted of familiarization for the task. Language support was rather limited: the

Graphic symbols and typically developing children

experimenter reviewed the names of the symbols on the display, but offered no verbal model for descriptions of the video clips. The child completed the task using the symbol display first; then the task was repeated and the child was asked to use speech to describe the video clips. All children used English word order in their spoken responses but not in their symbol responses. Single-symbol responses were frequent among the 6-year-olds (44% of responses). The use of some form of SVO order (including two-symbol responses that were interpreted as SV, VO, SO combinations) increased from 34% in the 6-yearolds to 89% by 12 years. Other types of responses (i.e., more than one symbol but not following the SVO pattern) in the three older groups were primarily sequences that, in speech, would be considered an object-verb (OV) pattern. The data were not analyzed by length (i.e., number of symbols included in the response), so it is not possible to tease out when two-symbol responses were used or when the full target response emerged (see Figure 4.2). Taking into consideration the non-permanent visual stimuli and the limited verbal support supplied for performing the task, it seems reasonable to infer that the children in this study used at least some level of referring in performing the task. The younger children may still have relied on association, since they produced a large proportion of single-symbol responses, but the increasingly consistent use of sequences types in the older groups, either corresponding to English word order or a secondary sequence type (OV), suggests that they were referring in a stable way to video clips. There is

Figure 4.2 Percent of responses of each type (SVO, single symbol, OV, and other), for the youngest group (G1) on the left, and for the three older groups (G2, G3, G4 on the right). Note the different response categories in the two sections of the figure. Data from Sutton and Morford (1998).

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little evidence of representational intent in these data, but the task did not require demonstration of intent.

Sutton et al. (2010); Trudeau et al. (2007); Trudeau et al. (2010) These three studies were part of the same line of research and dealt with different aspects of the same data set. They were all conducted with French-speaking participants. For the purposes of ease of reading, the stimuli mentioned in the text have been translated into English. In Sutton et al. (2010), 3- and 4-year-old children (n = 30) were asked to use graphic symbols in conjunction with photographs and spoken sentences. The tasks were designed to make salient the ordering of the symbols in a sequence by using animate actors and reversible actions. The stimuli were constructed from a small pool of words and symbols: three actors (boy, girl, clown) and two actions (push as in a wheelchair, and pull as in a wagon) in different combinations to create contrasting events. There were language supports for children’s use of symbols, in that knowledge of the spoken words and ability to associate the words, symbols and elements of the photographs were established in a familiarization session. The social supports were somewhat more limited than in Smith (1996), in that the adults did not themselves use the symbols in any meaningful way during the interaction with the children. The two tasks were Construction and Interpretation. In the Construction task, a photograph of toy figurines engaged in an action was displayed on a board (easel). The experimenter said a short, subject-verb-object sentence describing the photograph. Rather than pointing to symbols on a fixed array, the child selected individual symbol cards and attached them to the display board to construct his or her response. Thus, in this task, there was physical movement of the selected symbol(s) and a permanent trace of what the child had placed on the board. In addition, the child could select and place the symbols in any order: only the final arrangement on the board was taken as the child’s response and the left-to-right position of the symbols was considered as the order of the symbols in the sequence. Each child received 8 trials. On the whole, these young children were not very successful at constructing a sequence of symbols on this task. Only 32% of responses would be considered ‘correct’ in that they adhered to the spoken model. The data were analyzed in greater depth by looking at individual the symbols. Most responses (95%) included symbols that were correct, but only 48% of responses contained all three target symbols (regardless of the order); 59% had extraneous symbols, even though only a limited number of words and symbols was available. There was considerable variability in response patterns across children. Only one child produced the target response consistently (i.e., at least 6/8 trials). One third of the children used a consistent response pattern, but not the full target response (i.e., all three correct symbols). Half of the children did something different on almost every response. The finding that only 5% of responses contained an extraneous symbol (i.e., a symbol other than those corresponding to the words of the spoken sentence and the elements of the photograph) can be interpreted as evidence that the children were able to associate symbols with words and photographs; however, the way they did so

Graphic symbols and typically developing children

was not consistent and included a variety of lengths and orderings. The data were not specifically analyzed by length, as in Smith (1996). These data seem to indicate an association level of functioning in general. Whether the children chose one or two symbols to associate with the verbal and visual stimuli may indicate different degrees of detail they picked out for association; this is hard to determine in the data as presented. It may be possible to interpret some of the individual response patterns as evidence of referring, not only association. Three children included all three of the target symbols from the spoken sentence stimuli but did not match the word order presented. These children did something consistently that neither simply matched the spoken word order nor the left-to-right visual configuration of the elements in the photograph. Turning to the Interpretation task in Sutton et al. (2010), the children were presented with an array of four photographs (the same photographs as those used in the Construction task) on a computer screen. Three symbols then appeared one at a time from left to right (a symbol sequence) above the array and the child was asked to point to the corresponding photograph. There were four trials for each child on this task. Overall, about half (51.7%) of all responses were correct. Half (16/30) of the children responded consistently (3/4 trials), including 11/16 choosing the correct response. It seems likely that the children responding consistently were making associations between the graphic symbols and the elements of the photograph in a certain relationship; what is harder to determine is whether these results provide evidence of a referring level of symbolic function. An argument could perhaps be made that, in responding consistently, the children were attempting to find some relation among the symbols in order to make their choice. Since all the photographs contained the elements corresponding to the symbols in the sequence presented, association alone would not require a consistent response pattern. A comparison of performance on the two tasks (Construction and Interpretation) revealed that six children used a consistent response pattern on both Construction and Interpretation. Whether these children could be considered to be at a referring level of symbolic representation would require further exploration, but they may be the closest to that level among the group. Consistent responders tended to have higher language scores (vocabulary and grammar comprehension) than inconsistent responders on the Construction task, although the relationship did not reach statistical significance, but there was no such tendency on the Interpretation task. It is not possible to determine whether the six children who were consistent on both tasks would stand out in a particular way. Trudeau et al. (2007) studied more advanced levels of performance on a task similar to the Construction task just described. The participants were older than those in Sutton et al. (2010): 7- and 8-year-olds (n = 30), 12- and 13-year-olds (n = 30), and a group of adults (n = 30); the task was more difficult (selecting symbols from an array versus manipulating); and the stimulus sentences were longer (both single-proposition and two-proposition stimuli). There were 8 single-proposition trials and 12 or 16 two-proposition trials (for 7- to 8-year-olds and 12- to 13-year-olds, respectively). The participants were asked to select symbols on a fixed display on a computer screen to create sequences of symbols corresponding to spoken sentences and photographs in one of two conditions: when the photographs were presented one at a time (the

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Neutral condition), or in an array of four photographs with one identified as the target (the Contrast condition). Language support included use of known words in the stimuli, provision of a verbal model of target utterances, and speech synthesis feedback for each symbol selection and for the whole sequence. The social support consisted of training for task, and familiarization with symbols and the spoken words. One of the conditions provided a context in which the need to distinguish between two of the sentence types was highlighted. For the single-proposition stimuli, which were the same as those used in the Construction task of Sutton et al. (2010), even the 7- and 8-year-old group in Trudeau et al. (2007) performed at ceiling: they all selected symbols on the display in the same order as mentioned in the examiner’s spoken sentence. Thus they were easily able to associate symbols in a sequence to correspond to the words of a spoken sentence. For the two-proposition stimuli, the situation was somewhat more complicated. These stimuli corresponded to spoken sentences that were complex syntactic structures. The spoken stimuli were two types of sentences with different syntactic structures but that can have the same word order: subject and object relative clauses (“the girl who pushes the clown wears a hat” versus “the girl pushes the clown who wears a hat”). Without syntactic markers, the symbol sequences corresponding to these word orders would be identical. However, with the graphic symbols display, the only way to signal such differences in the syntactic structure is through manipulating the order in which the symbols are selected. Thus, in order to maintain the distinction across a set of utterances, it would be necessary to deviate from the spoken word order in the sequence of selecting symbols. Participants who produced different symbol orders corresponding to the two

Neutral condition Contrast condition

7–8 years

12–13 years

adults

Figure 4.3 N  umber of participants using distinct orderings of symbols corresponding to two spoken sentence structures. Data from Trudeau et al. (2007).

Graphic symbols and typically developing children

types of spoken sentence structures could be attributed with some ability to step back from an individual stimulus item in order to avoid ambiguity between the two types of stimuli. This would demonstrate at least some level of explicit knowledge, in order to use a strategy that requires deviating from the spoken word order (see Figure 4.3). Almost all of the 12- and 13-year-old participants used different sequences of symbols for the two types of complex sentences, similar to the response patterns of adults. As for the younger group, 13 of the 7- and 8-year-olds constructed sequences of symbols that made some sort of distinction between the two spoken sentence structures, although this could be by responding consistently on one and inconsistently on the other. These response patterns can be taken as evidence of representation because they suggest awareness of the need to modify the spoken order heard in order to rearrange the symbol elements in a systematic way. Although these data provide some evidence of explicitness and reference, they do not permit evaluation of intent to refer or to represent, as the task does not strictly require reference or intent to refer. The limited vocabulary used, the fact that the corresponding photographs were visible throughout, and the presence of a spoken model are elements that make direct evaluation of reference and intent somewhat difficult on the basis of this study. In a complementary study to Trudeau et al. (2007), Trudeau, Sutton and Morford (2010) studied interpretation of graphic symbol sequences. The participants were the same as described in the previous two studies: 3- and 4-year-olds (n = 30); 7and 8-year-olds (n = 30); 12- and 13-year-olds (n = 30); and adults (n = 30). In the Interpretation task, symbols were presented one at a time in a left-to-right arrangement above an array of four photographs on a computer screen. As each symbol appeared, it was accompanied by a synthesized speech label. The symbol sequences were of two different lengths: three symbols, and four symbols. Some sequences at each length were consistent with spoken English word order (SVO) and others were not (e.g., VSO or SOV). The response required was to point to one photograph in an array of four corresponding to the sequence of symbols presented above the array. The participants were familiar with the symbols and the materials because they had just previously performed the Construction task reported in Trudeau et al. (2007). The inclusion of symbol sequences that were not consistent with the canonical word order of the spoken language is a unique feature of this study. The non-canonical sequences were confusing even for the adults and the 12- and 13-year-olds (consistency scores 58–75%, compared to over 93% for all canonical sequences across the two groups; see Figure 4.4). Consistency was generally low for the youngest group (31%–63%), the highest consistency level being obtained for short sequences following canonical word order (as reported also in Sutton et al., 2010). Responses to longer sequences (four symbols), even if following the canonical spoken word order, were significantly less consistent (only 35%–40%) in the youngest group. In between high consistency in the older groups and low consistency in the youngest group, the 7- and 8-year-olds displayed response patterns that suggest some kind of transition may be in progress (see Figure 4.4). As a group, they were highly consistent on symbol sequences that followed canonical spoken word order, regardless of length. On non-canonical sequences, however, their consistency patterns differed

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Figure 4.4 Number of participants in each age group making each type of response choice when the stimuli were sequences of three or four symbols that followed one of three orderings: the canonical spoken word order (“Canonical”), and two non-canonical orderings, one mentioning the action symbol last (“Verb-final”), one mentioning the action symbol first (“Verb-initial”). The response choices are shown in the bars: N1 = the photograph depicting the first symbol as agent of the action; “Other” = the photograph depicting another symbol as agent of the action. Data from Trudeau et al. (2010).

depending on the particular type of sequence. The children were more likely to respond in a consistent way, regardless of length, if the symbol corresponding to the action was displayed last in the sequence (called ‘verb-final’), than when it was displayed first (called ‘verb-initial’): 76% and 81% for verb-final length 3 and length 4, respectively; 29% and 24% for verb-initial length 3 and 4 respectively. Thus, they seem to be moving away from the general pattern of uncertainty (inconsistent responses) of the 3- and 4-year-olds towards the pattern used by the older children and adults, that is, the same response on canonical sequences but less consistency on non-canonical sequences. The fact that the 7- and 8-year-olds responded more consistently than the younger children suggests that they may have been using a strategy of some kind, while the younger children did not have a strategy. The fact that they responded more consistently than the 12- and 13-year-old children on some sequence types suggests that they may have been using a different strategy than the older children, or that their strategy was to treat verb-final sequences as if they were canonical. The analysis of individual response patterns provides further insight into the transition that seemed to be happening in the 7- and 8-year-old group. Aside from short canonical sequences, the number of children responding consistently was slightly lower among the 7- and 8-year-olds than the 12- and 13-year-olds (Figure 4.4). However, the response strategy seems to change between these age groups: interpreting the first personage mentioned in the symbol sequence as the agent of the action was the predominant response among the 7- and 8-year-olds, regardless of

Graphic symbols and typically developing children

sequence type; in the older group, there is a shift to interpreting the second personage as agent for non-canonical orders in general, but particularly for verb-initial sequences, regardless of length (Figure 4.4). What aspects of these results can be interpreted as an indication of the children’s level of symbolic functioning? The ability to associate the individual symbols with their referents in the photographs was established prior to beginning the testing, but association and reference were not directly evaluated in the experimental task. Since response options contained all the individual elements represented in the symbol sequences, responding could not be accomplished solely on the basis of association of individual symbols with elements of the photograph (although much of it could be done this way). Consistency of responding on both canonical and non-canonical sequences with some differentiation of response patterns could indicate some level of reflection for the sequence presented, a more explicit level of awareness of relationships among symbols. At least some of the 7- and 8-year-old group may have been sensitive to the difference in sequence types, but it was not until the teenage years (the 12–13-year-old group) that children responded differently based on the order of the symbols. This finding seems to be clear evidence that they were treating the symbol sequences as if there were a relationship among them: they demonstrated different response patterns even though the same symbols were presented and the response options were the same across the different sequences types. Some awareness of a relationship among the symbols would be required in order to do this, whether or not the sequence the children chose was the same as the spoken word order. Evidence of the influence of language on graphic symbol performance can be observed in this study in the difference in performance on canonical versus noncanonical sequences in some age groups. Responses were more variable for noncanonical than for canonical sequences (both were accompanied by spoken labels), suggesting that the canonical word order was easier, or at least more stable. However, the difference between canonical and non-canonical was less pronounced among the youngest group (3–4 years), since performance was inconsistent on canonical sequences as well. The school-age group responded more consistently on canonical than noncanonical stimuli, and essentially all the teenage group responded consistently for both canonical and non-canonical symbol sequences. There is no clear evidence in Trudeau et al. (2010) that the participants perceived an intent to represent on the part of the constructor of the symbol sequences that they were asked to interpret, but the data do seem suggest that the participants intended to interpret the symbols as a representation. These response patterns also suggest that the participants viewed the symbols as a representation, thus indicating intent to represent.

Boyer et al. (2012); Poupart et al. (2013); Trudeau et al. (2014) These three studies are products of another research agenda and are drawn from the same data set. The last study, although published later, is presented first, since the other two studies refer to different aspects of the larger data set of Trudeau et al. These studies were all conducted with French-speaking participants and any examples of stimuli mentioned in the text have been translated into English.

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Trudeau, Sutton and Morford (2014) designed their study to systematically manipulate the use of symbols and spoken words as input and as output in experimental tasks, in order to attempt to isolate the impact of each on children’s performance. This approach contrasted with studies in which symbols, speech, and photographs or other visual information may have all been available at the same time. A separate task was created for each combination of input and output (see Figure 4.5) using a common set of stimuli, symbols, spoken sentences, and toys and props, which were incorporated as required by the particular input-output combination of the specific task. Children were given verbal instructions for all tasks and were familiarized with all of the words involved in the tasks. The tasks of particular interest here are those involving graphic symbols as input, as output, or both: Copy: symbol input and symbol output Reading: symbol input, speech output Dictation: speech input, symbol output Interpretation of symbol sequences: symbol input, action output Construction of symbol sequences: action input, symbol output The participants were children in four age groups : 3-year-olds (n = 23), 4-year-olds (n = 38), 5-year-olds (n = 27) and 6-year-olds (n = 23). All participants were highly successful on all tasks not involving graphic symbols (repetition, imitation, spoken sentence comprehension, and spoken sentence production). On tasks involving symbols, in contrast, there was considerable variability in performance across the tasks, particularly among the two younger groups. Although the majority of the 3-year-olds were able to match (Copy) and name (Read) symbols when presented in a printed sequence (83% and 74% of the group, respectively), only about a third of them (30%) could select toys and perform the action shown in the printed sequence (Interpretation of symbol sequence; see Figure 4.6). Even fewer children in this group (13%) were successful in using symbols as output (selecting symbols in a sequence), whether the task involved only association of symbols with spoken words (Dictation) or a less straightforward Stimuli

Response Speech

Symbols

Action

Speech

Repetition

Dictation

Sentence

Symbols

Reading

Copy

Interpretation of symbol sequence

Action (Videoclip)

Sentence production

Construction of symbol sequence

Imitation

Figure 4.5 Task matrix of input (speech, symbols, action) and output (speech, symbols, action). Shaded cells indicate tasks where the input and output are the same. From Trudeau et al. (2014).

Graphic symbols and typically developing children

relationship of selecting a sequence of symbols corresponding to an event depicted in video (Construction of symbol sequences). Among the 4-year-olds, a different pattern of performance was observed. More children (90%) passed the tasks. In contrast to the younger group, where performance was equally low on the tasks requiring children to select symbols to form a sequence, more than half of the 4-year-old group passed Dictation and Interpretation of symbol sequences. Performance on Construction of symbol sequences remained somewhat lower (30%), although still an increase from the proportion of the 3-year-olds. The 5- and 6-year-olds were successful on all tasks: over 80% and over 95% accuracy for 5- and 6-year-olds, respectively. Although some of the tasks in this study likely involved association only (Copy, Reading, Dictation), the results for Interpretation and Construction of symbol sequences could be interpreted as revealing a more advanced level of symbolic knowledge. These tasks were specifically designed to dissociate, at least to some degree, the use of symbols from spoken words because they involved only symbols and actions (either video or toy manipulation by the child); no verbal model was provided with the printed symbol sequence presented as input (Interpretation) nor as a model for the child’s response for symbol output (Construction). What level of symbolic function can be inferred from these data? It is unlikely that consistently correct performance on the Interpretation and Construction tasks could be achieved on the basis of association alone. In the Interpretation task, although the symbol sequence remained visible while the child was responding, the child had to perform an action using appropriate props: this required demonstrating relationships between the referents identified by the symbols. Simple association of the symbols with

3yrs n = 23

4yrs n = 38

5yrs n = 27

6yrs n = 23

Figure 4.6 P  ercentage of group passing each task. ISS = Interpretation of Symbol Sequences; Dict = Dictation; CSS = Construction of Symbol Sequences. Based on data from Trudeau et al. (2014), p. 193, Table 4.2.

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their referents in the symbol sequence would not be enough: the child had to then do something with them. The success of the 5- and 6-year-olds can be interpreted as at least a certain level of representation: an understanding that there are relationships among the symbols. The younger children had not yet reached this level, and therefore significantly fewer of them were successful on the Interpretation task. Nonetheless, they were almost as likely as the older groups to pass the tasks having the same input (symbols) as the Interpretation task (Copy and Read), where these tasks did not require the child to treat the symbols as a sequence in order to respond correctly. In the Construction task, after viewing the event (video), the child had to remember it, identify one or more of the symbols on the display associated with the elements of the video, and select the symbols in a particular sequence. In order to accomplish this, it seems likely that a strategy would be required, including some level of explicit understanding of the symbols and the relationships among them. The possibility exists, though, that children called on their verbal skills to assist in this task, by creating a verbal version of the event (either by speaking aloud or internally). Although a spoken model was not provided for this task, the children had already performed a Sentence production task, which had the same input as the Construction task and may have primed them to call on verbal skills to assist in this more difficult task. There was no attempt in this study to inhibit the child from drawing on language for support. Taking Interpretation and Construction performance together, it is reasonable to propose that children who pass both tasks, that is, most of the 5- and 6-year-olds, are likely demonstrating a level of representation. These children have shown that they can use graphic symbols in different ways: as a source of information to guide their own actions (Interpretation) and as symbols that can be arranged in different visual configurations to correspond to different depicted events (Construction), that is, different relationships among the symbols. Trudeau et al. (2014) suggest that increasing memory skills across this age range help children succeed on Interpretation and Construction tasks with symbols. The findings are nonetheless consistent with explanations of development related to level of symbolic representation, and suggest a level of explicit awareness of function of symbols. Another comparison of note in this study is the contrast in performance on Dictation, a difficult task for children until the age of 5 years, with performance on Copy and Read, which were passed by most children even in the youngest group. Children easily associated the symbol with its verbal label and could do so for more than one symbol at a time (Read). This is likely a familiar task for children (naming pictures in their environment) and the task included a visual trace. For Dictation, however, the child had to remember the spoken words (two or three) while locating each of the named symbols and then placing them in the correct order – an unfamiliar task for most children, and an activity that they had not likely observed adults performing in their environment. This contrast suggests that Dictation may require some referential ability since there is no visual support for the task and the child would have to disregard those symbols in view that were not named. If this inference is correct, the data in Figure 4.6 suggest that more than half of the 4-year-olds demonstrated a symbolic level of reference. Two studies examined certain subsets of data from the Trudeau et al. (2014) study in greater detail. Boyer et al. (2012) focused on the comparison of performance on the

Graphic symbols and typically developing children

Reading and Interpretation of symbol sequences tasks in the 4-year-old group. Because responses on the Reading task were spoken, it was possible to observe whether children treated the symbols as individual items, by naming them one by one (boy wash car), or whether they put them together to create a unit, by producing a grammatical spoken sentence with a conjugated verb (the boy washes/is washing the car). Both of these responses would be considered correct in the scoring of the task. The latter response, however, is clear evidence that the child perceived relationships among the graphic symbols in the sequence because the verb has been conjugated to correspond to the subject, suggesting a more advanced level of symbolic function, approaching (if not exemplifying) representation. Boyer and colleagues reanalyzed the data on the Reading task, on the basis of whether or not the child produced a spoken sentence containing a conjugated verb and then compared the performance of verb-conjugators and non-conjugators on the Interpretation task. At all age levels, producing conjugated verbs on the Reading task predicted success on the Interpretation task (see Figure 4.7). These findings lend weight to the argument that success on the Interpretation task can be construed as evidence of a representational level of symbolic functioning. Poupart et al. (2013) looked at aspects of the Dictation task from the Trudeau et al. (2014) study, in the three older groups only (4-, 5-, and 6-year-olds: n = 26, 25, 23 respectively). First, they explored the relationship between the need for training in the initial study and children’s performance on the same task a month later (maintenance).

Fail Pass

3-year-olds

4-year-olds

5-year-olds

6-year-olds

Figure 4.7 Percentage of children at each age who passed and failed the Interpretation of symbols sequences task who were classified as infinitive-users or conjugators on the Dictation task. From Boyer et al. (2012), p. 101, Figure 1.

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Children who passed the task without training (61 children) were highly likely to pass again at the maintenance testing (57 children). However, children who passed initially only after training (8 children) were only marginally more likely to pass (5 children) than to fail (3 children) at maintenance testing. This finding suggests that children may have needed training initially in order to pass because their understanding was not solid enough to be maintained over time; training may have helped children to perform the task in the short term, but was not adequate in the long term when no exposure to the task was provided in the interim. Poupart et al. (2013) also analyzed the children’s error responses on the first block of trials of the Dictation task. About half of the children made errors of some kind, but in general errors were not frequent in these age groups. The majority of errors were produced by the 4-year-olds, since fewer of these children passed (18/24) than in the 5- or 6-year-olds (24/25 and 20/23 respectively). Among the 99 errors, about half were classified as inversion errors, that is, all of the target symbols were present in the sequence the child created, but they were not in the correct order; 30% were omission errors and about 20% were substitutions (see Figure 4.8). Thus, in most of their responses, the children included a symbol for each of the words in the stimulus, even if the sequence did not correspond exactly to the spoken word order. This further detail about the Dictation task is consistent with the interpretation suggested above, that correct performance could be achieved by association between the spoken words and the symbols.

Alant et al. (2007) In a different line of research Alant, du Plooy and Dada (2007) examined whether the

Figure 4.8 Number of children who passed and failed on the maintenance testing who had passed with or without training on the initial testing. Based on data from Poupart et al. (2013).

Graphic symbols and typically developing children

Figure 4.9 Percentage of children who used each type of Response Sequence when the category symbols were arranged in an SVO or SOV sequence. Data from Alant et al. (2007).

sequence in which symbols were presented in a question related to a story influenced the sequence of symbols used in the response. The participants, 40 children aged 7 to 8 years, were familiarized with 15 PCS symbols (five people, five actions, five locations), and shown how to classify them and select them to respond to questions. Correct spoken sentence formulation accompanied each question and verbal labels were provided for each symbol as it was selected and displayed on the computer screen. Social supports included training for the task and use of a story context. Following the presentation of the story, questions were posed accompanied by a sequence of graphic symbols. The child responded on a computer display by selecting a category symbol and then the desired response symbol. The spoken question was presented in correct English word order and the sequence of symbols corresponded to this order. The visual arrangement of the categories that the children were to use in constructing their responses was different in the two conditions: in one condition, the category symbols were arranged in a left-to-right sequence of people, actions, things (called the SVO condition) and, in the other, the left-to-right arrangement of the category symbols was people, things, actions (called the SOV condition). It was this difference in the visual sequence of category symbols that was of interest to the authors. The data were pooled for all the children (N = 232 responses). Single-symbol responses were frequent (65% and 39% for the two types of questions, see Figure 4.9). This contrasts with the 7- to 8-year-olds performance on the construction task in Trudeau et al. (2010), which was essentially at ceiling for 3-symbol sequences, but certain task differences may account for these differences (the inclusion of a visual and verbal model for the target response and the incorporation of a story context). Alant et al.’s task seems more clearly referential rather than the task used in Trudeau et al. (2010), as discussed above.

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Interestingly, the children’s responses did differ across the conditions. Children in the SVO condition were more likely to produce a single-symbol response. In the SOV condition, in contrast, they were much more likely to select a sequence of symbols that followed a spoken SVO structure. This suggests that the children as a group were sensitive to the differences in the visual arrangement of the category symbols. Further, this response pattern could be taken to suggest a certain explicit level of understanding of the symbols. When the response frame was consistent with a canonical word order (SVO), children may recognize that they can take advantage of a familiar linguistic frame and respond with a single-symbol. However, when the response frame was not consistent with a canonical word order, the context was less familiar and may have prompted them to provide more information in a symbol sequence that followed the canonical word order.

Summary These studies of symbol sequences included children from the age of 3 and into the teenage years. There is ample evidence that young children are able to associate at least one symbol with a spoken sentence and with a corresponding photograph depicting an event. There is some evidence in these studies of preschool-aged children’s ability to use symbols to refer, and of a representational level emerging in the early school years. By the teen years, the capacity to step back from the symbols and take into account relationships among the symbols can be observed. Since these studies were not designed to directly target aspects of symbolic development, particularly intent to represent and explicitness, it is not surprising that they provide limited evidence of higher representational levels. However, these gaps in the information extracted from the studies cannot be taken as indications of limitations in the children’s skills or knowledge, but rather are the consequence of a different focus in the studies leading to tasks and procedures that did not incorporate ways to evaluate all aspects of symbolic development.

Bringing the initial sketch into focus In the literature on aided communication, there is a strong tendency to try to draw parallels between graphic symbols and spoken language. Historically, graphic symbols were provided to compensate for speech production limitations, initially for individuals within the expressive group (von Tetzchner & Martinsen, 2000) and later extending to individuals who could benefit from aided communication for many different reasons. A number of scholars have reflected on the relationship of graphic symbols and spoken language and are generally cautious regarding the degree to which graphic symbols can be considered as a form of language representation (e.g., Loncke, Campbell, England, & Haley, 2006; Smith, 2006; Tenny, 2014). Nonetheless, in the aided communication literature, references to graphic symbols seem to equate them with spoken words; linguistic terms such vocabulary, grammatical categories, and sentences structures abound. The symbolic development perspective, in contrast, serves to underscore that spoken and graphic symbols are not equivalent in typical development and highlights

Graphic symbols and typically developing children

elements of symbolic development that are not yet fully understood as they relate to graphic symbol use. There is consensus in the AAC literature that the use of graphic symbols by children with typical development does not simply follow the path of spoken language comprehension and production. When examined from the perspective of development of symbolic representation taken in this chapter, it is evident that use of graphic symbols does not line up directly with symbolic representation either. Graphic symbols in aided communication are intended to refer to words and concepts; however, the portrait obtained from this review is one of substantial evidence that it is the association level of representation that is most frequently elicited in research studies. The observation of limited evidence of more advanced levels may be a consequence of the fact that only a few studies provided data that can be interpreted as reference or representation levels of symbolic functioning. Further, association and reference may be blurred because of the materials available and language support for task performance. Language and social supports, believed to contribute to children’s symbolic functioning, are generally present in the research reviewed, but their influence on symbolic representational level is not usually the researcher’s primary interest (the exceptions could be the three training studies mentioned above). Language is generally viewed as a support to graphic symbol use; there has been little effort to isolate symbols from language in the research literature. This approach is not surprising, since most studies are interested in children’s performance on a symbol task rather than distinguishing language from symbols. The support that spoken language can provide for graphic symbol use and the degree to which the two can (or even should) be distinguished is a conundrum for aided communication research. Children with typical development may call on their spoken language skills when engaging in aided communication tasks, whether or not they are instructed or encouraged to do so. Children who use aided communication are also likely to call on their language skills, which may rely more heavily on comprehension than their production abilities. Across the literature reviewed, the extent and diversity of linguistic support for symbol meaning makes it difficult to dissociate the contribution of language from demonstration of symbolic function in task performance. Providing a significant amount of language support for symbol tasks, such as using concepts and vocabulary that are well within the knowledge of the participants, may be well-intentioned, but the consequence may be that it is difficult to tease out symbolic knowledge from language knowledge (for example, when spoken words and symbols are presented together). The notion of social supports was incorporated in most of the studies reviewed, although not necessarily identified as such by the researchers. Training and familiarization were judged to be a kind of social support, but these elements do not match the way the term is used in the symbolic development literature, that is, exposure to experts using symbols in culturally appropriate ways. In fact, another point of consensus in the AAC literature is that there are differences between the language learning experiences of children who require aided symbols and those of children with typical development, in their exposure to the communication that they will be expected produce themselves (Smith & Grove, 1999, 2003; Sutton, Soto, & Blockberger, 2002). Recognizing that exposure to expert use is believed to be an important element in symbolic development

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lends additional support for intervention approaches that incorporate adult modelling of graphic symbol use. The volume of exposure that could be provided in this way is relatively small compared with spoken language exposure; nonetheless, there is evidence of the effectiveness of these types of approaches (Kent-Walsh, Binger, & Buchanan, 2015; Tönsing, 2015). It is possible that the extent of exposure to expert use of graphic symbols required to facilitate progress in symbolic development is much less than that provided to children in speech. Although some parallels can be drawn between the two bodies of literature regarding supports for symbolic functioning, there is a striking gap between them in the comparison of developmental progress. In the symbolic development literature, progress toward full symbolic representation is driven by (a) children’s ability to grasp and incorporate representational intent into their use of symbols, and (b) the increasing explicitness of understanding of symbols and their various dimensions. These elements were not directly addressed in the research on use of graphic symbols by children with typical development, although a few studies may have touched on them. The studies reviewed here did report developmental changes over the age ranges included, but these changes were not linked to the elements believed to be key contributors to progress in children’s symbolic development. A further aspect of dissimilarity is that the interest in sequences of symbols in aided communication really has no parallel in the symbolic development literature. The presumed relationship between graphic symbols and spoken language has led researchers to go beyond single symbols/words and consider symbol sequences as sentences in the aided communication literature, but not in the symbolic representation literature.

Future directions Two directions for future research emerge from this review that could add depth and precision to understanding of children’s use of graphic symbols. First, teasing out the relative contributions of language and social supports to demonstration of level of symbol understanding could help identify more finely grained steps in the development of use of graphic symbols in aided communication. It may be profitable to explore what happens when, for example, language and symbolic information are in conflict rather than one supporting the other (in a sense, a graphic symbol version of the McGurk effect (McGurk & MacDonald, 1976)), or when they provide different levels of specificity (such as the study mentioned above by Callaghan (2000)), with young children. Secondly, it may be necessary to design studies specifically in order to evaluate evidence of: (a) level of symbolic understanding beyond association (reference, representation); (b) intent to represent (recognition of the viewer’s intent to interpret graphic symbols as symbols); and (c) explicitness of understanding (reflection on symbols and their relationships). Tasks in which the child is asked to do something with the symbols (beyond associating them with referents or spoken words) may reveal higher levels of symbolic representation. Studies in which task demands are challenging in principled ways to approach the upper limits of children’s abilities,

Graphic symbols and typically developing children

rather than staying within a comfortable range of abilities may reveal emerging levels of symbolic understanding. When the focus is on performance on a task, as is usually the case in aided communication studies, data is often analyzed relative to an expected response (e.g., correct or incorrect). To detect the representational level demonstrated, however, it may be necessary to look for converging evidence from more than one task, particularly when a degree of reflection or detachment from the actual symbols is sought, as is the case with higher levels of representation. Studies designed specifically to target the referential and higher levels of symbolic representation using graphic symbols may be needed in order to fully understand their potential as representational systems. Symbolic development is, of course, only one perspective on graphic symbols in aided communication; the review focused on it intentionally in order to explore the extent to which it could illuminate the existing literature on graphic symbol use by children who are developing typically. Although the available studies alone may not reveal the full picture, the symbolic development perspective may explain, at least to some degree, the late emergence of the ability to construct and interpret sequences of graphic symbols relative to spoken language skills. Studies looking at memory span using graphic symbols were included here because they involve sequences of graphic symbols, though not intended as meaningful utterances. This perspective is of growing importance in the AAC literature (Oxley & Norris, 2000; Thistle & Wilkinson, 2013), and other cognitive perspectives (Murray & Goldbart, 2009; Wilkinson & Hennig, 2009), notably visual cognition (Wilkinson, Light, & Drager, 2012) are also needed to enrich the theoretical knowledge base underlying the study of graphic symbols in aided communication. Further reflection and discussion is needed to incorporate and reconcile these views, along with the symbolic development perspective, in order to fully understand the developmental course and relevant contributing factors for the use of graphic symbols as a representational system within aided communication.

Note Two other studies looked at graphic symbols beyond the single-word level, but cannot be interpreted in terms of representational level. Musselwhite and Ruscello (1984): Although the Words subtest data from this study has been included in the single symbols section, there were two other subtests in this study that involved symbol combinations (Phrases and Sentences subtests). A spoken sentence was presented with an array of four response options, each of which was a group of symbols. Since the symbols were not selected one at a time, these data cannot be interpreted as symbol sequences. Quach and Beukelman (2010) were interested in the effect of two types of training on children’s ability to locate symbols on a device. They presented spoken sentences as stimuli and the children were asked to select symbols in a sequence. However, the data are reported in terms of overall accuracy and response time, and it is thus not possible to examine performance on the symbol sequences. A third study could not be located: Basson, M. & Alant, E. (2005). The iconicity and ease of learning of picture communication symbols: A study with Afrikaans-speaking children. South African Journal of Communication Disorders, 52, 4–12.

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Fuller, D. (1997). Initial study into the effects of translucency and complexity on the learning of Blissymbols by children and adults with normal cognitive abilities. Augmentative and Alternative Communication, 13, 30–39. Doi: 10.1080/07434619712331277818 Fuller, D., & Lloyd, L. (1992). Effects of configuration on the paired-associate learning of Blissymbols by preschool children with normal cognitive abilities. Journal of Speech and Hearing Research, 33, 1376–1383. Doi: 10.1044/jshr.3506.1376 Ganea, P., Pickard, M., & DeLoache, J. (2008). Transfer between picture books and the real world by very young children. Journal of Cognition and Development, 9, 46–66. Doi: 10.1080/1524837070183659 Gross, J., & Hayne, H. (1999). Young children’s recognition and description of their own and others’ drawings. Developmental Science, 2, 476–489. Doi: 10.1111/1467-7687.00091 Harmon, A., Schlosser, R., Gygi, B., Shane, H., Kong, Y-Y., Book, L., Macduff, K., & Hearn, E. (2014). Effects of environmental sounds on the guessability of animated graphic symbols. Augmentative and Alternative Communication, 30, 298–313. Doi: 10.3109/07434618.2014.966206 Hetzroni, O., & Lloyd, L. (2000). Shrinking Kim: Effects of active versus passive computer instruction on the learning of element and compound Blissymbols. Augmentative and Alternative Communication, 16, 95–106. Doi: 10.1080/07434610012331278934 Hochstein, D., McDaniel, M., Nettleton, S., & Neufeld, K. (2003). The fruitfulness of a nomothetic approach to investigating AAC: Comparing two speech encoding schemes across cerebral palsied and nondisabled children. American Journal of Speech-Language Pathology, 12, 110–120. Doi: 10.1044/1058-0360(2003/057) Huang, C-H., & Chen, M-C. (2011). Effect of translucency on transparency and symbol learning for children with and without cerebral palsy. Research in Developmental Disabilities, 32, 1829–1836. Doi: 10.1016/j.ridd.2011.03.013 Jacko, J., & Rosenthal, D. (1997). Psychology of computer use XLVI: Age-related differences in the mapping of auditory icons to visual icons in computer interfaces for children. Perceptual and Motor Skills, 84, 1223–1233. Doi: 10.2466/pms.1997.84.3c.1223 Jennische, M., & Zetterlund, M. (2015). Interpretation and construction of meaning of Bliss-words in children. Augmentative and Alternative Communication, 31, 97–107. Doi: 10.3109/07434618.2015.1036117 Kent-Walsh, J., Binger, C. & Buchanan, C. (2015). Teaching children who use augmentative and alternative communication to ask inverted yes/no questions using aided modeling. American Journal of SpeechLanguage Pathology, 24, 222–236. Doi: 10.1044/2015_AJSLP-14-0066 King, M., Binger, C., & Kent-Walsh, J. (2015). Using Dynamic Assessment to evaluate the expressive syntax of children who use augmentative and alternative communication. Augmentative and Alternative Communication, 31, 1–14. Doi: 10.3109/07434618.2014.995779 Laws, G., & Lawrence, L. (2001). Spatial representation in the drawings of children with Down’s syndrome and its relationship to language and motor development: A preliminary investigation. British Journal of Developmental Psychology, 19, 453–472. Doi: 10.1348/026151001166119 Light, J., Drager, K., McCarthy, J., Mellott, S., Millar, D., Parrish, C., Parsons, A., Rhoads, S., Ward, M., & Welliver, M. (2004). Performance of typically developing four- and five-year-old children with AAC systems using different language organization techniques. Augmentative and Alternative Communication, 20, 63–88. Doi: 10.1080/07434610410001655553 Light, J., Worah, S., Drager, K., Bowker, A., Burki, B., D’Silva, K., Kristiansen, L., Jones, J., & Hammer, C. (2008). Children’s representations of early language concepts: Implications for AAC symbols. Technical Paper presented at ASHA, Chicago, IL, November 2008. Loncke, F., Campbell, J., England, A., & Haley, T. (2006). Multimodality: A basis for augmentative and alternative communication – psycholinguistic, cognitive, and clinical/educational aspects. Disability and Rehabilitation, 28, 169–174. Doi: 10.1080/09638280500384168

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McCarthy, J., Light, J., Drager, K., McNaughton, D., Grodzicki, L., Jones, J., Panek, E., & Parkin, E. (2006). Re-designing scanning to reduce learning demands: The performance of typically developing 2-yearolds. Augmentative and Alternative Communication, 21, 269–283. Doi: 10.1080/00498250600718621 McGurk, H., & Macdonald, J. (1976). Hearing lips and seeing voices. Nature, 246, 746-748. Doi: 10.1038/264746a0 Mineo, B., Peischl, D., & Pennington, C. (2008). Moving targets: The effect of animation on identification of action word representations. Augmentative and Alternative Communication, 24, 162–173. Doi: 10.1080/07434610802109915 Mizuko, M. (1987). Transparency and ease of learning of symbols represented by Blissymbols, PCS and Picsyms. Augmentative and Alternative Communication, 3, 129–136. Doi: 10.1080/07434618712331274409 Mizuko, M., & Esser, J. (1991). The effect of direct selection and circular scanning on visual sequential recall. Journal of Speech and Hearing Research, 34, 43–48. Doi: 10.1044/jshr.3401.43 Mizuko, M., Reichle, J., Ratcliff, A., & Esser, J. (1994). Effects of selection techniques and array sizes on short-term visual memory. Augmentative and Alternative Communication, 10, 237–243. Doi: 10.1080/07434619412331276940 Murray, J., & Goldbart, J. (2009). Cognitive and language acquisition in typical and aided language learning: A review of recent evidence from an aided communication perspective. Child Language, Teaching and Therapy, 25, 31–58. Doi: 10.1177/0265659008098660 Murray, J., & Goldbart, J. (2011). Emergence of working memory in children using aided communication. Journal of Assistive Technologies, 5, 214–232. Musselwhite, C. & Ruscello, D. (1984). Transparency of three communication symbol systems. Journal of Speech and Hearing Research, 27, 436–443. Doi: 10.1044/jshr.2703.436 Myers, L., & Liben, L. (2008). The role of intentionality and iconicity in children’s developing comprehension and production of cartographic symbols. Child Development, 79, 668–684. Doi: 10.1111/j.14678624.2008.01150.x Myers, L., & Liben, L. (2012). Graphic symbols as ‘the mind on paper’: Links between children’s interpretive theory of mind and symbol understanding. Child Development, 83, 186–202. Doi: 10.1111/j.14678624.2011.01693.x Olin, A., Reichle, J., Johnson, L., & Monn, E. (2010). Examining dynamic visual scene displays: Implications for arranging and teaching symbol selection. American Journal of Speech-Language Pathology, 19, 284–297. Doi: 10.1044/1058-0360(2010/09-0001) Oxley, J., & Norris, J. (2000). Children’s use of memory strategies: Relevance to voice output communication aid use. Augmentative and Alternative Communication, 16, 79–94. Doi: 10.1080/07434610012331278924 Petersen, K., Reichle, J., & Johnston, S. (2000). Examining preschoolers’ performance in linear and row-column scanning techniques. Augmentative and Alternative Communication, 16, 27–36. Doi: 10.1080/07434610012331278884 Pierroutsakos, S., & DeLoache, J. (2003). Infants’ manual exploration of pictorial objects varying in realism. Infancy, 4, 141–156. Doi: 10.1207/S15327078IN0401_7 Pierroutsakos, S., DeLoache, J., Gound, M., & Bernard, E. (2005). Very young children are insensitive to picture- but not object-orientation. Developmental Science, 8, 326–332. Doi: 10.1111/j.14677687.2005.00420.x Poupart, A., Trudeau, N., & Sutton, A. (2013). Construction of graphic-symbol sequences by preschoolaged children: Learning, training, and maintenance. Applied Psycholinguistics, 34, 91–109. Doi: 10.1017/S0142716411000622 Preissler, M., & Carey, S. (2004). Do both pictures and words function as symbols for 18- and 24-monthold children? Journal of Cognition and Development, 5, 185–212. Doi: 10.1207/s15327647jcd0502_2

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Quach, W., & Beukelman, D. (2010). Facilitating children’s learning of dynamic-display AAC devices: The effect of two instructional methods on the performance of 6- and 7-year-olds with typical development using a dual-screen prototype. Augmentative and Alternative Communication, 26, 1–11. Doi: 10.3109/07434610903561068 Raghavendra. P., & Fristoe, M. (1995). “No Shoes; They Walked Away?”: Effects of enhancements on learning and using Blissymbols by normal 3-year-old children. Journal of Speech and Hearing Research, 38, 174–188. Doi:10.1044/jshr.3801.174 Robillard, M., Mayer-Crittenden, C., Roy-Charland, A., Minor-Coriveau, M., & Bélanger, R. (2013). Exploring the impact of cognition on young children’s ability to navigate a speech-generating device. Augmentative and Alternative Communication, 29, 347–359. Doi: 10.3109/07434618.2013.849754 Robinson, E., Nye, R., & Thomas, G. (1994). Children’s conceptions of the relationship between pictures and their referents. Cognitive Development, 9, 165–191. Doi: 10.1016/0885-2014(94)90002-7 Salsa, A., & Peralta de Mendoza, O. (2007). Routes to symbolization: Intentionality and correspondence in early understanding of pictures. Journal of Cognition and Development, 8, 79–92. Doi: 10.1080/15248370709336994 Schlosser, R., & Lloyd, L. (1993). Effects of initial element teaching in a story-telling context on Blissymbol acquisition and generalization. Journal of Speech and Hearing Research, 36, 979–995. Doi: 10.1044/ jshr.3605.979 Schlosser, R., & Lloyd, L. (1997). Effects of paired-associate learning versus symbol explanations on Blissymbol comprehension and production. Augmentative and Alternative Communication, 13, 226–238. Doi: 10.1080/07434619712331278058 Schlosser, R., Koul, R., Shane, H., Sorce, J., Brock, K., Harmon, A., … & Hearn, A. (2014). Effects of animation on naming and identification across two graphic symbol sets representing verbs and prepositions. Journal of Speech, Language, and Hearing Research, 57, 1779–1791. Doi: 10.1044/2014 Schlosser, R., Shane, H., Sorce, J., Koul, R., Bloomfield, E., Debrowski, L., … Neff, A. (2012). Animation of graphic symbols representing verbs and prepositions: Effects on transparency, name agreement, and identification. Journal of Speech, Language, and Hearing Research, 55, 342–358. Doi: 10.1044/10924388(2011/10-0164) Shepherd, T., & Haaf, R. (1995). Comparison of two training methods in the learning and generalization of Blissymbolics. Augmentative and Alternative Communication, 11, 154–164. Doi: 10.1080/07434619512331277279 Simcock, G., & DeLoache, J. (2006). Get the picture? The effects of iconicity on toddlers’ re-enactment from picture books. Developmental Psychology, 42, 1352–1357. Smith, M. (1996). The medium or the message: A study of speaking children using communication boards. In S. von Tetzchner & M.H. Jenson (Eds), Augmentative and Alternative Communication: European Perspectives, pp. 119–136. San Diego, CA: Singular Publishing Group. Smith, M. (2006). Speech, language and aided communication: Connections and questions in a developmental context. Disability and Rehabilitation, 28, 151–157. Doi: 10.1080/09638280500077747 Smith, M. (2015). Language development of individuals who require aided communication: Reflections on state of the science and future research directions. Augmentative and Alternative Communication, 31, 215–233. Doi: 10.3109/07434618.2015.1062553 Smith, M., & Grove, N. (1999). The bimodal situation of children learning language using manual and graphic signs. In F. Loncke, J. Clibbens, H. Arvidson & L. Lloyd (Eds), New Directions in AAC: Research and Practice, pp. 9–30. London: Whurr. Smith, M., & Grove, N. (2003). Asymmetry in input and output. In J. Light, D. Beukelman & J. Reichle (Eds), Communicative Competence for Individuals who use AAC, pp. 163–198. Baltimore: Brookes. Stephenson, J. (2009). Iconicity in the development of picture skills: Typical development and implications for individuals with severe intellectual disabilities. Augmentative and Alternative Communication, 25, 187–201.

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Sutton, A., & Morford, J. (1998). Constituent order in picture pointing sequences produced by speaking children using AAC. Applied Psycholinguistics, 19, 525–536. Doi: http://dx.doi.org/10.1017/ S0142716400010341 Sutton, A., Soto, G., & Blockberger, (2002). Grammatical issues in graphic symbol communication. Augmentative and Alternative Communication, 18, 192–204. Sutton, A., Trudeau, N, Morford, J., Rios. M., & Poirier, M.-A. (2010). Performance of three and fouryear-olds on production and comprehension tasks using graphic symbol utterances. Journal of Child Language, 37, 1–26. Doi: http://dx.doi.org/10.1017/S0305000909009477 Swim, O. (2014). Children’s and adults’ visuospatial and temporal memory abilities using picture communication symbols. Master’s Thesis, Ball State University. Tenny, C. (2014) A linguist looks at AAC: Language representation systems for augmentative and alternative communication, compared with writing systems and natural language. Writing Systems Research. Doi: 10.1080/17586801.2014.959459 Thistle, J., & Wilkinson, K. (2009). The effects of color cues on typically developing preschoolers’ speed of locating a target line drawing: Implications for augmentative and alternative communication display design. American Journal of Speech-Language Pathology, 18, 231–240. Doi:10.1044/10580360(2009/08-0029) Thistle, J., & Wilkinson, K. (2013). Working memory demands of aided augmentative and alternative communication for individuals with developmental disabilities. Augmentative and Alternative Communication, 29, 235–245. Doi: 10.3109/07434618.2013.815800 Thomas, G., Nye, R., & Robinson, E. (1994). How children view pictures: Children’s responses to pictures as things in themselves and as representations of something else. Cognitive Development, 9, 141–164. Doi: 10.1016/0885-2014(94)90001-9 Thompson, D. (2012). Typically developing preschooler’s location of digital photos on speech generating devices using visual scene displays. Master’s Thesis, University of Minnesota. Tonsing, K. (2015) Supporting the production of graphic symbol combinations by children with liited speech: A comparison of two AAC systems. Journal of Developmental Physical Disabilities. Doi: 1007/s10882-015-9435-5 Trudeau, N, Sutton, A., Dagenais, E., de Broek, S., & Morford, J. (2007). Construction of graphic symbol utterances by children, teenagers, and adults: The impact of structure and task demands. Journal of Speech-Language and Hearing Research, 50, 1314–1329. Doi: 10.1044/1092-4388(2007/092) Trudeau, N., Sutton, A., & Morford, J. (2010). The role of word order in the interpretation of canonical and non-canonical graphic symbol utterances: A developmental study. Augmentative and Alternative Communication, 26, 108–121. Doi: 10.3109/07434618.2010.481563 Trudeau, N., Sutton, A., & Morford, J. (2014). An investigation of developmental changes in interpretation and construction of graphic AAC symbol sequences through systematic combination of input and output modalities. Augmentative and Alternative Communication, 30, 187–199. Doi: 10.3109/07434618.2014.940465 Visser, N., Alant, E., & Harty, M. (2008). Which graphic symbols do 4-year-old children choose to represent each of the four basic emotions? Augmentative and Alternative Communication, 24, 302–312. Doi: 10.1080/07434610802467339 von Tetzchner, S., & Martinsen, H. (2000) Introduction to Alternative Communication, 2nd ed. London: Whurr Wagner, B., & Jackson, H. (2006). Developmental memory capacity resources of typical children retrieving picture communication symbols using direct selection and visual linear scanning with fixed communication displays. Journal of Speech, Language, and Hearing Research, 49, 113–126. Doi: 10.1044/1092-4388(2006/009)

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White, A., & Carney, E. (2010). Group-item and directed scanning: Examining preschoolers’ accuracy and efficiency in two augmentative communication symbol selection methods. American Journal of Speech-Language Pathology, 19, 311–320. Doi: 10.1044/1058-0360(2010/09-0017) Wilkinson, K., Carlin, M., & Jagaroo, V. (2006). Preschoolers’ speed of locating a target symbol under different color conditions. Augmentative and Alternative Communication, 22, 123–133. Doi: 10.1080/07434610500483620 Wilkinson, K.M., Carlin, M., & Thistle, J. (2008). The role of color cues in facilitating accurate and rapid location of aided symbols by children with and without Down syndrome. American Journal of Speech-Language Pathology, 17, 179–193. Doi: 10.1044/1058-0360(2008/018) Wilkinson, K., & Coombs, B. (2010). Preliminary exploration of the effect of background color on the speed and accuracy of search for an aided symbol target by typically developing preschoolers. Early Childhood Services, 4, 171–183. Wilkinson, K., & Hennig, S. (2009). Consideration of cognitive, attentional, and motivational demands in the construction and use of aided AA systems. In G. Soto & C. Zangari (Eds), Practically Speaking: Language, Literacy and Academic Development for Students with AAC Needs, pp. 313–334. Baltimore: Brookes. Wilkinson, K., & Snell, J. (2011). Facilitating children’s ability to distinguish symbols for emotions: The effects of background color cues and spatial arrangement of symbols on accuracy and speed of search. American Journal of Speech-Language Pathology, 20, 288–301. Doi: 10.1044/1058-0360(2011/10-0065) Wilkinson, K., Light, J., & Drager, K. (2012). Considerations for the composition of visual scene displays: Potential contributions of information from visual and cognitive sciences. Augmentative and Alternation Communication, 28, 137–147. Doi: 10.3109/07434618.2012.704522 Wilkinson, K., O’Neill, T., & McIlvane, W. (2014). Eye-tracking measures reveal how changes in the design of aided AAC displays influence the efficiency of locating symbols by school-age children without disabilities. Journal of Speech, Language, and Hearing Research, 57, 455–466. Doi: 10.1044/2013_ JSLHR-L-12-0159 Worah, S., McNaughton, D., Light, J., & Benedek-Wood, E. (2015). A comparison of two approaches for representing AAC vocabulary for young children. International Journal of Speech-Language Pathology, 17, 460–469. Doi: 10.3109/17549507.2014.98781 Zaitchik, D. (1990). When representations conflict with reality: The preschooler’s problem with false beliefs and “false” photographs. Cognition, 35, 41–68. Doi: 10.1016/0010-0277

5 S yntax and morphology in aided language development Sally Clendon and Kate Anderson

Introduction Although there is substantial variability across individuals who use aided communication, many appear to experience significant difficulty in developing mature syntax and morphology (Binger & Light, 2008). Even into adulthood, many communicate in very brief, often single-symbol utterances, and make limited use of questions, commands or negatives. Other characteristics of output in aided communication include atypical word order patterns, and telegraphic-type messages that feature keywords but omit small structural words and morphological markers (Soto, 1997, 1999). There has been considerable discussion in the AAC literature about possible reasons for these difficulties. Some have questioned whether they are actually ‘difficulties’ as such, or whether they can be attributed to the unique features inherent in aided communication methods (Kraat, 1985; Smith & Grove, 1999; Sutton, Soto, & Blockberger, 2002). Indeed, many characteristics of aided communication could influence the structure of language that individuals acquire and produce. In order to understand the nature of syntax and morphology in aided language, we need to ask several questions. Firstly, what facilitates the initial emergence of these structures in children who use aided communication? What, in essence, drives that critical transition from single- to multi-word utterances, or from simple to complex word forms? And what factors or contexts predict ongoing use of these structures once acquired? Finally, what influences do AAC system design and AAC interventions have on the types of syntactic and morphological forms that individuals who use aided communication produce? In this chapter, we consolidate a large body of research that has attempted to answer such questions, illustrated with data from our own research, and consider some potentially important implications for clinical practice and AAC system design. Various theories have attempted to explain the emergence of language in young children. Two major influences appear to be the language input that children receive, and the environmental demands that exist for more advanced communication. For

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example, in his seminal text, Brown (1973) described how children may be able to make their intentions clear at home with family members but, when faced with unfamiliar communication partners, are forced to attempt more complex language forms to get their message across. Such instances of communication problem solving can offer important learning experiences for children, and yet these experiences may not occur to the same extent for children with disabilities (see also Chapter 2, this volume). The section that follows discusses the language demands of the environment for children who use aided communication, the language input provided to these children, and broader issues surrounding efficiency and rate of aided communication.

Language demands of the environment The habitually simple language structures used by many individuals who use aided communication may be partly attributed to their communication environments. A rich and responsive communication environment is relevant to all communicators, but it is particularly critical for children with disabilities. These children often have limited opportunities to explore and interact with their physical environment, and to develop a ‘world knowledge’ model upon which to map language (Light, 1997). These limitations can be due to the child’s motor and sensory limitations, as well as opportunity barriers in the environment (Light & Kelford-Smith, 1993; Sturm & Clendon, 2004). For example, many children with disabilities spend a large proportion of their day having mealtime or physical care needs met, leaving little time for free play and socialising (Light & Kelford-Smith, 1993). Finally, due to logistical, technology, or positioning constraints, access to a comprehensive AAC system may also be limited during language-rich functional activities such as storybook reading, personal care and outdoor/physical activities (Datillo, Estrella, Estrella, Light, et al., 2008; Light & Kelford-Smith, 1993). As a result of these factors, there may be limited opportunities for children to practise their emerging syntactic and morphological skills within daily contexts and routines. Children’s language development is also mediated by the expectations and interaction behaviours of their communication partners. Caregiver responsivity, which includes the contingency of caregiver utterances to a child’s current state, behaviour, or focus of attention, is one such factor. Maternal responsivity is strongly associated with a variety of cognitive and linguistic outcomes including vocabulary and syntax development, for children with and without disabilities (Bornstein, Tamis LeMonda, & Haynes, 1999; McDuffie & Yoder, 2010; Warren, Brady, Sterling, Fleming, & Marquis, 2010). As Broberg and colleagues pointed out: “Initiating and maintaining a highly responsive interaction style with a child with a developmental disability can be highly challenging, even for a parent with the best intentions, but is crucial for positive communication development” (Broberg, Ferm, & Thunberg, 2012, p. 244). The interaction dyads of children with disabilities and their caregivers may also differ substantially from those observed for children with typical development. Features of caregiver communication reported in the literature include heavy use of directive and requestive acts, and minimal pauses for the child to respond (Light, Collier, &

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Parnes, 1985a; Light, Binger, & Kelford-Smith, 1994; Pennington & McConachie, 1999). Topics of conversation may also lack depth and reciprocity (Ferm, Ahlsén, & Björck-Åkesson, 2005). Possible reasons for this pattern may be the difficulty that children with disabilities can experience in (a) indicating the focus of their interest, and (b) gaining and directing the attention of others. As a result, parents may miss communicative initiations from their child (McCollum & Hemmeter, 1997), thereby reducing the number of syntactic or morphological models that are contingent on the child’s current interests and attention (Blockberger & Sutton, 2003). Another way that communication partners influence the production and potentially the acquisition of syntax for children who use aided communication is through a process called co-construction. When children generate aided language, their responses are often translated and extended by their partners. Communication partners draw on shared knowledge and questioning to support children to formulate their message and to convey their meaning or communicative intent (Sutton et al., 2002). An example of co-construction can be seen in the excerpt below, where Jaya, who is learning to use a speech-generating device, is asked to select a storybook to read.

Extract 5.1 Jaya: “piglet” Mother: Piglet! Where’s piglet? Jaya: [reaches for the chosen book] Mother: Ok, ‘pig’. Alright. So the name of the book is ‘this little pig’, isn’t it. … Do you remember where to find “this?” on this computer? I think it’s under here [guides child to first icon]. It’s under the magician. This. Jaya: “this” Mother: Now, do you remember where little is? That’s right, the dice [she is referring here to the first icon in the sequence for ‘little’]. Jaya: “little” Mother: This little. What goes next? ...

Co-construction is regarded as a positive strategy for supporting children who use aided communication. It can help to facilitate children’s narrative productions (Liborion & Soto, 2006; Solomon-Rice & Soto, 2011) and can result in positive collaborations with communication partners (Brekke & von Tetzchner, 2003). The most effective forms of co-construction are those that are child-centred. Child-centred strategies involve following the child’s lead and allowing the child plenty of time to contribute and to construct messages using his/her AAC system (Solomon-Rice & Soto, 2011). When interactions are very adult-directed, the child may perceive the interaction as being more about education than communication (Smith, 2003). Compared to the

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earlier example, the following excerpt between Theo, a boy with intellectual disability, and his mum is more clearly directive.

Extract 5.2 Mum: What did we do yesterday Theo? We… Theo: “yesterday” Mum: Yeah, what did we do? What did we do yesterday? We… Theo: “we” Mum: Went… where did we go? Theo: “went” WENT Mum: Yeah, what did we do? Where did we go? What did we do yesterday? We went… did we, what is it? In the water? [gestures SWIMMING] Theo: [voc.] aah Mum: Yeah what did we do in the water? In the pool, what did you do in the pool? We went… we went… go to shoes [she is referring here to the shoe icon which leads to a list of activities]. Yeah. We went… Theo: “swimming” [Activates speech window] “yesterday we went swimming”.

Frequent and extensive use of co-construction, especially when it is adult-directed, may also result in ongoing partner dependency. Constant guessing and scaffolding by primary communication partners may mean that the child has limited opportunities to practise the syntactic, morphological and pragmatic skills required for independent communication with unfamiliar partners. Expert AAC clinician Carole Zangari (2014) reflected on this from a practitioner perspective: We [as familiar partners] use the context and our knowledge of the learner to read into their utterance and interpret what they are saying. Often (but not always), we guess correctly. That’s necessary in some contexts, of course. But think about this: When we do that, they have no need to be clearer, more detailed, or more precise in what they say … When we do this, we ‘teach’ them to be dependent on informed, familiar listeners (para 6). This is illustrated in the excerpt below where the teacher aide working with Max asks him what he’s doing on the weekend. He starts to construct his utterance, but she quickly completes it for him.

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Extract 5.3BAC Teacher Aide: What are you doing this weekend? Max: “maybe” Teacher Aide: Maybe going to the football? Max: YES (raises eyebrows) Given the apparent impact of communication environments and interaction features on children’s language development, it follows that changes in communication partner behaviours may result in a diversification of language structure and content and improved language trajectories for children who use aided communication. For instance, Soto and Hartmann (2006) suggested that prompts such as contingent queries and verbal redirection should be used when a message is not explicit enough and additional information is required. They caution that this must be done gently so as to not overtake the conversation. Providing sufficient wait time (at least 10 seconds) for young people who use aided communication to respond is also critical (Mathis, Sutherland, & McAuliffe, 2011). Another strategy that may be useful is recapping. This involves the communication partner providing regular summaries of the information the child has communicated thus far. This strategy may support syntax development by pulling together co-constructed language into a more concise, coherent form. In the excerpt below, Megan and her mum are having a conversation about what Megan will do when she grows up and leaves home. She has indicated that she would like to live in the city and they are now talking about how she will spend her weekends. Notice how Megan’s mum recaps at the end.

Extract 5.4BAC Parent: And what are you going to do on your busy Sunday mornings? Megan: “shop” Parent: Go shopping. Megan: YES (nods) Parent: and what … Megan: FOR FOOD (signs) Parent: For food. For groceries Megan: WEEK (signs) Parent: For the week. Megan: YES (nods) Parent: Ah, go grocery shopping for the week. That’s a sensible idea.

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Finally, the amount of language input that children receive is an important factor for their language and cognitive development. For instance, Brady, Thiemann-Bourque, Fleming and Matthews (2013) found that the quantity of adult input at home directly influenced the cognition, comprehension, play, and presymbolic communication development of children aged 3–6 years. Furthermore, these skills in combination predicted the number of words the children eventually produced. Given this, it is important to examine what defines ‘optimum’ communication partner input for children who use AAC, and how partner input can influence grammar development specifically.

Communication partner input and aided language exposure Children who use aided communication typically experience a mismatch between the modality of language input (in other words the primary spoken language they are exposed to), and their own language output (Smith & Grove, 2003). These two modalities may differ in terms of their realization (auditory versus visual forms), as well as the rules and linguistic codes governing their production (i.e., pragmatic, syntactic, morphological and lexical constrains) (Smith & Grove, 2003). A related challenge is that these children often have limited exposure to models of proficient aided communication use (Light, 1997; Light, Collier, & Parnes, 1985b). They may have little to no contact with those experienced in aided communication (Light et al., 1985b) and they may not observe aided communication modes being used outside of formal teaching contexts (von Tetzchner & Jensen, 1996) (see also Chapter 2, this volume). The key strategy employed to manage these challenges has been the use of aided language input. Aided language input involves communication partners supplementing their spoken communication by modelling on a child’s AAC system (Kent-Walsh, Binger & Hasham, 2010). This modelling provides important learning opportunities for the child who uses aided communication. It also encourages communication partners to learn the child’s system. Furthermore, it slows the interaction down, giving the child more time to process language and learn (Parker, 2014). Many variants of aided language input have been described in the literature, including Aided Language Stimulation (ALgS), the System for Augmenting Language (SAL), and Aided Language Modelling (ALM). Beukelman and Mirenda (2013) provide a comprehensive description and discussion of each approach. There is now a strong research base providing evidence that aided language input leads to a number of positive communication and language outcomes, including increases in the number of communicative turns (e.g., Kent-Walsh et al., 2010; Rosa-Lugo & Kent-Walsh, 2008), the number of semantic concepts expressed (e.g., Kent-Walsh et al., 2010; Rosa-Lugo & Kent-Walsh, 2008), the number of multisymbol utterances produced (e.g., Binger & Light, 2007; Binger, Kent-Walsh, Berens, Del Campo, & Rivera, 2008; Binger, Kent-Walsh, Ewing, & Taylor, 2010; Bruno & Trembath, 2006; Romski & Sevcik, 1996) and the number of grammatical morphemes used (e.g., Binger, MaguireMarshall, & Kent-Walsh, 2011). These studies have been conducted with a range of communication partners including parents (Binger et al., 2008; Kent-Walsh et al., 2010; Rosa-Lugo & Kent-Walsh, 2008) and educational assistants (Binger et al., 2010). One issue seen to be of particular importance for aided language input is the

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grammatical complexity of the models produced. There is general agreement that simplifying language is an important part of the language modelling process because it helps to make language forms accessible for children and to keep them engaged (Fey, 1986). The controversy lies in the manner in which the simplification is achieved (van Kleeck, Schwarz, Fey, Kaiser, et al., 2010). There are two main approaches. The full grammatical input approach involves the communication partner simplifying the content of the utterance (e.g., reducing length and complexity and simplifying vocabulary), but preserving the adult grammar of the utterance, for example: “Dolly is eating the cake”. In contrast, the telegraphic approach involves simplifying the grammatical and morphological structure of the utterance by removing all but the content words, for example, “Dolly eat cake”. Many arguments have been put forth for both approaches. Some evidence suggests that telegraphic simplification can be beneficial in some contexts, for example when eliciting new structures (e.g., two-word combinations) from children with cognitive disability (Willer, 1974). This follows the premise that children will be able to imitate new structures more easily if these fall within their zone of proximal development (ZPD), a term coined by Vygostsky in 1974 to refer to the “zone” between a child’s current, independent ability, and their level of potential performance given support (Paul, 2001). As an example, for a child who currently produces single-word utterances, a two-word utterance may be within their ZPD, but a four-word utterance is probably beyond this zone. However, the majority of authors support the preservation of grammatical form for the following reasons. Firstly, children with poor expressive language but strong receptive language may be ‘short-changed’ and developmentally disadvantaged if communication partners reduce their language to match the children’s language production abilities (Fey, Long, & Finestack, 2003). Furthermore, syntax and morphology, particularly inflectional morphology, is challenging for children to master. If we are expecting children to learn these forms eventually, then early exposure should be important (Fey et al., 2003). Evidence also suggests that children may rely on the prosody patterns in fullgrammatical utterances in order to parse spoken sentences (Bedore & Leonard, 1995). For example, in spoken English, content words typically begin with a stressed syllable while function words such as ‘it’, ‘a’, ‘and’, etc. are unstressed. It has been proposed that this prosodic contrast helps to highlight the content words in spoken sentences. Indeed, many studies indicate that children demonstrate better comprehension when sentences are provided in a full grammatical form rather than a telegraphic form (van Kleeck et al., 2010). Overall, research on this issue is inconclusive (van Kleeck et al., 2010); on balance it appears that children learning spoken language benefit from exposure to full grammatical structures, although telegraphic input may offer some advantage in eliciting new structures during targeted language teaching. For aided language input, there are some additional complications that need to be considered:

• Aided modelling typically occurs at a slower rate than spoken modelling,

especially when the communication partner lacks confidence or competence with the AAC system, a scenario which is rare in spoken language modelling.

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A full grammatical model generated over a long period of time may sacrifice the child’s engagement and therefore lose the associated benefits.

• The benefits of prosody contrast will not apply in the same way with aided

language modelling. In addition, it is not known whether children exposed to aided full-grammatical models will be able to ‘filter out’ the developmentally superfluous forms in the same way as they can with spoken models – in which case, could a greater degree of grammatical complexity be a developmental disadvantage in the aided context?

• Children who use aided communication may have a large discrepancy between their receptive and expressive language skills, making it difficult to fulfil the input needs of each language modality simultaneously.

Current practice in aided language modelling typically involves the communication partner providing a full grammatical model in the spoken modality while providing a telegraphic model using the child’s AAC system. This telegraphic model is tailored to match the child’s ZPD in the expressive language mode. For example, the communication partner of a child using a communication board who is using predominantly 1–2-word symbol constructions might model the following: “{YOU you} look {HUNGRY hungry}. {WHAT what} do you {WANT want} to {EAT eat}?” Fey (2008) acknowledged that the modelling scenario for children who use aided communication is quite unique. He queried whether aided language input should also be grammatically complete and then stated that his current view is that spoken models should be complete, but that “simultaneous AAC models cannot correspond one-to-one with the target grammar” (p. 48). Children who are exposed to spoken and aided language input must split their attention between the auditory and visual models and their real-world referents in the communication context. The impact of these factors on expressive and receptive syntactic and morphological development are as yet not well understood, and are areas in need of further research. The next section highlights another challenge unique to aided communication – the fact that message generation can be extremely slow. Individuals who use aided communication may take a long time to construct their messages. Rate factors may partly explain some of the issues mentioned previously in this chapter such as the tendency for communication partners to dominate interactions, and the heavy use of co-construction (see also Higginbotham et al., and Smith et al., this volume). The following section discusses broader issues surrounding efficiency and rate for individuals who used aided communication (see also Murray et al., this volume).

Rate and efficiency Communicating efficiently is extremely important for individuals who use aided communication. Minimizing keystrokes helps to conserve cognitive and physical resources and enhances communication rate (Blockberger & Johnston, 2003; Harris, Doyle, & Haaf, 1996). A slow rate of message generation can have a socially debilitating

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impact. It can lead to frustration for individuals who use aided communication and their communication partners and make it difficult for individuals who use aided communication to attain and maintain control of the conversational floor (Higginbotham & Wilkins, 1999; Todman, 2000). Further, if an individual is unable to keep pace with rapidly-changing topics or threads in conversation, he/she may produce utterances that appear out of context. This in turn can lead to inaccurate and harmful judgements about the person’s intelligence or communicative competence (Higginbotham & Wilkins, 1999). Individuals who use aided communication may employ a variety of strategies to increase their efficiency. One strategy is the use of pre-stored phrases or sentences, which will be explored in the following section (see also Jagoe & Smith, this volume). Another strategy is utilizing key words, which involves communicating sufficient information for the intent to be understood but omitting unnecessary structural words and/or grammatical markers (Blockberger & Johnston, 2003). For example, an individual might point to YESTERDAY BEACH on a communication board to communicate “yesterday I went to the beach”, or SAD to communicate “I am feeling sad”. Such strategies can improve the flow of interactions, reduce frustration, and help individuals who use aided communication to be active participants in conversation. The development of strategic competence should be a focus for all individuals who use aided communication as it enables them to cope with the linguistic, operational and social constraints inherent in this communication mode (Light & McNaughton, 2014). As discussed previously, however, it is also critical that children have the opportunity to learn to construct novel utterances that are syntactically correct and complete (Clendon, 2006, 2011), and to recognize when a grammatically complete utterance is required. In many contexts, precise communication is critical. It is necessary for the prevention of communication breakdowns and misunderstandings, for the communication of complex ideas, and for written language development (Lund & Light, 2007; Sutton et al., 2002). Light & McNaughton (2014) explained that as individuals who use aided communication …expand their social circles and interact with a broader audience in a wider range of environments, there are increased demands for independent, intelligible messages utilizing appropriate vocabulary, syntax, and morphology as defined by the tools and contexts of communication (p. 12). The next section examines how the design of AAC tools and their implementation can influence the nature of syntactic and morphological constructs in aided communication.

AAC system design: Influences on syntax and morphology Aided language may be generated in a number of different ways. Spelling offers the greatest degree of flexibility, as utterances are not constrained by the range of prestored content available. Advances in word-prediction technology help to improve the rate of spelled message generation (Beukelman & Mirenda, 2013). For people who are not yet able to spell conventionally, however, language can also be represented

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on an AAC system using whole text (written words or sentences), picture icons, or symbols (Beukelman & Mirenda, 2013). Language can be pre-stored in a number of formats, including single words, short phrases, or complete utterances. Individuals may also combine several of these strategies to increase the rate and efficiency of message generation – for example, a person may choose to use pre-stored utterances in predictable situations, icon sequences to access high-frequency whole words and phrases, and spelling for words that are not stored. Each of these system designs will have an impact on the type of grammatical structures that are typically produced.

Pre-stored versus word-by-word message retrieval As discussed earlier, a common strategy to increase the rate of aided communication is the use of pre-stored phrases as opposed to word-by-word message generation. This strategy is particularly effective for supporting social and transactional communication where the phrases needed are reasonably predictable, for example greetings such as “Hi, how are you?” or phrases with open slots such as “I would like to order…”. Although such strategies may improve efficiency, the need to provide access to word-by-word message construction, in addition to any pre-stored content, has been recognized as being particularly critical for children. Many professionals have expressed concern that having access to pre-stored phrases may be detrimental to children’s language development. Specifically, they have questioned the impact of providing children with access to utterances that are syntactically and morphologically more advanced than those that they are able to produce independently (Gerber & Kraat, 1992). They have also expressed concern that acquiring language in the context of pre-stored messages may prevent children from learning to construct their own novel messages (Bedrosian, 1997; Hill, n.d.; Nelson, 1992). One researcher, Hill (n.d.) introduced the acronym SNUG (Spontaneous Novel Utterance Generation) to advocate for an approach that favours precise communication, and the provision of language tools that enable an individual to “say anything he or she wants at any time” (para. 2). Certainly, the importance of providing children with access to true language systems (Light & McNaughton, 2014) that enable them to achieve linguistic competence and precise communication cannot be emphasized enough. Nevertheless, research conducted outside the field of AAC suggests that the use of pre-stored phrases is not a characteristic unique to individuals who use aided communication. Adults and children who use spoken language as their primary mode of face-to-face communication also rely heavily on prefabricated language forms. Extensive support for the prevalence of pre-stored phrases can be found in the linguistics literature, particularly in the body of research that is concerned with formulaic sequences. A formulaic sequence is defined as: A sequence, continuous or discontinuous, of words or other elements, which is, or appears to be, prefabricated: that is stored and retrieved whole from memory at the time of use, rather than being subject to generation or analysis by the language grammar (Wray, 2002, p. 9).

Syntax and morphology in aided language development

Formulaic sequences are used extensively in both spoken and written language (Erman & Warren, 2000). In fact, formulaic sequences may comprise as much as 70% of language produced (Altenberg, 1990). A number of different types of formulaic sequences have been identified including idioms (e.g., that’s the way the cookie crumbles), collocations (e.g., sheer coincidence or pure coincidence, but not great coincidence), sentence frames and builders with open slots (e.g., Could you pass the ____?), and standard situational utterances (e.g., Can I help you?) (Wray, 1998). It is generally accepted that formulaic sequences occur frequently in language usage because of issues relating to cognitive resource allocation (Schmitt, Grandage, & Adolphs, 2004). They enhance fluency while at the same time freeing up cognitive resources so that individuals can focus on higher-level language processing such as the structure of discourse and the social aspects of interaction (Nattinger, 1988). One developmental theory (Wray & Perkins, 2000) proposes that very young children rely heavily on the use of formulaic sequences, but that this tapers off at around 20 months of age when children develop an increasing awareness of grammar. Children continue to learn formulaic sequences and use them in their spoken language, but the proportion of creative language compared to formulaic language increases. At approximately 8 years of age, the strategy of creating messages from scratch becomes inefficient and a process of reorganization occurs. During this process, groups of words that have been repeatedly encountered and/or constructed are collapsed and restored as single formulaic frames. The language processing system is then continuously reorganized and refined until adult patterns of formulaic and creative language processing are achieved. Lieven, Behrens, Speares and Tomasello (2003) analyzed the spoken multiword utterances produced by a 2-year-old girl during an hour of interaction with her mother. They then compared these to the utterances used in recordings obtained at intervals across the previous six weeks (five one-hour recordings per week) and to utterances recorded in a parent diary. Of the 295 multiword utterances produced, 37% appeared to be novel. The remaining 63% could be traced back to an utterance that the child had said in the previous six weeks. In the majority of cases (74%), the child appeared to use a single operation to arrive at the new utterance such as substituting one word (e.g., I got the butter à I got the door) or adding a word on to the beginning or end of an utterance (e.g., I got one àI got one here). In discussing this research, Tomasello (2003) concluded that the child in this study …does not begin with words and morphemes and glue them together with contentless rules; rather, she starts with already constructed pieces of language of various shapes, sizes, and degrees of abstraction … and “cuts and pastes” these together in a way appropriate to the current communication situation (p. 310). What this research means for children who use aided language and for AAC system design is unclear. It is always difficult to draw parallels between spoken language development and aided language development and it is entirely possible that this research may have limited relevance to children acquiring language using aided communication. In saying that, there are potential applications that need to be considered and researched. The

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technology is now available within many AAC systems to capture the language that children produce. It seems possible that these technologies could be used to identify key multiword constructions (e.g., sentence frames with open slots) that could be used as building blocks to support further language growth. These technologies could also be used to identify frequently-used constructions that the child or adult is able to produce word-by-word. These could then be stored as phrases to support more efficient communication. Future research is needed to explore these possibilities. In formulaic language generation, syntactic and morphological structures are preassigned. In contrast, creative language processing requires decisions to be made about word order, word endings, and the inclusion of structural words within an utterance. One factor that has implications for the generation of syntax and morphology in creative aided language output is the approach used for language representation (i.e., the lay-out of words in a system, and the use of graphical representation forms), as discussed below.

Graphic representation forms Graphic (picture-based) representations of language in AAC systems may affect the realization of grammatical form in a number of ways. Structural words such as prepositions, determiners and auxiliary verbs often have poor imageability and may be left out of symbol sets (Beukelman & Mirenda, 2013). Furthermore, attempts to graphically represent these words may bear little relation to the ways in which children represent them (Light, 1997; Light, Worah, Drager, Burki, D’Silva, et al., 2008; Lund, Millar, Herman, Hinds, & Light, 1998). There are also challenges relating to the representation of multi-meaning words. Erickson, Hatch and Clendon (2010) discussed how a word like ‘back’ can function as a noun, a verb and an adjective, and it can be represented using a variety of different symbols. The potential confusion for children is that if one symbol (e.g., a person’s back) is selected to represent all meanings then that choice may or may not correspond to the intended use in a particular context. However, if a different symbol is selected to represent every possible meaning, then that “would require students to learn literally dozens of symbolic representations with varying abstractness” (Erickson et al., 2010, p. 4).

Impact of representation at different stages of development Children developing spoken language acquire inflectional morphology in a U-shaped pattern characterized by three phases (Plunkett & Marchman, 1993). The first phase is associated with a rote-learning method, where children acquire both irregular and regular verb forms as individual words, and can produce these learned forms correctly. The second phase is associated with a rule-learning process, where children gain an understanding of a regular morphological rule (e.g., past-tense inflection), and overregularization errors occur. For instance, a child at this stage might say ‘eated’ instead of ‘eat’, or ‘mouses’ instead of ‘mice’. Finally, children at the third stage begin to refine their understanding; they can distinguish irregular from regular forms, and apply the inflection rule discriminately.

Syntax and morphology in aided language development

One primary issue relating to graphic representation of morphology in aided language is that the symbols themselves may imply morphological and syntactic information. In some instances, the symbol gloss (the text accompanying a symbol) may already specify a tense or morphological form – for example, a child may produce the complete word SHOES on a communication board without having to use a plural modifier or understand plural rules (Smith & Grove, 2003). Without a gloss the tense/ form of the symbol may be flexible (Smith, 1996). For example, an icon of someone eating an apple could be interpreted by a communication partner as ‘eat’, ‘eating’ or ‘ate’ depending on the context, without requiring the addition of a tense-modifier (e.g., -ing). For children in the early stages of morphological development (i.e., the ‘rote-learning’ phase), both of these single-icon representation types (form-restricted or flexible) may reduce the metalinguistic load to a developmentally appropriate level. As in spoken language development, young children using such representation systems can produce a limited set of regular and irregular word forms correctly without understanding the underlying morphological rules. The impact of these restrictive or flexible icon representations on children’s transition to later developmental phases, however, has not been researched to date. Systems that automatically predict correct morphological forms could also influence this developmental trajectory.

Automatic morphology prediction Many high-tech systems are now able to predict, adapt and automatically correct the grammatical structures that individuals produce. For example, on some systems a single icon is used to modulate the tense of a verb (regardless of whether it is a regular or irregular form), and the system generates the correct form automatically. In this case, the icon for ‘mouse’ and the ‘plural’ icon combine to produce the word ‘mice’, and not ‘mouses’. In addition, in many systems inflectional morphemes are only made available once a base word has been typed – for example, the word ‘eating’ becomes available after the word ‘eat’ is activated; however, the suffix ‘-ing’ is not available in isolation. These strategies can simplify page layout and improve access efficiency. Nonetheless, an indirect consequence is that they prevent language learners from experimenting with, and learning from, the morphological ‘errors’ commonly seen in children developing speech. These include the over-regularization errors described above (e.g., eated – Plunkett & Marchman, 1993), as well as over-extension (e.g., I broomed her for I hit her with a broom, or I’m souping for I’m eating soup – Radford, 1990). Feedback from practice errors (i.e., making a morphological mistake and experiencing communication breakdown or corrective feedback from partners as a consequence) is assumed to be of importance to the language learning process (Fey et al., 2003). The impact of such predictive functions on children’s receptive language development and morphology production beyond the system (for example in written language forms), is unknown.

Modality-specific constructions The exact nature of the relationship between spoken language and the construction of utterances using graphic symbols is still relatively unknown. There has been

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considerable discussion in the AAC field as to whether graphic symbol combinations are modality-specific constructions that are generated directly, or whether they reflect a transposition from spoken language. One possibility is that individuals who use aided communication construct their utterances by generating their messages using subvocal speech, and then translate these messages from spoken language into graphic symbols. This is known as the transposition hypothesis (Smith, 1996; Smith & Grove, 2003). With this hypothesis, differences in syntax (e.g., word order problems, omitted grammatical markers) are attributed to the individual employing compensatory strategies to bypass the limitations inherent in their AAC system (Trudeau, Sutton, Dagenais, de Broeck, & Morford, 2007). The second hypothesis, the modality-specific hypothesis (Sutton et al., 2002) attributes the structural features of the language produced by individuals who use aided communication to the process of generating language in a visual/graphic modality. A number of studies (e.g., Smith, 1996; Sutton, Gallagher, Morford, & Shahnaz, 2000; Sutton & Morford, 1998) have contrasted the utterances produced by individuals without disabilities in the spoken and AAC modalities. The utterances produced using aided communication tend to be shorter in length and often do not reflect conventional English word order, suggesting that they are not direct translations from spoken language into the visual graphic modality. Instead, it appears that individuals may construct utterances in aided communication modes by adhering to linguistic patterns that are unique to the visual graphic modality. Sutton and colleagues conducted two studies that examined word order effects in aided communication. The first study included 43 adults with no disabilities (Sutton et al., 2000) and the second study (Sutton, Morford, & Gallagher, 2004) included 25 adults who used aided communication. In both studies, the participants were presented with a series of subject and object relative clause sentence pairs (e.g., ‘the girl who pushes the clown wears a hat’ and ‘the girl pushes the clown who wears a hat’) accompanied by photographs. The participants were asked to reproduce sentences by selecting line-drawn picture symbols on an AAC device. The symbols did not include any grammatical markers so placement of the relative pronoun who could not be marked. The second study (Sutton et al., 2004) also included an interpretation task. For this task, the examiner used the picture symbols to construct a series of subject and object relative clause sentence pairs. The participants were asked to choose one photograph from an array of two that best depicted the symbol utterance. Since the picture symbols did not include the relative pronoun who, both the subject sentences and the object sentences were identical. In Sutton et al.’s (2000) study, 36 out of the 43 adults with no disabilities made some kind of distinction between subject and object sentences. The participants tended to use English word order when they were producing object sentences. For instance, for the sentence The girl pushes the clown who wears a hat, a frequent response was GIRL, PUSH, CLOWN, HAT. In contrast, the participants tended to use non-English word order when they were producing subject sentences. For instance, for the sentence The girl who pushes the clown wears a hat, an example of a response was GIRL, HAT, PUSH, CLOWN. Most of the participants used a proximity strategy to convey the distinction between the two sentence types. When they were producing subject sentences, they

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altered the word order by moving the attribute (e.g., HAT in the example above) closer to the first noun. In Sutton et al.’s (2004) study, only six of the 25 adults who used aided communication distinguished between subject and object sentences greater than 75% of the time. These six participants typically employed the constituent proximity strategy previously described to convey the distinction between the two sentence types. Overall, the participants used 18 different word orders. The most frequently-occurring word order (75%) was the word order that most closely adhered to conventional English. The participants who failed to distinguish between subject and object sentences typically used the same word order for both sentences and then associated this word order with a single interpretation (10 chose the subject sentence interpretation and 2 chose the object sentence interpretation). This finding indicated that the participants understood that a distinction existed between the two sentence types, but they did not mark the distinction in their own symbol productions. The performance patterns of the participants in this study were extremely heterogeneous. The researchers observed that there was much more variability in the sample of participants who used aided communication than was evident in the sample of participants with no disabilities (Sutton et al., 2000). Recent research suggests that developmental level may have a powerful influence on the ability to construct and interpret symbol-based utterances (see also Chapter 4, this volume). Trudeau and colleagues conducted studies with individuals without disabilities that explored performance across the age span from 3-year-old children through to adulthood. The children in these studies exhibited markedly less accuracy and greater variability than the teenagers and adults (Trudeau et al., 2007; Trudeau, Morford, & Sutton, 2010). Several key factors were identified as potentially important for promoting development and stability including language skills, metalinguistic abilities, cognitive development, and degree of literacy experience (Trudeau, Sutton, et al., 2010). In a further study (Trudeau, Sutton, et al., 2010), 27 individuals who used AAC were asked to construct and interpret symbol-based utterances. The individuals were aged between 8 and 49 years. Those who exhibited the most stable response patterns were found to have higher levels of receptive syntactic skills and cognitive ability. Interestingly, there was no predictive relationship, however, for any of the other variables evaluated including chronological age, receptive vocabulary, degree of motor impairment, and AAC system characteristics such as type of system, or length of use. The authors concluded that: …this confirms that when it comes to AAC, intervention should not be dictated by the availability of technology, the apparent challenges imposed by severe motor impairments, or other such factors. While intervention and tools should always aim at optimizing the client’s potential, the current results show that even individuals using simple communication systems without direct access were able to consistently construct sequences of symbols corresponding to both simple and complex sentence structures (p. 311).

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The final section of this chapter focuses on intervention, and key principles and strategies for maximizing syntactic and morphological development in children who use aided communication.

Intervention considerations Fey (2008) highlighted five principles underlying grammar intervention likely to be relevant for children who use aided communication. These principles provide an important backdrop for further discussion around approaches to intervention. According to Fey (2008), the primary objective of intervention should be to help children improve so that they are more effective communicators across modalities and genres. Skills must be taught in meaningful and functional contexts. In addition, specific goals should be based on children’s “functional readiness and need for the targeted forms” (p. 46). These principles align with the earlier discussion about the need to create real reasons for children to be clearer and more precise in their aided communication. Fey (2008) also suggested that the “social, physical, and linguistic contexts of intervention should be manipulated” (p. 46) to enable frequent adult models and practice opportunities. He recommended the use of recasts that allow children to contrast their production attempts with the adult forms. Finally, as mentioned previously, he encouraged the use of complete phrases, clauses and sentences when modelling language for children, not telegraphic-type input. Interventions targeting the language skills of children who use aided communication sit along a broad continuum. Some focus on general strategies for enhancing the language environment and the interactions that take place between children and their primary communication partners, while others include more explicit instruction of target skills. Pennington and colleagues (Pennington, Goldbart, & Marshall, 2004) conducted a systematic review of research on interaction training for communication partners of children with cerebral palsy. The interventions focused on increasing partner responsiveness, face-to-face contact, and imitation, or on teaching partners to facilitate an individual’s use of AAC, for example through appropriate positioning and the use of open questions. The review authors highlighted some modest changes in partner interaction behaviours for most study participants; however, many of these changes showed high variability or were not maintained after treatment. The studies also contained several methodological flaws, and as a result Pennington and colleagues found the results inconclusive. More recently, Kent-Walsh and colleagues (Kent-Walsh, Murza, Malani, & Binger, 2015) carried out a systematic review and meta-analysis to determine the overall effectiveness of communication partner instruction for individuals using aided communication. Seventeen studies met the criteria for inclusion. Across these studies, there were 53 participants who used aided communication. They were aged between 2;5 and 26;0 years and had a range of diagnoses including autism spectrum disorders, intellectual disability, cerebral palsy and childhood apraxia of speech. The interventions were implemented with a range of communication partners including caregivers, educational assistants, parents, teachers and peers. These partners were

Syntax and morphology in aided language development

taught strategies such as aided language input, and the use of expectant delay and open-ended questions. The key finding was that communication partner instruction was found to have positive effects. There was variation across participants; however, the average effect size indicated that in general the interventions were “very effective”. The authors concluded that “partner instruction should be viewed as an integral part of AAC assessment and intervention” (p. 280). Creating responsive and stimulating communication environments is obviously critically important for children who use AAC. There is growing awareness, however, that this may not always be sufficient (Binger et al., 2011; van der Schuit, Segers, van Balkom, Stoep, & Verhoeven, 2010), and explicit instruction around the comprehension and use of specific language structures may also be required. This was demonstrated clearly by Binger et al. (2011). In this study, aided AAC models and recasts were used to teach three children to use three grammatical morphemes. The results indicated that the children learned the first morphemes very quickly with less than 2 hours of instruction. However, none of the students maintained the use of the first morpheme during the first set of probes. In response to this finding, a second intervention phase was introduced which included contrastive intervention targets in addition to the AAC models and recasts. Following this, the students were able to maintain their use of the target morphemes. The researchers concluded that “discrimination learning appears to be critical” (p. 174). A recent study by Kent-Walsh, Binger and Buchanan (2015) also provides support for the use of aided modelling in combination with contrastive targets. In this study, three children were successfully taught to ask inverted yes/no questions. Binger et al. (2014) urged the AAC community not to underestimate the learning capabilities of children who use aided communication. Preliminary results from a study teaching two-term semantic-syntactic structures (e.g., agent-action) indicated rapid learning for the 5-year-old children. The 3- and 4-year-old children were also successful, but needed a little more time. Binger et al. suggested that if children are struggling to learn particular language skills, then it is important to consider the impact of the navigational demands inherent in their AAC system. Access to a comprehensive AAC system and the ability to use it generatively remain primary goals for children using aided communication. Nonetheless, at times, removing the navigational demands and presenting children with a single page of symbols may assist them to focus their cognitive resources on sentence building and other syntactic and morphological skills.

Summary This chapter has discussed key factors and contexts influencing the development of syntax and morphology in children who use aided communication. While learning to be an efficient and strategic communicator is vital, having access to individual words and the syntactic and morphological skills needed to combine and manipulate them is absolutely critical. The presence of responsive communication partners who can provide quality input in the child’s own language modality is of high importance. Likewise, AAC system design factors play a role in shaping the unique language learning patterns of children acquiring aided communication. Finally, the chapter has explored strategies for enhancing the syntactic and morphological skills of these children,

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including the need for intervention that is grounded in meaningful, functional, and motivating contexts. As always, it is critical to recognize that children who use aided language are individuals with extreme heterogeneity in terms of cognitive, sensory and language processing abilities, as well as differences across broader sociocultural, linguistic, family and educational backgrounds. While it is important that we take all of these differences into account, we must also take Binger et al.’s (2014) advice and continue to push for development for all children in these important language domains.

References Altenberg, B. (1990). Speech as linear composition. In G. Caie, K. Haastrup, A.L. Jakobsen, J.E. Nielsen, J. Sevaldsen, H. Specht & A. Zettersten (Eds), Proceedings of the Fourth Nordic Conference for English Studies (pp. 133–143). Denmark: Department of English, University of Copenhagen. Bedore, L.M., & Leonard, L.B. (1995). Prosodic and syntactic bootstrapping and their clinical applications: A tutorial. American Journal of Speech-Language Pathology, 4(1), 66–72. Bedrosian, J.L. (1997). Language acquisition in young AAC system users: Issues and directions for future research. Augmentative and Alternative Communication, 13, 179–185. Beukelman, D.R., & Mirenda, P. (2013). Augmentative and Alternative Communication: Supporting Children and Adults with Complex Communication Needs, 4th ed. Baltimore, MD: Brookes. Binger, C., & Light, J. (2007). The effect of aided AAC modeling on the expression of multi-symbol messages by preschoolers who use AAC. Augmentative and Alternative Communication, 23, 30–43. Binger, C., & Light, J. (2008). The morphology and syntax of individuals who use AAC: Research review and implications for effective practice. Augmentative and Alternative Communication, 24, 123–138. Binger, C., Kent-Walsh, J., Berens, J., Del Campo, S., & Rivera, D. (2008). Teaching Latino parents to support the multi-symbol message productions of their children who require AAC. Augmentative and Alternative Communication, 24, 323–338. Binger, C., Kent-Walsh, J., Ewing, C., & Taylor, S. (2010). Teaching educational assistants to facilitate the multisymbol message productions of young students who require augmentative and alternative communication. American Journal of Speech-Language Pathology, 19(2), 108–120. Binger, C., Kent-Walsh, J., King, M., Buenviaje, E, Ekman, M., Mansfield, L., … Whitaker, M. (2014). Teaching preschoolers to produce rule based messages using an iPad App. Paper presented at the International Society for Augmentative and Alternative Communication (ISAAC) Conference, Lisbon, Portugal. Handout retrieved from: http://aac-ucf.unm.edu/common/handouts/isaac_2014_ binger_et_al_teaching_preschoolers.pdf Binger, C., Maguire-Marshall, M., & Kent-Walsh, J. (2011). Using aided AAC models, recasts, and contrastive targets to teach grammatical morphemes to children with developmental delays who use AAC. Journal of Speech-Language-Hearing Research, 54, 160–176. Blockberger, S., & Johnston, J.R. (2003). Grammatical morphology acquisition by children with complex communication needs. Augmentative and Alternative Communication, 19, 207–221. Blockberger, S., & Sutton, A. (2003). Toward linguistic competence: Language experiences and knowledge of children with extremely limited speech. In J.C. Light, D.R. Beukelman & J. Reichle (Eds), Communicative Competence for Individuals who use AAC (pp. 63–106). Baltimore, MD: Brookes. Bornstein, M.H., Tamis-LeMonda, C.S., & Haynes, O.M. (1999). First words in the second year: Continuity, stability, and models of concurrent and predictive correspondence in vocabulary and verbal responsiveness across age and context. Infant Behavior and Development, 22, 65–85.

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Brady, N.C., Thiemann-Bourque, K., Fleming, K., & Matthews, K. (2013). Predicting language outcomes for children learning augmentative and alternative communication: Child and environmental factors. Journal of Speech, Language, and Hearing Research, 56, 1595–1612. Brekke, K.M., & von Tetzchner, S. (2003). Co-construction in graphic language development. In S. von Tetzchner & N. Grove (Eds), Augmentative and Alternative Communication: Developmental Issues (pp. 176–210). London, UK: Whurr. Broberg, M., Ferm, U., & Thunberg, G. (2012). Measuring responsive style in parents who use AAC with their children: Development and evaluation of a new instrument. Augmentative and Alternative Communication, 28, 243–253. Brown, R. (1973). A First Language. Cambridge, MA: Harvard University Press. Bruno, J., & Trembath, D. (2006). Use of aided language stimulation to improve syntactic performance during a week-long intervention program. Augmentative and Alternative Communication, 22, 300–313. Clendon, S.A. (2006). The language of beginning writers: Implications for children with complex communication needs. (Unpublished doctoral dissertation) University of North Carolina at Chapel Hill. Clendon, S.A. (2011). The syntax of beginning writers: Implications for children with complex communication needs. New Zealand Journal of Speech-Language Therapy, 66, 5–23. Dattilo, J., Estrella, G., Estrella, L.J., Light, J., McNaughton, D., & Seabury, M. (2008). “I have chosen to live life abundantly”: Perceptions of leisure by adults who use augmentative and alternative communication. Augmentative and Alternative Communication, 24, 16–28. Erickson, K.A., Hatch, P., & Clendon, S.A. (2010). Literacy, assistive technology, and students with significant disabilities. Focus on Exceptional Children, 42, 1–16. Erman, B., & Warren, B. (2000). The idiom principle and the open-choice principle. Text, 20, 29–62. Ferm, U., Ahlsén, E., & Björck-åkesson, E. (2005). Conversational topics between a child with complex communication needs and her caregiver at mealtime. Augmentative and Alternative Communication, 21, 19–41. Fey, M.E. (1986). Language Intervention with Young Children. San Diego, CA: College-Hill. Fey, M. (2008). Thoughts on grammar intervention in AAC. Perspectives in Augmentative and Alternative Communication, 17, 43–49. Fey, M., Long, S.H., & Finestack, L. H. (2003). Ten principles of grammar facilitation for children with specific language impairment. American Journal of Speech-Language Pathology, 12, 3–15. Gerber, S., & Kraat, A. (1992). Use of a developmental model of language acquisition: Applications to children using AAC systems. Augmentative and Alternative Communication, 8, 19–32. Harris, L., Doyle, E.S., & Haaf, R. (1996). Language treatment approach for users of AAC: Experimental single-subject investigation. Augmentative and Alternative Communication, 12, 230–243. Higginbotham, D.J., & Wilkins, D.P. (1999). Slipping through the timestream: Social issues of time and timing in augmented interactions. In D. Kovarsky, J. Duchan & M. Maxwell (Eds), Constructing (In) competence: Disabling Evaluations in Clinical and Social Interaction (pp. 49–82). Mahwah, NJ: Erlbaum. Hill, K. (n.d.) Augmentative and alternative communication decisions. Accessed from: http://www.asha. org/public/speech/disorders/CommunicationDecisions/. Kent-Walsh, J., Binger, C., & Buchanan, C. (2015). Teaching children who use augmentative and alternative communication to ask inverted yes-no questions using aided modelling. American Journal of Speech Language Pathology, 24(2), 222–236. Kent-Walsh, J., Binger, C., & Hasham, Z. (2010). Teaching European and African American parents to support their children who use AAC during storybook reading. American Journal of Speech-Language Pathology, 19, 97–107.

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Kent-Walsh, J., Murza, K.A., Malani, M.D., & Binger, C. (2015). Effects of communication partner instruction on the communication of individuals using AAC: A meta-analysis, Augmentative and Alternative Communication, 31, 271–284. Doi:10.3109/07434618.2015.1052153 Kraat, A. (1985). Communication Interaction Between Aided and Natural Speakers: A State of the Art Report. Toronto, Canada: Canadian Rehabilitation Council for the Disabled. Liborion, N., & Soto, G. (2006). Shared storybook reading with a student who uses alternative and augmentative communication: A description of scaffolding practices. Child Language Teaching and Therapy, 22, 69–95. Lieven, E., Behrens, H., Speares, J., & Tomasello, M. (2003). Early syntactic creativity: A usage approach. Journal of Child Language, 30, 333–370. Light, J. (1997). “Let’s go star fishing”: Reflections on the contexts of language learning for children who use aided AAC. Augmentative and Alternative Communication, 13, 158–171. Light, J., & Kelford-Smith, A. (1993). Home literacy experiences of preschoolers who use AAC systems and of their nondisabled peers. Augmentative and Alternative Communication, 9, 10–25. Light, J., & McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication? Augmentative and Alternative Communication, 30, 1–18. Light, J., Binger, C., & Kelford-Smith, A. (1994). Story reading interactions between preschoolers who use AAC and their mothers. Augmentative and Alternative Communication, 10, 255–268. Light, J., Collier, B., & Parnes, P. (1985a). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Part I – discourse patterns. Augmentative and Alternative Communication, 1, 74–83. Light, J., Collier, B., & Parnes, P. (1985b). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Part III – Modes of communication. Augmentative and Alternative Communication, 1, 125–133. Light, J., Worah, S., Drager, K., Burki, B., D’Silva, K. … et al. (2008, November). Children’s representations of early language concepts: Implications for AAC symbols. Paper presented at the annual convention of the American Speech-Language-Hearing Association, Chicago, IL. Lund, S., Millar, D., Herman, M., Hinds, A., & Light, J. (1998, November). Children’s pictorial representations of early emerging concepts: Implications for AAC. Paper presented at the annual convention of the American Speech-Language-Hearing Association, San Antonio, TX. Lund, S.K., & Light, J. (2007). Long-term outcomes for individuals who use augmentative and alternative communication: Part II – Communicative interaction. Augmentative and Alternative Communication, 23, 1–15. Mathis, H., Sutherland, D., & McAuliffe, M. (2011). The effect of pause time upon the communicative interactions of young people who use augmentative and alternative communication. International Journal of Speech-Language Pathology, 13, 411–421. McCollum, J., & Hemmeter, M.L. (1997). Parent and child interaction intervention when children have disabilities. In M.J. Guralnick (Ed.), The Effectiveness of Early Intervention (pp. 549–576). Baltimore, MD: Paul H. Brooks. McDuffie, A., & Yoder, P. (2010). Types of parent verbal responsiveness that predict language in young children with Autism Spectrum Disorder. Journal of Speech Language and Hearing Research, 53, 1026–1039. Nattinger, J. (1988). Some current trends in vocabulary teaching. In R. Carter & M. McCarthy (Eds), Vocabulary and Language Teaching (pp. 62–82). New York, NY: Longman. Nelson, N.W. (1992). Performance is the prize: Language competence and performance among AAC users. Augmentative and Alternative Communication, 8, 3–18.

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Parker, R. (2014). Using aided language input to build communication opportunities! Retrieved from http://praacticalaac.org/strategy/using-aided-language-input-to-build-communication-opportunities/ Paul, R. (2001). Language Disorders from Infancy Through Adolescence, 2nd ed. St Louis, MO: Mosby. Pennington, L., Goldbart, J., & Marshall, J. (2004). Interaction training for conversational partners of children with cerebral palsy: A systematic review. International Journal of Language and Communication Disorders, 39, 151–170. Pennington, L., & McConachie, H. (1999). Mother-child interaction revisited: Communication with non-speaking physically disabled children. International Journal of Language and Communication Disorders, 34, 391–416. Plunkett, K., & Marchman, V. (1993). From rote learning to system building: Acquiring verb morphology in children and connectionist nets. Cognition, 48, 21–69. Radford, A. (1990). Syntactic Theory and the Acquisition of Syntax. Oxford, UK: Blackwell. Romski, M.A., & Sevcik, R.A. (1996). Breaking the Speech Barrier: Language Development Through Augmented Means. Baltimore, MD: Brookes. Rosa-Lugo, L.I., & Kent-Walsh, J. (2008). Effects of parent instruction on communicative turns of Latino children using augmentative and alternative communication during storybook reading. Communication Disorders Quarterly, 30, 49–61. Schmitt, N., Grandage, S., & Adolphs, S. (2004). Are corpus-derived recurrent clusters psycholinguistically valid? In N. Schmitt (Ed.), Formulaic Sequences (pp. 127–152). Amsterdam, The Netherlands: John Benjamins. Smith, M.M. (1996). The medium or the message: A study of speaking children using communication boards. In S. von Tetzchner & M.H. Jensen (Eds), Augmentative and Alternative Communication: European Perspectives (pp. 119–136). London: Whurr. Smith, M.M. (2003). Environmental influences on aided language development: The role of partner adaptation. In S. von Tetzchner & N. Grove (Eds), Augmentative and Alternative Communication: Developmental Issues (pp. 155–175). London: Whurr. Smith, M., & Grove, N. (1999). The bimodal situation of children learning language using AAC. In F.T. Lonke, J. Clibbens, L.L. Lloyd, & H.H. Arvidson (Eds), Augmentative and Alternative Communication: New Directions in Research and Practice (pp. 8–30). London: Whurr. Smith, M.M., & Grove, N.C. (2003). Asymmetry in input and output for individuals who use AAC. In J. Light, D.R. Beukelman, & J. Reichle (Eds), Communicative Competence for Individuals who use AAC (pp. 163–199). Baltimore, MD: Paul H. Brookes. Solomon-Rice, P.L., & Soto, G. (2011). Co-construction as a facilitative factor in supporting the personal narratives of children who use AAC. Communication Disorders Quarterly, 32, 70–82. Soto, G. (1997). Multi-unit utterances and syntax in graphic symbol communication. In E. Björk-Åkesson & P. Lindsay (Eds), Communication... Naturally: Theoretical and Methodological Issues in Augmentative and Alternative Communication. Proceedings of the Fourth International Society for Augmentative and Alternative Communication Research Symposium (pp. 26–32). Västerås, Sweden: Mälardalen University. Soto, G. (1999). Understanding the impact of graphic sign use on the message structure. In F.T. Loncke, J. Clibbens, H.H. Arvidson & L.L. Lloyd (Eds), Augmentative and Alternative Communication: New Directions in Research and Practice (pp. 40–48). London: Whurr. Soto, G., & Hartmann, E. (2006). Analysis of narratives produced by four children who use augmentative and alternative communication. Journal of Communication Disorders, 39, 456–480. Sturm, J.M., & Clendon, S.A. (2004). Augmentative and alternative communication, language and literacy: Fostering the relationship. Topics in Language Disorders, 24, 76–91.

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6N  arrative development and aided communication Gloria Soto and Renee Starowicz

Narrative is recognized as a core human communication activity, central to most of our interactions. There is growing evidence that children with language difficulties demonstrate particular difficulties in mastering this form of language use. Children using aided communication face a particular challenge in that, most often, their communication partner is involved in interpreting and co-constructing their communication output. Thus, ownership of narratives in these situations is often ambiguous. In addition, these linguistic differences impact the development of identity through interaction. This chapter explores the unique context of narrative development in aided communication, outlining the linguistic, pragmatic and social importance of this particular form of discourse and the unique co-construction that typifies narratives in aided communication. Throughout this chapter, we discuss the use of narratives, their developmental trajectory and implications, and their relationship to autobiographical memory and identity. Further, we will discuss narrative practices in aided communication and suggest how the emergence of narratives can be supported.

What are narratives? “Following the narrative patterns of their specific communities and families, children produce narratives when they translate past experiences into language, retell tales previously told to them, or improvise fantasy stories” (Uccelli, Hemphill, Pan, & Snow, 2005, p. 216). There are many definitions of narrative depending on the discipline of study, for instance, literature, psychology or history. If one were to give a purely structural definition of narrative, one could say that narrative is a form of written or spoken communication that describes a story or account of events in a way that clearly presents the relationship between them (Ninio & Snow, 1996). Narratives can take many forms and cover a wide range of discourse structures, from an informal conversational exchange between

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two friends to the most elaborate fiction tale (Ochs & Capps, 2001). A narrative can be about events one has heard or read about, but it can also be about events that one has experienced directly or has imagined. Narratives can be told in a monologue or in the course of a conversation (Waller, 2006). Yet, despite different narrative styles and genres, the description of how events unfold through time and the relationship between events is implicit in all forms of narratives and central to the concept of narrativity (Nelson, 1998). Narratives, however, are much more than just a form of extended discourse or artistic literary work (Baquedano-Lopez, 2001; Hunston & Thompson, 2000). Bruner (1997) suggests that narrative is a universal mode of human language, and something that differentiates humans from other species. He explains that humans use narratives to process their experiences, by providing cohesion and meaning to a sequence of seemingly disconnected events and presenting them as a coherent whole representing our consciousness. Through narratives, we make meaning by telling and retelling stories about ourselves that both refigure the past and create purpose in the present and the future. Through narratives, we imbue personal meaning to our experience and are able to share our self with others. As such, narratives have a tremendous transformative power having to do with identity development (Nelson, 1998). Through narratives, we make connections, heal profound wounds and develop a sense of who we are in relation to our own experience. As Bruner notes, narratives reveal the self and, as our stories change, so too does our identity (Bruner, 2006). Identity is an essential component of development that has implications for understanding the self and others (Wickenden, 2011). Self-identity is a person’s own view and sense of who they are in relationship to others. The emergence of self-identity is constructed in interactions with others (see Parrott, Chapter 11, this volume) and linked to the emergence of complex language skills. In fact, narrative language is both the result of and the principal vehicle for transferring cultural practices and values that shape self-identity. It is through language that individuals are able to negotiate and establish identity, discuss who they think they are and how they would like others to view them (Ochs & Capps, 2001; Uccelli et al., 2005; Wickenden, 2011). Narratives also serve a critical social and cultural function, for it is within the contexts of telling and sharing narratives that children learn about themselves and the world around them (McCabe, 1997; Nelson, 1998). As Nelson indicates, children learn to tell the stories that conform to the social values and the models of the society to which they belong (Nelson, 1989, 2003). Thus, storytelling is a major mechanism of socialization. Children are socialized into narrative practices and through narrative practices (Ochs & Capps, 2001; Rogoff, 1990). They learn to understand and produce different types of narratives in different contexts, such as when they are having conversations with elders or peers about a personal event, or during storybook reading, or through movie watching. In fact, sharing personal stories is what social communication is all about. We share our stories when we tell others what we did or are going to do, what we like or don’t like and why, how we feel about a specific event or series of events, even if these have not happened yet. The importance of sharing personal stories increases with age. As we get older, we spend more of our time sharing stories with others about our

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past (Stuart, 2000). Personal narratives are also the main vehicle for elders to transfer culturally useful information to the following generation.

Narrative development Narrative forms vary developmentally and culturally, suggesting that narrative discourse develops as a product of cognitive organization, social interaction and cultural models provided through linguistic forms (Baquedano-López, 2001; Uccelli et al., 2005). Narrative abilities develop over time, with narrative features having their genesis in early forms of adult–child conversations from as early as 2 years of age, and appearing in multiple discourse types (e.g., fantasy play, early conversation, show and tell) (Nelson, 1989; Ninio & Snow, 1996; Uccelli et al., 2005). At that age, young children are typically able to participate in conversations about personally meaningful events with adult support. This may be in the form of adult questions designed to elicit relevant information or to indicate that the information provided by the child is unclear or insufficient, as well as in the form of verbal models and recasts to expand and support what the child is saying (Ninio & Snow, 1996; Ochs & Capps, 2001). Although earlier conversations with young children are limited to the here and now, children soon expand their contributions to incorporate information about the non-present, fantasy talk, and about jointly remembered past events (see Table 6.1) (Eisenberg, 1985; Miller & Sperry, 1988; Uccelli et al., 2005). As children become better narrators, they report not only events but also how they feel about them (Labov, 1972). This ability to discuss emotions comes with age (typically around 6–7 years) but also through narrative practice. To be able to report how one feels about an event, one must have a sense of oneself, as a ‘self ’, separate from the event. There is a close relationship between overall linguistic skill and narrative ability. Full narrative discourse is not possible until complex language is learned; it depends upon the manipulation of extended language forms which requires a reasonably complex level of language competence. Children at the 1-word stage produce sequences that are highly scaffolded by adults – they contribute new pieces of information over several turns, with intervening questions and comments from the listener. The ability to sequence 2–3 words in a single utterance appears to be a significant milestone in narrative development. Previous to this level, children find it difficult to produce extended sequences of narrative discourse that link and combine propositions within two or more events (Grove & Tucker, 2000; Miller & Sperry, 1988).

Narratives and development of autobiographical memory There is a growing body of work that describes, and in some cases demonstrates, how children’s production of narratives is at the core of their ability to retain memories that are verbally available (see Uccelli et al., 2005, for an extensive review). Studies of mother–child talk about the past and the present provide strong evidence that children learn to talk about and to remember their experiences in specific ways. They learn to ‘narrativize’ their experience (e.g., Nelson, 1998; Snow, 1990). Their experiences become memories and memories serve a social function – we share them with others.

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Table 6.1 Trajectory of narrative development (modified from Grove & Tucker, 2003).

• 2 years Children begin to make reference to past events, and can participate in narrative when scaffolded by an adult. They begin to temporally order events (Miller & Sperry, 1988). Narratives are prominent in adult–child discourse from this point on.

• 3–4 years

Children begin to use structural components. Only one component may be present at 3 years. By 3;6, children are able to refer to setting (where), but have more difficulty referring to characters (who) (Peterson & McCabe, 1983). Episodes become more complete as children get older. Four-year-olds are more likely to include introductions, complications and orientations. Affect is increasingly used in narrative (Reilly, Klima, & Bellugi, 1990).

• 5–6 years

Children regularly include orientation statements, and begin to organize stories around conflict involving a progression of events. By age 6, children can produce complete structured narratives.

• Later development

Narrative skills continue to develop in childhood, and the number of complete episodes increases up to the age of about 16 (Liles, 1993). It’s obvious that adults can also develop their storytelling abilities by learning from others, such as skilled practitioners. In cultures which privilege story telling, this skill development is more common than in those that do not.

This social function of memories underlies not only our storytelling but also our relationships with others, as it is through sharing our personal stories that we develop positive relationships (Nelson, 1993; Ochs & Capps, 2001). Typically, children learn to engage in talking about the past, guided initially by adults who construct a narrative around the bits and pieces contributed by the child, incorporating adult values about what aspects of the experience are important to remember and therefore reportable, and the formats for remembering (Nelson, 1998; Ochs & Capps, 2001; Snow, 1990). According to this account, young children’s memory for personal events tends to be boosted when the event evokes an emotional reaction and, more specifically, when adults discuss and reminisce about the emotional event with the child (e.g., Liwag & Steig, 1995). In fact, existing research indicates that mothers who have been trained to incorporate elicitation techniques which highlight the reportable and emotional components of an event during conversations with their children were able to support a more elaborate event representation from their young children than those who had not (Boland, Haden & Orstein, 2003). As Nelson calls it, ‘memory talk’, or talk about the past, is an important context for early conversations between parents and their young children. It has been found that children of mothers who help their children make a story, by co-constructing a sequence of events and providing an evaluative comment about it, tend to be children who engage in memory talk and remember events for a longer period of time than children of mothers who talk about concrete and practical matters and focus on the who and what, rather than the where, the when, the how and

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the why. The support in the form of co-construction by parents contributes to a more indepth story development and skillful organization of the past events. Elements of joint reference in co-construction provide for a more effective memory formation and preservation (Nelson & Fivush, 2004). According to Nelson (2003), parental style of memory talk is not an all or nothing issue, but rather one that points along a continuum, with extremes where some parents cast a great deal of talk about the past in narrative form, and others talk very little about past events and provide little scaffolding for the child’s contributions. In a controlled event memory study, Tessler and Nelson (1994) concluded that children tend to recall those events that had been talked about between mother and child in elaborate ways. In their study, mothers and children visited a museum. Half of the mothers were asked to engage with their children as they regularly would while the other half were asked to respond to questions but not initiate or elaborate on conversations. Children were interviewed a week later to discuss what they recalled about the visit. They found that in order for the child to remember the event it was not enough for the mother to talk about the event. What helped solidify the memory was an interaction between the mother and the child where the mother focused on framing the narrative, by attaching an emotional component to it and relating it back to the child’s previous experiences. These results are consistent with previous findings that had shown that when adults frame an event using autobiographical material, playful verbal exchange, feelings and intentionality while it is being experienced, children are more likely to retain a subsequent memory of that event than when parents simply use a descriptive style. The use of what Bruner calls a paradigmatic style of narration by the adult provides the child with connectivity and contextualization of the new event in relationship to the child’s prior experiences (see Bruner, 1990). However, Nelson warns us against attributing a causal relation between mother’s style of talk and child’s narrative skills. “Adult-child dyads are mutually influentiable; therefore, attributing causal relations is not possible” (Nelson, 1998; p. 168). It is possible that mothers tell more elaborate narratives with children who are more verbal, more responsive to the telling, and more interested in the kinds of details such narratives contain. Moreover, mothers inclined to story telling about their child’s experiences may tend to have children who are more inclined to engage in similar narrative constructions, thus encouraging the mother’s efforts. The richness and complexity of remembered events increase as children mature and their linguistic skills improve. Although an event may have occurred in the past when linguistic skills were not as developed, children may provide additional descriptive complexity as their skills improve. Older children may recall greater detail in their memory of something that results in further linguistically advanced descriptions and further solidifies the memory of that event (Hamond & Fivush, 1991).

Monological and conversational narrative practices Personal narratives are ubiquitous. Whether in a store, along the road, at work, play, home or other community settings, when people are together, they are inclined to talk about events – those they have heard or read about, those they have experienced

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directly, and those they imagine. Their talk about events often takes the form of personal narrative…Personal narrative is a way of using language or another symbolic system to imbue life events with a temporal and logical order, to demystify them and establish coherence across past, present, and as yet unrealized experience (Ochs & Capps, 2001, pp. 1–2). Narration can take many forms depending, among other factors, on whether it is personal or fictional, done monologically or in face-to-face interaction, or whether it is spoken or written (see Allen, Kertoy, Sherblom, & Pettit, 1994 for an extensive description of structural differences in different narrative genres). Ochs and Capps (2001) argue that conversational narrative is the ontogenic origin of all narrative genres, its most common form and at the cornerstone of narrative development. In face-to-face interaction, narratives are jointly constructed by both the narrator and the listener. According to Norrick (2001), during a conversational narrative, the listener can – in addition to responding appropriately to the story – redirect the story line, reformulate the point of the story or become a co-teller of the story by contributing details and dialogue, responding to stories with evaluation, and discussing stories of his/her own. The listener’s participation is influenced by two main factors: the degree of familiarity between the narrator and the listener, and the degree of familiarity between the listener and the narrated events (Norrick, 2001; Ochs & Capps, 2001). The more familiar the narrator and the listener are, the more involved the listener typically is in the narrative construction. While variations in frequencies, purposes, and preferred methods of co-telling exist cross-culturally, specific types of co-telling have been observed in adult–child interaction, including elicitation, questioning, prompting, glossing, repeating and modeling (Ochs & Capps, 2001; Uccelli et al., 2005). Across cultures, elicitation is a common strategy used by adults to get a child to narrate a personal event, e.g., “Tell me where you went today.” Adults also recruit children’s participation and exert control over personal storytelling through open-ended questioning about past events or attitudes about past events, e.g., asking “Then what happened?” or “Why did you do that?” Questions can be designed to encourage the child to recount what the adult already knows or to recount events unfamiliar to the questioner. Another common strategy involves prompting children about what to say, e.g., “Tell me more about that.” The purpose of prompting is not only to make narrative assertions but also to elicit information about past actions. Sometimes children are corrected after they produce an utterance that is considered inappropriate or incomplete. For example, the child might say “First I played on the swings,” and the adult co-teller might respond “Didn’t you play with your brother on the monkey bars first?” This practice is referred to as glossing as the adult provides a culturally acceptable translation of the child’s content. Ochs and Capps (2001) note that, in some cultural communities, co-construction also includes repetitions of all or part of what the child produced during the narrative. These repetitions serve a range of pragmatic functions including topic maintenance, displaying agreement, providing empathy, and acknowledging tentative understanding. Finally, adult co-construction also consists of providing models of content, vocabulary and grammatical structures for children’s subsequent personal narrative attempts. The use of elicitation, open-ended questioning, prompting, correction/glossing, repetition,

Narrative development and aided communication

and modeling during personal narrative storytelling with typically developing children has been documented extensively across cultures (see Feldman, 1989; Fivush, Hamond, Harsch, Singer, & Wolf, 1991; Heath, 1986; Meng, 1992; Miller & Sperry, 1988; Ochs & Capps, 2001; Ochs & Taylor, 1992; Schiefflin, 1990; Wiley, Rose, Burger, & Miller, 1998). The structure of conversational narratives is very different from the structure of more linear, coherent, monological narratives. These typically have a plot structure that includes a sequence of temporarily and casually ordered events, organized around a high point, which typically include an unexpected, tellable incident, and moves toward an ending that provides some sort of resolution (see Heath, 1983). Plot structure is typically analyzed in terms of story grammar elements, including main characters, emotional states of story characters, setting, initiating event, resolution, and evaluation (Allen et al., 1994). On the other hand, conversational narratives tend to be less structured and more open ended, and as such do not lend themselves to a purely structural analysis (Norrick, 2001). Instead, Ochs & Capps (2001) propose to analyze conversational narratives along four primary dimensions of narrative practice: tellership, tellability, linearity, and moral stance. Tellership refers to the extent and kind of involvement of conversational partners in the construction of the narrative. Tellership can range from one primary teller to a relatively passive audience to multiple active co-tellers who respond by providing specific narrative details, queries, and reactions. Tellability refers to the extent to which narratives include a sequence of reportable events, and make a point in a rhetorically effective manner (e.g., by including prosody, intonation or other pragmatic devices). Tellability ranges along a continuum from high tellability, or narratives that can be told again and still be appreciated, to low tellability or narratives that report on relatively ordinary and barely reportable events. Sometimes a failure in the inclusion of rhetorical elements turns a reportable event into a low tellability narrative. Cultural expectations and the child’s social and cognitive skills impact the frequency, complexity and shape of the tellability of personal narratives. Younger children’s personal narratives consist of both normal, routine activities, as well as casting an event as unanticipated in view of what normally would be expected. Personal narrative linearity also exists along a continuum ranging from linear, which is one event anticipating, causing, or leading to another in a coherent, progressive, forward-moving time line, to nonlinearity, which is open to possibility, unpredictability, and indeterminacy. The dimension of linearity is displayed through temporal markings (e.g., simple present and progressive tense), temporal sequences (e.g., sequencers such as after, then, when), plot coherence (e.g. how events are causally interrelated with the framework of a plot), and linear trajectories (e.g., ability to increasingly articulate relevant and informative temporal and logical progression of events). The dimension of nonlinearity is displayed through intense emotionality, incoherent description of the storytelling events that may be related to cognitive immaturity, uncertainty about the nature and direction of the life events, and parallelisms such as use of repetitions of forms (nouns, verbs) and themes. Finally, moral stance is the recognition of moral standards of right and wrong. Morality in personal narratives is conveyed through focus on unexpected events which reinforce what are both normative and valued. For younger children, the moral stance of a narrative is typically

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articulated through adult co-tellership. In conversations with children, adults often instill a moral stance into the child’s personal narrative by labelling events as right or wrong, pointing out child or other’s errors, shaming and/or praising. In addition, adults often encourage children to identify the feelings they have about the specific events being narrated (Ochs & Capps, 2001).

What do we know about narrative development and AAC? Despite the proven relationship between narrative abilities and a range of other developmental variables, including academic achievement and the acquisition of conventional literacy (e.g., Fazio, Naremore, & Connell, 1996; Snow, 1983; Tabors, Snow & Dickinson, 2001), narratives and narrative development have received very little empirical attention in the field of AAC, with a few exceptions. In 2003, Grove and Tucker described the narratives of ten (10) children with cognitive disabilities who used manual signs as their primary means of expression. They found that their study participants produced one- or two-sign utterances and did not string lexical constituents. The children’s narratives were incoherent and did not explicitly mark the agent, the patient, the relationship between the characters, or the temporal order of events. In 2006, Soto and Hartmann used the Narrative Assessment Profile (NAP) (Bliss, McCabe, & Miranda, 1998) to analyze the personal and fictional narratives produced by four children with severe physical and speech impairments who used aided AAC under several elicitation conditions which included personal photo description, book reading and retelling, story stem, conversational narrative and ‘reading’ a wordless picture book. The NAP evaluates six discourse dimensions considered to be critical for the production of structurally appropriate narrative discourse: topic maintenance, event sequencing, explicitness, referencing, conjunctive cohesion, and fluency. Topic maintenance refers to how well all utterances in a narrative relate to a central topic. Event sequencing involves presenting a series of events in chronological order. Explicitness relates to the degree of completeness, elaboration and description in the narrative. Referencing involves the adequate identification of individuals, locations and events. Conjunctive cohesion involves linking utterances and events, specifically using coordination, temporal links, causality, enabling, disjuncture, and pragmatic links. Fluency refers to the fluidity of the discourse and the absence of lexical or phrasal interruptions (see Bliss et al., 1998 for an extensive description of each and all of these discourse dimensions). The NAP is particularly applicable to individuals who use AAC because it enables practitioners to assess diverse dimensions of narrative discourse simultaneously; the result is a profile of the relative strengths and weaknesses that individuals exhibit with respect to a variety of dimensions critical to narrative discourse. Another feature of the NAP is that it can be used across the life span (Bliss et al., 1998). Soto and Hartmann found that, despite some individual variation, the children’s responses to these tasks displayed organizational difficulties and extremely limited used of available vocabulary. The children’s narratives lacked elements typically used in narrative discourse, such as conjunctions, elaborated noun phrases, prepositional or relative clauses, mental and linguistic verbs or adverbs. In addition, both within

Narrative development and aided communication

and across turns, the children’s contributions lacked temporal, referential, causal and spatial coherence. Pronouns were never used. In the excerpt below, D is describing a photograph of himself watering some plants using his picture board. His difficulty formulating a coherent narrative leads his teacher to ask multiple questions to figure out what he is trying to say.

Extract 6.1 D. 1 2

((points to icon: IN))

3 4 5 6 7 8 9 10 11 12

Teacher What did you do?

In ((points to board/IN)) You are showing me the in. Did you put something in the pot? ((points to photograph)) Oh, you ((points to photograph)) put something in the pot. What’d you put in the pot? What is that sign you used before? What did you and Grandma put in the pot? ((points to icon: OUT)) Oh, you took something out of the pot? What did you take out of that pot?

D’s messages lacked elements of narrative such as conjunctions, elaborated noun phrases, prepositional or relative clauses, and mental and linguistic verbs or adverbs. His utterances did not include the basic elements expected of a typical story: a setting with characters introduced and an episode structure with an initiating event, attempt, and a consequence. In addition, both within and across turns, his contributions lacked temporal, referential, causal and spatial coherence. He never used pronouns even though these were available on his picture board (Soto & Hartmann, 2006). However, a structural account is of limited value when assessing aided narrative. Aided narratives are typically produced during conversational exchanges with an adult, and therefore the child’s narrative abilities cannot truly be evaluated outside of such interactions. That is, the structural nature and quality of the children’s narratives may be as much a reflection of their communication partner’s skills in eliciting necessary features of narrative discourse as they are of the children’s own skills in producing them. For instance, different types of adult prompting or questioning may affect the child’s abilities to produce fuller narratives, as in the case of excessive yes/no questioning

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on the part of the adult (Müller & Soto, 2002). In addition, children who use AAC have been found to strategically use those dimensions and features of communicative discourse that are best afforded by each elicitation context. For instance, children who use AAC typically demonstrate abilities in labelling, describing, and answering questions through yes-no responses. Difficulties commonly emerge in attempts at controlling conversations or narrating (Soto & Hartmann, 2006). Furthermore, with a co-present book, or in picture description tasks, they have been found to be able to provide adequate referencing and event sequencing, as the book or the photo can be used strategically as a communication aid. Given the dynamic and complex nature of aided interaction, it is difficult to know whether or not the narratives of children who use aided AAC reflect problems with specific narrative features, a lack of experiential knowledge of how to tell a story, a communication system that does not afford the range of structures necessary for narrative discourse, or conditions typically present in aided interactions (see Clarke, Chapter 8, this volume). The dimensions of tellership, tellability, linearity, and moral stance discussed earlier have also proven useful when analyzing the personal narratives of children who use aided AAC, even when these are co-constructed with adults (Solomon-Rice & Soto, 2014). In the excerpt below, tellership is jointly co-constructed by a young woman who uses an SGD (Nicole) and a speech language pathologist. Tellership marks the level of participation that the conversation partner(s) has during the actual telling of Nicole’s narrative. As Nicole begins to tell her friend Gigi about something that happened over the weekend, the SLP facilitated Nicole’s tellership by presenting her with additional questions (marked with * below) and models to clarify her intention.

Extract 6.2 1.

N

“He feels so sad” ((looks at SLP))

2.

SLP

*What?

3. SLP *Who are we talking about? 4.

N

“Ben”

5. SLP Ben, okay, so tell Gigi…Ben feels so sad.

This is an example of shared tellership. Here, Nicole is the primary teller as she is providing the narrative content, and the SLP is the secondary teller through the use of co-constructive strategies that help elicit, repair, clarify and further elaborate a more completed narrative. Tellership is of particular relevance to the analysis of AACmediated narratives, since these are typically constructed through shared tellership. In AAC-mediated interaction, communication partners typically participate as active co-tellers of the users’ narratives by helping them produce a more detailed, organized and elaborate story.

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151

Tellability ranges along the continuum of high tellability, with the reporting of highly interesting and memorable events, to low tellability, with the reporting of mundane events. The following excerpt illustrates how the communication partner can increase the tellability of an ordinary event (e.g., a birthday party) by showing positive emotion and excitement as the child tells the story and turn a relatively ordinary event into an exciting one.

Extract 6.3 1.

SLP

I have another question to ask you.

2. SLP What happened here? ((pointing to a story grammar map)) 3. SLP What is this picture about? 4. C

“My birthday”.

5.

SLP

Oh, your birthday ((with great excitement))

6.

C

My birthday ((smiling)) (Solomon-Rice & Soto, 2014, p. 77)

Increasing the tellability of a personal story can heighten the desirability for the child to further describe and retell such a happening. In aided communication, helping the child develop ordinary stories into highly interesting topics of conversation might facilitate further participation in conversational narratives and subsequent narrative development. Personal narratives can range from linear and sequential narratives to nonlinear, unpredictable and incoherent ones. The narratives of children who use AAC seldom demonstrate linearity as a result of limited expressive language skills (Solomon-Rice & Soto, 2014; Soto & Hartmann, 2006). They often lack clear linguistic structures that mark temporal sequencing and plot coherence. In the example below, an SLP assists Nicole with facilitating the linearity of her narrative. As the passage begins, the SLP focuses on a series of clarifying questions to ensure that the user constructs a statement that best describes what she means. [box text]

Extract 6.4 1.

SLP

Do you wanna ask them if you can take the shirt off?

2.

N

((nods))

3. SLP Or, if you can wear it only before the dance, for the dance? 4.

N

Ahh

5.

SLP

((looks at N)) Continues on next page

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The Silent Partner?

6.

N

((nods))

7.

SLP

Okay, which one?

8. SLP If you can wear it… only, for the dance? 9.

N

((looks at SLP))

10. SLP

Is that what you want to ask them, okay?

11. N

((looks at SLP))

12. N

Mmm-hmm ((nods))

13. SLP

Okay, so, how can we say that?

In this excerpt above, the SLP is using questions to help Nicole clarify her intentions and organize the sequence and coherence of her story. Lastly, advanced linguistic abilities are necessary to discuss the moral standards of right and wrong. In Excerpt 6.5, the SLP is assisting Nicole to ask her friend Gigi something by prompting her to formulate an appropriate question with a positive emotion that would result in morally appropriate approval.

Extract 6.5 1.

SLP

If you don’t know what to ask, then she can ask~ .

2.

G

I know.

3.

SLP

you a question, oh you know, okay, excellent, so, you ready, Gigi?

4.

G

Yeah ((smiles))

5. SLP Excellent. 6.

G

I’m ready, Freddy ((smiles))

7.

SLP

((laughs))

8.

G

((laughs, covers mouth))

9.

N

“Can I take picture” ((looks at G))?

10. G

((Gigi rubs eyes))

11. N

((smiles))

12. SLP

(whispers) Excellent.

13. N

((smiles, laughs)).

14. N

“of you”

15. N

“please?”

16. N

“Can I take picture of you please?”

Narrative development and aided communication

In the excerpts above, the dimensions of tellership, tellability, linearity and moral stance are affected by the limited expressive language skills of the child who uses AAC. In all cases the adult participated as a co-teller, helping the child produce a more detailed and organized story, and prompting the child to provide greater detail rather than controlling the story. The adult followed the child’s lead, keenly observes how the child attempts to solve communication problems, allows sufficient time for child responses, and uses co-constructive strategies to increase the dimensions of tellership, tellability, linearity and moral stance.

How to support narrative development in users of aided communication? To date, despite the documented link between narrative skills, overall communicative competence and other developmental skills, there is very little information about the early narrative experiences of children with complex communication needs and how these experiences may be supported through the use of aided communication. Support for narrative formulation can range from scaffolding participation in narrative activities, through scaffolding the co-constructed generation of narratives, to supporting the independent generation of narratives. There are a number of studies that illustrate how narrative-based devices and software can be used to support participation in narrative activities (e.g., Waller, 2006). For instance, Waller and her colleagues (2001) described the use of an AAC system with a prestored narrative retrieval software program called Talk:AboutTM (Don Johnston, Inc.) to improve the conversation narratives of a 9½-yearold girl. The authors found that consistent use of Talk:AboutTM paired with specific instruction resulted in considerable increases in the child’s conversation initiations and increased coherence in story structure. While the use of the software resulted in the child’s improved pragmatic skills, the use of the software did not seem to result in linguistic improvements. Other studies go further in describing narrative intervention approaches that can be used to support the co-constructed (Solomon-Rice & Soto, 2014) and the independent generation of narratives by children who use aided AAC (e.g., Soto, Solomon-Rice, & Caputo, 2009). These studies suggest that – given the complex and multilayered nature of narrative discourse – systematic exposure to multi-component intervention packages can lead to improvements in the quantity and quality of the narratives of children who use aided AAC (see Davies, Shanks, & Davies, 2004; Peterson, Jesso, & McCabe, 1999). Research to date suggests that effective approaches to narrative intervention are multifaceted and include: (a) the design and frequent implementation of a wide range of structured narrative opportunities and experiences; (b) the coaching of communication partners to provide careful scaffolding; and (c) the utilization of visual and other communication supports that would explicitly scaffold the development of story structure, such as graphic story maps, explicit verbal and written feedback and core vocabulary (Bliss, 2002; Davies et al., 2004; Grove & Tucker, 2003; Hayward & Schneider, 2000; McCabe & Peterson, 1991; McGregor, 2000; Peterson & McCabe, 1983; Peterson et al., 1999; Schoenbrodt, Kerins, & Gesell, 2003; Waller et al., 2001).

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In a single subject study, Bedrosian, Lasker, Speidel and Politsch (2003) used peer support and multiple instructional methods (including the use of a story map, story writing software and relevant story vocabulary programmed on an Alpha Talker™) to support the written narrative skills of a 14-year-old student diagnosed with autism. Postintervention results suggested that the student became a more balanced conversational partner by contributing more story ideas, and increasing the length, cohesion and detail of his written narratives. In a detailed case study, Soto, Yu and Henneberry (2007) described the process used by a teacher to support the narrative skills of an 8-year-old child with severe physical and speech impairments who used an AAC system to communicate. The teacher used a multicomponent intervention package targeting story grammar elements with the aim of helping the child recognize and generate grammatically complete narratives. The program consisted of three different narrative activities: (a) storybook reading and retelling, supported with a graphic story map; (b) generation of personal stories, supported with fill-in-the-blank graphic scaffolds; and (c) generation of fictional stories, assisted with graphic cue cards. After consistent implementation of the intervention procedures, the narratives of the participating child showed a marked improvement in vocabulary complexity and increased inclusion of relevant story elements. In a related single-subject study, Soto and her colleagues (2008) found that systematic instruction that included: (a) storybook reading and retelling, assisted by the use of a verbal scaffold and a story map targeting main story elements (Bedrosian et al., 2003); (b) personal storytelling, supported by commercially available fill-inthe-blank stories created for students who have significant communication disorders (Richman, 1989); and (c) fictional storytelling, supported by the use of story elements provided by the clinician (Davies et al., 2004; Hayward & Schneider, 2000) resulted in a marked improvement in the expressive vocabulary, sentence complexity, use of relevant story elements, and advancement in plot structure organization of a 12-yearold girl who used aided AAC. More recently, Soto and her colleagues (2009) implemented a multifaceted intervention that incorporated four features that had been previously found to be influential in helping children to generate more elaborate and grammatically correct personal narratives. First, their intervention included an interactive process whereby the clinician supported the children’s generation of personal stories by using open-ended questions, verbal prompts, binary choices, and verbal models and recasts. Second, their intervention incorporated the use of visual prompts such as the use of a visual story map and a large board where the clinician wrote everything the children expressed to support their later recall of the story they were generating. Third, both the intervention activities prompted the child to reflect on the emotion attached to the event the child was narrating. This had also been found to contribute to children’s remembering of personally meaningful events in children with other language impairments (see Liwag & Steig, 1995). Last, their intervention provided each child with repeated opportunities to narrate, which may have contributed to their improved narrative competence. The study included maintenance data that indicated the reported narrative gains were not transitory. Approximately one month after intervention had been completed, study participants were still using a richer lexicon, in structurally more complex narratives.

Narrative development and aided communication

Together, these results from the emerging body of work in narrative intervention with users of aided AAC support the notion that participation in an intervention programme where participants engage in description of personal events that are associated with an emotion may be related to more developed personal narratives. Using the child’s emotional connections to a series of events could be facilitative for several reasons: (a) as a means by which the adult can overcome a child’s initial reluctance to produce multi-word utterances; (b) a means by which the adult can elicit additional details and maintain interest in the task; and (c) a means for the child to evaluate the events narrated. All of these factors are also a part of regular classroom narrative writing activities, where children are encouraged to start a narrative with an emotional incident, and then to wrap it up by including an evaluative conclusion. In closing, a considerable amount of evidence has established a strong link between narrative abilities and a range of emotional, cognitive, social, linguistic and academic skills and abilities (see Petersen, 2011, for a review). However, only limited progress has been made in our understanding of how narrative skills can be facilitated for children with severe communication disorders who use AAC to communicate. There is an emerging body of evidence that indicates that repeated, shared and engaging story telling and explicit teaching of story grammar structure accelerates narrative development. Thus, parents, clinicians and educators of children with AAC needs should create frequent opportunities for the children to engage in authentic conversations not just about the present, but also about the non-present, fantasy, and past and future events. Narratives emerge from children’s natural drive to share experiences. Conversational interaction in AAC should be carefully crafted to encourage and support children’s active engagement, complex language use, through verbal scaffolding and co-construction, extended utterances, balanced participation and expectation for generation of narratives via linguistic means. Experience in a broad range of authentic narrative activities is crucial for later autonomous narrative production.

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Bruner, J.S. (1990). Acts of Meaning. Cambridge, MA: Harvard University Press. Bruner, J. (1997). A narrative model of self-construction. Annals of the New York Academy of Sciences, 818, 145–161. Bruner, J. (2006). Culture, mind and narrative. In J. Bruner, C.F. Feldman, M. Hermansen & J. Mollin (Eds), Narrative Learning and Culture, pp. 13–24, Copenhagen: Nyt fra Samfundsvidenskabern. Davies, P., Shanks, B., & Davies, K. (2004). Improving narrative skills in young children with delayed language development. Educational Review, 56, 271–286. Eisenberg, A.R. (1985). Learning to describe past experiences in conversation. Discourse Processes, 8, 177–204. Fazio, B.B., Naremore, R.C., & Connell, P.J. (1996). Tracking children from poverty at risk for Specific Language Impairment: A 3-year longitudinal study. Journal of Speech, Language, and Hearing Research, 39, 611–624. Feldman, C.F. (1989). Monologue as problem-solving narrative. In K. Nelson (Ed.), Narratives from the Crib, pp. 98–119. Cambridge, MA: Harvard University Press. Fivush, R., Hamond, N.R., Harsch, N., Singer N., & Wolf, A. (1991). Content and consistency in early autobiographical recall. Discourse Processes, 14, 373–388. Grove, N., & Tucker, S. (2003). Narratives in manual sign by children with intellectual impairments. In S. von Tetzchner & N. Grove (Eds), Augmentative and Alternative Communication: Developmental Issues, pp. 229–255. London: Whurr. Hayward, D., & Schneider, P. (2000). Effectiveness of teaching story grammar knowledge to pre-school children with language impairment. An exploratory study. Child Language Teaching and Therapy, 16, 255–284. Heath, S.B. (1983). Ways with Words: Language, Life and Work in Communities and Classrooms. Cambridge: Cambridge University Press. Heath, S.B. (1986). Taking a cross-cultural look at narratives. Topics in Language Disorders, 7, 84–94. Hamond, N.R., & Fivush, R. (1991). Memories of Mickey Mouse: Young children recount their trip to Disneyworld. Cognitive Development, 6, 433–448. Hunston, S., & Thompson, G. (Eds) (2000). Evaluation in Text: Authorial Stance and the Construction of Discourse. Oxford: Oxford University Press. Labov, W. (1972). Language in the Inner City: Studies in the Black English Vernacular, Vol. 3. Philadelphia, PA: University of Pennsylvania Press. Liles, B.Z. (1993). Narrative discourse in children with language disorders and children with normal language: A critical review of the literature. Journal of Speech, Language, and Hearing Research, 36, 868–882. Liwag, M.D., & Steig, N.L. (1995). Children’s memory for emotional events: The importance of emotionrelated retrieval cues. Journal of Experimental Child Psychology, 60, 2–31. McCabe, A. (1997). Developmental and cross-cultural aspects of children’s narration. In M. Bamberg (Ed.), Narrative Development, pp. 137–174. London; New Jersey: LEA. McCabe, A., & Peterson, C. (Eds) (1991). Developing Narrative Structure. Hillsdale, NJ: Psychology Press. McGregor, K.K. (2000). The development and enhancement of narrative skills in a preschool classroom: Towards a solution to clinician-client mismatch. American Journal of Speech-Language Pathology, 9, 55–71. Meng, K. (1992). Narrative and listening in kindergarten. Journal of Narrative and Life History, 2, 235–252. Miller, P.J., & Sperry, L.L. (1988). Early talk about the past: The origins of conversational stories of personal experience. Journal of Child Language, 15, 293–315.

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Müller, E., & Soto, G. (2002). Conversation patterns of three adults using aided speech: Variations across partners. Augmentative and Alternative Communication, 18, 77–90. Nelson, K. (1989). Monologue as the linguistic construction of self in time. In K. Nelson (Ed.), Narratives from the Crib, pp. 284–308. Cambridge, MA: Harvard University Press. Nelson, K. (1993). The psychological and social origins of autobiographical memory. Psychological Science, 4(1), 7–14. Nelson, K. (1998). Language in Cognitive Development: The Emergence of the Mediated Mind. Cambridge, UK: Cambridge University Press. Nelson, K. (2003). Narrative and self, myth and memory: Emergence of the cultural self. In R. Fivush & C. Haden (Eds), Autobiographical Memory and the Construction of a Narrative Self, pp. 3–28. Mahwah, NJ: Erlbaum. Nelson, K. (2009). Young Minds in Social Worlds: Experience, Meaning, and Memory. Cambridge: Harvard University Press. Nelson, K., & Fivush, R. (2004). The emergence of autobiographical memory: A social cultural developmental theory. Psychological Review, 111, 486. Ninio, A., & Snow, C.E. (1996). Pragmatic Development. Essays in Developmental Science. Boulder, CO: Westview Press. Norrick, N.R. (2001). Discourse markers in oral narrative. Journal of Pragmatics, 33, 849–878. Ochs, E., & Capps, L. (2001). Living Narrative: Creating Lives in Everyday Storytelling. Cambridge: Harvard University Press. Ochs, E., & Taylor, C. (1992). Family narrative as political activity. Discourse & Society, 3, 301–340. Petersen, D.B. (2011). A systematic review of narrative-based language intervention with children who have language impairment. Communication Disorders Quarterly, 32, 207–220. Peterson, C., & McCabe, A. (1983). Developmental Psycho-linguistics: Three Ways of Looking at a Child’s Narrative. New York: Plenum. Peterson, C., Jesso, B., & McCabe, A. (1999). Encouraging narratives in preschoolers: An intervention study. Journal of Child Language, 26, 49–67. Reilly, J., Klima, E.S., & Bellugi, U. (1990). Once more with feeling: Affect and language in atypical populations. Development and Psychopathology, 2, 367–391. Richman, L. (1989). Stories About Me. Solana Beach, CA: Mayer-Johnson, Inc. Rogoff, B. (1990). Apprenticeship in Thinking: Cognitive Development in Social Context. New York: Oxford University Press. Schieffelin, B.B. (1990). The Give and Take of Everyday Life: Language Socialization of Kaluli Children. New York: Cambridge University Press. Schoenbrodt, L., Kerins, M., & Gesell, J. (2003). Using narrative language intervention as a tool to increase communication competence in Spanish-speaking children. Language, Culture and Curriculum, 16, 48–59. Snow, C.E. (1983). Literacy and language: Relationships during the preschool years. Harvard Educational Review, 53, 165–189. (Reprinted in S. Beck & L.N. Oláh (Eds), Perspectives on Language and Literacy: Beyond the Here and Now, pp. 161–186. Cambridge, MA: Harvard Educational Review Reprint Series). Snow, C.E. (1990). Rationales for native language instruction. In A.M. Padilla, H.H. Fairchild & C.M. Valadez (Eds), Bilingual Education: Issues and Strategies, pp. 60–74. Newbury Park, CA: Sage Publications. Solomon-Rice, P.L. & Soto, G. (2014). Facilitating vocabulary in toddlers using AAC: A preliminary study comparing focused stimulation and augmented input. Communication Disorders Quarterly, 35, 204–215.

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Soto, G., & Hartmann, E. (2006). Analysis of narratives produced by four children who use augmentative and alternative communication. Journal of Communication Disorders, 39, 456–480. Soto, G., Solomon-Rice, P., & Caputo, M. (2009). Enhancing the personal narrative skills of elementary school-aged students who use AAC: The effectiveness of personal narrative intervention. Journal of Communication Disorders, 42, 43–57. Soto, G., Yu, B., & Henneberry, S. (2007). Supporting the development of narrative skills of an eightyear-old child who uses an augmentative and alternative communication device. Child Language Teaching and Therapy, 23, 27–45. Soto, G., Yu, B., & Kelso, J. (2008). Effectiveness of multifaceted narrative intervention on the stories told by a 12-year-old girl who uses AAC. Augmentative and Alternative Communication, 24, 76–87. Stuart, S. (2000). Understanding the storytelling of older adults for AAC system design. Augmentative and Alternative Communication, 16, 1–12. Tabors, P O., Snow, C.E., & Dickinson, D.K. (2001). Homes and schools together: Supporting language and literacy development. In D.K. Dickinson & P.O. Tabors (Eds), Beginning literacy with language, pp. 289–339. Baltimore, MD: Brookes. Tessler, M., & Nelson, K. (1994). Making memories: The influence of joint encoding on later recall by young children. Consciousness and Cognition, 3, 307–326. Uccelli, P., Hemphill, L., Pan, B.A., & Snow, C. (2005). Conversing with toddlers about the nonpresent. In L. Balter & C.S. Tamis-LeMonda (Eds), Child Psychology: A Handbook of Contemporary Issues, 215–237. Waller, A. (2006). Communication access to conversational narrative. Topics in Language Disorders, 26, 221–239. Waller, A., O’Mara, D.A., Tait, L., Booth, L. Brophy-Arnott, B., & Hood, H.E. (2001). Using written stories to support the use of narrative in conversational interactions: Case study. Augmentative and Alternative Communication, 17, 221–232. Wickenden, M. (2011). Whose voice is that? Issues of identity, voice and representation arising in an ethnographic study of the lives of disabled teenagers who use Augmentative and Alternative Communication (AAC). Disability Studies Quarterly, 31(4), 1–19. Wiley, A.R., Rose, A.J., Burger, L.K., & Miller, P.J. (1998). Constructing autonomous selves through narrative practices: A comparative study of working-class and middle-class families. Child Development, 69, 833–847.

7 Literacy learning and aided communication Annika Dahlgren Sandberg

Literacy learning and aided communication Reading and writing are among the most important acquired skills in our society, permitting us to share information irrespective of distance and time. We need reading and writing abilities in order to take an active part in society, to get information, to keep up to date with new technology, for communicative, educational, and vocational purposes and for leisure activities. Acquisition of literacy skills is thus one of the major milestones in a child’s development. With the ability to read, the child gets access to a whole new world of experiences outside of the here and now, of imaginative worlds, of other persons’ thoughts. In the case of persons who use aided communication, writing could be an excellent way of gaining access to the potentially unlimited vocabulary of the spoken language of their community. However, personal accounts of those who use aided communication, their teachers and parents, in addition to research results, have revealed that many children and adults who use aided communication have great difficulties in this area and that there is an inconsistency between the intellectual level and the reading and spelling abilities (e.g., Dahlgren Sandberg, 2001, 2006; Lund & Light, 2006; Smith, 2001; Smith, Dahlgren Sandberg, & Larsson, 2009). Thus, acquisition of literacy skills seems to be a specific problem for individuals who use aided communication.

What are reading, writing and spelling? Spoken language is a symbol system used in face-to-face communication and, as such, is presumed present from the emergence of modern homosapiens with a specific biological foundation (Lenneberg, 1967). In contrast to spoken language, written language is a rather late construction. It is a cultural invention demanding special skills for reading and writing and it is transmitted in a social and cultural context. In order to be able to decode print and to extract information from the message, the child needs explicit training. Written languages are systems of signs for representation of spoken language in a graphic and permanent manner. The representations – i.e., the orthographies – are

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of different kinds: logographies where written signs represent words or morphemes; syllabaries, i.e., written representations of syllables; or alphabetic where the combination of signs corresponds to the sound structure of the spoken language (Gleitman & Rozin, 1977). With a representational system where each phoneme is represented by a symbol, the number of symbols is relatively small, while the abstractness of the relation between the written symbol and the meanings increases. Relative to spoken language, there are greater demands on a written product to be clear, exhaustive and comprehensible without support from the context or the producer of the message (Lundberg & Høien, 1991). Written language requires of the child a high degree of abstraction and analytical thinking, including a requirement to attend to the sound aspects of the spoken language and to convert these aspects into a graphic form. According to the so-called “simple view of reading” (Gough & Tunmer, 1986; Hoover & Gough, 1990), reading consists of two core components: decoding and linguistic comprehension. The dual-route model of reading explains that individuals use either an orthographic or a phonological strategy to decode words. Words that are familiar are directly recognized and decoded visually, based on their orthographic features, through the orthographic route. New, unfamiliar words are decoded through the phonological route, the process by which the reader translates printed words to speech in oral or silent reading. In the phonological route, letters first need to be recoded into their phonological form. The individual phonological representations are stored in auditory short-term memory and blended together to form a unit, leading to phonological word recognition. Proficient readers mainly use the orthographic route while beginning readers are more dependent on the phonological route. Encoding refers to the sound-to-letter relationships, the analysis of words into sound units and representation of each unit by a letter, thus explaining the process of writing. Important cognitive variables are involved in reading and writing and literacy acquisition, such as general intelligence, visual and auditory memory, and different levels of language ability, where the best predictors have been found in the language area. Language delayed children and children with low results on vocabulary, verbal comprehension tests and tests of syntactic knowledge during preschool years have been shown to be at risk regarding reading development (Catts, Adlof & Weismer, 2006; Bishop & Snowling, 2004; Miniscalco & Dahlgren Sandberg, 2010; Rankin, Harwood, & Mirenda, 1994; Rutter, 1978; Stanovich, 1986; Steele & Watkins, 2010). However, the relation among speech, language and reading disorders is not easily understood, and instead of being regarded as different entities with different backgrounds they rather should be regarded as intimately interdependent (for a discussion see Pennington & Bishop, 2009). A variety of research has focused on the importance of phonological awareness, referring to the ability to recognize and manipulate the separate phonological units within a word in reading and spelling development (e.g., Goswami & Bryant, 1990; Ziegler & Goswami, 2005). The results have stressed this cognitive skill to be a strong predictor of literacy skills (e.g., Hulme & Snowling, 2014; Landerl & Wimmer, 2008; Snowling & Hulme, 2014; Stanovich, Siegel, & Gottardo, 1997). Apart from phonological awareness, there is evidence that phonological memory is an important factor in reading acquisition (Gathercole & Adams, 1994; Gathercole &

Literacy learning and aided communication

Figure 7.1 Schematic view of the reading process.

Baddeley, 1990). Of special interest are the memory processes at work during the rapid processes of decoding and encoding. These processes involve the use of phonological coding in working memory (Baddeley, 2002; Wagner & Torgersen, 1987). Stable phonological representations need to be constructed and stored in verbal short-term memory, assumed to serve as a working memory system when spelling and reading (Gathercole & Baddeley, 1993). The end product of efficient reading is comprehension, extraction of meaning, by means of syntactic and semantic information and use of earlier experiences. Thus, besides the cognitive processes needed for the de- and encoding processes of reading and writing, language comprehension, experiences and knowledge about the surrounding world is fundamental to comprehending written text. In this chapter the literacy abilities of persons who use aided communication are discussed, based on empirical studies. Besides oral language deficits, persons who use aided communication often have additional difficulties. In many cases, they have both fine motor and gross motor impairments, creating barriers to their interaction with the physical world. This in its turn causes restrictions in the experiences that provide the foundation for the comprehension part of the reading process. Due to their motor problems, they also have difficulties engaging in independent literacy activities such as handling books, paper and tools for writing experiences. The language difficulties are often connected to a restricted expressive vocabulary, defined by the options available in the specific type of aided communication used, but also possible limitations in language understanding.

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From the preschool years, typically developing children spontaneously practise the sound structure of spoken language, helping them to develop phonological awareness. This opportunity is denied to children who use aided communication, unless specifically guided by parents and teachers. The effect of the aided system itself can be bidirectional, depending on the type of aid. It gives the user access to language, which is important in the reading and spelling process, and it offers the beginning reader access to information about print and words (Dahlgren Sandberg & Hjelmquist, 1997; S. McNaughton & Lindsay, 1995). In the same vein, Light and McNaughton (2012) discuss the benefits of augmentative and alternative communication for children with complex communication needs in the development of communication, language and literacy. Conversely, many aided communication systems are organized on the basis of the word level, which could be counterproductive when learning to read and spell according to the analytical alphabetical principle (Bishop, Rankin, & Mirenda, 1994). Acquiring literacy skills obviously can be a challenge for persons who use aided communication. To date, research presents a varied picture of literacy learning in the context of aided communication. Not all persons who use aided communication have difficulties acquiring literacy skills. They use aided communication for many different reasons and they bring different skills and experiences to the situation. As indicated above, literacy skills are also multidimensional. Another challenge is the assessment of language skills in persons who use aided communication to compensate for significant speech impairments, due to the fact that most assessment tasks require oral responses. This challenge is evident in research as well as in clinical work. Taken together, these factors can explain why it is difficult, if not impossible, to present an unambiguous solution to understanding the challenges of reading and spelling acquisition in the context of aided communication, and the consequent challenge of proposing an unambiguous picture of appropriate interventions.

Empirical studies of literacy attainment As noted above, difficulties in reading and spelling in persons who use aided communication have been well documented in research, although the number of participants is small. Often results are based on single case studies. Most studies are from English speaking countries (e.g., Erickson & Clendon, 2009; Koppenhaver, Hendrix, & Williams, 2007; Light & McNaughton, 2012; Smith, 2001, 2005; Sturm, Spadorcia, Cunningham, Cali, Staples, et al., 2006) but also from the Netherlands (e.g., van Balkom, & Verhoeven, 2010) and from Sweden (e.g., Larsson, Dahlgren Sandberg, & Smith, 2009a), all presenting the same picture of both decoding and comprehension difficulties. Research has been dedicated to trying to go behind these difficulties, to find explanations and to find a basis for possible interventions. Different possible underlying factors have been studied, amongst which is phonological awareness. The research in this field has been inconclusive. There are studies indicating that many children perform at the same level, or at least not significantly below, their peers with typical development on many measures of phonologic awareness (e.g., Bishop & Robson, 1989; Dahlgren Sandberg, 2001, 2006; Foley & Pollatsek, 1999). Other researchers

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have found significantly weaker performance on the part of the children with severe speech and physical impairments (Vandervelden & Siegel, 2001). In an attempt to find out more about phonological abilities in children who use aided communication, Larsson and Dahlgren Sandberg (2008a) studied their performance on a range of phonological awareness tasks comparing the results with those of children without disabilities. The results overall were positive, varying from 24 to 87% correct in the aided group and from 22 to 88% in the typically developing group. The authors concluded that phonological awareness does not depend on articulatory ability, but that articulatory ability might affect children’s ability to manipulate the sound structure in tasks where an oral prompt was not available. On the one task that the children were supposed to solve without oral support from the experimenter, i.e., only with visual cues, the aided group achieved a mean score of 35%, while their typically developing peers achieved 75% correct. This was a rhyming task presented in two versions, one where the experimenter named rhyming pairs of pictures immediately before the child was asked to give the answer by indicating which pictures made up a rhyming pair. In the second version, the pictures were labelled at the beginning of the testing session. They were then put aside and at the end of the session, approximately one hour later, the child was shown the pictures again and asked to indicate the rhyming pairs. The results from this task demonstrated a specific problem for children who use aided communication. The results (65% correct for labelled rhymes and 35% for unlabelled) suggest that lack of articulatory ability may pose challenges in creating and recreating sound images in short-term memory, sound images that would have helped the children to solve the unlabelled rhyme task. Further, in the Dahlgren Sandberg studies (e.g., 2001, 2006) phonological abilities did not seem to have the same power to predict literacy acquisition as is normally reported in typically developing children (Lundberg & Høien, 1991), since the participating children’s reading and spelling abilities were at a low level in spite of good phonological abilities. The opposite results were found by Vandervelden and Siegel (2001), with low phonological abilities corresponding to low reading levels. Pursuing the same question Leitão and Fletcher (2004) conducted a longitudinal study. At preschool the children showed weak phonological awareness and restricted literacy skills. Fourteen of the original 36 students were tested for literacy skills at the age of 12–13 years. Briefly, their results supported the notion of a long-term impact of speech impairment, with low results on phonological awareness tasks on the one hand corresponding to low spelling and reading skills on the other. Trying to identify precursors to reading development, Peeters, Verhoeven, de Moor and van Balkom (2009) firstly found that children with cerebral palsy and speech impairment performed more poorly on all reading precursors at the age of 5;06; secondly, that they also lagged behind on a word decoding task at the age of 7. In further analyses, they found that the predictive value of phonological awareness for early reading skills in children without disabilities did not hold for a group of children with cerebral palsy and speech impairment. Instead, speech production was the most important predictor. Since assessment of language variables is difficult in persons who use aided communication, responses that bypass speech and that involve a selection process have sometimes been used in tasks measuring phonological awareness. The question about

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what might happen to the reliability and validity of test performance when the response mode is changed from an oral to a visuomotor channel has been acknowledged, but seldom with any further information and measures taken. In a well-conducted and -controlled study, Gillam, Fargo, Foley and Olszewski (2011) examined the internal consistency and construct validity in a nonverbal phoneme deletion task using a selection response method in comparison to a standard verbal version of the same task. They found high internal consistency, high correlation between the two versions of the task and the same degree of construct validity for both versions in relation to a word-level reading task. This indicates that the results from earlier research, which has used the same kind of nonverbal task with selection instead of retrieval of the answer, can be interpreted with some reliability and that tasks using a nonverbal response can be recommended. In the same vein and with the same procedures, Erickson, Clendon, Cunningham, Spadorcia, et al. (2008) found results supporting the validity of a task requiring visuomotor responses. These results indicate that results from other studies can be relied upon with some certainty and that the non-oral response mode can be used in clinical work. Memory, especially phonological memory, is another variable that has been examined and found to correlate with reading and spelling in research on literacy in persons who use aided communication. Short-term and working memory are important abilities in language and reading and writing acquisition (Larsson, Dahlgren Sandberg, & Smith, 2009b; Nithart, Demont, Metz-Lutz, Majerus, et al., 2011). Given the close links between overt articulation and memory capacity, persons who use aided communication and who lack articulatory ability could be expected to experience phonological memory problems. Furthermore, their phonological representations may be characterized by reduced specificity. This may in turn lead to problems with both phonological awareness and literacy acquisition. As with phonological awareness, research on phonological memory in individuals with severe speech and physical impairments is inconclusive. Some studies have revealed unimpaired or close to unimpaired verbal short-term memory, e.g., with word length and similarity effects pointing to the effective use of articulatory coding (e.g., Foley & Pollatsek, 1999; Smith, 2001). Other results point to weak phonological and visuo-spatial memory capacity in individuals with speech impairment (e.g., Dahlgren Sandberg, 2006; Dahlgren Sandberg & Hjelmquist, 1997; Larsson & Dahlgren Sandberg, 2008b; Peeters, Verhoeven, van Balkom, & de Moor et al., 2009). As with assessment of language variables in the absence of spoken language abilities, assessing phonological memory creates problems for the researcher or the clinician. The different solutions chosen by varying researchers might be one explanation for the conflicting results often reported. While comparisons between children who use aided communication and children with typical speech can be useful, comparisons within a group of children who use aided communication can also be useful in exploring the importance of memory capacity for development of reading and spelling abilities. Such comparisons were done in the Dahlgren Sandberg and Hjelmquist study (1997). In this study, 10 children were judged to be readers and 17 were non-readers. The readers outperformed the non-readers on both the visuo-spatial memory tasks and the phonological memory task, indicating that memory is one important variable involved in reading and spelling ability.

Literacy learning and aided communication

As was argued concerning phonological awareness, phonological memory problems alone cannot explain the difficulties met by persons who use aided communication when learning to read and spell. Other potential considerations have been proposed, for example the importance of auditory discrimination skills and general language skills such as vocabulary, verbal comprehension and syntactic knowledge (Dahlgren Sandberg & Hjelmquist, 1997; Ferreira, Rönnberg, Gustafson, & Wengelin, 2007; Iacono & Cupples, 2003, 2004; Sturm & Clendon, 2004). However, literacy acquisition does not only depend on individual factors. Literacy is a cultural invention and, as such, is transmitted in a social and cultural context. Research in literacy development in typically developing children has found the home literacy environment, exposure to print, grown-ups’ expectations and active participation in storybook reading are important for development of reading and spelling (e.g., Lundberg, 1991; Scarborough & Dobrich, 1994; Stanovich & Cunningham, 1992). Everyday life of many persons who use aided communication is filled with timeconsuming practical activities. Little time is left over for literacy activities, and even in school they are not always given appropriate priority. From a few early studies on the impact of environmental variables on reading and spelling development (Koppenhaver & Yoder, 1992; Light, Binger & Kelford-Smith, 1994; Light & Kelford-Smith, 1993; Light & McNaugthon, 1993) it can be concluded on the one hand that there were small differences in literacy environments during preschool years but, on the other hand, that children with severe disabilities seemed to receive less literacy instruction in school. Parents have been found to give high priority to communicative activities and interaction in general, while literacy activities were ranked lower among the parents of the children with disabilities than among the parents of the children with typical development. Expectations for reading development were somewhat higher among the teachers than among the parents (Dahlgren Sandberg, 1998). Furthermore, Peeters et al. (2009) found, as did Dahlgren Sandberg (1998), that the interaction pattern in storybook reading differed, with the children who used aided communication being less actively involved in this process than their typically developing peers. They also found that the children’s speech intelligibility was related to their degree of participation and predicted amount of emergent literacy activities. In the Dahlgren Sandberg study (1998) the children with severe speech impairments asked fewer questions about the text than did their peers, and the parents adapted their pattern of activity to their child’s motor difficulties and lack of oral production. Here, use of the aided system during storybook reading could give the child the possibility of actively taking part, thereby developing language comprehension and literacy skills. With a few exceptions – for example, research from Sweden (the Dahlgren Sandberg group) and from the Netherlands (the van Balkom group) – most research in literacy acquisition in people who use aided communication and the relationship between reading and spelling skills and background variables, such as phonological awareness and memory, has been conducted in English-speaking countries (Erickson & Sachse, 2010). Reading, according to the alphabetic principle, rests on the ability to connect graphemes to phonemes, or mapping letters to sounds. The grapheme– phoneme relationship differs in different languages. There are languages with so-called transparent or shallow orthographies, where the correspondence between graphemes

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and phonemes is quite simple, approaching a one-to-one relation. Examples of such languages are Italian, Finnish, German and, to a lesser degree, Swedish. In other languages, like in English, the relation is more opaque, which means that there can be multiple phoneme correspondences to one and the same grapheme combination. Research in reading skills in typically developing children has demonstrated that reading acquisition is more rapid in transparent orthographies than in languages with a deep orthography (Frith, Wimmer, & Landerl, 1998; Seymour, Aro, & Erskine, 2003) and that learning to read and spell builds on larger bricks, combinations of graphemes, e.g., morphemes like endings, in the opaque languages (Ziegler & Goswami, 2005). There is very little empirical evidence of the impact of the linguistic structure on reading acquisition in children who use aided communication. Larsson et al. (2009b) compared reading and spelling in children from Ireland, with an opaque language, and from Sweden, where the children learn to read and spell in a transparent language context, and found few differences. Both groups presented comparable and good results on the phonological awareness tasks, but the Swedish children were less successful in using their phonological skills when reading and spelling than were the Irish children. The Irish children showed relatively more problems with spelling of nonwords, a task heavily resting on the ability to use grapheme–phoneme correspondences, than with other tasks, which might indicate some impact of the linguistic context. The authors also discussed the performance as a result of different years in school with more literacy experiences, approximately two more years in the Irish group. However, the fact that the advantage of the Irish children was not greater could be a result of the linguistic environment, with a slower rate of literacy acquisition (Frith et al., 1998). In sum, research demonstrates that both individual and environmental variables contribute to literacy development in typically developing children, whereas cognitive deficits, especially linguistic ones, seem to be more influential than environmental variables in persons with reading problems. To be able to transfer knowledge from research on literacy acquisition in different linguistic environments and from studies on strategies for improving literacy skills, we need more cross-linguistic collaboration.

Intervention studies As described above, reading according to the alphabetic principle consists of a decoding process, the ‘translation’ of letters into sounds, combined with written language comprehension. Perfect decoding skills can help you read fluently but according to this definition, reading has not taken place unless you understand the text. For comprehension to take place the reader needs different types of knowledge about text: word knowledge, knowledge of sentences in written language as opposed to spoken language, and knowledge of the composition of sentences into different types of text. However, this is not enough. To be able to understand a text you also need world knowledge, a context where you can place the text. Writing, too, is composed of different processes; encoding, ‘translation’ of sounds into written characters, but also planning to be able to put words together into acceptable and comprehensible sentences. Koppenhaver et al. (2007) discussed evidence-based literacy interventions and argued that there is enough evidence for teachers to build on to work with literacy development

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in children who use AAC. Generally, literacy has been given low priority for too long in school and at home. They stressed the heterogeneity in the group and recommended individualized interventions. Based on knowledge about the reading and spelling process, an increasing number of intervention studies have been conducted, mostly on decoding skills and, to a much lesser degree, focusing on reading comprehension (Erickson, 2003). However, reading interventions in children with reading difficulties need to focus not only on the underlying problems and decoding skills, but also on motivation, attention and socio-cultural aspects (Snowling & Hulme, 2014), a field that is largely unknown in the case of children who use aided communication. In a review paper on evidence-based literacy interventions from 2010, Machalicek, and colleagues reported 18 studies that met their criteria for inclusion, where one of the criteria was use of aided communication. All studies used a single subject design with few participants. Instruction methods varied from direct instruction to writing workshops focusing on, for example, phonemic awareness and vocabulary but also on text comprehension and participation in literacy activities. The overall results were positive, suggesting that students who use aided communication benefit from evidencebased literacy instruction, even in skills that usually are regarded as problematic, e.g., grapheme–phoneme correspondences. Some of the studies also examined long-term effects, showing positive effects lasting from a couple of days to eight weeks. In 11 studies, generalization to new books and new words proved to take place. The authors concluded that systematic instruction and least-to-most prompting with time delay seemed to be the most effective strategies to teach literacy skills to children who use aided communication. However positive these results, the authors also stress that the results must be interpreted with caution since some research designs were weak in terms of rigour, the majority of them being non-experimental. Focusing specifically on component skills of decoding (phonological awareness and letter–sound correspondences), Barker, Saunders and Brady (2012) in their review found eight studies on literacy intervention in children who use aided communication. Instruction methods represented were direct teaching of phonological awareness and reading and spelling skills. In some studies, the Nonverbal Reading Approach (Heller, Fredrick, Tumlin, & Brineman, 2002) was used. The important ingredient in this method is to make the student use internal speech. All studies used a single subject design, with two to five participants. Different measures of phonological awareness were targeted, e.g., letter–sound knowledge, blending, segmentation of words and phonemes, but also spelling and word identification. As in the Machalicek et al. (2010) review, generally the results were positive. There was an increase, for example, in correct selection of printed words, in letter–sound knowledge, in segmentation of phonemes and also in spelling of words. The intervention effect on decoding skills was tested through reading words other than those trained. In five of the six studies examining this skill, generalization to new text was demonstrated (Fallon, Light, McNaughton, Drager, & Hammer, 2005). However, the same caution in interpreting the results as in the Machalicek et al. (2010) review applies to the data in the Barker et al. (2012) review, that is, the results rest on single subject designs and small numbers of participants. The development and use of technology is a promising field for literacy interventions. There is initial evidence to suggest a positive role for voice output in supporting

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literacy learning for children who use aided communication (Dahlgren Sandberg & Hjelmquist, 1997). Ten out of the 27 children in the latter study demonstrated some reading and spelling skills. All 27 children used synthetic speech but one of the differences between the two groups was use of synthetic speech during silent reading and spelling. The teachers of all the ten children categorized as readers made explicit use of speech synthesis during reading and spelling instruction. An illustration of the problem alluded to in the section on phonological abilities is found in the results of the Dahlgren Sandberg and Hjelmquist study (1997) and in the study by Dahlgren Sandberg (2006.) These findings have relevance for a discussion related to lack of articulatory speech and the use of speech synthesis. The children in these studies were presented with three different spelling tasks. In one of the tasks, the target word to be spelled was presented as a photograph and the child was asked to spell the corresponding word. The photographs represented everyday objects known to all the children. Many children looked surprised and told the experimenter that they knew what was on the photograph but that they could not spell it. When asked if they wanted to try if the experimenter pronounced the word, they started to spell. Again, this is an indication of a difficulty in retrieving a sound image in the absence of articulatory speech, in order to encode from phonemes to graphemes. Here speech synthesis can be very helpful in spelling. More recent research has demonstrated positive impact of voice output on participation during reading (Bellon-Harn & Harn, 2008), but also on spelling (McCarthy, Hogan, Beukelman, & Schwartz, 2014). McCarthy et al. (2014) found that the accuracy of spelling of pseudo-words increased with access to computerized sounding out. Using the Nonverbal Reading Approach, Coleman-Martin, Heller, Cihak and Irvine (2005) examined the effect on decoding and word identification of three different methods; teacher assistance combined with computer, teacher only and computer only. Since all participants benefitted from all three methods the authors concluded that computer-assisted instruction could be effective, especially in the context of limited access to teacher time. As mentioned above, intervention studies in reading comprehension are almost nonexistent. Light, McNaugthon, Weyer and Karg (2008) undertook a comprehensive study as far as target areas are concerned. The participant was an 8-year-old girl who used aided communication. Besides training phonics through direct instruction, reading of connected text and reading comprehension skills were also included. The girl was also given an opportunity to use her knowledge during shared reading activities, where she was encouraged to take part and indicate words. To motivate her, personalized books were used. During the intervention process that lasted for 16 months, involving 55 hours of instruction in total, she started to read simple sentences with a high degree of accuracy. She also learned to type small stories, with a personal content. Not only did she develop reading skills but the expectations for further success also increased among the teachers. In Erickson’s paper from 2003 with a specific focus on silent reading comprehension, she highlighted two components for written language comprehension: knowledge of text structure and knowledge of the topic. She stressed the importance of selecting texts that are meaningful and thereby motivating to the student. Both the study by Light et al. (2008) and Erickson’s discussion (2003) underscore the importance of motivation discussed in the paper by Snowling and Hulme (2014).

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In sum, the results from the intervention studies outlined above are promising. There is enough material, descriptions of different methods and different targets to encourage teachers and parents to give priority to development of literacy skills in individuals who use aided communication.

Conclusion and further directions There is no doubt that reading and writing are among the most important abilities in our everyday life, gaining even more importance with the growing arena of social media for communication. The constant technological advances also demand literacy abilities. The demands for reading and writing abilities are no less among people who use aided communication. However, experiences from the individuals themselves, parents and teachers along with research results point at clear difficulties to acquire reading and spelling skills. Different explanations of these difficulties have been proposed, often focused on problems within the individual, such as weak phonological abilities or weak phonological memory. It is argued, and some support for this argument has been found in research, that the lack of articulatory ability could affect subvocal rehearsal, contributing to problems in creating a stable and well-specified sound image or phonological representation in verbal short-term memory, stable enough to permit the coding of phonemes to graphemes and vice versa, that is needed for reading and spelling to take place. If such representations are poorly specified, then spelling a word shown as a picture should be more difficult than if the target word is spoken. There is both anecdotal evidence, children declaring that they “cannot hear the word in their heads”, and research referred to in this chapter supporting this interpretation. Such problems would make reading and spelling acquisition more difficult than in children with easy access to natural speech. Factors in the environment have also been discussed. Research has shown that literacy activities often are given low priority in schools and we all know that you do not learn to read unless you practise reading! Motor difficulties constitute another problem for some individuals who use aided communication. Due to difficulties in mobility, in handling objects and also books and writing material, children who use aided communication may get less input than individuals without these disabilities, input that creates a setting or context for written language comprehension. A reasonable explanation of the pervasive difficulties that have been reported in acquisition of literacy skills must encompass both individual and environmental factors acting reciprocally upon each other. Fairly recently, research on intervention has grown. The picture is promising: children develop phonological awareness and decoding skills through different instruction strategies. However, much more needs to be learned about development of reading comprehension and writing activities. The field needs to be developed further, preferably exploiting computerized assessment procedures for clinical use and for research purposes. Individuals who use aided communication constitute a heterogeneous and limited group, explaining why much research has been done on small groups, often case studies. Results must be treated with caution. Therefore, in the future, research

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should be taken through collaboration between researchers, creating larger groups and with scientifically sound experimental designs. To attain this, a cross-linguistic approach would be recommended. A database of empirically sound studies on reading instruction for children who use aided communication would inform both research and clinical work.

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Pennington, B., & Bishop, D.V.M. (2009). Relations among speech, language, and reading disorders. Annual Review of Psychology, 60, 283–306. Rankin, J.L., Harwood, K., & Mirenda, P. (1994). Influence of graphic symbol use on reading comprehension. Augmentative and Alternative Communication, 10, 269–281. Rutter, M. (1978). Prevalence and types of dyslexia. In A. Benton & A. Pearl (Eds), Dyslexia: An Appraisal of Current Knowledge, pp. 3–28. New York: Oxford University Press. Scarborough, H.S., & Dobrich, W. (1994). On the efficacy of reading to preschoolers. Developmental Review, 14, 245–302. Seymour, P.H.K., Aro, M., & Erskine, J. (2003). Foundation literacy acquisition in European orthographies. British Journal of Psychology, 94, 143–174. Smith, M.M. (2001). Simply a speech impairment? Literacy challenges for individuals with severe congenital speech impairments. International Journal of Disability, Development and Education, 48, 331–353. Smith, M.M. (2005). Literacy and Augmentative and Alternative Communication. Boston, MA: Elsevier. Smith, M., Dahlgren Sandberg, A., & Larsson, M. (2009). Reading and spelling in children with severe speech and physical impairments: A comparative study. International Journal of Language and Communication Disorders, 44, 864–882. Snowling, M.J., & Hulme, C. (2014). Closing a virtuous circle: Reciprocal influences between theory and practice in studies of reading intervention. Journal of Research on Educational Effectiveness, 7, 300–306. Stanovich, K.E. (1986). Matthew effects in reading: Some consequences of individual differences in the acquisition of literacy. Reading Research Quarterly, 21, 360–407. Stanovich, K.E., & Cunningham, A.E. (1992). Studying the consequences of literacy within a literate society: The cognitive correlates of print exposure. Memory & Cognition, 20, 51–68. Stanovich, K.E., Siegel, L.S., & Gottardo, A. (1997). Converging evidence for phonological and surface subtypes of reading disability. Journal of Educational Psychology, 89, 114–127. Steele, S.C., & Watkins, R.V. (2010). Learning word meanings during reading by children with language learning disability and typically-developing peers. Clinical Linguistics & Phonetics, 24, 520–539. Sturm, J., & Clendon, S. (2004). Augmentative and alternative communication, language and literacy. Topics in Language Disorders, 24, 76–91. Sturm, J., Spadorcia, S.A., Cunningham, J.W., Cali, K.S., Staples, A., Erickson, K., Yoder, D.E., & Koppenhaver, D.A. (2006). What happens to reading between first and third grade? Implications for students who use AAC. Augmentative and Alternative Communication, 22, 21–36. van Balkom, H., & Verhoeven, L. (2010). Literacy learning in users of AAC: A neurocognitive perspective. Augmentative and Alternative Communication, 26, 149–157. Vandervelden, M., & Siegel, L. (2001). Phonological processing in written word learning: Assessment for children who use augmentative and alternative communication. Augmentative and Alternative Communication, 17, 37–51. Wagner, R., & Torgesen, J. (1987). The nature of phonological processing and its causal role in the acquisition of reading skills. Psychological Bulletin, 101, 192–212. Ziegler, J.C., & Goswami, U. (2005). Reading acquisition, developmental dyslexia, and skilled reading across languages: A psycholinguistic grain size theory. Psychological Bulletin, 131, 3–29.

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Part II L anguage use in aided communication: Theoretical and empirical considerations

8 C o-construction, asymmetry and multimodality in children’s conversations Michael Clarke

Introduction Studies focused on face-to-face interaction involving children provided with augmentative and alternative communication (AAC) tools have, explicitly or implicitly, been concerned with examining the ways in which interactions are accomplished as a product of the interplay between: (a) the practical demands of AAC use (e.g., time required to locate language concepts on the device); (b) the repertoire of other communicative resources utilized by children (e.g., use of body positioning, gaze fixation and transfer, vocalization, use of everyday environmental objects etc.); and (c) what might be considered ‘ideal’ standard models of face-to-face human interaction (e.g., normative practices of turn taking). Such studies have tended to adopt one of two general approaches: quantitative, distributional approaches or qualitative approaches which are either descriptive1 or use the methods and findings of conversation analysis (Wooffitt, 2005). While both sets of methods share a broad concern for examining organizational features of interaction involving AAC use, and generally tend to examine naturally-occurring interactions, they vary in important ways. The term distributional is used in this chapter to represent a body of AAC interaction research that shares a common quantitative approach to analysis (Higginbotham, Mathy-Laikko, & Yoder, 1988), and that draws on pragmatics and in particular speech act theory (Austin, 1962; Searle, 1969) to examine interactions involving AAC. Speech act theory is concerned with the ways in which language is used to perform actions (e.g., promising, requesting, thanking). Participants in conversation are deemed to be able to use and interpret actions because they are presumed to share knowledge of the rules that categorize language according to its functions, plus world/cultural knowledge about how those functions may operate. For instance, a request for information necessitates action on the part of another participant who will provide the requested information. Furthermore, particular rules of interpretation are applicable to the use of speech acts. For example, the request for action in a turn such as “Could I have the salt?” can be 1  Descriptive studies have tended to focus on characteristics of message construction.

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classified as a command because it contains the modal verb element could (Coulthard, 1977, cited in Levinson, 1983). Conversation analysis (CA) has its origins in sociology and is a qualitative and inductive method of analysis. It is concerned with the ways in which social actions are achieved in everyday interaction, and relationships between human communicative behaviour (use of spoken language and nonverbal resources) and the accomplishment of those actions. In the context of everyday conversation, social actions refer to things like arguing, assessing, agreeing, etc., or in institutional settings, to activities such as carrying out an assessment, taking a case history from parents, giving advice, setting shared goals, etc. Historically, distributional approaches have been a mainstay of AAC interaction research, and there now exists a strong body of work that has identified a recurring set of features that appear to characterize much AAC-related interaction. These features include an apparently pervasive asymmetry of conversational contribution by participants, the co-constructed character of AAC users’ contributions, and limitations in AAC use relative to other communicative modalities such as vocalizations and embodied actions such as gestures (Light, Collier, & Parnes, 1985a–c; Pennington & McConachie, 1999). More recently, studies using CA have begun to provide further detailed insights into how these features of conversation come about and are managed by participants (e.g., Clarke & Wilkinson, 2007, 2008). The aim of this chapter is to outline briefly the methods used in distributional approaches and CA, and in particular to illustrate some of the ways in which studies using CA are contributing to knowledge about AAC-related interaction. The chapter will first briefly expand on the use of distributional analyses used in AAC interaction research and highlight the main findings from this body of work related to (a) asymmetry in contribution, (b) co-construction in conversation, and (c) relations between AAC use and other communicative modalities. Subsequently, the chapter will focus on presenting studies using conversation analysis that address and develop insight into these same key themes.

AAC interaction research – Distributional analyses Distributional approaches typically take individual participants’ conversational turns as the primary units of analysis. These can be defined in different ways but commonly this is done according to time elapsed between different participants’ contributions (e.g., 1- or 2-second gap between speakers, not including when a child is operating their AAC system). These turns are ascribed to predefined taxonomies that categorize various aspects of discourse. AAC interaction research has focused primarily on classifying turns according to: (a) the speech act (or illocutionary function) they perform such as a request for an action (directive, e.g., “come over here”), or request for information (elicitation, e.g., “where are you going?”); (b) structural aspects of discourse such as initiation (e.g., turns initiating new topic of conversation) or response (e.g., turns responsive to initiations); and (c) the modality with which contributions are delivered (e.g., speech, AAC, gesture, etc.). Comparisons can then be made of the relative distribution of frequency and type of speech acts, structures and modalities between AAC users and their communication partners.

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In order to reflect the view that aspects of interaction, such as participants’ use of speech acts, work under a basic set of operating principles, to which participants adhere (e.g., that requests for information ‘oblige’ a co-participant to provide that information), some studies have used methods of applied probability to examine associations between such features of analysis (Buzolich & Wiemann, 1988; Light et. al., 1985a–c; Pennington & McConachie, 1999). In these studies, probabilities of certain types of events occurring consecutively (e.g., that provision of information follows a request for information) are compared with sequences of successive events occurring by chance. Research studies adopting frameworks of distributional analysis have returned a core set of findings with remarkable persistence. Perhaps the most commonlyreported characteristic is the asymmetry in conversational contribution by participants. Asymmetry is considered to be a consequence of the ways in which contributions by children provided with AAC are co-constructed and delays in the production of AAC-mediated contributions compared to spoken interaction (e.g., Brekke & von Tetzchner, 2003; Clarke & Kirton, 2003; Hjelmquist & Sandberg, 1996; Light et al., 1985a–c; Müller & Soto, 2002; Pennington & McConachie, 1999; Smith, 2003; von Tetzchner & Martinsen, 1996). Here, the term asymmetry is used strictly in relation to participants’ actions in constructing and managing face-to-face interactions, rather than to the mismatch between language input received by children using AAC (speech) and their output via AAC (graphic symbols) (Smith & Grove, 2003).

Asymmetry and co-construction Asymmetry in interaction is typically characterized as a marked imbalance observed between the number and type of contributions (e.g., structural aspects) made by children using AAC and their naturally-speaking communication partners (e.g., Light et al., 1985a–c). This may be summarized briefly as characterized by communication partners using natural speech providing a much higher proportion of contributions that are typically described as initiators of conversational interaction, and a greater number and more diverse range of speech acts (e.g., Pennington & McConachie, 1999). These interactions have also been described as commonly performing particular activities that are ‘controlled’ or organized by the participant using natural speech, including the focus of conversational topic (e.g., Harris, 1982; Hjelmquist & Sandberg, 1996; von Tetzchner & Martinsen, 1996). In these terms, children using AAC are typically observed to produce relatively few turns compared with their communication partners; their turns are usually described as responsive to others’ initiations, and such turns tend to be characterized by a relatively limited range of illocutionary acts. Within these interactions communication aids are described as being used minimally, or at least perhaps not to the extent expected or desired (e.g., Light et al., 1985c). Speaking partners’ use of multiple questions that make relevant minimal answers by children using AAC is perhaps the classic expression of asymmetry and a strategy by which children’s contributions may be co-constructed. This profile of interaction is hypothesized to come about as a result of naturally-speaking participants’ motivation to increase the overall speed of conversational interaction, to adhere more closely to normative

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timing of naturally spoken interaction (e.g., Beukelman & Mirenda, 1992; Light et al., 1985a; von Tetzchner & Martinsen, 1996). Co-construction is a broad term that is applicable to a vast host of human activity. In an essential sense all interactions are co-constructed in that they are collaboratively accomplished (Jacoby & Ochs, 1995). In the AAC field, the term co-construction has been used predominantly to describe instances where AAC users’ contributions are incrementally developed across interactional turns (e.g., Solomon-Rice & Soto, 2011). Practices of co-construction, including the types of question-answer sequences seen in conversations involving AAC, are not unique to these interactions, but are observed extensively in exchanges between adults with communication disorders and others (e.g., Bloch & Beeke, 2008; Hörmeyer & Renner, 2013), and in interactions between young children developing typically and their carers (e.g., Scollon, 1976, 1979; Snow & Ferguson, 1977). A common theme here is that marked asymmetries appear commonplace in conversations between ‘competent’ users of language and those who may be deemed to be less proficient. Arguably, however, key factors underpinning the emergence of asymmetric interaction patterns in children who use AAC that distinguishes them from typically developing language learners, concern the significant delays inherent in communication aid use coupled with the potential for children’s nonverbal resources to be limited in scope and clarity of expression. In addition, and unlike interaction involving children who use natural speech, such patterns observed in AAC interaction are seen to persist into adulthood.

AAC use and multimodality All speakers and listeners in conversation use a host of multimodal resources in everyday interaction (e.g., Streeck, Goodwin, & LeBaron, 2011). AAC-mediated output, particularly from speech generating devices (SGDs) is commonly incomplete, either grammatically and/or in terms of signalled intent. Therefore, as part of the coconstruction of the contributions of those using AAC, a shared explicit orientation to communication as a multimodal practice is critical. Distributional approaches have been used widely in AAC research concerned with multimodal expression. In such research, mutually exclusive categories of non-aided communication behaviours are identified, tallied, and typically compared with frequency of use of aided communication. A common outcome of such research is the recognition that aided communication modes are used relatively infrequently by children compared with unaided modalities such as vocalization and gesture (e.g., Clarke & Kirton, 2003; Light et al., 1985c; Pennington & McConachie, 1999). For example, in a distributional analysis of interaction between 12 children using AAC and their peers, Clarke and Kirton (2003) reported that only 9% of conversational moves (defined for example as initiations and responses) were carried out using AAC devices. While this figure masks some individual variation, children in these interactions predominantly used unaided modalities. Other types of distributional analyses of multimodality have considered the degree to which unaided modes are deployed by children as complementary or supplementary to the propositional content of the child’s aided contribution. Modalities are described as complementary when different modes contribute different parts of

Co-construction, asymmetry and multimodality in children’s conversations

the proposition, and supplementary when different modes contribute overlapping propositional content (Hanson, Beukelman, & Yorkston, 2013; Heim & Baker-Mills, 1996; Light et al., 1985c; Sutton, Soto, & Blockberger, 2002). For example, using such an approach, an unintelligible vocalization produced in combination with AAC use may be categorized as supplementary, if it is deemed not to provide additional content, but is instead used for some form of emphasis. In a longitudinal case study, Heim and Baker-Mills (1996) reported a developmental progression in the use of different communication modes over a period of two-and-a-half years by a girl with cerebral palsy who used AAC (age 2;7 to 5;0). In general, supplementary combinations (that is, those in which different modes contribute overlapping propositional content) were rare and most of the child’s multimodal turns were complementary, whereby different modes contributed different parts of the proposition. The authors also report interesting changes in the distribution of modality use over time, suggesting that over the course of the study the child appeared to display a growing preference for using the modes that provided a range of symbolic possibilities (e.g., use of deictic eye gaze to an object, person or location).

Summary The application of distributional approaches to the analysis of interaction in the AAC field has provided valuable insights into the character of these complex exchanges. Indeed, findings from the studies, some of which were conducted 30 years ago, demonstrate the widespread and persistent occurrence of asymmetry in communicative contribution, recurring features of co-construction of AAC users’ contributions, and common patterns in the use of AAC and non-AAC modalities. This body of work has been influential in shaping research agendas and philosophies underpinning clinical support for those using AAC and their communication partners. For example, given the long-term persistence of the type of asymmetrical contributions seen in these interactions, a tension has been highlighted between co-construction as asymmetry in relation to ‘getting the message across’, that is a sort of ‘functional asymmetry’, and the legitimate concerns that persistent asymmetry limits opportunities for selfexpression, language learning (Binger & Light, 2008; Sutton et al., 2002; von Tetzchner & Martinsen, 1996), and leads to children adopting ‘passive’ interaction styles (Basil, 1992) in the long term – that is, a type of ‘dysfunctional asymmetry’ (e.g., see Pilnick & Dingwall, 2011, for a discussion of functional and dysfunctional asymmetry in relation to doctor–patient interaction). Next, this chapter considers some examples of the contribution made by the method of conversation analysis to the three key themes of asymmetry, co-construction and multimodality in interaction.

Conversation analysis There is a growing body of interaction research in AAC that uses conversation analysis (CA), or CA-inspired analysis, as its methodological approach. Emerging from the field of sociology, CA’s primary interest is in identifying and describing the structures and procedures with which participants themselves accomplish interaction (e.g., ten Have,

181

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The Silent Partner?

2007; Hutchby & Wooffitt, 2008; Schegloff, 1987), rather than dissecting interaction into component parts based on researcher-designed taxonomies. In particular, it is the specific sequential placement of communicative behaviours as well as their design that is understood to determine the ways in which participants orient to them. Conversationalists typically treat each new contribution as linked to the immediately prior turn, and as assigning a specific set of possibilities for what might relevantly be said next. For example, if a question is asked then essentially an answer is relevant next, and the lack of a delivery of an answer is accountable in some way. This inherent sequential organization or sequentiality (Schegloff, 1984, 2007) of conversational interaction provides a framework within which participants themselves display to each other, and to the analyst, how they are interpreting each other’s prior turns, and what elements of those prior turns are relevant for them. Focusing on those features of the conversation that the participants themselves publically treat as meaningful, through the design and placement of their own turns, provides a strong ecological validity for the analytical claims made by CA (Heritage, 1984). Equally, by taking as relevant evidence of what it is the participants orient to as noticeable and meaningful, a CA methodology applied to interactions involving children using AAC can make reasonable claims to afford insights into the situated experience of disability from the perspective of children with disability themselves (Clarke & Wilkinson, 2009).

Conversation analysis – Insights into asymmetry The characterization of asymmetry from a quantitative, distributional analysis perspective has been invaluable in terms of informing clinical intervention and theoretical perspectives on development in this group. One intriguing point of discussion concerns issues of function versus dysfunction associated with the use of question-and answer sequences as a form of asymmetry in these interactions, and in particular in relation to the typical engagement of individuals using AAC in conversations as respondents to others’ initiations. For instance, in the context of children’s peer talk, Clarke and Wilkinson (2008) suggest that such asymmetry, while potentially problematic for long term language learning, may also function as a resource for speaking participants to understand AAC-mediated contributions, particularly those produced via speech generating devices (SGDs), and for children to deliver SGD-mediated contributions that can be relatively easily understood by others. Where children generate initiated SGD-mediated contributions (that is, contributions that are not as responses to others), these may be more difficult for their conversation partners to understand. That is, more than simply seen as a strategy, or outcome of efforts, to allow AAC users to ‘get messages across’, the realisation of asymmetry can function as a resource and barrier to shared understanding. The following extract, reproduced from Clarke and Wilkinson (2010), is from a conversation between two boys. Jamal (7;11) has cerebral palsy affecting his whole body, and has been provided with a SGD that he accesses using an infra-red light source mounted on a headband. By holding the infra-red light steady over icons on the interface he is able to activate the device. A small LED light in each cell of the interface lights up when the infra-red light has targeted that particular cell. Colin (7;05)

Co-construction, asymmetry and multimodality in children’s conversations

is a child who has typical development. The boys were alone in a school office at the time that this conversation took place. Generally, the boys conducted the conversation by asking each other a series of known answer questions (Schegloff, 2007) in a testquestion activity. (Note, detail regarding the specific transcription conventions here can be found in Appendix 8a).

Extract 8.1 Jamal (J) and Colin (C) (from Clarke & Wilkinson, 2010) →

01

C

02 →

⎜((looking ahead & to right)) ⎦ ⎣ ((looks at SGD))

03

J

⎣(( head tilted and turned towards C))

04

J

⎡((orients to SGD))⎤ * ⎡((oriented to SGD))⎤ * “of course”

05

C

⎜((looking at SGD))⎜ ⎜ (looking at SGD)) ⎜

06 →

⎣

(1.6)

⎦ ⎣

⎦

J

⎡((oriented to SGD))⎤ * ⎡((oriented to SGD))⎤ * “four” ⎡((looks at C))⎤

08

C

⎜((looking at SGD)) ⎜ ⎜ ((looking at SGD)) ⎜

10

⎣ C

11 →

(3.0)

07 09

→

⎡ how many times have Brazil ⎤ ⎡won the world cup

12

15

⎦

⎣

(1.0)

⎦ ⎡ :eah

⎡ye:

⎣((flicks arm forward and pulls it back towards chest, looking at J)) ⎣ ((arm reaches chest, looks at VOCA)) C

13 14

(0.8)

⎣ ((looks at J)) ⎦

⎡

spot on

⎤

⎜((leaning back looking at VOCA))⎜ J

⎜ ⎣

(vocalizes)

⎜

((turns head left and down)) ⎦

Essentially, this extract illustrates an exchange where Colin asks a question and Jamal answers it. More specifically, Colin’s question prompts Jamal’s use of his SGD because he is unable to respond intelligibly using the unaided resources at his disposal. Questions make answers the most relevant next action (Sacks, Schegloff, & Jefferson, 1974). Therefore, Colin’s question makes relevant an answer from Jamal, and in order to answer the question Jamal will need to use his SGD. As such, a specific sequential “slot” (that is, a point or position in the sequence of events) is created for Jamal’s SGD use, and for Jamal to use it for a particular job (answer the question), and, in part at least, the likely content of that contribution is projected. Jamal can answer the question fully by providing a single word answer, in this case a number (four). After working with his device Jamal produces “of course” (line 04). While not the answer, it can be heard as a form of stance or attitude towards the forthcoming next element of his contribution, which turns out to be the answer “four” (line 07). Colin then celebrates and affirms the answer as correct, saying “yeah” and “spot on” (line 10-12).

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The Silent Partner?

184

Clarke and Wilkinson observe that because questions make answers relevant next, by asking a question, speaking partners generate specific interactional slots for the use of AAC (in their examples, use of an SGD) that may be treated as an answer, despite being limited in content and form (e.g., a single letter), and potentially being significantly delayed in production. Clarke and Wilkinson contrast AAC-mediated contributions produced as responses with initiated AAC-mediated turns. In these latter types of exchanges it is possible that because initiated AAC-mediated turns are generated outside pre-defined conversational slots, they are more vulnerable to being misunderstood in terms of how elements of a contribution combine and relate to what has just been said. For example, the extract provided here is from a conversation between two young people, here called Tina and Lucy (Clarke & Wilkinson, 2008). This extract has been shortened from the original but without altering the sequential alignment and progression of each girl’s contribution. Like Jamal, Tina (14;10) has cerebral palsy affecting her whole body. She gains access to her SGD via head switches positioned in her headrest. By triggering the switches she operates a scanning procedure on her device. Each column is highlighted in turn and when the column with the target is illuminated she activates a head switch to start scanning the row in which that target is positioned. When the specific target is highlighted she can select it by hitting her head switch again. Lucy, (14;4) also has cerebral palsy affecting her lower limbs predominantly, and she has fully intelligible speech. In this exchange the girls are alone in a room in their school and they have been talking about the previous weekend and have just finished chatting about what Lucy ate for dinner.

Extract 8.2 Tina (T) and Lucy (L) (from Clarke & Wilkinson, 2008, p.8) 01

L

did ⎡you wanna come back to school ⎤

02

→

T

((nods head falling forward with chin down to chest))

04

L

((looks away))

05

T

⎡((lifts head up looking at SGD, hits switch twice)) ⎤ * ⎡ ((oriented to SGD, switching)) ⎤

06

L

⎜

08 10

L T

ya g ⎡un⎤ na say something = ⎡

*

T

⎤

⎡((looking at SGD, hits switch))⎤ * ⎣

L

(0.8)

ya gonna ⎡say⎤ ↑­something

⎜ ⎜ ⎦

⎣((small head movement forward & back))⎦

13 14

(3.0) ⎡* ⎤

11 12

((looking away))

⎣

09

→

⎦

03

07 →

((raises arms))

⎣

⎦

((looks at T))

⎜

Co-construction, asymmetry and multimodality in children’s conversations

15

⎣*⎦

→

16

T

((nods looking at SGD))

→

17

L

⎡yes⎤

18 21

185

⎣ * ⎦ * * Tina continues to work with her SGD T

(29.7) “g”

22

Over the next 47.9 seconds Tina spells out the word green 25

T

26

“green” (1.9)

27

L

green

28

T

((head nods forward))

29

(4.2)

30

L

is it something that you (wore/brought)

31

L

you went out and saw a green((raises hand))

32

T

“s”

33 34

(3.4) L

35

o:h: = (7.5)

36

L

(3 syllables) a picture of green

37

T

((shakes head orientated to SGD))

38

L

no

39 40

(5.4) L

41 42

um: (3.0)

L

43

°I don’t know° (2.1)

44

L

do I know what it is

45

T

((nods))

46 47

0.8) L

48

is it that cardboard thing over there (2.7)

49

L

°no° I know what it is

51

T

((forward head movement, remains looking at SGD))

52

L

is it (.) i:s it in school =

53

T

“dinner”

54

(2.1) Continues on next page

The Silent Partner?

186

55

L

gr↑een↑­din↓ner

56

T

⎡((small forward head movement))⎤ “greens dinner”

57 58

⎣ L

59

(2.4)

⎦

f°h (0.2) >what ya< (2.5)

60

L

um you had (.) um (2.7) you ha:d veg

61

T

((large nod forward, chin dropping to chest & sigh))

62 63

(1.1) L

oh

Lucy then goes on to ask did you wanna come back to school (line 01). Tina starts working with her head switches and apparently observing this Lucy asks ya gunna say something (lines 08 and 14), which is confirmed by Tina with a nod (albeit while still looking at her SGD (line 16)) to which Lucy provides verbal receipt saying yes line (17). Tina then goes on to spell the word green letter by letter. Lucy then begins to establish the intended meaning of the single word by offering a sequence of candidates that Tina can presumably accept as accurate or reject as not. Lucy then offers candidates based on her treatment of green as an adjective and in relation to her own preceding question about the weekend, when it transpires Tina intends it as a noun (vegetable) and in relation to the earlier conversation about what she had eaten for dinner. At line 32 Tina generates a further letter “s” in isolation, and after 3.4 seconds Lucy says oh: (line 34) extending the vowels. It is uncertain whether oh is related to Tina’s production of the letter “s” or not, but Lucy does not explicitly orient to it. Instead she continues to offer candidate interpretations of the word green to which Tina responds non-verbally. Tina then uses her SGD to produce the word “dinner” (line 53). Lucy combines dinner with green and the apparent absurdity of this combination green dinner is evidenced in her extreme shift in pitch. Tina then also generates the two words combined using her SGD to say “greens dinner”. It is only at this point that Lucy finally understands the intended meaning of Tina’s SGD-generated contribution. Tina is telling Lucy that she had greens (a vegetable) for dinner – that is she is referring back to their prior topic of conversation, while Lucy had erroneously been treating green as an adjective and related to other weekend activities. Clarke and Wilkinson (2008) argue that this exchange illustrates a potential problem that can exist for both participants in conversations, where SGD-mediated talk is generated outside the context of a prior initiating turn (e.g., question) by the participant using natural speech. While the girls eventually established the meaning of Tina’s contribution, the time and effort in doing that was considerable. Using conversation analysis to examine the sequential alignment of the participants’ actions, Clarke and Wilkinson begin to suggest that it is possible for certain advantages to be gained by children provided with AAC and their communication partners in the asymmetrical character of turn exchange, observed so prevalently in these types of conversations. Conversationalists seek to understand each other’s contributions with reference to the immediately prior turn. AAC-mediated contributions (particularly

Co-construction, asymmetry and multimodality in children’s conversations

SGD contributions) may be easier for conversation partners to understand when generated as ‘responses’ than those that are generated as “initiated” turns, that is, not in response to others. As responses, AAC-mediated contributions are operating under the relevance framework projected by the natural speaker’s immediately prior turn, so although potentially limited in content and form, they may be interpreted with respect to the likelihood that they are in some way linked with the prior turn. Equally, for children using AAC, contributions produced as responses (that is, under the relevance framework set up by the prior turn) may be easier to produce so that they are understood. Here then, the operating principle of sequence organisation (or sequentiality) inherent in conversational interaction provides both opportunities and potential constraints on mutual understanding.

Time, timing and asymmetry A further central issue for conversation involving AAC use and its pervasively asymmetrical character concerns time and timing in relation to participants’ contributions (Engelke & Higginbotham, 2013; Higginbotham & Wilkins, 1999). It is well documented that contributions generated via AAC systems take longer to produce than spoken ones. The widespread patterns of asymmetry observed in these conversations (e.g., question and answer sequences) have, in large part, been accounted for in terms of participants’ response to dealing with delays in the delivery of AAC-mediated contributions intrinsic to AAC use (e.g., Harris, 1982; Light et al., 1985a). That is, asymmetry is a consequence of speaking engineering conversations, and AAC use in those conversations, such that they replicate more closely the progressivity (Lerner, 1996; Schegloff, 1979, 2007) of conversational interaction more typical of natural speakers. One important aspect of progressivity in relation to interactions involving AAC use concerns the regular fact that next parts of “structured units” (Schegloff, 1987, p. 268) such as turns in a conversation or elements of an individual turn, should typically occur contiguously and continuously. Conversational interaction that becomes discontinuous, for example, due to delays in the production of a participant’s turn, is conspicuous and accountable in some way. Not all delays are the same or are oriented to in the same way by participants, and differences in the ways in which delays are treated by participants can be seen to be related to the specific sequential location in which they are produced (Clarke & Wilkinson, 2010; Engelke & Higginbotham, 2013; Higginbotham & Wilkins, 1999). In the context of turn exchange from the end of a natural speaker’s turn to the start of a SGD-mediated turn, Clarke and Wilkinson (2010) have hypothesised that in addition to aiding the clarity of meaning of SGD-mediated contributions, the positioning of SGD-mediated turns as responses to others’ turns may provide slots where delays to progressivity are relatively unproblematic, or at least the reason for delay may be accounted for because an answer is due. For instance, considering again extract 1 above, Colin’s question how many times have Brazil won the world cup (line 01) unmistakeably allocates Jamal as the next speaker and so any delay in responding is essentially attributable to Jamal. A delay of 4.6 seconds emerges before Jamal generates “of course” (line 04), which is much larger than the typical maximum observed silence of about 1 second occurring between turns (Jefferson, 1989). It transpires that “of course”

187

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The Silent Partner?

is the spoken start of this answer. However, although the production of synthesised speech is delayed this sequential slot is occupied with Jamal’s SGD-oriented activity (e.g., looking at the device) and the production of a bleep, which turns out to be in production of the first element of the answer “of course”. Clarke and Wilkinson propose that this SGD-focused activity functions as a form of pre-beginning (Schegloff, 1996), signalling that the spoken element of the turn is forthcoming. Pre-beginnings in spoken interaction include actions like throat-clearing or accentuated in-breath. These are actions that project the onset of speech, but are not speech themselves. Here, Colin waits in silence, looking at the SGD, arguably displaying an orientation to delay as unproblematic. AAC-mediated turns that are not generated as responses may be more prone to natural speakers’ talk co-occurring with potential pre-beginnings, for example, in bids to clarify the intention of SGD activity. In extract 8.2 above, following confirmation with a head nod that she wanted to come back to school, Tina initiates an SGD-mediated turn. Here, Lucy generates talk co-occurring with the pre-beginning of Tina’s turn, that is her SGD-oriented activity in preparation for the first spoken element of the word “green”. Lucy asks whether Tina is going to say something and Tina nods in affirmation (line 08-14). Following that exchange Lucy waits for a full 29.7 seconds in silence while Tina generates the first letter of the word green. Clarke and Wilkinson suggest that Lucy appears to apply a form of “relevance framework” in relation to Tina’s SGD actions, by which she can establish the implication of delays. This is not to say that all pre-beginnings of SGD responses are immune to other’s co-occurring talk, or that all SGD-mediated turns delivered other than as responses are problematic at the pre-beginning phase. Rather, it is possible that the collaborative realisation of pre-defined points of speaker transfer seen in these children’s conversations show an active orientation to delays in progressivity, where delays are not only likely but relevant.

Conversation Analysis – Insights into multimodality Interactions in which AAC is integrated can be seen as versatile and creative “semiotic environments” (Streeck et al., 2011 p. 2), in which a range of resources with different properties can be combined to create communicative contributions. In order to gain a rich understanding of the ways in which multimodality operates in AAC-related conversations, an appreciation of the specific, local points at which different modalities are treated as relevant in an on-going sequence of conversation may compliment or help to elucidate findings from distributional research. Highlighting and explicating the inherent, integrated multimodality of conversational practice involving children with complex needs has been a prominent aspect of CA-inspired work in the field, including where formal AAC systems are not in use (Korkiakangas & Rae, 2013; Sigurd Pilesjö, 2014). While such work highlights a range of interesting phenomena, the discussion in this chapter considers aspects of multimodality in relation to the generation of AAC-mediated contributions; specifically that is, with respect to the content of the AAC-mediated contribution. In so doing the analyses presented highlight issues related to multimodality as it is responsive to and simultaneously propagates so-called

Co-construction, asymmetry and multimodality in children’s conversations

189

“triadic” interaction frameworks. That is, how the participants demonstrate how they are physically and interactionally oriented to each other and the AAC device or tool. The following extract taken from Sundqvist, Plejert and Ronnberg (2010) demonstrates a particular way in which Helen, a 10-year-old child with cerebral palsy, systematically deploys a particular eye movement (looking up) at specific slots in relation to her communication partner’s “reading” of the latest symbol to which she has pointed, to signal problems with her turn construction. Helen uses a Bliss symbol chart and points to items using a head-mounted light source. An excerpt from Sundqvist and colleagues’ longer transcript is shown here and some minor amendments have been made to the original transcription notation, in order to provide consistency with other extracts in this chapter. Nevertheless, the core sequential relationship between the participants’ actions shown here is unaltered from the original. This example provides a useful and accessible illustration of the integration of AAC use plus eye movements as a multimodal strategy in message construction.

Extract 8.3 Helen (He) and Hass (Ha) (from Sundqvist et al., 2010, p.170) 01

He

I,MY

02

Ha

I

03

(4.0)

04

He

AM

05

Ha

am

06

(6.0)

07

He

COLD ((points on other chart))

08

Ha

cold

09

(6.0)

10

He

I,MY

11

Ha

I

12

(1.0)

→

13

He

((looks up))

→

14

Ha

no

15

(4.0)

16

He

COULD

17

Ha

could

18

(2.0)

19

He

YOU,YOUR

20

Ha

you Continues on next page

The Silent Partner?

190

21 22

(1.5) He

23

((looks up)) (6.0)

24

He

I,MY

25

Ha

my

26

(2.0)

→

27

He

((looks at Hass, looks up))

→

28

Ha

no (0.5) could you ((looks at Helen))

29 30

(3.0) Ha

31

could (1.0)

→

32

He

((looks at Hass, looks up))

→

33

Ha

no (0.5) from the beginning

34 35

(2.0) He

I,MY

Following each occasion that Helen points to the communication chart, Hass voices Helen’s selections, thus providing a public/audible treatment of Helen’s actions. Helen’s choice of symbol and the role played by Hass in speaking those selections aloud echoes what Goffman (1981) refers to as the author (or person who chooses the words) and animator (or sounding box) distinction. Here Helen authors the contribution and by animating it (speaking it) Hass presents it as “in play” (Wilkinson, Bloch, & Clarke, 2011). Of particular interest for this discussion is Helen’s use of looking behaviour at lines 13, 27, and 32. In the sequential slot immediately after Hass has spoken aloud his reading of the symbol to which she has just pointed, Helen looks up. In particular, at lines 27 and 32 following Hass’ public treatment of Helen’s symbol selection, Helen looks directly at Hass, apparently to gain his visual attention, before looking up. On each occasion immediately after Helen looks up, Hass says no (lines 14, 28 and 33). The precise point at which Helen produces this looking behaviour in relation to her pointing at the Bliss board and Hass’ spoken treatment of that point, has implications for the generation of the AAC-mediated contribution. Sundqvist and colleagues contend that Helen’s looking behaviours initiate a self-repair (Schegloff, Jefferson, & Sacks, 1977) on part of her contribution thus far, and that Hass makes public his treatment of this looking behaviour by saying aloud no. While Hass is treating Helen’s actions as initiating some form of repair, it may be uncertain to him which specific element of the contribution so far is problematic. For instance, at line 33 following Helen’s look at him and glance up, Hass says no (0.5) from the beginning. Whether from the beginning is intended as a request for how Helen might proceed, and/or how Hass is preparing to interpret what Helen does next, is perhaps uncertain. Nevertheless, Hass treats Helen’s looking behaviours as an indication that he might delete the relevance of the symbol(s) to which she has just pointed and/or his

Co-construction, asymmetry and multimodality in children’s conversations

treatment of Helen’s point. In the context of this discussion, the key issue concerns how Helen’s contribution is co-constructed through the integration of multiple modalities, including AAC use accessed via pointing, the specific placement of Helen’s looking behaviours, and Hass’ orientation to and spoken treatment of those actions. In relation to Helen initiating a self-repair of her turn so far, the specific placement of Helen’s looking behaviours in relation to Hass’ speech appears crucial. A slot is available immediately following Hass’ spoken receipt of her point for Helen to signal any misunderstandings of intended meaning displayed by Hass, or to continue to develop her message (which implicitly signals that Hass’ interpretation of the meaning of her symbol point is accurate). Aided speakers and their speaking partners’ collaborative engagement with AAC-mediated contributions in this specific way, (termed “pointresponse routine” by Higginbotham & Wilkins, 1989, p. 70) has also been recognised as a potentially useful mechanism for reducing misunderstandings in adult conversation involving AAC use (Higginbotham & Wilkins, 1989; Higginbotham & Wilkins, 1999). The sequential organisation of the participants’ actions involving combined use of AAC and looking behaviours is key to the effective co-construction of Helen’s contribution, and it is shared orientation to each other and the AAC system that establishes and maintains the interaction as triadic. In the case of low-tech AAC use more generally, it is a shared (visual) orientation to the AAC “interface” (the chart or page) that is central to their use. While this is an operating principle of low-tech AAC use, it is observed also in children’s use of SGDs. For instance, evidence of shared orientation to device interface is seen in the extract from Jamal and Colin’s conversation above where, following his question, Colin turns to look at Jamal’s device interface even before he has finished his question how many times have Brazil won the world cup, suggesting a shared alignment with the device as the likely animator (Goffman, 1981) of Jamal’s utterance. The next example, drawn from Noren, Svensson and Telford (2013) illustrates further a shared “triadic” operation that has been seen to occur in these types of conversations. Like Sundqvist and colleagues’ example above, the current exchange demonstrates how shared access to the device interface, this time in the context of high-tech AAC use, in adult-child interaction has implications for the ways in which the interaction is co-constructed. Unlike the example above, in this exchange Noren and colleagues (2013) highlight how both the adult and child have visual access to the device screen; this affords the adult an opportunity to use carefully timed and subtle vocalisations in relation to the child’s physical actions of access to the touch-screen device (pushing on-screen symbols) to influence the selection of vocabulary prior to their SDG speech production. As such, the role of author and animator becomes unclear (see also Smith, 2003). In the conversation just prior to the extract below, Emil, a 13-year-old child with cerebral palsy and his teacher have been discussing a trip Emil made to the theatre with his relatives and a stay in a hotel. The key issues for this discussion concern the point where, after smiling at one of the camera operators (CO1), Emil moves his hand toward the device interface. The teacher observes this movement and at the exact moment that Emil stops moving and holds his hand over the symbol for PLACES (line 07), the teacher opens his mouth and is heard to take a deep breath, which can be heard as the potential initiation of a spoken turn (see pre-beginnings discussed above). Emil then

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immediately moves his hand on to a position poised over the PERSONS symbol. Again, just as his hand stops over a possible symbol selection the teacher produces a further vocalisation, this time described by Noren and colleagues as an ‘acknowledgement’ where the consonant is elongated and designed with a distinctive rise in pitch mm:::?. Emil then selects the PERSONS symbol and immediately subsequent to that, and before Emil accesses the submenu of persons, the teacher asks a question who came along on (.) down on the trip (line 13/14); a question that makes relevant the production of a name in response, delivered in the knowledge that Emil has selected the PERSONS folder.

Extract 8.4 Emil (E) and Teacher (T) (Noren et al., 2013) 01

E

02

→ → →

⎡o(inga) fick va med¿o

⎤

⎜(no one) could come along’

⎜ ⎜

03

T

⎜((turns gaze down at object in his own hand))

04

E

⎣((smiles, turns head and gaze towards CO1, and back))⎦

05

E

((moves hand towards screen )) ⎡((continues moving moves hand towards screen)) ⎤

06

T

07

E

⎡((stops finger over PLACES, 1.0))⎤

08

T

⎣pt .hh::::

09

E

((moves finger over screen, stops finger over PERSONS))=

10

T

=mm:::?=

11

E

={MM:MÄNNISKOR}

12 13

T E

20

⎜ down on the trip’

⎜

⎣{PEM:FAMILJ}

⎦

‘FAMILY’ E

18 19

vilka va de som va med på- (.) ⎡ner (.) på resan ⎤ ‘who came along on-‘

16 17

⎦

‘PERSONS’

14 15

((looks at Emil’s hand))

⎣

{FM:MORMOR “mormor”} ‘GRANDMA grandma’

T

mormor va med ja. (0.6) j↑ust de. ‘grandma came along yes that’s right’

Noren and colleagues argue that the specific sequential placement of the teacher’s vocalisations, at the points at which symbol activations are potentially imminent, act to display the teacher’s orientation or stance toward that potential symbol/superordinate language category. Noren and colleagues suggest that while the intention of the teacher’s first vocalisation may appear ambiguous from a third party analyst perspective, its

⎦

Co-construction, asymmetry and multimodality in children’s conversations

sequential placement with respect to Emil’s point and Emil’s subsequent withdrawal of the point suggest that Emil may treat the adult’s vocalisation as a signal not to select that symbol. The teacher’s second vocalisation is however distinctly audible and recognisable as a “go ahead” (Goodwin, 1986) to select the symbol. Critically from a CA perspective, it is Emil who appears to treat it as such by his activation of the symbol, immediately following the adult vocalisation. It is possible also that, in stopping and holding his finger above the symbols and not immediately selecting them, Emil may invite some form of comment from the teacher. Thus, the teacher and Emil display a finely tuned and collaborative orientation to SGD use in what might be described as a triadic configuration of interaction. In this exchange, the multimodal resources deployed are distributed between teacher and child, and the sequential management and structure of the exchange is the mechanism by which the Emil and his teacher collaboratively establish an SGD-mediated contribution.

Summary In this chapter, distributional approaches have been outlined alongside a description of the principles and methods of conversation analysis. Quantitative distributional analyses of AAC interaction have provided researchers and clinicians with a well-established and generalised understanding of essential characteristics of AAC interaction. Key features of interaction drawn from such analyses addressed in this chapter are those related to marked asymmetry in participants’ contributions to interaction, associated with co-constructed AAC-mediated contributions, and concerns for the use of AAC tools in relation to other communicative modalities. Conversation analytic studies reported here have provided insights into the ways in which asymmetry may contribute to, or hinder, shared understanding of AAC-mediated contributions – that is, not just that asymmetry is present in these conversations but how so-called functional and dysfunctional asymmetry may be realised. Equally, the type of sequential analysis afforded by CA has shed light on the ways in which issues of time and timing may or may not be consequential to the interaction, and how the relevance of delays as problematic may vary on a moment-by-moment basis. Finally, qualitative sequential analyses have highlighted some ways in which children with communication disabilities and their communication partners utilise multiple modalities specifically in relation to AAC use, and how both participants may treat the AAC tool as a shared resource. While the examples presented have been discussed in relation to particular aspects of analysis (asymmetry, co-construction, time and timing, multimodality), each of these aspects of interaction is evident in each of the examples provided. For instance, all face-to-face conversation is a multimodal accomplishment, and Extracts 8.1 and 8.2 that have been used in a discussion of asymmetry are equally as rich in their use of multiple modalities as Extracts 8.3 and 8.4, which are used specifically to illustrate this aspect of interaction. Equally, each extract represents a collaborative enterprise by the child using AAC and their co-participant. As such it has been suggested that the collaborative orientation to AAC use by both participants in conversational dyads may precipitate a subtle shift in the way such conversations are characterised. That is,

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rather than referring to them as conversation between children using communication aids and others, they may more accurately be referred to as conversations that use communication aids (Clarke & Wilkinson, 2007). Analyses of these types of conversations invariably characterise aspects of communicative competence – that is competence as the outcome of a shared multi-party performance (Clarke & Wilkinson, 2013). Here qualitative sequential analysis provides a bottom-up examination of competence “….as it plays out in all its incredible complexity as people go about managing their identities, their relationships and their lives” (Jacoby & Ochs, 1995, p. 179). Finally, given the dynamic creativity of conversations that involve communication aid use, clinicians and researchers in the field are charged to continue to explore methodological approaches that can capture as fully as possible, its diversity and brilliance.

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Light, J., Collier, B., & Parnes, P. (1985c). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Part III—modes of communication. Augmentative and Alternative Communication, 1, 125–133. doi:10.1080/07434618512331273621 Müller, E., & Soto, G. (2002). Conversation patterns of three adults using aided speech: variations across partners. Augmentative and Alternative Communication, 18, 77–90. doi:10.1080/07434610212331281181 Norén, N., Svensson, E., & Telford, J. (2013). Participants’ dynamic orientation to folder navigation when using a VOCA with a touch screen in talk-in-interaction. Augmentative and Alternative Communication, 29, 20–36. doi:10.3109/07434618.2013.767555 Pennington, L., & McConachie, H. (1999). Mother-child interaction revisited: communication with non- speaking physically disabled children. International Journal of Language & Communication Disorders, 34, 391–416. Pilnick, A., & Dingwall, R. (2011). On the remarkable persistence of asymmetry in doctor/patient interaction: A critical review. Social Science and Medicine, 72, 1374–1382. doi:10.1016/j.socscimed.2011.02.033 Sacks, H., Schegloff, E. a, & Jefferson, G. (1974). A simplest systematics for the organization of turn taking for conversation. Language, 50, 696-735 doi:10.2307/412243 Schegloff, E. (1979). The relevance of repair for syntax-for-conversation. In T. Givon (Ed.), Syntax and semantics 12: Discourse and syntax (pp. 261–288). New York: Academic Press. Schegloff, E. (1984). On some questions and ambiguities in conversation. In J. M. Atkinson & J. Heritage (Eds.), Structures of social action: Studies in conversation analysis. Cambridge: Cambridge University Press. Schegloff, E. (1987). Analyzing Single Episodes of Interaction: An Exercise in Conversation Analysis. Social Psychology Quarterly, 50, 101–114. Schegloff, E. (1996). Turn organisation: One intersection of grammar and interaction. In E. Ochs, E. Schegloff, & S. A. Thompson (Eds.), Interaction and grammar (pp. 52–133). Cambridge: Cambridge University Press. Schegloff, E. (2007). Sequence organisation in interaction: A primer in conversation analysis. Cambridge: Cambridge University Press. Schegloff, E., Jefferson, G., & Sacks, H. (1977). The preference for self correction in the organisation of repair in conversation. Language, 53, 361–382. Scollon, R. (1976). Conversations with a one year old: a case study of the developmental foundation of syntax. Honolulu: University Press of Hawaii. Scollon, R. (1979) A real early stage: An unzippered condensation of a dissertation on child language. In E. Ochs & B. Schieffelin (Eds.) Developmental Pragmatics. London: Academic Press. pp215-227. Searle, J. (1969). Speech acts: An essay in the philosophy of language. Cambridge: Cambridge University Press. Sigurd Pilesjö, M. (2014). Creating meaning through the coordination of gaze direction and arm / hand movement. Journal of Interactional Research in Communication Disorders, 5, 63–96. Smith, M. M. (2003). Environmental influences on aided language development: The role of partner adaptation. In S. von Tetzchner & N. Grove (Eds.), Augmentative and alternative communication: Developmental issues (pp. 155–175). London: Whurr. Smith, M. & Grove, N. (2003). Asymmetry in input and output. In J. Light, D. Beukelman & J. Reichle (Eds.). Communicative competence for individuals who use AAC (pp. 163-198). Baltimore: Brookes. Snow, C. E., & Ferguson, C. A. (1977). Talking to children: Language input and acquisition. Cambridge: Cambridge University Press. Solomon-Rice, P., & Soto, G. (2011). Co-Construction as a Facilitative Factor in Supporting the Personal Narratives of Children Who Use Augmentative and Alternative Communication. Communication Disorders Quarterly, 32, 70–82. doi:10.1177/1525740109354776

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Streeck, J., Goodwin, C., & LeBaron, C. (2011). Embodied interaction in the material world: An introduction. In J. Streeck, C. Goodwin, & C. LeBaron (Eds.), Embodied interaction: Language and body in the material world. Cambridge, UK: Cambridge University Press Sundqvist, A., Plejert, C., & Rönnberg, J. (2010). The role of active participation in interaction for children who use augmentative and alternative communication. Communication and Medicine, 7, 165–175. doi:10.1558/cam.v7i2.165 Sutton, A., Soto, G., & Blockberger, S. (2002). Grammatical issues in graphic symbol communication. Augmentative and Alternative Communication, 18, 192–204. doi:10.1080/07434610212331281271 von Tetzchner, S., & Martinsen, H. (1996). Words and strategies: Conversations with young children who use aided language. In S. von Tetzchner & M. H. Jensen (Eds.), Augmentative and alternative communication: European perspectives (pp. 65–88). London: Whurr. Wilkinson, R., Bloch, S., & Clarke, M. T. (2011). On the use of graphic resources in interaction by people with communication disorders. In J. Streeck, C. Goodwin, & C. LeBaron (Eds.), Embodied Interaction: Language and Body in the Material World (pp. 152–168). Cambridge: Cambridge University Press. Wooffitt, R. (2005). Conversation Analysis and Discourse Analysis: A Comparative and Critical Introduction. SAGE Publications. Retrieved from https://books.google.com/books?id=zDmTB8KlKGwC&pgis=1

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Appendix 8a Additional transcription notation ((smiles)) text in double brackets represents a description of non-verbal action. Font size is reduced in order to accommodate a suitable description within the space available in the transcript. ⎡ ⎣ ⎤ ⎦ (.) (1.7) * ­↑↓ stress

a left‑hand bracket links an ongoing utterance with an overlapping utterance or non-verbal action at the point where the overlap/simultaneous non-verbal action begins a right‑hand bracket marks where overlapping utterances/simultaneous non-verbal actions stop overlapping a full stop in single brackets indicates an interval of tenth of a second or less in the stream of talk a number on single brackets indicates the time interval to one tenth of a second speech generating device (SGD) generated bleep marked rising and falling shifts in intonation are indicated by upward and downward pointing arrows immediately prior to the rise or fall underlining indicates emphasis

oh:

a colon indicates an extension of the sound or syllable it follows (more colons prolong the stretch)

°no°

degree signs indicate a passage of talk which is quieter than surrounding talk

>talk>little - Arrow brackets indicate that Karl selected a word on his word prediction list. ^ LIGHT UP A LITTLE - SGD output.

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Figure 9.5 Karl and Jess. Left: Jess evaluating whether Karl’s eye-tracker is working. Middle: Jess adjusts Karl’s map. Right: Jess looks on while Karl spells “LITTLE”.

until he completes and delivers his utterance via synthesized speech (Engelke & Higginbotham, 2013, p. 103). In the beginning, Jess uses the selection clicks and letters appearing on the message display as evidence for the functionality of Karl’s eyetracker (lines 6–7). However, Jess does not regard Karl’s typed output as the beginning of a relevant response to her question Is it ok Karl? (line 6). Instead, she uses Karl’s typing behaviour as an affirmative answer to her question (lines 6–7). That is, Jess assumes that Karl’s typing actions are sequentially relevant to her ongoing talk. As pointed out by Higginbotham and Engelke (2013), “Jess’s actions assume their own interactional rhythm and expectations of responsivity, constituting a temporal-sequential order different from that of Karl’s persistent typing, and more in line with normative practices of mouth-speech interaction” (p. 104). For instance, in lines 17 and 18, Jess uses Karl’s just completed word (up) as an affirmative response to her question: Do you want the other light on? Again in line 21, Jess asks, Does that help Karl?, while standing at the end of the bed. Walking around the bed and looking at Karl’s display, Jess interprets Karl’s most recent letter productions (a l-i) as a relevant response to her question –- although the letters really constitute only a part of Karl’s intended response to Jess’s question in line 6. Karl and Jess experience a temporal misalignment due to the different expectations that emerge from their largely unshared communication projects. When completing his composition 55 seconds later, Karl speaks Light up a little, then glances up at the overhead light. Once spoken, Jess reorients her activity to address Karl’s request. Their interactions, uncoordinated during the previous minute, sync back up when Karl produces speech through his SGD and coordinates his subsequent interactions through gesture. In this situation, Karl made a costly decision: to attempt to gesture his intentions without guarantee of his interlocutor’s attention or correct interpretation, or slowly type out a response, risking misinterpretation and recasting of his in-progress composition. Karl chose the latter and persevered through his wife’s unintended hijacking of his utterance-in-composition. In this case, the graphic display of the SGD and Karl’s persistent activity was not enough to keep Jess from adhering to her normative temporal-sequential expectations of her interlocutor, even though Karl was unable to conform to them using his device.

Time and timing in interactions

Time, timing, and SGDs: Summary and conclusion You all know the test for artificial intelligence – the Turing test. A human judge has a conversation with a human and a computer. If the judge can’t tell the machine apart from the human, the machine has passed the test. I now propose a test for computer voices – the Ebert test. If a computer voice can successfully tell a joke and do the timing and delivery as well as Henny Youngman, then that’s the voice I want (Ebert, 2011). Roger Ebert’s closing at his TED Talk in 2011 provides an honest and humorously pointed critique of synthesized speech output. It all comes down to timing and delivery – and he was still waiting for it. As we have tried to describe in this chapter, Ebert’s problem with SGDs is that it takes time to compose what you want to say and control in “getting it out”, so that the talk is relevant and effective. Just as Ebert used his friends to give most of his TED Talk, we found that the interaction costs of using current SGDs prompt their users to frequently employ other means to get talk-in-interaction done. The following is a summary of our findings based on the videos analyzed in this chapter, as well as our general observations of the dataset: 1. The individuals we observed – both the augmented speakers and their interlocutor partners – sought to coordinate their actions to achieve the contingent co-production of meaning through real-time (Higginbotham & Wilkins, 1999; Suchman, 2007, p.23). They consistently sought to ground their spoken and gestured contributions in spite of a variety of significant bodily and technical constraints. 2. SGD use was a decision made by the augmented speaker based on the task requirements at given points in the interaction. In the situations observed, augmented speakers used SGDs primarily to convey specific referential information in the wayfinding task. Outside of this occasioned SGD use, all other collateral talk including agreement checks, attention bids, and the expression of opinion, attitude, and humor were handled via body-based resources. 3. When available, the SGD’s visual display was a preferred means by which interactants jointly coordinated their actions to ground their utterance contributions. The display makes visible the composition progress, as well as maintaining a permanent record of the content of the utterance-in-progress. 4. When SGD’s were used, the augmented speaker’s utterance composition time postponed immediate grounding between interlocutors. Both participants appeared acutely aware of it, as evidenced by their use of strategies to mitigate the delays resulting from SGD use. Strategies included guessing, installments, scaffolding, interaction policy making and persistent typing. These findings are not exhaustive of all strategies used in AAC, but represent those actions observed in our dataset. 5. Interactants experienced problems coordinating their talk within a normative temporal order. As described here, these problems were often noted by the

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unimpaired interlocutor in ways that held the augmented speaker accountable. The unimpaired interlocutors’ comments, recommendations and complaints appear to be motivated, in part, to reduce difficulties in maintaining joint attention, as well as to remain engaged in the interaction. These efforts can be seen as attempts to minimize opportunities for misunderstanding and/or forgetting what was said – all of which further delay or derail the grounding of the augmented speaker’s intended contribution.

In-person interaction via SGD We fully recognize that SGDs are important for providing a means for individuals with complex communication needs to interact via spoken linguistic modes; however, the evidence provided here points out a number of ways that SGDs fail to support some basic aspects of language use during in-person interaction. In part, these shortcomings can be attributed to SGD designs based on a sender-receiver model of communication. The underlying design principles are these: 1. Unimodal/speech-based: SGDs are designed to transmit information along a single communication channel – synthesized speech (hence their designated name). Although the message display is also used, most SGDs have not been designed to accommodate screen access by the communication partner. 2. Composition-based: Modern SGDs are designed to promote independent utterance composition, a task that frequently requires the full attention of the augmented speaker, who composes and edits their message alone, until it is issued as an entire utterance. 3. Atemporal: The composition process takes time and does not have strict temporal boundaries. Although typing displays may be optimized for selection efficiency and include word prediction, there is little evidence that, in and of themselves, these features offer noticeable rate enhancement. As shown in this chapter, utterances frequently take minutes, not seconds to compose. 4. Text/Linguistic-based: SGDs are designed to issue sentences, not utterances or installments – at least in the performative sense. SGDs issue utterances as speech synthesized text. All prosody, stress, timing and intonation is derived from the typed text. The resulting speech production can be said to be selfcontained. It is not influenced by the just-before or ongoing interaction, only by the words and punctuation contained in the composition. Given these device constraints, SGDs provide good ways to give lectures, issue prepared texts (e.g., lists), or other sorts of communications that can be delivered as a monologue. But when other people are in-time and in-person, and particularly faceto-face, these technologies are not well equipped to facilitate talk during interaction. From our observations there appears to be a strong preference for interactants to maintain a normative temporal order of interaction, and they work to establish ways of displaying and monitoring interaction progress – often through vocalization and speech, gesture, joint interaction with the SGD display, etc. By design, SGDs are not equipped to support the real-time interactive grounding of utterances that forms the

Time and timing in interactions

basis of talk in interaction. As described above, talk-in-interaction is multimodal, collaborative, performed in real-time, and is an emergent product of what has gone on just-before in the interaction. When the means by which to produce talk cannot function within the temporal-sequential requirements of in-person interaction, then the participants using that technology must use alternative means. As with Addy and Louise in Extract 9.1, interactants may avoid the SGD, with the augmented speaker making use of their residual body-based communication modalities. They may adapt the design features, when possible, to facilitate their grounding needs, as evidenced by Phil and Jane’s iPad passing. Likewise, they may attempt to alter interaction protocols in an attempt to offset the most egregious costs to interaction (e.g., Max’s desire for Rita to use one-word/letter utterances, or Phil’s solicitation to Jane to let him just read it).

Talk-in-interaction analysis to assess design and use This chapter presents a view of augmented interaction from a talk-in-interaction perspective. This approach, used by a small but energetic segment of the AAC research community, utilizes micro-analytic techniques to describe and analyze the talk as it occurs in moment-by-moment interaction (Bloch, 2005; Bloch & Beeke, 2008; Bloch & Wilkinson, 2004; Clarke, Bloch, & Wilkinson, 2013; Clarke & Wilkinson, 2008; Wilkinson, Bloch, & Clarke, 2011). Higginbotham and Engelke (2013) provide a primer for using this approach for studying augmentative communication interactions. The use of talk-in-interaction research to assist in technology design has been advocated over the years, mostly as recommendations based on investigation results (Brennan, 1998; Higginbotham & Caves, 2002; Suchman, 2007). We propose that the use of talk-in-interaction inspired research methods such as video microanalysis provides a powerful way to analyze how individuals use SGD technologies, and to locate and describe specific SGD-related problems that impede successful social interaction. The work reported here focused on temporal issues of SGD use. Thus, it seems fitting to provide a list of design recommendations based on time and timing concerns:

Time Time-based recommendations focus on the speed of composing and producing talk. In this domain, three sorts of time appear relevant: Now-time: Now-time focuses on immediate responsive expression. SGDs need to be built to stay out of the way of body-based forms of expressive modes that can be immediately produced. Eye- and head-tracking should be designed to be immediately suspended (and not destroy what is being composed) if an individual wishes to communicate by eye or face. AAC designers may consider ways of immediately alerting others to look at the augmented speaker, and/or provide alternative and amplified views of expressive gestures. Near-time: Much of what we need to say has to be accomplished quickly. Research and development of utterance-based systems have proposed the use of quickfires and

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other means of rapid utterance access and display (Higginbotham, Wilkins, Lesher, & Moulton, 1999; McCoy, Bedrosian, & Hoag, 2010; McCoy, Hoag, & Bedrosian, 2011; Todman, Alm, Higginbotham, & File, 2008; Todman, File, & Higginbotham, 2003). Designing quick access to pragmatically powerful preconstructed phrases, could go a long way in reducing costly delay time while keeping the interlocutor engaged in the interaction. Delayed-time: There’s no getting around the inevitability of significant delays associated with message composition. However, there is much that could be done to reduce time spent in composition mode. First, all devices need to have multiple ‘scratchpads’ allowing the device-user the ability to produce a new utterance as quickly as possible and not interfere in the ongoing utterance production. Karl could have made great use of a scratchpad and quickfires when trying to direct Jess’s well-intended but wrong solutions to his lighting problems. Providing a well-organized history of previous utterances could also reduce composition time, particularly if the utterances can be edited before speaking. Most important is the need to provide ways of sharing the composition interface so as to keep the interlocutor engaged and informed about the progress being made. A shared interface could provide different forms of partner access, from being able to view a ‘progress meter’, seeing the composition in progress, to having some type of direct access to responding to or shaping the composition itself. Obviously this would involve a set of personal choices about displaying one’s composition in progress, which could change based on the particular communication partner.

Timing and delivery Timing has to do with the placement of talk at particular points in the interaction stream. One of the things that we know from early studies in social interaction is that we parcel out phrasal and clausal chunks of talk in coordination with the attention provided by our interlocutor (Goodwin, 1979, 1981; Higginbotham & Engelke, 2012). Instead of issuing a sentence ‘whole-cloth’, providing the ability to speak an utterance a clause at a time, repeating where necessary could provide a contextually powerful means of speaking and performing needed repairs. Quickfire phrases can also go a long way in providing the timely responses for maintaining the normative temporal order in the interaction.

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References Atkinson, J. M., & Heritage, J. (1984). Structures of Social Action: Studies in Conversation Analysis. Cambridge University Press. Beukelman, D.R., Fager, S., Ball, L., & Dietz, A. (2007). AAC for adults with acquired neurological conditions: A review. Augmentative and Alternative Communication, 23(3), 230–242. Beukelman, D.R., Garrett, K.L., & Yorkston, K.M. (2007). Augmentative Communication Strategies for Adults with Acute or Chronic Medical Conditions. Baltimore, MD: Paul H. Brookes Publishing Company. Beukelman, D.R., & Mirenda, P. (2011). Augmentative and Alternative Communication: Management of Severe Communication Disorders in Children and Adults, 4th ed. Baltimore, MD: Paul H. Brookes Publishing Company. Bloch, S.J. (2005). Co-constructing meaning in acquired speech disorders: Word and letter repetition in the construction of turns. In K. Richards & P. Seedhouse (Eds), Applying Conversation Analysis, pp. 38–55. Basingstoke, UK: Palgrave Macmillan. Bloch, S.J., & Beeke, S. (2008). Coconstructed talk in the conversations of people with dysarthria and aphasia. Clinical Linguistics & Phonetics, 22(12), 974–990. Bloch, S.J., & Wilkinson, R. (2004). The understandability of AAC: A conversation analysis study of acquired dysarthria. Augmentative and Alternative Communication, 20(4), 272– 282. Bongioanni, P. (2012). Communication impairment in ALS patients: Assessment and treatment. In M. Maurer (Ed.), Amyotrophic Lateral Sclerosis. INTECH. Brennan, S.E. (1998). The grounding problem in conversations with and through computers. In S.R. Fussell & R.J. Kreuz (Eds), Social and Cognitive Approaches to Interpersonal Communication, pp. 201–225. Hillsdale, NJ: Lawrence Erlbaum. Brewster, S.J. (2007). Asymmetries of Power and Competence and Implications for AAC: Interaction between Adults with Severe Learning Disabilities and their Care Staff. Ed.D. Thesis, University of Birmingham. Carletta, J., Isard, A., Kowtko, J., & Doherty-Sneddon, G. (1996). HCRC Dialogue Structure Coding Manual. University of Edinburgh: HCRC Publications. Clark, H.H. (1996). Using Language. Cambridge, UK: Cambridge University Press. Clark, H.H. (2006). Social actions, social commitments. In N.J. Enfield & S.C. Levinson (Eds), Roots of Human Sociality: Culture, Cognition and Interaction, 1st ed., pp. 126–150. London: Bloomsbury Academic. Clark, H.H., & Brennan, S.E. (1991). Grounding in communication. Perspectives on Socially Shared Cognition, 13, 127–149. Clarke, M. & Wilkinson, R. (2008). Interaction between children with cerebral palsy and their peers 2: Understanding initiated VOCA-mediated turns. Augmentative and Alternative Communication, 24(1), 3–15. Clarke, M., Bloch, S., & Wilkinson, R. (2013). Speaker transfer in children’s peer conversation: Completing communication-aid-mediated contributions. Augmentative and Alternative Communication, 29(1), 37–53. Doi: 10.3109/07434618.2013.767490 Creech, R. (1992). Reflections from a Unicorn. RC Publishing. Dediu, D. & Levinson, S.C. (2013). On the antiquity of language: The reinterpretation of Neandertal linguistic capacities and its consequences. Frontiers in Psychology, 4, 1–17. Dediu, D. & Levinson, S.C. (2014). The time frame of the emergence of modern language and its implications. In D. Dor, C. Knight, & J. Lewis (Eds), The Social Origins of Language, 1st ed. Oxford, UK: Oxford University Press.

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Doyle, M. & Phillips, B. (2001). Trends in augmentative and alternative communication use by individuals with amyotrophic lateral sclerosis. Augmentative and Alternative Communication, 17(3), 167–178. Ebert, R. (2011). Remaking my voice. Retrieved April 6, 2015, from http://www.ted.com/talks/roger_ ebert_remaking_my_voice?language=en Enfield, N.J., & Levinson, S.C. (Eds) (2006). Roots of Human Sociality: Culture, Cognition and Interaction. New York: Berg. Engelke, C.R. & Higginbotham, D.J. (2013). Looking to speak: On the temporality of misalignment in interaction involving an augmented communicator using eye-gaze technology. Journal of Interactional Research in Communication Disorders, 4(1), 95–122. Farrier, L., Yorkston, K., Marriner, N., & Beukelman, D. (1985). Conversational control in nonimpaired speakers using an augmentative communication system. Augmentative and Alternative Communication, 1(2), 65–73. Goldberg, J.A. (1975). A system for the transfer of instructions in natural settings. Semiotica, 14(3), 269–296. Goodwin, C. (1979). The interactive construction of a sentence in natural conversation. In G. Pasathas (Ed.) Everyday Language: Studies in Ethnomethodology, pp. 97–121. New York: Irvington Publishers. Goodwin, C. (198). Conversational Organization: Interaction between Speakers and Hearers (Language, Thought, and Culture). New York: Academic Press. Higginbotham, D.J. (2009). In-person interaction in AAC: New perspectives on utterances, multimodality, timing, and device design. SIG 12 Perspectives on Augmentative and Alternative Communication, 18(4), 154–160. Higginbotham, D.J. & Caves, K. (2002). AAC performance and usability issues: The effect of AAC technology on the communicative process. Assistive Technology, 14(1), 45–57. Higginbotham, D.J. & Engelke, C.R. (2013). A primer for doing talk-in-interaction research in augmentative and alternative communication. Augmentative and Alternative Communication, 29(1), 3–19. Higginbotham, D.J. & Wilkins, D.P. (1999). Slipping through the timestream: Social issues of time and timing in augmented interactions. In D. Kovarsky, M. Maxwell, & J. Duchan, (Eds), Constructing (in) Competence: Disabling Evaluations in Clinical and Social Interaction, 1st ed., pp. 49–82). London: Psychology Press. Higginbotham, D.J. & Wilkins, D.P. (2006). The short story of Frametalker: An interactive AAC device. Perspectives on Augmentative and Alternative Communication, 15, 18–21. Higginbotham, D.J., Wilkins, D.P., Lesher, G.W., & Moulton, B.J. (1999). Frametalker: A communication frame and utterance-based augmentative communication device. In Proceedings of the RESNA 99 Annual Conference, pp. 52–54. Hoag, L., Bedrosian, J., Johnson, D., & Molineux, B. (1994). Variables affecting perceptions of social aspects of the communicative competence of an adult AAC user. Augmentative and Alternative Communication, 10(3), 129–137. Jefferson, G. (2004). Glossary of transcript symbols with an introduction. In Conversation Analysis: Studies from the first generation, pp. 1–10. Amsterdam: John Benjamins Publishing Company. Levinson, S.C. & Holler, J. (2014). The origin of human multi-modal communication. Philosophical Transactions of the Royal Society B: Biological Sciences, 369(1651), 1–9. Linell, P. (2004). Written Language Bias in Linguistics: Its Nature, Origins and Transformations. London: Routledge. McCoy, K.F., Bedrosian, J., & Hoag, L. (2010). Implications of pragmatic and cognitive theories on the design of utterance-based AAC Systems. In Proceedings of the NAACL HLT 2010 Workshop on Speech and Language Processing for Assistive Technologies, pp. 19–27). Los Angeles, California: Association for Computational Linguistics.

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McCoy, K.F., Hoag, L., & Bedrosian, J. (2011). Next generation utterance-based systems: What do pragmatic studies tell us about system design? Perspectives on Augmentative and Alternative Communication, 20, 57–63. Monk, A. (2008). Common ground in electronically mediated conversation. Synthesis Lectures on HumanCentered Informatics, 1(1), 1–50. Müller, E. & Soto, G. (2002). Conversation patterns of three adults using aided speech: Variations across partners. Augmentative and Alternative Communication, 18(2), 77–90. Robillard, A. (1994). Communication problems in the intensive care unit. Qualitative Sociology, 17(4), 383–395. Robillard, A. (2006). Paralysis. In G. Albrecht (Ed.), Encyclopedia of Disability, Vol. 3, pp. 1197–11201. Thousand Oaks: Sage Publications. Robillard, A.B. (1999). Meaning of a Disability: The Lived Experience of Paralysis. Philadelphia: Temple Univ Press. Sacks, H., Schegloff, E., & Jefferson, G. (1974). A simplest systematics for the organization of turn-taking for conversation. Language, 50(4), 696–735. Schumann, J., Favareau, D., Goodwin, C., Lee, N., Mikesell, L., Tao, H., … Wray, A. (2007). Language evolution: What evolved? Marges Linguistiques, (11), 1–33. Seale, J. (2015). Symmetry patterns in augmented speaker and/or mouth speaker map-task interactions. Unpublished manuscript, SUNY Buffalo, Buffalo, NY. Shannon, C.E. (1948). A mathematical theory of communication. The Bell System Technical Journal, 27(3), 379–423. Suchman, L. (2007). Human-Machine Reconfigurations: Plans and Situated Actions. Cambridge University Press. Sweidel, G.B. (1989). Stop, look and listen! When vocal and nonvocal adults communicate. Disability, Handicap & Society, 4(2), 165–175. Sweidel, G.B. (1991). Management strategies in the communication of speaking persons and persons with a speech disability. Research on Language & Social Interaction, 25, 195–214. TTodman, J., Alm, N., Higginbotham, J., & File, P. (2008). Whole utterance approaches in AAC. Augmentative and Alternative Communication, 24(3), 235–254. Todman, J., File, P., & Higginbotham, J. (2003). Video extracts of effective social conversation using a whole-utterance VOCA. In G.M. Craddock, L.P. McCormack, R.B. Reilly, & H. Knops, Assistive Technology é Shaping the Future. IOS Press. Walsh, T.J. (2010). Utterance-based systems: Organization and design of AAC interfaces. In Proceedings of the 12th International ACM SIGACCESS Conference on Computers and Accessibility, pp. 327–328. Wilkinson, R., Bloch, S., & Clarke, M. (2011). On the use of graphic resources in interaction by people with communication disorders. In J. Streeck, C. Goodwin, & C. LeBaron (Eds), Embodied Interaction: Language and Body in the Material World, pp. 152–168. Cambridge University Press.

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Transcription Notation The transcriptions presented in this paper utilize the conversation analysis transcription conventions proposed by Gail Jefferson (see Atkinson & Heritage, 1984; Jefferson, 2004). Additional notational forms are used to depict aspects of interaction not covered by existing conventions (e.g., AAC device sounds, text displayed on the screen).

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10 R elevance in the context of multimodality and aided communication Caroline Jagoe and Martine Smith

Introduction Multimodality is a feature of all human communication, but individuals who use augmentative and alternative communication may rely in a unique way on multimodal communication, incorporating unaided modes such as gaze and vocalizations, as well as aided modes, as they participate in the co-construction of meaning with communication partners in interaction. The impact of multimodal communication on the conversation process, in terms of how aided components are ‘treated’ in the interaction, how a speaker makes choices of which message elements to encode in aided communication and how listeners receive and interpret messages have been explored through various different paradigms, including structural-linguistic (Binger & Light, 2008; Soto, 1997), conversation analysis (Bloch & Beeke, 2008; Bloch & Clarke, 2013; Clarke & Wilkinson, 2007, 2008, 2009; Hornmeyer & Renner, 2013) and discourse analysis (Light, Collier, & Parnes, 1985a). A theoretical framework that has seen less application in the field of AAC is that of Relevance Theory (RT), a cognitive-pragmatic approach to interpreting communication and interaction phenomena. RT offers the potential to increase our understanding of the cognitive-pragmatic processes at play in interactions involving the use of aided communication, offering a potential explanatory framework for interpreting communication behaviours. This chapter will present a brief introduction to the notion of relevance as it evolved from Gricean pragmatics and will then provide an overview of some key concepts in Relevance Theory (RT), before applying specific features of the theory to data involving the use of aided communication in interactions between a child, a teacher and a researcher.

The roots of relevance: Gricean pragmatics and aided communication The role and importance of relevance in communication has long been recognized. In his classic analysis of discourse, Grice (1975) proposed that a fundamental organization

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principle supporting successful conversations was the Co-Operative Principle: “Make your conversational contribution such as is required, at the stage at which it occurs, by the accepted purpose or direction of the talk exchange in which you are engaged” (p. 45). From this fundamental principle flow four categories of maxims or rules governing conversations: quantity, quality, relation and manner. The maxim of quantity presumes that a speaker’s contribution provides sufficient but not excessive information for a communication partner, given the context (make your contribution as informative as is required). Quality refers to a speaker’s efforts to make a contribution a truthful one. Manner relates to the clarity of an utterance, encompassing sub-maxims such as avoiding obscurity and ambiguity of expression, and being orderly and brief. The maxim of relation is formulated succinctly: be relevant. The terseness of the formulation of the maxim belies the complexity of the notion of relevance, and of the processes that allow speakers to negotiate shifts in relevance in the course of a talk exchange. However, a fundamental tenet of the cooperative principle is that interactants should assume that a contribution is intended as relevant by the speaker and so should be interpreted in that light. While Grice’s maxims are not prescriptive, if the overt meaning of a sentence does not seem consistent with the maxims, and yet the circumstances suggest that a speaker is complying with the cooperative principle, a communication partner typically seeks to discover what the speaker might mean in that context. A key question supporting this search for alternative meanings could be framed in terms of relevance: given what I know, how could this contribution be relevant to what has gone before and therefore what interpretation is available and potentially appropriate? This search for a relevant meaning offers a framework for explaining how it is possible for an interaction partner to interpret “it’s ten o’clock” as an adequate response to an invitation to a cup of coffee. As pointed out by Bedrosian, Hoag and McCoy (2003), individuals who use aided communication frequently face situations where it is extremely difficult for them to comply with the above conventions of orderly, structured conversation behaviours. Many of these difficulties arise from the necessarily slow rate of aided communication, as well as vocabulary constraints which mean that both ambiguity and obscurity may be unavoidable. In a series of studies, (Bedrosian et al., 2003; Hoag, Bedrosian, McCoy, & Johnson, 2004, 2008; McCoy, Bedrosian, Hoag, & Johnson, 2007), Bedrosian and colleagues explored the impact of competing pressures in relation to three of Grice’s maxims (quantity, relation and manner) on the attitudes of observers towards individuals using voice output devices. Participants in these studies observed scripted events where actors used a voice output device to interact with service personnel in a bookstore, a movie theatre and a hair salon. The scripts were constructed to simulate situations where the contribution provided using aided communication was manipulated to mirror a range of possible situations: a pre-stored context-relevant utterance (i.e., complying with the maxims of both manner and relation); a pre-stored partially relevant utterance (rapid but violating the maxim of relevance); a pre-stored utterance that was edited within the interaction causing a delay, (i.e., relevant but slow, violating the maxim of manner); a pre-stored utterance that contained repetitions (relevant, but violating the maxim of quantity). Not surprisingly, observers consistently rated interactions that combined

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relevance and speed more favourably than other interactions, although floor-holding contributions which alerted listeners that there might be a long delay in generating the next contribution (“I am going to communicate a message but need a bit of time”), enhanced observers’ tolerance of slow communication. However, scripts that involved some violation of the principle of relevance were consistently rated least favourably of all the scenarios. Together, this series of studies suggests that, for naïve communication partners at least, messages which are delivered slowly but that are clearly relevant are perceived more favourably than messages that are delivered quickly, but where the relevance is hard to determine. Additionally, it seems that violation of the maxim of manner (i.e., through slow rate) can be ameliorated or attenuated through the use of a floor-holder. While the work of Bedrosian and her colleagues has yielded important insights into the judgements made by observers about the relative impact of message relevance and speed of delivery on the success of an interaction, this work does not explore how participants in an interaction negotiate the complex landscape of relevance against a backdrop of limited resources for disambiguating contributions in aided communication. Faced with vocabulary limitations, children and adults using aided communication must often deal with a situation where the vocabulary they need to express a specific communicative intent is either not available to them, or cannot be located. In such a situation they often must select what could be described as a ‘least bad – most relevant’ match between an internal lexical representation and an external lexical option, while their interaction partner must often also struggle to determine how an apparently tangential contribution could be interpreted as relevant to the context of the specific conversation. The rest of this chapter explores some of the principles of relevance and the struggles implicit in wrestling with the conundrum of being relevant, when the requisite resources are not easily available.

Relevance Theory: An overview Although RT has its roots in Grice’s (1967) cooperative principle, it differs from Gricean pragmatic theory in fundamental respects. The most significant departure is in relation to the maxims proposed by Grice. RT sees Relevance as superseding all of these maxims (Sperber & Wilson, 1986/1995). The claims of Relevance Theory are embedded within claims about the nature of human cognition (Carston, 2002) and the notion of relevance is defined very specifically. Relevance is seen as a property of human cognition, allowing us to attend to stimuli that are ‘worthwhile’. In other words, rather than expending cognitive effort on inputs that are not worth processing, human cognition is aimed at processing information that is potentially pertinent and will ‘benefit’ the person involved. In RT terms, such benefits are called cognitive effects, in recognition that a stimulus is only relevant if it results in some “worthwhile difference to the individual’s representation of the world” (Wilson & Sperber, 2004, p. 608). Relevance, therefore, is a property of two variables – the cognitive effects of the input, balanced against the processing costs to achieve that cognitive effect (Sperber & Wilson, 1986/1995) – in other words, a balance between effect and effort (van der Henst, Carles, & Sperber, 2002).

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Any input to the cognitive processes of an individual is potentially relevant and inputs can be either external (such as perceptual stimuli) or internal (such as assumptions or the output of inference, imagination, stimulus processing) (Sperber & Wilson, 1986/1995). An input (such a natural speech utterance, voice output from a communication device or a physical point to a graphic symbol) is processed in the context of assumptions already held by the individual; the effect will be to allow the individual to ‘update’ their representation of the world. When an interaction involves the use of aided communication, these principles, seen as universal by RT, still apply. However, the nature of the aided communication contributes another element of ‘inputs’ that are potentially relevant. For example, in selecting an item from a device using symbols and orthographic representations, the listener has available the speech output of the device (equivalent to the fleeting auditory input in a spoken utterance), the symbol itself and the written word. While we can assume that in most cases the meaning of these different modes overlap and, hence, all contribute to the relevance of the utterance, the aligning of relevance may not always apply. Assuming that cognitive processes are geared to maximizing relevance, communicative utterances that demand the hearer’s attention (are ‘ostensive’ in RT terms) create an inherent expectation of relevance (Carston, 1997). The hearer is entitled to assume that the speaker produced the utterance for a reason; indeed, in attracting the hearer’s attention the speaker provides this tacit guarantee of relevance (Sperber & Wilson, 1986/1995). However, it would not be feasible for communicators to consistently produce utterances with the lowest possible processing costs and highest possible cognitive effects. The hearer is therefore entitled to expect that the speaker has produced the most relevant utterance that they are willing and capable of producing at that time and in that context; in other words, an utterance of optimal rather than maximal relevance (Sperber & Wilson, 1986/1995). It is this presumption of optimal relevance which guides both how communicators produce utterances and the process which hearers undertake in interpreting these communicative events. This cognitive drive for relevance has far-reaching implications for explaining how communication occurs. A hearer is entitled to exploit the expectation of optimal relevance, in guiding their interpretation of an utterance, “follow[ing] a path of least effort in computing cognitive effects” (Wilson, 2000, p. 420). However, expectations of optimal relevance have implications, not only for the hearer of an utterance, but also for the speaker. As stated by Carston (2006) “It also follows from this [RT] view of communication that a speaker/writer should formulate her utterance […] in such a way that her intended meaning can be grasped with a minimal expenditure of effort by her audience” (p. 3). In formulating utterances, therefore, speakers are engaged in inferring what information is both worthwhile for their listener and easy to process (van der Henst et al., 2002).

Utterance construction by aided speakers and expectations of relevance Based on their inferences about potential cognitive effects and processing demands, all speakers make choices about what elements of a message to encode to maximize the possibility that a specific hearer in a specific context will derive the intended inferences,

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and arrive at the target interpretation of an utterance. Decisions about which elements to encode are arguably far more complex in the context of aided communication. One important decision is about which message elements to encode using the aided modality and which elements may be more effectively or more efficiently encoded in unaided modes. Unaided modes of communication have been reported to dominate in many interactions where aided modes are potentially available (Clarke & Wilkinson, 2007; Falkman, Sandberg, & Hjelmquist, 2002; Light, Collier, & Parnes, 1985b). Adults who use aided communication have reported that they rely more frequently on unaided modes of communication (McCall, Marková, Murphy, Moodie, & Collins, 1997; Smith & Connolly, 2008) and that a decision to encode a message using an aided modality is influenced at least as much by consideration of who they are talking with, as what they are talking about (Smith & Connolly, 2008). It might seem intuitively sensible to encode simple affirmative agreement messages using head nods, vocalization or facial expression, rather than selecting “yes” or “no” on a communication board or a speech output device, especially if such a selection involves both physical effort and time delay. However, strategic use of aided communication for such apparently unnecessary situations may enhance the illocutionary force of the agreement or disagreement (Hornmeyer & Renner, 2013). Having decided on an element or aspect of a message to encode in aided communication, a second layer of decision-making involves how best to capture that element with the available resources. While spoken language represents one representational system (phonemes and morphemes), most aided communication systems offer multiple representation options. For example, communication boards frequently display a range of picture symbols, photos, letters and words or phrases (e.g., Binger & Light, 2007). Graphic symbols themselves typically incorporate at least two layers of information: a pictorial icon and a text label. The relationship between the icon and the text label can vary greatly. The label may name the referent (e.g., cat), may refer to a feature of the pictured referent (e.g., elbow). It may refer to a context where the pictured element may occur (e.g., countryside), or it may refer to a phonological rather than semantic feature of the pictured element (e.g., a picture of knees together to represent need). Additionally, each person viewing the icon may infer additional meanings or interpretations, based on prior experience and specific experience with pictures (Stephenson, 2009). As a child selects a graphic symbol, multiple potential layers of information are offered to the speaker. The question is, how do both interactants come to understand which dimension of the selected symbol is the one the child intends the interaction partner to pay attention to? If graphic symbols are displayed on a speech output device, another layer of complexity comes into play. Speech output devices offer the option of programming a range of different kinds of messages linked to a symbol. For example, a page may contain a cell with a line drawing of a partly-filled glass, and a text label drink. When selected, the speech output may match the verbal label (“drink”). Alternatively, the speech output may be the name of a specific drink (e.g., “lemonade”) or a longer stored phrase (“My favourite drink is milk”). A child using the device may select a symbol, focused on the icon, (i.e., DRINK), thereby generating a spoken message that bears only a tangential relationship with his or her communicative intention. For

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example, Light (1997, p. 165) recounts how Tim, a child sitting at dinner, vocalized to get his mother’s attention, then looked at his dinner, looked back at his mother and then selected a single symbol that contained a line drawing of a dog and the written label dog on his speech output device. The message generated by the device was a pre-programmed phrase “My dog’s name is Skippy”. As Light recounts, after numerous attempts, Tim’s mother eventually determined that Tim intended her to attend to the orthographic label dog rather than the pre-stored speech message and that he was trying to tell her to give his dinner to the dog because he didn’t like it. Even a text-based communication board typically offers a combination of single, frequently-used words, short phrases and letters. Prospective speakers may have to make a strategic choice between spelling out a specific message, with associated time considerations, or selecting an available whole word or short phrase that may offer a less-than-perfect but acceptable match to the intended message. For example, if Peter wishes to persuade a busy nursing assistant to open his window, he may choose to spell out “I-s t-h-e-r-e a-n-y c-h-a-n-c-e y-o-u c-o-u-l-d o-p-e-n t-h-e w-i-n-d-o-w f-o-r m-e?” (thereby meeting his desire to be persuasively polite, but risking losing the nursing assistant’s attention). Alternatively, he may select an available phrase I’m too hot, which may be more quickly expressed, but has a potential mismatch with his desired tone, as well as being potentially more ambiguous (Should the assistant remove a blanket? Open the door? Turn down the heating?). All these choices occur within the context of considerations of efficiency in item or utterance selection, as speakers using aided communication must navigate through their available options in order to produce the utterance that best matches their communicative intent and in a way that is likely to be interpretable by a communication partner. How these complex decisions, affecting both participants in interactions involving aided communication, manifest within conversations is of interest from a pragmatic perspective and may have implications for interventions with those using AAC and their conversational partners.

Relevance, modality and aided communication Relevance and modality choices: Considerations for the aided speaker In the extract below (Extract 10.1BAC), Noel aged 8 years is describing a picture to a teacher, who has worked with him over several years and who is very familiar with his communication. The teacher is sitting beside Noel and cannot see the picture he is describing (a bald man combing his hair with a toothbrush, see Figure 10.1). Noel is using a voice output device with a dynamic display. He uses two switches to access the device, one a head-switch and the other a switch mounted on his tray, which he activates using his fist. Noel finds physically accessing his device challenging, and his rate of aided communication is slow. He uses directed scanning, his head switch moving the highlighter across a row or block of cells and then using a switch on his tray with his fist to select a specific cell. The interaction in Extract 10.1BAC unfolds over a period of almost seven minutes. Throughout the interaction, the teacher can see Noel’s display, and his attempts to

Relevance, multimodality and aided communication

Figure 10.1 Picture illustration to be described by Noel (© Murray).

find and select symbols. As Noel’s device is set up with vocabulary organized in hierarchical branching pages, many top-layer pages contain folders that themselves open into lexical sets. Therefore, Noel often must make several selections before finally accessing the specific symbol he wishes to select and send to the message bar. Given his increasing literacy skills, Noel has several pages that contain written words only, and others that contain a combination of graphic symbols and written words. He also has a choice as to whether he activates the synthetic speech output as he selects each symbol, or whether he only generates the spoken output once all elements have been sent to the message bar1. Decisions about what elements to encode linguistically in this interaction are complex. The picture Noel is describing represents an unlikely scenario (a bald man brushing his hair with a toothbrush). The unpredictable nature of the scenario makes it likely that it will be effortful for the listener to process, as it will involve potentially setting aside assumptions that the listener might reasonably make (e.g., that a toothbrush is for brushing teeth). However, there is also a lot of other detail in the picture that Noel could choose to describe, such as the age or physical appearance of the man, his clothes, what he is holding. His challenge is to determine what the most salient element of the picture should be and then, from his aided communication system, determine selections based on the key components required to communicate the message, as would 1  In the extract of aided communication, following the conventions of von Tetzchner and Basil (2011), natural speech is presented in italic font, while synthetic speech is in italic font within parentheses. Graphic symbols are presented in upper-case italic font, and written words are underlined. The left-hand column sets out the interaction as it unfolds. In the right-hand column, detail is provided about the operational construction of aided communication output. A superscript F beside a symbol label indicates that selecting this symbol opens a pop-up folder containing additional vocabulary.

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Extract 10.1BAC Operational processes 1

N

(starts to navigate through system immediately)

2

T

so who’s in this picture?

PEOPLEF everyoneF granddad (pause of 8 sec on this symbol but not selected) GRANDDAD

3 4

N

“granddad”

5

T

[a granddad!

6

R

very good!] do you remember anything else about this picture?

7

N

‘no’ (vocalizes)

8

T

what’s granddad doing in the picture?

9

R

do you need a look?

10

N

‘yes’ (vocalizes)

11

R

(closes popup) now THINGSF (7 sec) CLOSE POPUP DESCRIBING WORDSF (11sec) BEFORE (the PCS symbol for ‘before’ shows two pictures, a person with uncombed hair and a person after combing their hair, with an arrow to the first picture)

12

13

N

before (word sent to message bar, no speech output activated)

14

T

before?

15

R

very like before, ok, yeah, it’s very like that

16

T

ok?

17

R

do you want another look? (shows picture, pointing to elements silently)

18

N

19

N

CD (word sent to message bar, no speech output activated)

20

N

“Granddad before CD” (activates the message bar)

21

T

granddad before CD?

22

N

‘no’ (moves head)

23

R

no? not quite? Ok. Do you want me to get rid of CD?

24

N

‘yes’ (vocalizes)

HOUSEF (10sec) CD

Relevance, multimodality and aided communication

25

R

ok (clears CD from display, shows picture again) DESCRIBING WORDSF (4 sec pause on OLD) PRETTY

26 27

N

“pretty”

28

T

pretty? Huh?… so, granddad before and pretty, ok …

29

R

(shows picture again) do you want to tell her about that? ACTION WORDSF (CLOSE POPUP) DESCRIBING WORDSF (scans the blocks on the page several times) BEFORE

30

31

N

before (no speech output activated)

32

T

pretty before? (all laugh)

33

R

I don’t know what picture T is imagining in her head! What are you imagining?

34

T

there’s granddad and he’s pretty and it was before … did something happen? … no? … can you tell me anything else about the picture? No?

35

R

can you tell her what granddad’s doing? (6 sec)

36

T

what’s he doing? (4 sec)

37

R

you’re allowed to use the exact words in this one to tell her exactly. Tell her exactly what he’s doing and see can she get that picture in her head

38

N

39

N

“gaeilge” (Irish)

40

R

as Gaeilge? (‘in Irish?’) Ok?

41

T

as Gaeilge? Now you’re really going to trick me!

QUICK CHATF GAEILGEF(a folder of Irish vocabulary)

AN CORPF GRUAIG

42 43

N

“an corp” (body) “gruaig” (hair)

44

R

wow! Yeah, gruaig

45

T

hair, uhuh

46

R

and is there anything else? BEAL

47 48

N

“béal” (mouth)

49

T

mouth? Ok … what’s happening to grandad’s hair and his mouth? (4sec) what’s he doing?

N

“fiacla” (teeth) “fiacla”

FIACLA

50 51

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Continues on next page

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The Silent Partner?

52

T

oh, his teeth? Oh, (laughs) I’m creating all pictures in my head here N. So grandad’s doing something with his hair and his mouth and his teeth?

53

N

‘yes’ (vocalizes)

54

T

is he washing his teeth?

55

N

‘yes’ (vocalizes)

56

T

is he?

57

N

‘yes’ (vocalizes)

58

T

are you sure?

59

N

‘yes’ (vocalizes)

60

N

‘yes’ (vocalizes with emphasis)

61

T

and is he combing his hair?

62

N

‘yes’ (vocalizes)

63

T

he’s going to become all pretty after he does that is he?

64

N

‘yes’ (vocalizes)

65

R

are we ready to show the picture?

66

N

C: ‘yes’ (vocalizes) Time taken 6 min 54 sec

be expected by his communication partner. He has decisions to make about modality, the processing effort required by the hearer and, in addition, message efficiency. Noel first navigates through two folders to establish the actor in the picture, “granddad” (line 4). Prompted to provide more information on what granddad is doing, he searches his THINGS folder, then closes it and opens a folder of DESCRIBING WORDS. After a long pause as he looks at the page, he selects the symbol BEFORE, sends it to the message bar, but does not activate the speech output (line 13). There is a strong visual similarity between the visual icon representing BEFORE, (an older man with messy hair and a brush with which to comb it) and the picture that Noel is trying to describe. The teacher appears confused, and the researcher steps in, interpreting the lack of speech output as indicating that the intended message is related to the symbol selected, but that the symbol is not to be interpreted literally. Of course, the researcher has the advantage of having seen the picture to be described, and so is able to establish the relevance of the selected item, inferring that it is the visual dimension of the symbol rather than the orthographic label that is optimally relevant. Noel’s next selection of CD raises further confusion. Again, he selects this symbol, but does not initially activate speech output. Once he has activated the speech output, he rejects this selection. He returns to his DESCRIBING WORDS folder and after hovering for some time over OLD he selects PRETTY (line 27) and repeats his selection of BEFORE (line 31), once again without activating speech output.

Relevance, multimodality and aided communication

The choice to encode the concept of brushing hair in this way is not only transparent but also creative when one has access to the context – the picture to be described. It appears that Noel has used BEFORE for the icon dimension of symbol (representing hair that needs brushing), rather than for the orthographic label. Noel does not activate the speech output for this item, treating it differently to other lexical items in the interaction. This decision is itself potentially significant in terms of signalling relevance, plausibly reflecting a decision to foreground the icon and minimize the linguistic label. In selecting this item, Noel is aware that the communication partner has visual access to his selection (in other words, that the teacher can see both the icon represented and its written label). In RT terms the item is mutually manifest; both parties are able to perceive the stimulus. Noel’s choice of item appears to provide the potential for a hearer to infer the concepts of old man, messy hair, made pretty and (assuming the inferential process progresses as anticipated), Noel could introduce the concept toothbrush to complete the message. However, it quickly emerges through the sequence of meaning negotiation, that the relevance of the item BEFORE is not readily accessible to the communication partner, who prioritises the unspoken linguistic label over the symbol content (a process presumably driven by her own considerations of relevance). Noel is clearly aware of this breakdown. Demonstrating further creativity in his attempt to create relevance for the hearer, he moves into his Irish language section of the device, where he can access vocabulary for body parts and produces “gruaig” (hair), along with “fiacla” (teeth). Focusing on the cognitive processes undertaken in this sequence of aided communication, it is clear that Noel is aware of the hearer’s needs, but has a complex balancing act of choices across modality (orthographic/linguistic label, graphic symbol, language) in the context of accessibility for the hearer. There is some evidence that speakers tend to act in such a way as to minimize the effort on the part of their hearers, even when there is extra p­rocessing cost to themselves: “they spontaneously adjust the level of accuracy of their utterances – up or down as the context requires – so as to optimise relevance” (van der Henst et al., 2002, p. 465). In choosing to capitalize on the visual dimension of the symbol associated with BEFORE, Noel makes a choice that involves greater effort for him (i.e., recalling that the symbol BEFORE includes a representation of messy hair, finding and navigating to the appropriate folder) but offers a potentially rich pictorial context to support message interpretation. His selection of this item involves 16 steps and approximately 48 seconds. In contrast, the selection he makes to repair the interaction through using his Irish vocabulary page takes 9 selections and approximately 23 seconds. This contrast suggests that even within the complexity of this aided interaction, Noel is taking his hearer’s expectations of relevance into account. Given his choices, the impact on the hearer will be considered next.

Relevance and modality choice: Challenges for the hearer Relevance Theory acknowledges that speakers are not always able to formulate an utterance that represents the most efficient communication of their message, or they may change their message mid-utterance. Speakers may assume information to be relevant to a person when it is not; for example, pointing out information without realizing that

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the hearer is already aware of the facts communicated (Sperber & Wilson, 1986/1995). Given the universality of the cognitive processes underlying communication, an RT approach suggests that speakers using aided communication can expect their hearers to engage in the same process of utterance interpretation, following the relevance theoretic process of “consider[ing] interpretations in order of accessibility [and] stop[ping] when your expectation of relevance is satisfied” (Wilson, 2000, p. 420). While Noel adjusts his utterance to convey the key elements initially missed by his communication partner (lines 43–51), the question arises to why the utterance still fails to achieve relevance for the hearer? The key issue appears to be the partner’s inability to move past the linguistic/orthographic label of before. It appears that the hearer remains stuck on what is arguably a literal interpretation of the utterance (or utterance component in the case of BEFORE), despite the fact that Noel treated this item differently to other selections, by avoiding activating the speech output. RT argues that an utterance is a “piece of evidence about the speaker’s meaning” (Wilson & Sperber, 2012, p. 20), and therefore that the words in an utterance act to point the listener towards the intended meaning. It is on this basis that RT argues that speakers may choose to use approximations which may not be literally true in order to satisfy the expectations of relevance. Interaction is arguably full of examples of ‘loose use’, in which the hearer is expected to construct an ad hoc concept from a lexically encoded concept during utterance interpretation. Carston (2002) illustrates this notion of loose use of a concept with an example where someone introduces a friend to a new cat saying, “Here’s my new flatmate”. In this example, the concept flatmate must be broadened to include non-humans if the utterance is to be interpreted as intended. The question arises as to whether such processes of loose use can be followed by hearers when an aided speaker uses a pictorial symbol in such a manner. Noel appears to expect his hearer to act in this manner – to interpret the item BEFORE in a loose sense, less constrained by the linguistic label, and embracing the pictorial content. Indeed, Noel provides his hearer with a cue that this is how he intends the item to be interpreted, through his lack of voice output for the item (in both lines 13 and 31). It appears that the communication partner disregards the pictorial content of the message, perhaps considering symbols as primarily supporting the aided speaker (for example, in navigating the vocabulary items), rather than adding to the message itself. Within the interaction in Extract 10.1 at least, the lexical-orthographic dimension of the symbol seems to assume priority for the communication partner as she seeks a potentially relevant interpretation. Noel clearly anticipates his partner will engage in the inferential work implicit in concept broadening and when this doesn’t happen, he takes steps to repair the conversation, thereby explicitly drawing attention to hair and teeth (lines 43–51). A second extract (Extract 10.2BAC) demonstrates a similar situation in which the aided speaker (again Noel) appears to expect the hearer to interpret his utterance in a loose sense, directing her towards an intended meaning. A key source of ambiguity in this example is the use of pre-stored messages. As noted previously, there is some evidence that pre-stored messages containing content that is not transparently relevant may be particularly problematic for interaction partners (e.g., Bedrosian et al., 2003; Hoag et al., 2008).

Relevance, multimodality and aided communication

Extract 10.2BAC Operational processes POWERCHAIR NEWSF WHEELCHAIR

1

N

2

N

“I got my powerchair a few weeks ago”

3

T

did that happen in the video?

4

N

‘Yes’ (vocalizes)

5

T

was the video about you in your powerchair?

6

N

‘Yes’ (vocalizes)

7

N

‘Yes’ (vocalizes)

8

N

‘Yes’ (vocalizes)

9

T

are you sure?

10

N

‘Yes’ (vocalizes)

11

T

yeah?

12 13

left N

“I can go left”

14

right

15

N

“I can go right”

16

T

and was that shown on the DVD?

17

N

‘Yes’ (vocalizes)

18

N

‘Yes’ (vocalizes)

19

T

yes?

20

R

and is there any more you want to say? No? that’s it? OK Time taken: 1 min 5 sec

Context: Noel has viewed a video where a young girl in a power wheelchair drove her wheelchair on a path and did a 360-degree turn before stopping.

Pre-stored messages are typically relevant for very specific situations, often including frequently-used phrases or specific information, such as personal introductions or salient items of news. These messages may, however, also contain linguistic elements that are not available to the aided speaker in other forms, unless their literacy level allows them to use spelling. For example, it is plausible that an individual may have a very specific utterance such as, “My grandmother lives in Paris”, but not have “Paris” stored as an individual element. In this case, creative use of the pre-stored message may help in directing a hearer towards the intended concept. In this type of scenario, the interactant using aided communication arguably expects his hearer to interpret

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The Silent Partner?

the utterance very broadly – extending the interpretation from referring to a specific event to more loosely referring to one linguistic element. As with all communication, the interpretation of the utterance is significantly context-bound. In other words, in the context in which the individual was asked, “what were you doing in France?” the use of the pre-stored message, “My grandmother lives in Paris” should, (and most likely would) be interpreted in its narrowest sense, that the speaker was visiting his grandmother, specifically in Paris. If the same utterance were used in response to a question “what did you think of the rugby match?” additional processing effort is likely to be required to define the potential scope of meaning that is relevant. The hearer is entitled to infer that the utterance has some meaning in the context, either related to the concept “grandmother” or to “Paris”. The production of an utterance itself guarantees relevance but the utterance requires additional processing on the part of the hearer: it is not fully specified for the context of interpreting a description of an unseen picture. The outcome is that the hearer must engage in additional inferential work to link the utterance to that specific context. Relevance Theory suggests that the hearer who is engaging in this additional work is likely to take a cautiously optimistic approach to the interpretation of the utterance, considering “what interpretation the speaker might have thought […] was relevant enough” (Wilson, 2000, p. 421). In the example in extract 10.2, Noel has viewed a video where a child driving a powered wheelchair has completed a circle, and Noel is describing the video to his teacher who was not present when the video was viewed. He selects three pre-stored messages, none of which are fully relevant, but each of which contain partially relevant information. An alternative option might be for him to attempt to spell out the target message, but it is not clear that he has the necessary literacy skills for this strategy. There may also be physical considerations in relation to spelling, given his very slow and effortful access. Using a pre-stored message may, in Grice’s terms, meet the demands of manner, but at the cost of the maxim of relation (i.e., relevance). In this extract, Noel needs to communicate the concept ‘powerchair’, as well as communicate an action of turning around in a circle. His hearer is aware that the purpose of this communication exchange is to describe a video clip. In this instance, without access to the stand-alone concept ‘powerchair’ Noel is arguably justified in selecting a pre-stored message containing the relevant word “powerchair” and expecting his hearer to draw the inference that the video was about a powerchair. Noel’s use of the pre-stored messages, similar to the example cited earlier from Light (1997), shows a high degree of creativity and efficiency. With knowledge of the content of the video, his rationale for selecting the pre-stored message seems clear. However, his listener does not interpret the utterances in the manner intended and, in this case, Noel does not attempt a repair. Again the hearer prioritizes the ‘literal’ linguistic content, despite her clear uncertainty that this is indeed the intended message (evident from her questioning in lines 5, 9 and 16). Noel accepts the hearer’s slightly inaccurate interpretation (that the video was of him moving left and right in the chair), perhaps because he has decided that the repair is too complex. Alternatively, he may feel that the hearer’s interpretation of the video (that a child is moving in a powerchair), is sufficiently close to satisfy expectations of relevance, particularly if he was tiring of the activity. The implications of an inaccuracy

Relevance, multimodality and aided communication

(who was in the powerchair and the precise type of movement that was made) may not seem sufficiently consequential to warrant engaging in complex meaning negotiation. This preference may be explained by the notion of optimal relevance: “a speaker aiming at optimal relevance may prefer a formulation that requires less effort from herself and more from the hearer, provided that the resulting utterance is still relevant enough to be worth the hearer’s attention” (van der Henst et al., 2002 p. 459).

Conclusion A Relevance Theory analysis of the interactions between Noel and his teacher portray a child clearly engaged in sophisticated and creative utterance formulation. An RT account demonstrates the high degree of complexity involved in modality choices for speakers using aided communication as they balance relevance for their hearer with efficiency in finding and selecting relevant elements for the intended utterance. Both participants in the interaction must engage with multiple modalities in parallel, to produce and interpret a single utterance, utilizing pictorial content, linguistic labels, verbal output, and novel behaviours such as withholding voice output to signal the primacy of the visual element of the message. These complex communicative decisions on the part of the speaker appear to be made with the expectation that the hearer will follow the process of utterance interpretation, using the elements as a blueprint to guide interpretation. The speaker using aided communication clearly expects the hearer to engage in an inferential process. In both analyses, however, the hearer appears to privilege the linguistic element or the surface form of the utterance produced through voice output. In the first extract analyzed, this approach to aided utterance interpretation leads to misunderstanding and subsequent repair by Noel. In the second extract, a misunderstanding is clear to the researcher who is aware of the intended message, but the participant using aided communication in this case appears to elect to allow the slightly erroneous interpretation to stand. In interactions involving aided communication, instances in which the hearer foregrounds the literal elements of the utterance, have been reported previously (Basil, 1992; Light, 1997). The reasons for the apparent privileged status of the verbal element or label requires some exploration. Two explanations will be proposed here, explored within a RT framework. This first is whether the verbal elements of the utterance are privileged in a cognitive sense for hearers. The second issue raised is whether there is a socio-pragmatic element to the hearers’ behaviour in these interactions. RT argues that utterances have unique features as inputs to the cognitive system. The first characteristic of utterances as stimuli is that they are ostensive (i.e., they place an overt demand on the hearer’s attention), and therefore place a direct demand on processing. In so doing, utterances create an expectation of their own relevance (Carston, 1997, p. 4). This ostensive characteristic is arguably present no matter what modality is used. However, selection of a less frequently-used modality (e.g., aided communication) may draw additional focus on such utterances, placing an even more overt demand on the hearer’s attention, perhaps to highlight a pragmatic intent (see for example, Hornmeyer & Renner, 2013). The other unique characteristic of a linguistic stimulus is that an utterance

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The Silent Partner?

employs a coded element that acts to direct the hearer’s processing and constrains the possible interpretations of the stimulus (Sperber & Wilson, 1986/1995). It could be argued that, in the context of aided communication, the verbal label associated with a particular symbol or the full surface form of a pre-stored message each provide more constraints on possible interpretations (i.e., the meanings of both the label and the pre-stored message are specified more explicitly) than the associated graphic dimension of the symbol. Processing the verbal label or the pre-stored message should therefore logically involve a lower processing effort. The concept of optimal relevance implies that hearers are entitled to expect that the speaker has produced the most relevant utterance that they are willing and capable of producing (Sperber & Wilson, 1986/1995) to allow the hearer to interpret that utterance, “follow[ing] a path of least effort in computing cognitive effects” (Wilson, 2000, p. 420). It is possible that a lexically encoded concept (whether as a written word or a pre-stored utterance) is perceived as guaranteeing a greater degree of relevance than a picture symbol (in that it provides a specific blueprint of meaning, reducing the guesswork associated with inferring meaning, and thereby reducing processing effort). A logical implication is that hearers might be expected to consistently foreground lexical labels in interactions involving graphic symbols and icons. The second explanation for the privileging of the verbal over graphic symbol information by the hearer involves a socio-pragmatic element. A hearer approaching interaction involving aided communication may do so with a predisposition to ‘treat the interaction as naturally as possible’. This approach may result from a general desire to demonstrate respect and acceptance of the communication form, or it may even arise from communication training in which conversation partners might be encouraged to ‘treat the person using aided communication as they would any other speaker’. From an RT perspective, this general disposition towards the speaker would be treated as an assumption, an internal cognitive input that makes up part of the context in which utterances are interpreted. The result of such an approach may be that the hearer works from the assumption that the output of the device (the linguistic elements of the utterance, whether selected or selected and spoken through voice output) comprises the intended message. The hearer may therefore approach the utterance as a code to be decoded – the exact approach to pragmatics that RT has demonstrated is unable to yield a reliable inferential interpretation. Treating the device as a conduit in which the output (product) is the meaning intended by the aided speaker may have its benefits (communicating acceptance for the aided modalities, respect for the individual as an independent communicator) but from a cognitive pragmatic perspective it may act to limit the assumptions available to the hearer, thereby potentially undermining the success of the interaction. An individual using aided communication has a potential challenge with regards to ‘loose use’ of language. As a speaker they may intend the listener to interpret an element of their utterance loosely, but in which modality? Creative use of a device may be useful to signal the relative supremacy of a modality in any given utterance, for example by avoiding voice output when the pictorial content is to be foregrounded. In the examples analyzed in this chapter, these strategies were not immediately successful and the lexical concepts encoded either in the orthographic label or the speech output of the device seemed to take priority for the hearer in the search for possible relevant meanings.

Relevance, multimodality and aided communication

Whether the act of privileging the verbal element of the utterance is a feature of the cognitive-pragmatic processes at play, or of socio-pragmatic expectations, there are clinical implications. One potential implication is that conversation partner training may require specific focus or sensitization of conversational partners to these features of interactions involving aided communication. The potential for creative use of multiple modalities, and evidence of ‘loose use’ of nonverbal modalities, and their associated pragmatic consequences should perhaps be explicitly discussed in order to enhance perceived success for all participants in interactions involving aided communication. Increased metapragmatic awareness may serve as an additional tool in facilitating successful navigation of these sophisticated modality choices. In sum, what a Relevance Theory lens suggests in the examples explored here is that communicators such as Noel can demonstrate exceptional creativity in the tools of communication available to them, in trying to provide evidence for a listener to guide meaning construction. However, the benefits of such creativity can only be realized where communication partners approach meaning construction with an awareness of the potential for such creativity and an openness to the ‘loose use’ problem-solving such creativity implies.

References Basil, C. (1992). Social interaction and learned helplessness in severely disabled children. Augmentative and Alternative Communication, 8(3), 188–199. Bedrosian, J., Hoag, L., & McCoy, K. (2003). Relevance and speech of message delivery trade-offs in augmentative and alternative communication. Journal of Speech Language & Hearing Research, 46, 800–817. DOI: 1092-4388/03/4604-0800 Binger, C. & Light, J. (2007). The effect of aided AAC modeling on the expression of multi-symbol messages by preschoolers who use AAC. Augmentative and Alternative Communication, 23(1), 30–43. Binger, C. & Light, J. (2008). The morphology and syntax of individuals who use AAC: Research review and implications for effective practice. Augmentative and Alternative Communication, 24(2), 123–138. DOI: 790496493 [pii] 10.1080/07434610701830587 Bloch, S. & Beeke, S. (2008). Co-constructed talk in the conversations of people with dysarthria and aphasia. Clinical Linguistics and Phonetics, 22(12), 974–990. DOI: 10.1080/02699200802394831 Bloch, S. & Clarke, M. (2013). Handwriting-in-Interaction between people with ALS/MND and their conversation partners. Augmentative and Alternative Communication, 29(1), 54–67. DOI: 10.3109/07434618.2013.767497 Carston, R. (1997). Relevance-theoretic pragmatics and modularity. UCL Working Papers in Linguistics, 9, 1–27. Carston, R. (2002). Thought and Utterances: The Pragmatics of Explicit Communication. Oxford: Blackwell Publishing. Clarke, M. & Wilkinson, R. (2007). Interaction between children with cerebral palsy and their peers 1: Organizing and understanding VOCA use. Augmentative and Alternative Communication, 23(4), 336–348. Clarke, M. & Wilkinson, R. (2008). Interaction between children with cerebral palsy and their peers 2: Understanding initiated VOCA-mediated turns. Augmentative and Alternative Communication, 24(1), 3–15. Clarke, M. & Wilkinson, R. (2009). The collaborative construction of non-serious episodes of interaction by non-speaking children with cerebral palsy and their peers. Clinical Linguistics and Phonetics, 23(8), 583–597. DOI: 10.1080/02699200802491132

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Falkman, K.W., Sandberg, A.D., & Hjelmquist, E. (2002). Preferred communication modes: Prelinguistic and linguistic communication in non-speaking preschool children with cerebral palsy. International Journal of Language Communication Disorder, 37(1), 59–68. Grice, H.P. (1975). Logic and conversation. In P. Cole & J. Morgan (Eds), Syntax and Semantics: Speech Acts, Vol. 3, pp. 41–58. New York: Academic Press. Hoag, L., Bedrosian, J., McCoy, K., & Johnson, D. (2004). Trade-offs between informativeness and speed of message delivery in augmentative and alternative communication. Journal of Speech, Language & Hearing Research, 47, 1270–1285. DOI: 1092-4388/04/4706-1270 Hoag, L., Bedrosian, J., McCoy, K., & Johnson, D. (2008). Hierarchy of conversational rule violations involving utterance-based augmentative and alternative communication systems. Augmentative and Alternative Communication, 24(2), 149–161. DOI: 10.1080/07434610802038288 Hornmeyer, I. & Renner, G. (2013). Confirming and denying in co-construction processes: A case study of an adult with cerebral palsy and two familiar partners. Augmentative and Alternative Communication, 29(3), 259–271. DOI: 10.3109/07434618.2013.813968 Light, J. (1997). “Let’s go star fishing”: Reflections on the contexts of language learning for children who use aided AAC. Augmentative and Alternative Communication, 13, 158–171. DOI: 10.1080/07434619712331277978 Light, J., Collier, B., & Parnes, P. (1985a). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Part III – Modes of communication. Augmentative and Alternative Communication, 1, 125–133. Light, J., Collier, B., & Parnes, P. (1985b). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Discourse patterns. Augmentative and Alternative Communication, 1, 74–83. McCall, F., Marková, I., Murphy, J., Moodie, E., & Collins, S. (1997). Perspectives on AAC systems by the users and by their communication partners. European Journal of Disorders of Communication, 32(3), 235–256. McCoy, K., Bedrosian, J., Hoag, L., & Johnson, D. (2007). Brevity and speech of message delivery tradeoffs in augmentative and alternative communication. Augmentative and Alternative Communication, 23(1), 76–88. DOI: 10.1080/07434610600924515 Smith, M. & Connolly, I. (2008). Roles of aided communication: Perspectives of adults who use AAC. Disability and Rehabilitation: Assistive Technology, 3(5), 260–273. DOI: 905849173 [pii]10.1080/17483100802338499 Soto, G. (1997). Multi-unit utterances and syntax in graphic communication. In E. Björk-Akesson & P. Lindsay (Eds), Communciating Naturally: Theoretical and Methodological Issues in Augmentative and Alternative Communication, pp. 26–32. Västeras, Sweden: Mälardalen University Press. Sperber, D. & Wilson, D. (1986/1995). Relevance: Communication & Cognition. Oxford: Blackwell Publishing. Stephenson, J. (2009). Iconicity in the development of picture skills: Typical development and implications for individuals with severe intellectual disabilities. Augmentative and Alternative Communication, 25(3), 187–201. van der Henst, J.-B., Carles, L., & Sperber, D. (2002). Truthfulness and Relevance in telling the time. Mind and Language, 17(5), 457–466. von Tetzchner, S. & Basil, C. (2011). Terminology and notation in written representations of conversations with Augmentative and Alternative Communication. Augmentative and Alternative Communication, 27, 141–149. Wilson, D. (2000). Metarepresentation in linguistic communication. In D. Sperber (Ed.), Metarepresentations: A Multidisciplinary Perspective. Oxford: Oxford University Press. Wilson, D. & Sperber, D. (2004). Relevance Theory. In L.R. Horn & G. Ward (Eds), The Handbook of Pragmatics. Oxford: Blackwell.

11 Communication participation of adults who are lifelong aided communicators Lynsey Parrott

Introduction This chapter explores social interactions of four adults with cerebral palsy (CP) who have a lifelong experience of aided communication. The data is taken from a larger qualitative research project involving ten adults, which formed the basis of a doctoral thesis (Parrott, 2014). This exploration shows how successful such users of augmentative and alternative communication (AAC) are in achieving one of the ultimate goals of human life, namely favourable and effective interpersonal interaction (Schiffrin, 1994). Being a flexible and efficient communication partner, confident and successful across a range of different contexts (Smith & Murray, 2011), is often viewed as a long-term goal for aided communicators. One step of inquiry could be to consider how talk, specifically its content and processes, happens in adult interpersonal interaction involving aided communication. In light of this, the current chapter takes a discourse analytic approach to exploring the extent to which four adults participated in interpersonal interactions about their lives, opinions and experiences. The goal of this analysis is to contribute to the emerging knowledge of the natural history of aided communication skills with a view to considering how these findings may inform AAC intervention (Johnson, Beitchman & Brownlie, 2010). An interactionist model of communication drives theoretical representation of communication beyond the discrete roles of the participants, the message and the medium (Bloom & Tinker, 2001; Schiffrin, 1994) to a point where all behaviours, whether intentional or unintentional, verbal, physical or paralinguistic, convey messages that are determined by contexts. The recipient of the information is as responsible for successful communication as the initiator. How adult aided communicators use multiple modalities to participate in talk-in-interaction, and how they manage intentional interpersonal interaction, is potentially more illuminating than trying to judge the isolated concept of their communicative competence (Light & McNaughton, 2014). Each modality contributes to a potentially rich interactional experience for both the aided communicator and their conversational partner. Participants’ involvement in

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communication is informed by their awareness of, engagement in and motivation to be effective social and cultural beings (Tetnowski & Franklin, 2003). The social construction of communication participation is the process of individuals’ engaging in talk-in-interaction (Kovarsky, Culatta, Franklin & Theadore, 2001), where interactional competence is consequently jointly generated, distributed and evaluated within this action of engagement (Duchan, Maxwell & Kovarsky, 1999). It can alternatively be described as the consequence of the participants’ location of self and how others locate them through their respective contributions, reflecting their personal and moral attributes as speakers (Harŕe & van Langenhove, 1991). Individuals can locate in conversations with different identities in real conversational exchanges and indeed are positioned by others as different kinds of people (Bucholtz & Hall, 2005; Davies & Harŕe, 1990). How any communicator experiences and learns these variations of position has to be constructed at an interactional level (Edwards & Potter, 1992). This seems particularly critical in aided interaction. Aspects of conversational style such as balance, pacing, humour, storytelling, and appropriateness of contributions vary according to the formality of the situation and location, and from person to person with reference to involvement, age, gender, interest and status (Fairclough, 2003; Tannen, 2005). The complexities and challenges involved in aided interaction require consideration of the components of both the natural speakers’ and adult aided communicators’ participation. In order to participate in an interaction and to subsequently organize and sustain the exchanges, an individual must have something to say or share, a response, a memory and interactional skill (Beukelman & Mirenda, 2013). Given that the cumulative experience of conversational involvement will influence the participation of adult aided communicators in specific conversations, the question of how they create a “communion of reciprocally sustained involvement” (Goffman, 1967, p. 116) is posed as part of the focus of this chapter. To explore the communication participation of adult aided communicators, it is helpful to collect and analyze extracts of authentic, unscripted communicative interaction (Schegloff, 2007). The transcribed extracts of data in this chapter were analyzed taking a Discourse Analytical (DA) approach, principally informed by the work of the social psychologists Potter and Wetherell (1987), to examine how talk and non-talk was used to locate, frame and maintain the interactants’ own realities and identities within the conversations. Edwards and Potter (2001) state that “talk” is the medium through which perceptions, motivations and thoughts happen, and therefore the “real language that real people use in the real world” (Woods, 2006, p. 10) must be examined. This necessitates analysis beyond the linguistic elements of the aided communicators’ utterances. Adult aided communicators might wish they had access to vocabulary perhaps not represented on their communication devices (Dark & Balandin, 2007) (see von Tetzchner & Stadskleiv, Chapter 2, this volume), so it is helpful to know how they use the resources and communicative repertoires they do have. It is also informative to recognize how aided talk is used to create identities, relationships and social roles through interaction (Shadden, 2005; Starks & Brown Trinidad, 2007). Analyzing authentic interactions with a focus on the active nature of its construction can yield unique insights into participation and identity.

Communication participation of adults who are lifelong aided communicators

Identity, as a theoretical construct, has been extensively researched (Jenkins, 2014). In this chapter, the analytical process of how the conversational participants established notions of self and others is viewed through an ethno-methodological perspective. What participants do and what they know about interaction is studied, with talk and other communicative repertoires the vehicle for observation. Identity is described as a vantage point from which an individual views, experiences and interacts with their social world. In this regard, communicators actively learn and create identities through constructing and exercising various discourses (Benwell & Stokoe, 2006; Davies & Harré,1990; Wetherell, 2001). In deconstructing interactions, it is possible to identify how the aided communicators positioned themselves in a category of an interactive other (Antaki & Widdicombe, 2008; Willig, 1999). An identity should be seen to be dynamic (Burman & Parker, 1993; Zimmerman, 2008) and therefore responsive to contextual variations. This has potentially significant implications for the aided communicator, who might be primarily reliant on the linguistic content of their voice output communication aid (VOCA) for such purposes. Smith and Murray (2011) commented that “aided communication devices can obscure the visibility of people who use AAC” (p. 295), implying that we do not see the identity of the person beyond the device or communication aid. It is entirely possible that aided methods of communicating will not dominate as the preferred mode, but, for example the degree of agency and independence some adults might achieve by directing their personal assistants is unknown (Smith & Connolly, 2008). Additionally, information about when and how they might use unaided communication signals to emphasize their strength of feeling or the construction of an opinion is limited in the research literature. DA methodology is used in this chapter as a tool to explore multimodal discourse from the perspectives of four contributors with the aim of illustrating their participation during interpersonal interaction.

Contributors The four contributors of data in this chapter were a woman, Ellen, and three men, Harry, Jacob and Ian. They were aged between 22–55 years and were lifelong users of multimodal communication, for example voice output communication aids (or speech generating devices/SGDs), symbol boards and unaided communication systems. Table 11.1 presents details of the four adults in the form of their pseudonym, age Table 11.1 Contributors’ details, topics and utterances.

“name”

Age (approx.) Illustrative quote

Ellen

20

“Just a minute. I want to say something else. What time does it finish?” [pre-stored]

Harry

25

“Proud not see my dad Sunday.”

Jacob

50

“I have take over”

Ian

40

“Can you come again”

249

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The Silent Partner?

(approximate) and quotations providing illustrative identity insights from one of their interviews. Specifically, each quote provides a single and brief insight into an aspect of their character or personality, hobby or interest, as well as their unique linguistic ability and message formulation style.

Data collection and analysis protocols In order to address some very specific challenges experienced by aided communicators, for example establishing and sharing mutually interesting or preferred topics of conversation, a multi-level analytical approach to the data was necessary. Conversationstyled interviews (Brown, Worrall, Davidson & Howe, 2010) between natural speakers and the four aided communicators were the focus of data collection. Protocols detailed by Taylor (2013) and Higginbotham and Engelke (2013) partially informed both the transcription and the data analysis of the interaction between the contributors. Additionally, the conversations were analyzed to reveal what the contributors talked about (topics) using a coding system reported by Tönsing and Alant (2004), for the identification of the occurrence and frequency of topics. Throughout all of this process, it is acknowledged that alternative discourses, and therefore topics for analysis, would be produced at different times with other partners in various settings. Talk is the focus of DA. This approach is used by practitioners and researchers and, although it does not have a single definition or theoretical basis (Cheek, 2004; Potter & Wetherell, 1987; Taylor, 2013), DA is commonly used to interrogate the practices and interactions of social life, cultures and identities. DA is thought of as an analytic mentality rather than a set of formalized processes (Schenkein, 1978; Smithson, 2015). Potter and Wetherell (1987) proposed that the core concerns or principles of DA are that talk is action-oriented and it enables people to perform social actions and to build meaning and beliefs. Within DA, the constructive process of the interaction is the focus of analysis, and any variation of the social context and interactional purpose is important to the construction of an individual’s relationship with, or their identity within, the social world (Edwards & Potter, 2001; Taylor, 2013). Previously-reported organizational features of conversations not involving aided communication (ten Have, 2007; Wooffitt, 2005) were selected to guide the analysis of how the interactions were accomplished, namely taking turns at contributing (that is, speaking) and topic, or conversation openings. These features acted as organizational markers for the initial readings of the transcripts. Following the initial readings, with and without accompanying video, extracts were selected for further study because they stood out for a particular feature (Taylor, 2013), for example, conversational openings. A further process was completed involving critical reflection on the similarities and differences across the speakers, as described by Wood and Kroger (2000). This intensity of analysis permitted an understanding of how contributors used their multimodal resources to construct their contributions in the sequences of interaction, rather than analysis of purely linguistic features. For example, the identification of the knowledge and meaning being exhibited through the individualized interactions with different discourses between employer and employee became the critical focus in the current analysis. Finally, the variability in the presence and absence of topic

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251

content, and the influence of this talk guided an understanding of the participatory involvement of the four aided communicators and their natural speaking partners (Potter & Wetherell, 1987). By looking at sequences of interaction, it was possible to consider how the conversational partners constructed identities. For example, an extract from Jacob discussing life, exemplifies persistence and moral agency (Extract 11.3). He is also positioned by his conversational partner as an individual with something valuable and important to say. An extract from Ian offers political opinions with moral consequences, as permitted through a co-constructed topic (Extract 11.5). In the extracts below, how the contributors have made their identities and participatory engagement relevant within specific conversational features is explored. The following section is divided into three parts, using the following frameworks. Part 1: Getting into conversations, including politeness routines and social etiquette (Extracts 11.1 and 11.2 with Harry). Part 2: Sustained participation in conversations about preferred topics (Extracts 11.3, 11.4 and 11.5 with Jacob, Ellen and Ian). Part 3: Maintaining participation in a preferred conversation by managing others to speak on their behalf (Extract 11.6 with Jacob).

Part 1 Getting into conversations: Politeness routines and social etiquette Extract 11.1 Harry – “Would you like coffee?” Some aided communicators can find it challenging to assert themselves as initiators of conversations for a variety of reasons. In this first extract, Harry successfully demonstrates his conversation involvement in an opening sequence, asserting a conventional politeness routine. His positioning through ‘participation’ constructs his confident personal identity as host, being an active agent with social control. His communicative repertoire includes a voice output communication aid (VOCA) mediated response. In the transcription, the initials LP denote the researcher. Lines of particular focus in this discussion are indicated with an arrow. A description of the interaction is necessary to fully illustrate the construction of his social positioning. Harry was heard laughing down the corridor whilst his personal assistant (PA) wheeled him to the sitting room in his shared occupancy bungalow. Harry began the interaction sequence immediately by spontaneously asking a question. An important feature of this opening at line 01, comes from Harry’s ability to achieve social control as host using an utterance with non-standard syntax. There is no intonation to suggest it is a question. The two-word phrase “coffee you” is a shortcut and is effective in its transference of meaning through its similarity to a typical question format (e.g., Coffee?) and context can be drawn on to infer meaning and the implied question. Given this social context, the offer and subsequent interaction is therefore made successful by both host and guest. Clearly, Harry is aware of the pragmatics of offers and requests. He ensures that, as guest, I understand that he is not simply requesting or demanding a coffee for himself from his PA, because he adds the pronoun “you” to indicate that he is offering me a drink. He indicates the pragmatic need to do this and that, as the host, it is his social

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The Silent Partner?

Extract 11.1 Line

Speaker

Transcription

01→

Harry

“Coffee you”

02

LP

Yes thanks – that’s kind of you. Black please. […] I’ve got a good shot of your knees ((PA goes off to kitchen))

03

Harry

Yuh

04

LP

All I am filming Harry is……((Harry interrupts/overlaps))

Extract 11.2 Line

Speaker

Transcription

01→

Harry

“How are you?”

02→

LP

(1.8) Not too bad thank you. I must admit I am a little bit all over the place.

03→

Harry

“Dentist”

04

LP

(3.8) Dentist ((requesting clarification))

05

Harry

Yeah. “you” + you

06

LP

Me? You remembered? Oh. You are so thoughtful. ((I had forgotten I had told him about my dental appointment.)) I am such a baby.

07

Harry

Laughs

08

LP

Don’t laugh. + Laughs + I had to have two massive fillings. ((Harry laughs)) I had to hold my mouth open for a whole hour. I couldn’t eat anything all day ((Harry laughs)) Go home to bed. I was a right sook about it.

09→

Harry

Laughs + “hahahaha”

obligation, or right to act in this way. He takes the conversational and interactional lead with the initiation of the turn and its content positions him as active and in control. These actions could be interpreted as reflecting a motivation that by doing this familiar act, he is perhaps offering normality as a part of his identity. The immediate acceptance of his offer in line 02 reinforces his action as host, valuing its intent and reinforcing the chances of later reciprocation and positioning in the host–guest discourse frame. On this occasion, the more formal and polite version, perhaps “Would you like a cup of coffee?” is not required. He uses his VOCA rather than his communication board, perhaps because he recognized that both myself and his PA were busy and therefore unable to read his selection from his board or, for this communicative act, using a voice was loud, instant, more assertive, powerful and typical. He thus positions himself strongly as the active and successful agent.

Communication participation of adults who are lifelong aided communicators

253

Extract 11.2 Harry – “How are you?” In this extract, Harry demonstrates successful participation by further developing his opening of the conversation using a conventional politeness routine. His positioning through participation with a friend discourse, constructs an empathic personal identity through his use and development of an emotional and health status enquiry. In terms of analysis, timed intervals with interpretative significance are coded with specific timings. His communicative repertoire includes a pre-programmed VOCA-mediated response as well as self-generated linguistic content. Joint laughter is also generated in this interaction, initially led by Harry. In this extract, Harry overlaps with an interruption (Extract 11.1, line 04). His signalling for the conversational turn terminates my comment about the direction of the camera, to enquire after my health, using a politeness discourse based on health status (Hayes & Hannold, 2007) and friend frame, using a pre-stored phrase (Extract 11.2, line 01). A non-specific and informal two-part response (line 02) follows, with a hesitancy indicating an uncertainty about the nature of his question as a routine opening inquiry that was perhaps not meant to be taken literally. Harry seems to regard this first-part polite response as unsatisfactory. He disregards the second part of the response and develops his turn and inquiry by expanding and adding more personal and contextual information (line 03 and 05). The response at line 04, with its initial pause of a longer timed duration suggests further uncertainty until Harry’s use of combined modalities finally achieves a shared topic of conversation of his preference. His persistence has been effective. Joint laughter follows realising social closeness and rapport. Harry’s expressions of concern for my welfare elicit a polite acceptance from me and also an evaluative comment, Extract 11.1 line 02 (that’s kind of you) and Extract 11.2 line 06 (you are so thoughtful) perhaps acknowledges his identity as a compassionate adult. At the close of Extract 11.2, Harry chooses to add some double laughter where he not only laughs naturally with his voice but also by pressing the particular cell on this VOCA (line 09). Both expressions through laughter are compassionate and are interpreted as genuine and contributing impact. It also helps to reinforce his turn and his identity as a compassionate, yet cheerful person with a sense of humour. Both extracts show Harry constructing the positions of speaker-initiator and empathic conversation partner. His ability to take social command and agency when offering me a drink strengthens his powerful identity as a person who is able to establish control. Overall, the positions constructed by these conventional politeness routines for Harry, were of a confident and assertive adult speaker who was mindful of the needs of others (van der Bom & Mills, 2015). This created an atmosphere of engagement and congeniality, engendering shared participation.

Part 2 Sustained participation in conversations about preferred topics Extract 11.3, line 02 Jacob – “I am happy as I am” One of the main challenges aided communicators face is maintaining contributions over several turns, particularly when it takes a significant amount of time to create a

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The Silent Partner?

Extract 11.3 Line

Speaker

Transcription

01

LP

Is there an expectation do you think that we want more or (.) have higher expectations on what we can achieve? What are your thoughts?

02

Jacob

((vocalizing)) “No I am happy like I am” ((FT 2 mins 2 sec.))

03

LP

….basically happy but you have noticed that things are changing.

04

Jacob

Sighs

05

LP

mmmm… so that’s just generally…. to do with….just life and not just about um…..things for people with disabilities?

06

Jacob

Vocalizes=no

07

LP

No…. mmmm ((There a sharp intake of breath denoting that I was going to say something but I stopped for his turn))

08→

Jacob

((vocalizing))… “I had talk yesterday about this” ((FT 2 mins 25 seconds)) ((vocalising))

09

LP

Did you?

10

Jacob

Nods …. Vocalising

11

LP

laughs ah ↑↓ ((recognizing the coincidence))

12→

Jacob

Sighs..vocalizing… “I said you see I got a disability I still a person” ((FT 5 mins 2 secs)) ((vocalizing))

13

LP

muh..mm… yeh.. so for you…what sort of things (.) do you value then about your life that makes you feel happy and pleased with what you’ve got … that makes you that content and happy?

14→

Jacob

…gulps… “I believe” looks at me ((as if expecting me to know what he is saying)) … ((FT 41 sec))

15

LP

So that’s your faith that guides you. Are there other things that you also value highly?

16

Jacob

(4 secs) V=wuh (no) + shakes head

17

LP

No that’s it…that guides you & gives you that happiness.

18→

Jacob

((vocalizing)) “I get to (deletes to) things wrong some time like all of us”. ((FT 2 mins 59 sec)) ((vocalizing)) Interaction time taken – 10 minutes

contribution. In this extract, Jacob demonstrates participation through his conversation involvement in maintaining the topic and in the elaboration of a preferred topic. His positioning through participation constructs his personal identity with an emotional and moral stance and a shared identity. His communicative repertoire includes vocalizations and VOCA-mediated linguistic content. Jacob participates in both speaker and listener positions in a 53-minute discussion around the preferred topic of life, and specifically, his thoughts about what has been good and the challenges he encountered. Formulation times (FT) are included, timed from the first click of the communication device (activation of a cell) to the spoken transmission, in addition

Communication participation of adults who are lifelong aided communicators

to the overall timed duration of the topic exchange. Jacob uses many variations of vocalizations throughout the conversation, indicated in the lines. Immediately (line 02) Jacob positions himself as feeling positive and as having an emotional and moral contentment with his life now. By using a personal pronoun and the present tense of the verb ‘to be’ he places himself firmly in the here and now. He replies instantly by vocalizing a negative to reject the first part of the question (line 01). He chooses to maintain the conversation and extends the topic (line 08). He does not reveal with whom he had been conversing or the context, but this demonstrates that he has other conversation partners and that he has opinions he likes to share through interaction with others. On line 12, he continues talking assertively about his satisfaction with life by using a double complex sentence including an example of reported speech, “I said” which takes him 5 minutes to formulate. He positions himself unequivocally as a person regardless of his disability, thus asserting his construction of normality. His use of the adverb ‘still’ in relation to himself (I am), conveys the longstanding nature of him being a person, despite a disability. Jacob’s subject+verb response at line 14, “I believe” is a direct reference to his faith, and takes persistence to generate, as evidenced by the timed duration of his holding the conversational floor. This emphasizes its importance to Jacob’s wellbeing and quality of life. In the final turn (line 18) he modestly states that regardless of his faith he makes mistakes and in using the pronoun “us”, aligns himself with the wider community and shares a common identity (van Langenhove & Harré, 1993), indicating a positive assessment.

Extract 11.4 Ellen – “shopping” The opportunity to be a combative interactant in an interaction with a speaking partner can be problematic, partly due to the fast pace of the turns. The fourth extract, from Ellen, demonstrates participation through her elaboration of a preferred topic. Her positioning through participation constructs her assertive personal identity as a holder of knowledge and opinion that confronts one of her communication partners. Her unaided communicative repertoire includes vocalizations coupled with quick eye-

Extract 11.4 Line

Speaker

Transcription

01

LP

What about things like shopping? Do you get to go shopping if you want?

02

Ellen

(UpL) ‘no’

03

LP

No

04→

Carer

((turns quickly to face Ellen)) What do you mean no?

05

LP

((pauses)) Would you like to do more shopping than what you do?

06→

Ellen

(UpR) ‘yes’ + V= uhuh

07

LP

There you are

08

Ellen

V=ahhh. ((In the background, carer is voicing displeasure)).

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The Silent Partner?

pointing, looking upwards and to the left (coded as UpL) for no, and upwards and to the right (upR) for yes. An interesting feature is when her male carer challenges (line 04) the accuracy and therefore integrity of her response (line 02). The interactional challenge is unexpected as illustrated by the carer’s surprise and request for clarification. The impact of Ellen’s decisive positioning (line 02), is possibly demonstrated in the carer’s responses (line 04), which seems to indicate that he perceives her challenge as a criticism of the institutional routine. Ellen manages his confrontation in line 06, by combining several communication modes to indicate depth of feeling, behaviours also reported by Hörmeyer and Renner (2013). This signals strength and confidence in her assertive position. Ellen chose not to assert any VOCA-mediated contributions, possibly because her device activation was unreliable and consequently, the message formulation times were too slow for such a combative exchange to occur. Importantly, this interactional contribution offers personal insight and knowledge, previously unknown to the conversational partners, despite the absence of any linguistic contribution.

Extract 11.5 Ian - “I think it is rubbish” Line

Speaker

Transcription

01

LP

[…] I wondered if you ever follow the news to find out what the party’s policies are… […]

02

Ian

shakes head “No thank you” ((FT 38 secs)) + still looking at VOCA

03

LP

Laughs Is that too much too much ((Ian smiles)) political information?

04

Ian

smiles + nods + still looking at VOCA

05

LP

I would agree with you there. Ian clears screen and turns to me […] D’you know, in Australia it’s compulsory to vote ((if you are over 18))

06→

Ian

“Why?” ((FT 16 secs)) + still looking at VOCA

07

LP

Because em, I think it’s because they want everybody (Ian begins FR) to have an opinion about the government because it’s a democracy […]

08→

Ian

“I think it is rubbish”. ((FT 36 secs)) + still looking at VOCA

09

LP

((Begins when Ian turns to me)) You like the system that we’ve got?

10

Ian

nods + looks at me ((atypical gaze shift – trouble?))

11

LP

[…] Do you know in Scotland, they’re going to lower the voting age I think it may be, sixteen. (.)

12

Ian

“I think it is rubbish because them at school”. ((FT 1 min 37)) + still looking at VOCA

13

LP

Mm. I’d agree with you there. […] But, it’ll be interesting to see what happens in Scotland. (Ian smiles and vocalises Q) Cos I think (LP touches Ian arm) that David Cameron was also thinking about lowering the voting age. ((Ian turns to VOCA))

14→

Ian

“If he do it I will off him”. ((FT 1 min 11 )) ((slowly turns to me))

15

LP

You’ll what him? ((Leans forwards)) I didn’t catch it. ((Reads and sits down.)) Oh you’ll off him? You’ll go off him? Total interaction time – 9 minutes 22 sec

Communication participation of adults who are lifelong aided communicators

Extract 11.5 Ian - “I think it is rubbish” The opportunities for an aided communicator to maintain and elaborate a preferred topic of conversation can be limited. In Extract 11.5, the extent of Ian’s conversational involvement illustrates a depth of participation. Additionally he demonstrates reciprocity. His positioning through sustained engagement constructs an informed personal identity as a holder of an opinion. His communicative repertoire includes VOCA-mediated responses and facial expressions. Within the longer, 20-minute discussion about politics, the topical and potentially controversial subject of voting age arose. Formulation times (FT) are included, timed from the first click of the device (activation of a cell) to the spoken transmission; in addition to the overall timed duration of the topic exchange. In this 9-minute extract, Ian positions himself as the active and curious speaker (line 06) and also interested listener. This assertive discourse presents him giving a view, (line 08) and offering an evaluative comment (line 12) with a possible political action or consequence (line 14). By using ‘I’ statements in lines 08 and 14 he signals unique and personal ownership (Harré & van Langenhove, 1991) or a mental state. He is unequivocal about this and does not choose to use any hedging devices, for example, “I think maybe” an example used by him in a different conversation. Notably in this extract, a reflective and non-judgemental position is presented through the question “I wondered…”, and this elicits a response that is polite, clear and strong (line 01). The opener ‘Do you know…” presents an invitation to comment (line 05 and 11), which he successfully accepts. The invitation positions him as a potential holder of knowledge and subsequent contributor. Indications of agreement and engagement are noticed in lines 03 and 04. Ian’s smiling responses occurred infrequently in our interactions so their occurrence in this extract is notable and unusual. A particular instance of social closeness occurs (line 13) where he smiles, triggering physical contact to his response. This reciprocated closeness is unusual for our conversations but perhaps it is associated with this sequence of agreement around a preferred topic. The topic is sustained for about 10 minutes by both parties utilising a variety of strategies including eye-gaze, listener silence and respectful curiosity. Questions are asked of each other to elicit clarification and information. There was equality in the sharing of views and opinions; reciprocity was created and the discussion continued for a further 5 minutes.

Part 3 Maintaining participation in a preferred conversation by managing others to speak on their behalf Extract 11.6 Jacob - “iPad” Many aided communicators use others to provide support for a variety of purposes. Sometimes in interaction the positions of these “others” is unclear. However in this final extract, the interactions construct a discourse between the ‘employer’ and ‘employed’. Jacob participates by confidently managing a “conversational other” to guarantee the maintenance of his preferred topic. How Jacob makes this relevant, and constructs himself as an organiser of others is explored. Jacob asks a VOCA-mediated question

257

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The Silent Partner?

Extract 11.6 Line

Speaker

Transcription

01→

Jacob

“What I was going to ask you do you now ((corrects spelling)) anyone know about ipad?” ((FT 4 mins 23 sec))

02

LP

Huh…so not…not, you are not thinking about an OT?

03

Jacob

No

04

LP

No. um… what about the ipad? Just….

05

Jacob

Shouts for his carer

06

Carer

Alright?

07→

Jacob

Will you?.....

08

Carer

Well he was… you were looking at something that he can go on from programme to programme and can take photos and email.

09

Jacob

Yuh

to help him pursue his interest in photography. Message formulation times (FT) are included in the double-brackets to indicate his strategy of holding the conversational floor. Additionally, he integrates usage of vocalizations here to expedite his request and to affirm his orientation to progressivity (Koole & Mak, 2014). Jacob opportunistically questions me, changing from a previous and possibly central topic about the availability of therapy services. In line 01, he initiates asking this question by politely prefacing his request with a hedging comment. Again, the lengthy time duration conveys the motivation and importance he attaches to furthering his agenda. What is noticeable in line 01 is the absence of interruptions. A position of competence is attributed, indicating that he can talk for himself, that he is not helpless and does not need rescuing, despite taking a turn of almost four and a half minutes duration. Jacob shouts (vocalises with volume) for his carer to join us from an outside room, to speak on his behalf to explain the intricacies of the problem (line 07), demonstrating not only his multimodal communication repertoire but also his polite regard for our time-limited conversation. He acts with definite and normative purpose. The carer quickly complies and by switching from ‘he’ to ‘you’ demonstrates deference and confirmation of Jacob’s status.

Discussion Part 1: Getting into conversations including politeness routines and social etiquette Most interactions with the four adults emerged in an extemporaneous manner, reminiscent of typical interactions where both parties develop co-ordinated and shared contributions (Hutchby & Wooffitt, 2006). The management of verbal and nonverbal behaviours was variable and necessarily responsive to the individual contexts. Typically, after a welcome routine, small talk occurred (Coupland, 2003), whilst the

Communication participation of adults who are lifelong aided communicators

aided communicator and others settled, creating a relaxed environment. Opening sequences are important in establishing the tone of the interaction (Riggio, Friedman & DiMatteo, 1981) and here they were generally varied and often unpredictable. It was noted that some, but not all, contributors observed common and familiar rules of social etiquette, for example, by offering a drink, but many contributors’ carers themselves executed the “would you like a cup of coffee/tea?” routine. Although Collins, Markova and Murphy (1997) carefully described how conversations between aided communicators and natural speakers were brought to a close, conversational openings have received much less attention in the AAC literature, by contrast to its visibility in naturally spoken research. Sidnell (2010), for example, describes how conversations are opened between natural speakers who do not know each other. Greetings act to express a desire and an availability to interact, and an agreement to participate (Orr, 2008). Conversational partners move from unfocused to focused interaction by incorporating non-verbal devices such as eye gaze, smiling and appeasement gestures such as back-patting or handshakes (Riggio, Friedman & DiMatteo, 1981). They act to establish or reaffirm the type of relationship, and are learned behaviours. The openings by Harry in Extracts 11.1 and 11.2 demonstrates some critical features of this type of discourse context; how they are organised, their vital function in the conduct of adult aided interaction and subsequent impression formation (Zimmerman, 2008), and also how they help create and maintain conversational partners’ social identity (Read, Moreton & Ryan, 2015). For some contributors, the language used and interactions constructed could be seen to reflect a position of ‘normality’. This construction of identity resonates with some of the conversations by adolescent aided communicators, reported by Wickenden (2011). Generally, interactional greetings help orientate participants to the purpose of the interaction. Additionally they may be important for aided communicators to position themselves as socially motivated towards putting others at their ease (Coupland, 2003). Countering any negative stereotypes or judgements may be a concern for aided communicators. Indeed, some of the adult aided communicators in the research by Trembath, Balandin, Stancliffe, and Togher (2010) encountered negative judgements by typical speakers. One of the limitations for aided communicators (of both genders) may be their inability or reluctance to initiate or reciprocate approximated physical gestures, for example, handshakes or body contact of some type. Expressing social recognition and the social closeness that accompanies the act can be one of the most critical phases in interactions. Variation in interactional openings by adult aided communicators exists, for varied reasons. The use of VOCA-mediated formal phrases (either novel or pre-programmed) can be associated with social etiquette and politeness routines. Another form of opening is a more casual, warming up style, with the aided communicator positioned with anticipation commensurate with the role of interviewee. These openings including the ‘how are you?’ inquiries that appear in ordinary interactions with natural speakers (Sidnell, 2010). One difference with aided communicators is perhaps the challenges in being able to respond flexibly and sensitively to the individual identity of the recipient. The ‘how are you?’ inquiry can portray the speaker as caring through conscious

259

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The Silent Partner?

engagement and awareness of the cultural rules of social etiquette. This opportunity to position oneself as socially aware is important because it creates a positive impression of communicative competence, and offers inter-personal expansion within the interaction (Orr, 2008) and may include friendship development (Rawlins, 2009). Openings therefore appear to be an important facet of interaction. Considerable variation in interaction openings exists across the contributors that may be influenced by individual differences in control of voluntary movements, levels of physical dependency and individual social contexts. In reality, it may be that some aided communicators have neither used nor practised these opening sequences, and consequently noticed the possible impact and value on subsequent interaction.

Part 2 Sustained participation in conversations about preferred topics Extracts from Jacob, Ellen and Ian revealed their motivated involvement in conversations about preferred topics, and how these demonstrate reciprocity and personal commitment. For natural speaking conversation partners, an analysis of topic talk reveals what the interaction is about and what the talk does. Both facets are important for adult aided communicators and their partners in terms of participation in conversations and the validation of self and identity. The availability of appropriate vocabulary is only one feature of topic talk. Other features that help identify what topic talk does in an interaction includes how people orient to and organise themselves to talk about conversational themes and also how they finish a topic (Sidnell, 2010). In addressing the first critical challenge for adult aided communicators of what the talk is about, topics of conversation were established by either of the contributors. When an aided communicator initiated the topic, it positioned them as assertive communicators with motivation to participate with equal authority to ask questions. On some occasions, unaided communication modes were used to signal disagreement or dissatisfaction with the speaker’s choice of topic. Topics that were more agreeable to the aided communicator or demonstrated affiliation or like-mindedness between the two parties, generated increased performance or take–up, a finding in accord with Clarke and Wilkinson’s (2013) analysis of interactions between children using aided communication and natural speech. This shared involvement promotes rapport and social closeness and is a common ability for competent communicators (Tannen, 2005). An ability to talk about agreed conversational themes is important to demonstrate one’s identity, knowledge and position in society. An aided communicator might be limited in their social interaction by many factors such as the availability of appropriate vocabulary (Dark & Balandin, 2007), opportunities to have practised talking about topics, or life-experiences (Milner & Kelly, 2009) that provide the “business of the social world” (Goodwin & Heritage, 1990, p.283). It is therefore important to know what content is possible for adult aided communicators to develop, what strategies they use and also what the talk does in terms of positioning themselves with identities such as sporty and healthy, or as contributors to communities, as easy going, opinionated or assertive. Topics were maintained by aided speakers, and using speaker self-references (Land & Kitzinger, 2007), they positioned themselves as opinionated and possessing personal

Communication participation of adults who are lifelong aided communicators

views that were passionate and informed. Participants reflected ownership of views and the perspectives of others. Speakers also positioned themselves with moral agency (Harŕe & van Langenhove, 1991; Krahn & Fenton, 2009). These all contributed to a free-flowing conversation maintained by mutual exchange of linguistic content and by the conversational partners’ own interactional competence. An aided communicator’s conversation partner can acknowledge the views, using a reflective questioning style or may need to respectfully invite elaboration or clarification depending on terms of agreement (Heritage & Raymond, 2005). The relatively short but complete sequences presented in the current chapter of collaboratively constructed conversation and interaction demonstrated the joint actions of both parties. In Extract 11.4, Ellen’s positioning as a communicator with moral agency, is made relevant by her novel contributions. Such contributions are recognised as personal, positive and authentic contributions that make an impact on the recipients, evoking an atypical response (line 04). Responses can be managed with humour, surprise, relief and other emotions, facilitating greater understanding and interpersonal involvement (Tannen, 2007). Novel contributions are either linguistic utterances (Todman & Rzepecka, 2003), creative vocabulary usage or interactional behaviours, for example as in Ellen’s case through sequences of unaided signals.

Part 3 Maintaining participation in a preferred conversation by managing others to speak on their behalf Jacob, in Extract 11.6, constructs a position of ‘employer’ and therefore organiser of others. Many adults with cerebral palsy employ carers or personal assistants for a variety of purposes, and in some settings and interactions, the carers may assume the position of ‘host’ on behalf of the adult. Whether or not this is with the aided communicator’s prior instruction, it seems that the carer’s compliance with procedures and practices may be monitored by the aided communicators. For other aided communicators, this discourse positioning may not be a recognised or important aspect to their management of interaction and their identity. An interactional feature described in the research on aphasia as “speaking for another” (Simmons-Mackie, Kingston & Schultz, 2004, p.116) highlights instances where the aided communicator had carers or family members who could or would speak on their behalf. It is interesting to note that the roles of the others are variable across and within the aided communicators who participated in this study, reflecting a critically important, dynamic and individual interactional need. The carers (or others), unilaterally or with permission, may assume roles as protectors, elaborators, spokespersons or facilitators. They may be employees with different status, parents or family members with different personality characteristics. For the four adult aided communicators who participated in this study, there were no spouses or intimate partners acting as others, unlike in many of the studies with people with aphasia (Brown, Worrall, Davidson & Howe, 2010; Simmons-Mackie, Savage & Worrall, 2014). These others might be required to animate, assert, support or elaborate in a manner acceptable to their employer, daughter or brother, and importantly these positions will change. In the interactions with Harry for example, when he pointed

261

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The Silent Partner?

to his targeted communication-aid-mediated contribution (i.e., a written word) he was considered the author and speaker, whilst the partner who spoke out his targeted contribution might be classified as the animator (Clarke & Wilkinson, 2013) or the voicer, a term suggested by Pilesjö & Rasmussen (2011). These may be considered unimportant classifications, but there is evidence to suggest the positioning of others positively or negatively affects interactional competence, as evidenced in the example interaction of Purves (2011) within a family with a person with dementia. The adult aided communicators employed different strategies to manage their other, by looking to invite in or by using a direct request. Some carers spontaneously offered to assist with topic development, for example, using phrases such as, “Do you want me to…” (implying, “I have information if you would like me to share it” ) versus “Can I share …” (implying ownership of information and “I want to share it”). Carers presented different roles, behaviours and limitations. Most demonstrated respect towards the aided communicator and the conversation-styled interview situation as a whole. In some of the literature about adults with intellectual impairments, when a support worker or carer speaks for that person when in their presence (Williams, 2011) this is viewed as limiting and therefore positions the person with the communication impairment as dependent. The same could be said when carers or support workers physically act on behalf of their employer/client. Even though care and support are individual matters, many carers working with a diversity of clients, wrongly but sometimes correctly, assume the role of gatekeeper (Parrott & Pettit, 2012). One older adolescent with cerebral palsy in Egilson’s study (2014) reported having multiple assistants. This situation was described as messy because each assistant had different expectations of the adolescent. Although gatekeeping has been described by people with aphasia and their spouses as stigmatising and embarrassing (Gillespie, Murphy & Place, 2010), this opinion was not offered by the adult aided communicators, all of whom had many years of acclimatisation and acceptance of their different communication styles (Kraat, 1987). The employees (carers, personal assistants and keyworkers) or parents of these four particular aided communicators, largely acted as a communication assistant (Collier, McGhie-Richmond & Self, 2010).

Conclusion In this chapter, discourse analysis has facilitated an exploration of communication participation through conversation-styled interviews. This approach supports debate around communicative competence and its measurement. From the selection of extracts, it has been possible to identify positions of assertiveness, agency and status. This process of reflection on the discourse is a technique that allows practitioners to evidence the extent to which adult aided communicators use their communicative repertoires to construct identities through their participation in interactions with their natural-speaking partners. Communication for any participant with a constrained linguistic repertoire inevitably presents challenges for conversational partners on both sides of the interaction. This chapter has presented some data that highlights how, by utilising DA, a unique

Communication participation of adults who are lifelong aided communicators

perspective about communication participation is possible, revealing authentic exchanges of knowledge, ideas and feelings. Harry, Ellen, Jacob and Ian do just that. This discourse perspective contributes to the existing measures around communicative competences such as device-centric analyses, (e.g., Baxter, Enderby, Evans & Judge, 2012), or frequency counts and user/carer views. An understanding of the ordinary, and sometimes subtle but important interactional features between conversation partners where one participant uses aided communication may be illuminated through analysis of discourse. Whilst the time taken to formulate a turn might be regarded as a delay or an obstruction to the typical synchronisation of exchanges, both parties in the conversations analysed here demonstrated capacity to accommodate asynchronous conversational style to enable conversational progression. The importance and relevance assigned to the conversation participants’ use of all communication modalities, from subtle non-verbal messages to sophisticated linguistic utterances, was highlighted by these selected extracts of data. The four aided communicators presented in this chapter, tended not to be interrupted when they held the conversational floor as demonstrated in Extract 11.3 with Jacob (line 12). This role identity and behaviour is not extensively documented in the literature regarding adult aided communicators. It was unknown if this was a novel and/or powerful position for them or if it facilitated an easier turn, knowing that they would not be interrupted once they had started. The opportunity to contribute uninterrupted turns may have facilitated not only linguistic performance but also interactional competence. Finally, I would like to conclude with an insight from another person, Polly, who participated in a larger qualitative research project on the communication participation of ten adults with cerebral palsy who used AAC (Parrott, 2014). Polly emailed me after her first interview to strongly assert that, “My communication aid […] is my voice and not my Life”.

Acknowledgements The author wishes to thank Harry, Jacob, Ian and Ellen for their enthusiastic involvement.

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12 “ …this is not going to be like, you know, standard communication?” Naturally speaking adults using aided communication

Martine Smith, Ellen McCague, Justyne O’Gara and Seana Sammon

Introduction The following extract is from a conversation between two participants, identified here as PA3 and PA4, as they talk about their recent social activities. In this extract, PA4 is using a communication board that contains a combination of graphic symbols, words and an alphabet board, accessed directly by finger pointing.

Extract 12.1 1.1

PA3

When was the last time you went out?

1.2

PA4

(8) MONDAY

1.3

PA3

Monday? Last Monday? Yesterday?

1.4

PA4

laughs

1.5

PA3

Where did you go?

1.6

PA4

(6) FOOD DINNER

1.7

PA3

Out for dinner, in town?

1.8

PA4

FRIENDS

1.9

PA3

With friends?

1.10

PA4

FRIENDS

1.11

PA3

Did you cook?

1.12

PA4

(…) HOME

1.13

PA3

home

270

The Silent Partner?

1.14

PA4

FRIENDS HOME FRIENDS

1.15

PA3

You went to a friend’s house? Oh, ok, ok. Was it nice?

1.16

PA4

YES

1.17

PA3

Good, you said you like to go to the cinema a lot?

1.18

PA4

YES

1.19

PA3

What was the last one you went to see?

1.20

PA4

ACTION

1.21

PA3

An action film?

1.22

PA4

c-a

1.23

PA3

Captain Phillips? Did you like it?

1.24

PA4

YES

1.25

PA3

Who did you go with?

1.26

PA4

(3) FRIENDS

The structure of the conversation in the above extract will be familiar to anyone who has experienced conversations involving aided communication, with several features that have been described as commonly occurring in such interactions. These include an apparent asymmetry in speaker roles, with natural speakers’ turns at talk occupying a disproportionate amount of the conversational space and consisting largely of questions to be answered by a partner using aided communication (Basil, 1992; Buzolich & Wiemann, 1988; Clarke & Kirton, 2003; Dahlgren Sandberg & Liliedahl, 2008; Kraat, 1987; Light, 1988; Light, Collier, & Parnes, 1985; Müller & Soto, 2002). The slow pace of conversation with long pauses of up to 8 seconds between turns (e.g., Line 1.2) is also widely reported (Clarke & Kirton, 2003). This slow pace may account for some of the speaking partner strategies of offering guesses or possible phrase-completions (Lines 1.21–1.22: ACTION: an action film?; 1.22–1.23 c-a: Captain Phillips). The structural features of the turns taken by the partner using aided communication are also similar to those frequently reported. These turns are: relatively short (1.6: FOOD DINNER; 1.14: FRIENDS HOME FRIENDS); appear to contain less propositional content than natural speaker contributions (Müller & Soto, 2002); and are constructed over a number of turns with confirmation and clarification contributions by the speaking partner (Hjelmquist & Sandberg, 1996; von Tetzchner & Martinsen, 1996). The aided output has little evidence of internal syntactic structure and grammatical elements are lacking (Sutton, Soto, & Blockberger, 2002). In short, this extract offers few surprises to those familiar with interactions that involve aided communication. However, what is perhaps unexpected is that both partners in the above interaction are college students, neither of whom have any communication impairments. In short, the features of the interaction are not related to the communication resources of either participant, nor do they reflect their typical spoken interaction styles. Instead, mirroring the findings reported by Farrier and colleagues (1985) three decades ago, these features seem to have emerged through the introduction of aided communication into their conversation. Clarke and Wilkinson (2008) propose that, rather than describing such

Adult use of aided communication

interactions as occurring between an individual using aided communication and a speaking partner, instead we should think of them as interactions involving aided communication. Adopting this perspective, this chapter draws on data from a project involving six undergraduate student classmates (PA1–6), who met each week for six consecutive weeks. Over the course of the project, students developed their own communication boards and then used these boards in interactions with peers. Students spent half of each hour-long weekly session in dyadic interactions using aided communication and then adopted the role of a natural speaker within the dyad. These interactions were video-recorded and transcribed. The participants also completed reflective logs after each session and finally completed a structured interview at the end of the six weeks. Unlike the children discussed in many of the chapters in this volume, adults have sophisticated metalinguistic skills that can be brought to bear on solving challenges that arise when communicating using an alternative modality. On the other hand, they also have extensive experience as competent communicators, and this experience may calibrate their expectations for their presentation of self within interactions to a greater extent than children. Therefore, the strategies applied by adults in interacting using aided communication are of interest, but so too are their perceptions of the experience of using aided communication. This chapter draws together some of the data from the transcribed interactions, the participants’ reflective diaries as well as the interview data to explore the impact of aided communication on the structure of conversations between these adult speakers and on their decisions as to what they could talk about. Finally, consideration is given to how the experience of using aided communication impacted on their sense of self as a communicator.

The structure of conversations As noted above, descriptions in the literature of interactions involving aided communication frequently highlight an asymmetry in the distribution of the amount of talk and in how topics are introduced into conversation in interactions where one participant uses aided communication (Clarke & Kirton, 2003; Hjelmquist & Dahlgren Sandberg, 1996; Kraat, 1987; Light, 1988; Tsai, 2013). Evidence of similar patterns can be found in the interactions described here. All participants were recorded both as natural speakers and as participants using aided communication, illustrating how their participation in conversation changed as they switched roles. On the whole, the amount of information units contributed by natural speakers within each conversational turn greatly exceeded that of the same participants when they used aided communication. Data were analyzed first in terms of the number of words/symbols per communicative turn and subsequently in terms of t-units, to capture the number of ideas expressed by participants within their turns at talk. A t-unit was defined semantically rather than as a syntactic unit (Foster, Tonkyn, & Wigglesworth, 2000), given the lack of structural organization of graphic symbol output. Natural speaker turns that repeated or glossed the contribution of the aided partner were excluded from this analysis, as such glosses represented semantic content from the aided communicator rather than original to the natural speaker. Figures 12.1 and 12.2 present within-speaker comparisons of the mean length of the conversational turns (Figure 12.1) and the mean number of ideas

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The Silent Partner?

Figure 12.1 Mean length of communicative turns of participants as aided (MLT-a) and natural speakers (MLT-s)*. * MLT for aided speakers was based on the number of symbols selected or words spelled within a communicative turn. Where a word was incompletely spelled, but was glossed by the speaking partner to an agreed interpretation, the word was counted as complete for the purposes of calculating MLT. MLT for natural speakers was based on mean length of turn in words, rather than morphemes. This decision was based on the fact that bound morphemes are not routinely available on communication boards and therefore may not be perceived as necessary by those using aided communication

expressed (Figure 12.2) as participants switched from using aided communication to using natural speech. The turns constructed by participants in their role as aided communicators were far shorter (up to four times shorter) than when they were the natural speakers in the dyad. It is also noticeable that, as well as being shorter, the number of ideas communicated within each turn is also reduced, with approximately twice as many t-units per turn occurring in the natural speaker turns (see Figure 12.2). This contrast in the amount of content contributed by aided and natural speakers within the interactions is illustrated in the two extracts below. In Extract 12.2, PA1, in the role of aided communicator, has introduced a new topic, her father’s birthday, leading PA6 into a long sequence, with t-units presented in closed square brackets:

Extract 12.2 2.1

PA1

[DAD (.) b-i-r-t-h-d-a-y ](1 t-unit)

2.2

PA6

It’s your dad’s birthday on Saturday so? Yeah, cause [I don’t know] cause [I’m helping out at the open day] and [I don’t know if I should stay up on Friday night] and [save myself getting an early bus] but [then I’ll definitely have to be staying over on Saturday anyway] [and I kind of hate staying two nights in a row] cause but [like I always have to bring clothes and stuff] so [I’ll just have to see] (8 t-units)

Adult use of aided communication

Figure 12.2 Mean t-units expressed per communicative turns of participants as aided (x t-unit-a) and natural speakers (x t-unit-s)*. * MLT for aided speakers was based on the number of symbols selected or words spelled within a communicative turn. Where a word was incompletely spelled, but was glossed by the speaking partner to an agreed interpretation, the word was counted as complete for the purposes of calculating MLT. MLT for natural speakers was based on mean length of turn in words, rather than morphemes. This decision was based on the fact that bound morphemes are not routinely available on communication boards and therefore may not be perceived as necessary by those using aided communication

Extract 12.3 involves the same participants in reversed roles – in this extract PA6 is using a communication board and PA1 is the naturally speaking partner:

Extract 12.3 3.1

PA6

[o-n f-r-i-d-a-y NIGHTCLUB] (1 t-unit)

3.2

what nightclubs are on a Friday? [I’m actually not sure!] [I know that there’s war and] ehm and (2 t-units)

3.3

[w-a-r g-a-y NIGHTCLUB] (1 t-unit)

3.4

saying that a gay nightclub? Yeah, [and they play loadsa like nineties music] and [it’s really good fun] (..) [I can’t remember what else]…[or we could just stay in and get drunk], [blast out the music] (5 t-units)

Across these two extracts, the relative contribution of semantic content is reversed as participants shift roles from using aided communication to natural speech, suggesting that conversational asymmetry is weighted in favour of the speaking partner. However, unlike in some previous reports (e.g., Basil, 1992; Light et al., 1985) participants using

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The Silent Partner?

Figure 12.3 Proportion of topics initiated by participants as aided and natural speakers as a percentage of total turns.

aided communication in this study were not primarily participating in obligatory turns within the conversation. In contrast, they frequently initiated topics, asked questions, and challenged natural speakers. For example, when using aided communication, participants assumed responsibility for topic introduction approximately 40% of the time (see Figure 12.3). In the final session, one participant was absent, necessitating grouping of three participants in dialogues, two natural speakers and one participant using a communication board. In this situation, the proportion of topics initiated by the aided communicator dropped to 15%. Whilst a change would be anticipated (given that turns at topic initiation had to be distributed over three rather than two participants), the marked drop suggests that even small group interactions may pose particular difficulties for those using aided communication seeking to introduce a new topic. Thus, structural analysis of the interactions suggests that some of the patterns commonly reported as occurring in aided-natural speaker conversations emerge even in interactions involving participants without disabilities. When participants used communication boards in the interactions recorded here, their turns at communication were shorter and contained less semantic content than their natural speaker turns. Nonetheless, in aided communication they continued to direct some of the topics of conversation and the interaction. In the data described here, the performance of the same speaker is compared across two different situations – as natural speaker and as aided communicator. In other words, differences in interaction style across these two contexts cannot be attributed to between-speaker differences.

Perceptions of control within conversations Following each session, participants were asked to reflect on how interactions had unfolded, and in particular on the differences between using a communication board

Adult use of aided communication

Table 12.1 Participant reflections on their status within conversations Dependent role when using aided communication Participant 1

“I relied very much on the other person to do most of the talking and even to jump in and correctly interpret what I was saying” “I found that I wanted them to take over the conversation”

Participant 2

“the conversational load is very much unequal, with the main effort on the non-board user” “it felt like I wasn’t the partner in control of the conversation”

Participant 3

“I would feel I wasn’t contributing as much to the conversation as someone who uses speech”

Participant 6

“I felt I was in a slightly inferior role because I was less in control of what we were talking about” Responsibility as a natural speaker

Participant 1

“I had to do a lot of the talking…I talked more to keep the conversation going and to make it easier for the person”

Participant 2

“I felt like I should fill in the blanks for my partner when they couldn’t find a word

Participant 3

“initiating and turn-taking seemed to be fairly equal but I think that was more due to my conversation partner actively acting to include me in the conversation “I consciously had to refrain from continuing to talk and allow time for my partner to respond”

and speech in conversations. Three of the participants reflected explicitly on their ‘status’ within conversations as they navigated between use of the communication board and being a natural speaker (see Table 12.1). This experience influenced participants’ perceptions of their role as natural speakers in the dyad, prompting a sense of responsibility for the conversation. The comments documented suggest that the asymmetry in the interactions in favour of natural speakers was interpreted differently across the dyads. At least one participant (PA1) was somewhat relieved at the willingness of the natural speaker to take responsibility for much of the talk. Indeed, at times this seemed to spill over to a sense that responsibility for maintaining conversation fell to the natural speaker, creating pressure to fill the conversational space. Participants therefore differed in terms of whether they attempted to provide support for aided communication through minimizing demands for contribution or through extending the time frame for contributions. This diversity in adaptation styles was also reported by the spouses of partners with ALS interviewed by McKelvey, Evans, Kawai and Beukelman (2012). Asymmetry within conversations is evidenced to some extent in each participant’s success at gaining the floor, that is, in the structure and management of turn-taking opportunities, a task that may be particularly complicated in interactions involving aided communication (Clarke, Bloch, & Wilkinson, 2013; Clarke & Wilkinson, 2007, 2008; Müller & Soto, 2002).

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The Silent Partner?

Turn-taking within interactions As noted by Kim and Kuroshima (2013, p. 268), “in any language and culture, turnsat-talk occur ‘in real time’, and interlocutors – both speakers and hearers – can project and anticipate actions in the unfolding course of a turn-in-progress”. As a current speaker projects how a turn-in-progress will come to a possible completion point, the prospective next speaker must track and anticipate that completion point in order to manage a successful and smooth transition in speaker and turn and maintain the essential ‘one speaker at a time’ system described by Sacks, Schegloff and Jefferson (1974). Depperman (2013) proposes that prospective speakers deal with four main tasks in order to produce a turn that precisely fits the interactional moment in which it is to be placed. They must achieve joint orientation to the upcoming turn, securing the recipient’s attention and arranging a joint interactional space; speakers must display uptake of prior turn(s) indicating responsivity to prior talk and how that prior talk has been understood; they must deal with projections from prior talk in terms of what content or structure is anticipated in the upcoming turn; and, finally, new speakers must project properties of their new turn-in-progress, establishing the topic of the turn and framing it. Although in spoken discourse, talk is central to the accomplishment of these tasks, it has long been recognized that gaze, gesture, facial expression, bodily posture and movement in space can all play a part in smooth and effective management of turn construction (e.g., Duncan & Fiske, 1977). As Depperman (2013, p. 92) suggests “an adequate treatment of turn-construction has to adopt a multimodal perspective, because dealing with tasks of turn-construction necessarily involves the simultaneous and sequential combination of various modal resources”.

Achieving joint orientation in interactions involving aided communication Multimodality may assume particular importance in interactions involving aided communication, both in terms of identifying a possible turn-completion point and achieving joint orientation to signal a desire to make a contribution. The pace of conversation is considerably slower, so that pause and timing expectations must be re-calibrated if participants using aided communication are to succeed in securing and maintaining the floor. Some of these reflections are presented in Table 12.2, suggesting some frustration at the challenges of unambiguously indicating uptake of an anticipated turn opportunity (see PA3, PA6). The slow pace of communication created a sense of pressure for some of the participants in turns where they used aided communication, while for two (PA4 and PA6), the slow rate of aided communication seemed to permeate through to their spoken communication also (see Table 12.2). Non-verbal communication signals are particularly important in regulating switches of speaker-listener roles in face-to-face interaction. Achieving joint orientation and securing the recipient’s attention can be difficult if eye-gaze signals are compromised, by virtue of visual attention being focused on the communication aid itself, rather

Adult use of aided communication

than on a communication partner. Over the course of the project, some participants reported adapting to the new modality demands of aided communication, at least to some extent. Emerging competence in coping with these modality demands is most explicit in the comments from PA6, who initially felt “when her finger moved too fast the whole message was lost which was stressful”, but by the end of the project reported “my eyes were getting faster at seeing what they were spelling out”.

Demonstrating responsivity: Following the thread Having secured joint orientation, prospective speakers then need to demonstrate responsivity to the preceding turn and deal with projections from prior talk (e.g., Depperman, 2013). These tasks link to Goodwin’s (2013) proposal that talk in interaction is comparable to other forms of human action where one participant decomposes a preceding action of another participant, reuses selected features of that action and thus transforms the action, offering a new action that in turn can be decomposed, reused and transformed. Thus, within a conversation a speaker reuses part of the preceding turn, either explicitly (a parent may respond to a teenager’s comment “I’m going out” with “you’re going OUT?”) or implicitly (the same parent responding with “where to?”

Table 12.2 Participant reflections on anticipating and aligning turns at talk Aligning timing expectations Participant 2

“I was unsure of when to take over my turn in conversation” “I was really slow, which made turn-taking not normal”

Participant 3

“in the flow of conversation, my partner may have moved on after I answered their question, not realizing that I wanted to ask a returning question…my partner tended to cut me off halfway” “I would probably feel that I am holding people up and disrupting the flow of conversation”

Participant 4

“I felt that I had to slow down my rate of speech significantly”

Participant 6

“I had to wait until my partner finished talking, and she always asked me a question before I could start a new topic” “I normally communicate very rapidly and I need to adjust my rate of speech” Adapting and developing new signals

Participant 6

“my communication partner and I seemed to develop a turn-taking system whereby if one of us started to move our hands towards the board, we could tell they were about to say something, which is similar to when someone opens their mouth or takes a breath to speak” “I really enjoyed it this week, I really tried to keep looking up at my partner’s face to see how they were feeling and reacting” “when her finger moved too fast the whole message was lost which was stressful” “my eyes were getting faster at seeing what they were spelling out”

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The Silent Partner?

indicating that the prior utterance is the essential context for interpretation of the new contribution). Such recycling of prior talk, common in many spoken interactions, may be particularly prominent in interactions involving aided communication, where it may serve an important function of conversation repair (Bloch & Beeke, 2008). In the shared cooperative function of establishing meaning, the offering of a specific set of graphic symbols, words or letters creates a communication problem space for both participants to focus on collaboratively. The task for one participant may be primarily to determine the optimally efficient, critical elements that are sufficient for the purpose of maintaining intelligibility (Grice’s maxim of Quantity), while the other participant (generally the speaking partner) must focus on the potential relevance of the offered elements to the preceding discourse, in order to interpret and construct a plausible shared meaning. Timing factors may interfere with this process (e.g., Clarke & Wilkinson, 2008). There have been many reports of speaking partners decomposing aided communication output, reusing the output and transforming it through what Goodwin (2013) describes as a process of lamination, adding additional layers of syntax, semantics, prosody in order to arrive at an agreed shared interpretation of the communication turn. For example, McCord and Soto (2004, p. 216), describe an interaction where a researcher asked Andrea what she liked about her voice output device. After a frustrated sigh, Andrea used her device to produce “build, classroom, house, school, together”, which her partner re-formulated as are you saying it helps you make connections between home and school? Similar processes were observed in the interactions recorded here. For example, in Extract 12.4, PA2 offers PA1 three symbols (4.1). At first, PA1 seems unable to interpret any plausible meaning and asks for a repetition. The same three symbols, when repeated, allow her to propose a possible interpretation (4.4), reusing elements from the output but transforming that output through the addition of new layers of semantic and syntactic organization. PA1 reuses the words TOWN and WEEK, and transforms the reference to future by applying a layer of syntactic structure incorporating a meaning of an event that has not yet happened so that the format of the reformulated message fits the context of a spoken interaction.

Extract 12.4 4.1

PA2

TOWN FUTURE WEEK

4.2

PA1

(…) ehm, …sorry, say that again

4.3

PA2

TOWN FUTURE WEEK

4.4

PA1

am I going out in town this week?

Sometimes the process of decomposing and reusing leads to misunderstandings that require repair. Extract 12.5 illustrates such a sequence. In this sequence, PA1 is interacting with one of the researchers (St3) who is in Year 4 of her programme of study. The labelling by St3 of the symbols and words spelled by PA1 (lines 5.2, 5.4) is a common feature of interactions involving aided communication (e.g., von Tetzchner

Adult use of aided communication

& Martinsen, 1996). Bloch and Clarke (2013) demonstrate how Goffman’s distinction (1981) between author and animator of conversational turns can usefully be applied in this context: one participant authors a contribution through pointing to a symbol or letter, while the recipient ‘animates’ the contribution by speaking the symbol name or word aloud. Such animation represents perhaps a unique and overt context of the reuse of prior content outlined by Goodwin (e.g., 2013). The animation offered may or may not be accepted by the author. In extract 12.5, for example, the animation how before (Line 5.4) is problematic, in part because of St3’s difficulty in working out how to decompose the preceding sequence produced by PA1:

Extract 12.5 5.1

PA1

HOW

5.2

St3

How?

5.3

PA1

BE 4 y-e-a-r

5.4

St3

How before?

5.5

PA1

4 BE

5.6

St3

Oh, how’s fourth year?

In this sequence of interaction, St3 maps BE and 4 together, to create ‘before’, apparently applying a phonological strategy as a first lamination layer (Goodwin, 2013) of additional information. PA1, recognizing the phonological confusion decomposes before and reuses but re-orders the elements (line 5.5: 4 BE), even though this transformation involves violating the preferred syntactic sequence expressed earlier (how be 4 year) to make explicit that the offered before is not an acceptable transformation. St3 accepts the offered explicit separation of the elements and with this clarification, re-orders the elements to reach an alternative interpretation: how’s fourth year (line 5.6). She marks her alternative animation as contrastive using the turn-beginning token “oh” with associated falling prosody and emphasis. A similar example of a difficulty in identifying where boundaries should be applied in decomposing previous contributions arises in Extract 12.6. In this extract, there are two speaking participants, PA3 and PA4. As this extract starts, the participants have been talking about family traditions for Christmas dinner and the following day. PA4 sets the topic of this sequence, noting that, in her family, on the day after Christmas food is based around the sandwich. Using her communication board, PA2 offers a contribution and, over a number of turns, all participants work to resolve how the aided contribution can be animated in a way that fits the focus of discussion, so that the conversation can proceed. At the end of the extract, after a total of 34 turns, PA3 again uses a turn-beginning token “oh” with marked falling intonation to signify understanding, before responding to the content of the agreed animation or glossed interpretation. Notable in this extract also is PA2’s use of symbol repetition (lines 6.10, 6.32, 6.35). PA2 was the only participant to demonstrate this pattern of repeatedly selecting the same symbol, explicitly lifting her finger and replacing it with

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emphasis, as if to indicate that a symbol was definitively relevant and thus guide the other participants to focus their attention and problem-solving on this symbol.

Extract 12.6 6.1

PA4

The sandwich, this is a tradition in my family

6.2

PA3

God

6.3

PA2

4

6.4

PA4

Four?

6.5

PA2

5

6.6

PA4

Five?

6.7

PA2

d-a-y-s

6.8

PA3

four or five

6.9

PA4

6.10

PA2

DOG DOG DOG DOG DOG (pointing with emphasis)

6.11

PA4

you’re getting a dog?

6.12

PA2

NO (shakes head vigorously) a-f-

6.13

PA4

a dog?

6.14

PA2

e-r

6.15

PA4

After

6.16

PA2

4(…) 5

6.17

PA3

Forty-five?

6.18

(all laugh)

6.19

PA4

after forty-five, four forty-five

6.21

PA2

(vocalizes, waves hand) a-f

6.22

PA4

af?

6.23

PA2

t

6.24

PA4

ter?

6.25

PA2

4

6.26

PA4

6.27

PA3

6.28

PA2

o-

6.29

PA3

6.30

PA2

d-a-

6.31

PA4

Adult use of aided communication

6.32

PA2

DOG DOG DOG DOG (pointing with emphasis)

6.33

PA4

Dog

6.35

PA2

DINNER DINNER DINNER (pointing with emphasis)

6.36

PA3

Oh: it’s for you to use the food for the dog’s dinner! Yeah, we give it to the cat

In sum, the extracts presented here suggest that these participants found the structural organization of turn-taking in the context of aided communication somewhat challenging, partly because of the slow pace, but also because some of the conventional behaviours that signal turn shifts were not as effective as in spoken conversations. Once the floor was accessed, the problem of establishing the relevance of contributions constructed using aided communication and demonstrating responsivity to the prior turn frequently required extended, collaborative problem-solving of all participants. In the next section, we turn our attention to the content of conversations, and participants’ perceptions of the impact of aided communication on what they could talk about.

The content of conversations All participants in the research reported here were ‘naïve’ users of aided communication. As part of the project, they devised their own communication boards, and were free to modify these over the course of the project. All participants included an alphabet on their boards, and most left some blank sections for later additions. Despite this apparent flexibility, all participants reported some frustration at what they perceived as the limitations of their aided communication resources. As noted above, the aided contributions to conversations tended to be short, described by PA4 as limited to “bare essentials” (see Table 12.3). Based on this experience, in their role as speaking partners the participants began to try to adapt their style of conversation, reducing the length of their own spoken contributions, planning and structuring questions to facilitate success within the interaction. However, maintaining a sense of a normal conversation within these adaptations was difficult at times. For some participants, the question/answer structure that emerged risked shifting the interaction from a conversation to an interrogation. PA6 consciously tried to resist the temptation to ask questions: “I was very conscious of avoiding an interview-style conversation, so I had to tell stories and monologue, which was difficult because normally people give verbal responses and encouragement, so I had to judge myself when to stop talking and engage her instead.” Participants also reported a sense of being restricted in what they could discuss because of their available vocabulary. Despite having access to an alphabet, the symbol vocabulary at times seemed to both dictate and limit the scope of topics for discussion (see Table 12.3). Although no instruction was issued that participants were required to use symbols rather than text, some participants (particularly PA4 and PA6) seemed to feel that spelling represented some kind of failure or they found it simply tedious and tiring. PA3 felt the slow pace of spelling created a pressure within the interaction

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Table 12.3 Participant reflections on the impact of using aided communication on the content of interactions.

Content constrained by timing considerations Participant 1

“long complicated answers were very difficult” “I was able to convey most factual information but I felt like I couldn’t tell a story or write long sentences”

Participant 4

“I…started limiting myself to bare essentials of answering questions without expanding”

Participant 6

“we couldn’t talk as freely as we normally would” Content constrained by conversation structure

Participant 1

“I used shorter phrases and asked a lot of basic questions, so that my partner could answer more around it”

Participant 2

“I think I will begin with closed questions and then work up to more open ones to ease our way in. I found it difficult as an AAC user personally, so this is why I would adjust this”

Participant 6

“I need to adjust the way I ask questions, because I tend to ask several questions in a row which was confusing for my conversation partner” The challenges of questions

Participant 4

[by the end of the project]“it was more like a conversation than an interrogation, as I felt there was more equal participation rather than being asked a string of questions”

Participant 5

“I felt like it was more like being interrogated than having a proper conversation” “I felt naturally under pressure to answer the questions so as not to lose the listener’s attention”

Participant 6

“I was very conscious of avoiding an interview-style conversation, so I had to tell stories and monologue, which was difficult because normally people give verbal responses and encouragement, so I had to judge myself when to stop talking and engage her instead” Content constrained by available vocabulary

Participant 1

“there were a lot of times when I gave up or changed what I wanted to say”

Participant 2

“many of the topics I wished to talk about were more abstract and I didn’t have the correct symbols for them”

Participant 4

“I felt I had to stick to topics I could see on the board” “I started to limit myself on what conversation pieces I used”

Participant 5

“I found that I was using a lot of time formulating responses based on the pictures that I had, which really slowed down the conversation” Spelling out the content

Participant 2

“spelling is too tedious and slow”

Adult use of aided communication

Participant 3

“I was sick of trying to spell things”

Participant 4

“for some reason, I kind of felt it was like a cop out, because number one it was slower and it’s also, it’s much more reliant on the other person” “sick of constantly spelling things”

Participant 6

“I constantly had to think through what I was going to say and then try to find a way of communicating it through the board, but frequently gave up and just relied on the alphabet board” Constraints on communicative functions and nuances of tone

Participant 1

“I would find having banter or jokes more difficult with a board” “spelling stuff out is quite serious”

Participant 4

“like obviously good and bad, they’re kind of basic ones, but I wouldn’t actually say good and bad, like I’d use you know, dramatic or kind of colloquial terms for it”

Participant 6

“I still [after six weeks] find it irritating how difficult it is to communicate subtle humour like sarcasm, as it is much harder to have a playful tone with the board” “I can’t use the same level of exuberance and enthusiasm using AAC as very dramatic words are easily misinterpreted” “talking about feelings with a communication board seems so much more intimate and serious”

“because of the listener and I was concerned if they were going to get bored and kind of wanted to give them a fast answer”. Even when the relevant vocabulary was available, certain kinds of communication functions seemed particularly difficult to manage using aided communication. Humour, sarcasm and emotions were perceived to take on a new tone if communicated through aided communication. For example, both PA1 and PA6 commented on the difficulty they experienced in expressing humour using a communication board (see Table 12.3). Personality, tone, enthusiasm and exuberance were reported to be hard to capture in the flat modality of aided communication. Even where the available vocabulary was appropriate, participants felt that topics could take on a new, unintended significance of tone in the aided modality: “talking about feelings with a communication board seems so much more intimate and serious” (PA6). Although Clarke and Wilkinson (2009) have elegantly described ‘non-serious’ interactions between children with cerebral palsy using aided communication with peers, much of the humour is communicated through unaided modalities such as smiling, nodding and laughing. For spoken humour, timing, gesture, facial expression, prosody and intonation are all critical elements. Adding these relevant ‘lamination layers’ may be particularly difficult if the propositional content is communicated through a graphic modality. In sum, the challenges encountered by these participants in recreating their typical conversation style and experiences when using aided communication emerged not

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only in the structure of the conversations, but also in what participants felt they could talk about, and how effectively they could modify the tone of their conversational contributions. Despite their expert literacy skills, spelling was not always a solution to these problems, particularly because the slow rate of spelling introduced a time pressure into interactions and was tiring, both for the aided participant and for the natural speaker.

The experience of using aided communication in interactions The adaptations outlined above in the structure, content and tone of conversations involving aided communication prompted some of the participants to reflect and discuss their own reactions to the unfamiliar role of aided communicator. A prominent theme in these reflections was one of effort (see Table 12.4). The effort involved diminished over time, as participants became more comfortable and more competent using their communication boards. However, in their interviews and reflections, several participants reported a lingering sense of self-expression being restricted by the aided modality. Using aided communication at times impacted their habitual conversation style, with PA6 going as far as to suggest that “using AAC seems to slow my thought process down”. PA1 felt that her natural style of rapid topic switching in spoken conversations was problematic in the aided context: “…so I have this terrible habit of jumping round in my conversations so I start point to one picture and then I’d be like, oh, wait a minute, I don’t want to say this and then I’d point to another and they’d be like, those two words /…/, those two pictures make no sense”. Despite having selected their own vocabulary and having access to an alphabet, most participants regretted some of their choices, particularly in relation to including grammatical markers and function words. PA4 had added some of these morphemes over the course of the project, and commented on their importance to her sense of self as a communicator: “…I didn’t like the idea of just putting the base verb because I don’t know I just think…I didn’t like /…/ like a kid or like I didn’t know what I was saying or something”. However, even with these additions, accommodating to being an aided communicator while maintaining an established sense of self as a communicator proved unexpectedly difficult, even in these short interactions. In part, this difficulty related to what was perceived as the somewhat impersonal nature of the communication boards and the limited vocabulary. Some participants had included their own personally unique words, “like the words like everyone has certain words that they use more because of like where they’re from or their sense of humour or whatever” (PA4). However, capturing these words was not always easy: “I couldn’t think of mine, but I saw that other people kind of had been able to capture that and then that was really good because their personality came through”. Not having access to these personal identifiers made expression of identity more difficult and made communication less enjoyable: “I think I had to try hard, to like try and communicate, which was kind of like, not upsetting, but it was definitely… it made me a bit uncomfortable, like I don’t know, I didn’t feel like myself at all” (PA4).

Adult use of aided communication

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Table 12.4 Participant reflections on their experience of using aided communication.

An effortful process Participant 1

“I never realized how hard it would be to pick out an individual word when they are right in front of you” “it’s quite hard for someone to keep in mind all that’s come before”

Participant 2

“speakers…have to do so much work to talk to me effectively”

Participant 3

“my communication board was much more difficult to use than I expected”

Participant 4

“the concentration required was enormous” “I had to concentrate more to remember each segment of the message”

Participant 6

“what surprised me about the experience was the amount of concentration required to decide what you were going to talk about and how you were going to convey what you mean” It takes time to adjust

Participant 6

“it has gotten easier, most markedly over the last two weeks…I feel a lot more positively about communication boards in general, because I stopped feeling self-conscious about sounding as if I was talking to myself, or about my hand shaking” Aided communication restricts self-expression

Participant 1

“if you’re pointing at a picture and then you’re pointing at another picture, then the person themselves has to kind of make the connection between the two…so I have this terrible habit of jumping round in my conversations so I start point to one picture and then I’d be like, oh, wait a minute, I don’t want to say this and then I’d point to another and they’d be like, those two words /…/, those two pictures make no sense”

Participant 4

“I couldn’t fully express myself ” “I think I had to try hard, to like try and communicate, which was kind of like, not upsetting, but it was definitely…it made me a bit uncomfortable, like I don’t know, I didn’t feel like myself at all”

Participant 5

“I could not express what I wanted to”

Participant 6

“when someone asks me a question in speech, I immediately respond, but using AAC seems to slow my thought process down” The importance of appropriate and personal vocabulary

Participant 1

“I really wish I’d put some auxiliary words in here”

Participant 4

“so I had like an ING and and –ED and then like a plural…it definitely gave me more control, cause I didn’t really like if I was talking about the pluralized form…and you just put the base. I didn’t like the idea of just putting the base verb because I don’t know I just think…I didn’t like /…/ like a kid or like I didn’t know what I was saying or something” Continues on next page

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Participant 6

“like fiddly grammatical words, I needed more of these” “I found like little prepositions, words and stuff like that I didn’t put enough of those in and those were quite important” Spelling out the content

Participant 2

“spelling is too tedious and slow”

Participant 3

“I was sick of trying to spell things”

Participant 4

“for some reason, I kind of felt it was like a cop out, because number one it was slower and it’s also, it’s much more reliant on the other person” “sick of constantly spelling things”

Participant 6

“I constantly had to think through what I was going to say and then try to find a way of communicating it through the board, but frequently gave up and just relied on the alphabet board” Constraints on communicative functions and nuances of tone

Participant 1

“I would find having banter or jokes more difficult with a board” “spelling stuff out is quite serious”

Participant 4

“like obviously good and bad, they’re kind of basic ones, but I wouldn’t actually say good and bad, like I’d use you know, dramatic or kind of colloquial terms for it”

Participant 6

“I still [after six weeks] find it irritating how difficult it is to communicate subtle humour like sarcasm, as it is much harder to have a playful tone with the board” “I can’t use the same level of exuberance and enthusiasm using AAC as very dramatic words are easily misinterpreted” “talking about feelings with a communication board seems so much more intimate and serious”

Summary and conclusion The participants in the research described here were all familiar with each other, were highly literate and effective communicators and had access to a communication board they had designed for themselves. Over a 6-week period, as they engaged with each other in interactions, several common themes and features emerged from the recorded interactions, their reflective logs and their structured interviews at the end of the project. One theme was the markedly slow pace of communication involving aided output, even in the absence of any physical disability, summed up by PA2,:“the main difference I have noticed is the reduced rate of conversation”. This slow rate seemed to have a number of consequences. Speaking partners sought to reduce the pressure and effort required of the person using aided communication by assuming the burden of responsibility for the conversation. They modified their conversational style, consciously selecting specific question strategies, or engaging in monologues to fill the time, avoiding conversation behaviours such as rapid topic shifts and even at times slowing their rate of spoken communication. However, when using aided communication, the slow rate engendered a sense of time pressure, a concern that listener attention might be lost, a sense of fatigue in trying to manage a much more

Adult use of aided communication

conscious and effortful planning of communication and a compensation strategy of avoiding complex, long conversation turns and contributions. It is perhaps natural that individuals who have lifelong experience of natural speech might find a transition to aided communication particularly challenging and that adjusting to the new modality might be predictably difficult. However, the insights offered by these participants highlight possible considerations when clinicians are planning introduction of aided communication with adults with acquired communication impairments, who likewise have a strong sense of how spoken interaction is ordered and expected to unfold. The ‘alien’ nature of the modality and its impact on how well participants felt they could express themselves and their personality emerged across all participants in different ways, making it “kind of hard to get used to” (PA6). The participants in this study also draw attention to some of the learning required of natural speaker partners for effective use of aided communication, including the memory demands. One participant found that, over time, she became more skilled at following and retaining the messages spelled out by her partner (“my eyes were getting faster” (PA6)) and all participants demonstrated creative use of available communication resources to sustain and maintain interactions effectively. However, whether using aided communication or natural speech in the dyad, communication using communication boards was perceived as more effortful, tiring and ‘serious’. While there has been quite extensive research on the structure of conversations that involve aided communication, less attention has been paid to the perceived experiences of participants involved in such conversations. The data presented here suggest that the impact of introducing aided communication into interactions extends beyond the nuts and bolts of structurally organizing turns at talk, to influence not only what can be talked about, but also how communicators perceive themselves within such interactions.

References Basil, C. (1992). Social interaction and learned helplessness in severely disabled children. Augmentative and Alternative Communication, 8, 188–199. Bloch, S., & Beeke, S. (2008). Co-constructed talk in the conversations of people with dysarthria and aphasia. Clinical Linguistics and Phonetics, 22, 974–990. Doi: 10.1080/02699200802394831 Bloch, S., & Clarke, M. (2013). Handwriting-in-Interaction between people with ALS/MND and their conversation partners. Augmentative and Alternative Communication, 29, 54–67. Doi: 10.3109/07434618.2013.767497 Buzolich, M., & Wiemann, J. (1988). Turn taking in atypical conversations: The case of the speaker/ augmented communicator dyad. Journal of Speech and Hearing Research, 31, 3–18. Clarke, M., & Kirton, A. (2003). Patterns of interaction between children with physical disabilities using augmentative and alternative communication and their peers. Child Language Teaching and Therapy, 19, 135–151. Clarke, M., & Wilkinson, R. (2007). Interaction between children with cerebral palsy and their peers 1: Organizing and understanding VOCA use. Augmentative and Alternative Communication, 23, 336–348. Clarke, M., & Wilkinson, R. (2008). Interaction between children with cerebral palsy and their peers 2: Understanding initiated VOCA-mediated turns. Augmentative and Alternative Communication, 24, 3–15. Clarke, M. & Wilkinson, R. (2009). The collaborative construction of non-serious episodes of interaction by non-speaking children with cerebral palsy and their peers. Clinical Linguistics and Phonetics, 23, 583–597. Doi: 10.1080/02699200802491132

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Clarke, M., Bloch, S., & Wilkinson, R. (2013). Speaker transfer in children’s peer conversation: Completing communication-aid-mediated contributions. Augmentative and Alternative Communication, 20, 37–53. Doi: 10.3109/07434618.2013.767490 Dahlgren Sandberg, A., & Liliedahl, M. (2008). Patterns in early interaction between young preschool children with severe speech and physical impairments and their parents. Child Language Teaching and Therapy, 24, 9–30. Doi: 10.1177/0265659007083566 Depperman, A. (2013). Turn-design at turn-beginnings: Multimodal resources to deal with tasks of turn-construction in German. Journal of Pragmatics, 46, 91–121. Doi: 10.1016/j.pragma.2012.07.010 Duncan, S., & Fiske, D. (1977). Face-to-Face Interaction: Research, Methods and Theory. Hillsdale, NJ: Erlbaum. Farrier, L., Yorkston, K.M., Marriner, N., & Beukelman, D. (1985). Conversational control in nonimpaired speakers using an augmentative communication system. Augmentative and Alternative Communication, 1, 65–73. Foster, P., Tonkyn, A., & Wigglesworth, G. (2000). Measuring spoken language: A unit for all reasons. Applied Linguistics, 21, 354–375. Goffman, E. (1981). Footing. In E. Goffman (Ed.), Forms of Talk, pp. 124–159. Philadelphia, PA: University of Philadelphia Press. Goodwin, C. (2013). The co-operative, transformative organization of action and knowledge. Journal of Pragmatics, 46, 8–23. Doi: http://dx.doi.org/10.1016/j.pragma.2012.09.003 Hjelmquist, E., & Dahlgren Sandberg, A. (1996). Sounds and silence: Interaction in aided language use. In S. von Tetzchner & M. Jensen (Eds), Augmentative and Alternative Communication: European Perspectives. London: Whurr. Kim, H., & Kuroshima, S. (2013). Turn beginnings in interaction: An introduction. Journal of Pragmatics, 57, 267–273. Doi: 10.1016/jpragma.2013.08.026 Kraat, A. (1987). Communication Interaction between Aided and Natural Speakers: An IPCAS Study Report, 2nd ed. University of Wisconsin-Madison: Trace Research & Development Center. Light, J. (1988). Interaction involving individuals using augmentative and alternative communication: State of the art and future directions. Augmentative and Alternative Communication, 4, 66–82. Light, J., Collier, B., & Parnes, P. (1985). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Discourse patterns. Augmentative and Alternative Communication, 1, 74–83. McCord, M.S., & Soto, G. (2004). Perceptions of AAC: An ethnographic investigation of Mexican-American families. Augmentative and Alternative Communication, 20, 209–227. McKelvey, M., Evans, D., Kawai, N., & Beukelman, D. (2012). Communication styles of persons with ALS as recounted by surviving partners. Augmentative and Alternative Communication, 28, 232–242. Doi: 10.3109/07434618.2012.737023 Müller, E., & Soto, G. (2002). Conversation patterns of three adults using aided communication: Variations across partners. Augmentative and Alternative Communication, 18, 77–90. Sacks, H., Schlegloff, E.A., & Jefferson, G. (1974). A simplest systematics for the organisation of turntaking in conversation. Language, 50, 696–735. Sutton, A., Soto, G., & Blockberger, S. (2002). Grammatical issues in graphic symbol communication. Augmentative and Alternative Communication, 18, 192–204. Tsai, M. (2013). The effect of familiarity of conversation partners on conversation turns contributed by augmented and typical speakers. Research in Developmental Disababilities, 34, 2326–2335. von Tetzchner, S., & Martinsen, H. (1996). Words and strategies: Communicating with young children who use aided language. In S. von Tetzchner & M. Jensen (Eds), Augmentative and Alternative Communication: European Perspectives, pp. 65–88. London: Whurr.

13 Conclusion Martine M. Smith and Janice Murray

The Silent Partner revisited The hypothesis that motivated the assembly of the chapters in this book was that the use of aided communication represents a unique interaction context, in which the innate human drive to communicate and connect, to share stories and build relationships, to construct identities and to develop social closeness, is made manifest. A number of factors combine to make this context unique. One is the representational forms that act as currency within such interactions. As referenced in many of the chapters, the status of these symbols (whether graphic symbols or orthographically transcribed word labels) is uncertain. They do not seem to function as ‘words’. Their external presence makes them available for tangible inspection in a way that differs radically from the “words in the mind” described by Aitchison (2012). The question posed by Nelson (1992) remains valid: “What does it mean for a child to ‘have a word’? At what point does a child who is nonspeaking and who ‘has’ a word on his board…also ‘have’ that word in his or her head?” (p. 10). However, interpreting these symbols or ‘not-quiteword forms’ involves a process by which they must be transformed into words. That transformation process is also unique, often involving several iterations of animations (Clarke & Wilkinson, 2009), repetitions, laminations (Goodwin, 2013), adjustments, recasting and revisions before an agreed interpretation can be reached. Sometimes these processes still result in a cul-de-sac, in which no resolution can be found, as illustrated by Higginbotham and colleagues in Chapter 9, this volume. While meaning construction is always a shared process of mind-meeting, the explicit co-construction of meaning in interactions involving aided communication challenges both parties to attend jointly to an externalized source as a starting point for negotiation. This external source, whether a speech generating device (SGD) or a communication board asserts its presence in the ways in which it impacts on the organizational structure of conversations as illustrated in Chapter 12 and the language structures within conversations, as discussed across many of the chapters of this book. Part I of this book explored patterns of change over time in many of the domains of development that influence the resources available to a child attempting to use aided communication: attention, memory, symbolic function, language structure, narratives

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and literacy skills. These chapters prompt consideration of what is developing and how it is developing, what is taught and how that teaching is construed. Collectively, the chapters highlight the complexity of the many individual sub-tasks that are involved in constructing an expression using aided communication, the many essential cogs in the wheel. They highlight the scale of the achievement of so many children and adults who incorporate aided communication into their communicative repertoires. These achievements are all the more remarkable given the additional impairments often experienced by young children who use aided communication: difficulties not only with motor speech production, but a range of physical and sensory impairments. In Part II, attention shifted from change over time to process in time – the unfolding of interaction and meaning negotiation, against the backdrop of the opportunities afforded by and the complexity of aided communication. The linking theme across all these chapters is the multimodal nature of communication and the opportunities that aided components offer to both participants as they co-construct a shared understanding. In many respects, these chapters celebrate the achievements of both participants in the interaction, simultaneously illuminating the challenges they navigate as they persist towards a shared interpretation, as in many of the extracts presented here, or simply discontinue the effort, as highlighted in others.

Towards communicatively accessible environments In Chapter 2, von Tetzchner and Stadskleiv drew attention to the importance of communicatively accessible environments. As they point out, such accessibility is multifaceted. It implies that aided communication is physically present and available and can be accessed, not simply from a physical or sensory point of view (although clearly that level of access is essential), but also from the point of view of cognitive-linguistic access. A communicatively accessible environment also implies that communication partners recognize the value and relevance of aided communication and can support and scaffold its use in a way that promotes communicative autonomy. As von Tetzchner and Stadskleiv point out, the provision of a wheelchair for someone with a physical disability is of limited value unless ramps are provided and barriers are removed. It may be tempting to draw a linear analogy between the wheelchair and a communication device. Clearly, environmental adaptations in the form of communicative ramps are necessary to enable effective use of aided communication. For example, as highlighted in the chapters by Clarke, by Higginbotham, Fulcher and Seale, and by Smith, McCague, O’Gara and Sammon, communication partners must adjust and recalibrate timing expectations to tolerate longer pause times, and accommodate to the slower rate at which aided communication can be formulated; more conscious effort may be required to ensure conversation participation is possible. Just as someone using a wheelchair must develop skills in controlling speed and direction of movement, there are many skills that children and adults using communication devices must acquire. As pointed out in many of the chapters in this volume, some of these skills are complex and draw on multiple domains of memory, symbolic functioning, language construction and interaction management. Individually, each of these skill domains is complex. However, they are also interrelated and mutually

Conclusion

dependent. It is therefore not surprising that learning to use aided communication takes time. There is no formula that underpins all conversations, merely a range of possibilities that require flexible use of a range of strategies and techniques that can be drawn on in different ways with different communication partners in different contexts. However, a key difference between expert use of a wheelchair and a communication device is that, while the wheelchair is designed to meet the mobility needs of the individual who sits in it, a communication device sits at the interface between the minds of two communication partners, both of whom are essential to the success of the communicative interaction. Meaning does not ‘reside’ in the communication device – it is constructed in the minds of those involved in the interaction. As acknowledged in many of the chapters, there is a well-established tradition of communication partner training within the field (e.g., Binger, Kent-Walsh, Ewing, & Taylor, 2010; Calculator, 1997; Kent-Walsh, Binger, & Hasham, 2010; Kent-Walsh & McNaughton, 2005). Much of this work has focused on identifying reliable and effective ways of enabling communication partners to adapt their conversational style to ensure that there are opportunities for a child or adult to use aided communication, or on ways of modeling and promoting more sophisticated expressive use of aided communication. Far less attention has focused on the strategies that might support communication partners in interpreting output generated in aided forms, strategies that focus on strategically interrogating how what has been communicated might be relevant, where it might fit within a multimodal exchange and how to balance the potentially competing demands of constraining possible meanings while still being open to creative and ‘loose’ use of symbol forms. What the discussions in the chapters in this book suggest is that the caution recommended by Sutton in interpreting how symbol forms reflect language is appropriate – if symbols are not words, how are they to be treated and how is their development to be supported? Answering these questions implies re-aligning the roles of the communication partners, acknowledging their joint responsibility for the construction of meaning through aided means. Although the device may clearly be in the literal ownership of one person, the communication that it is used for is in the shared ownership of both participants. Inevitably, this view implies that both partners require skills in using a device. The Silent Partner ‘belongs’ to both. The unique role played by aided communication in interactions has implications for many facets of research. As pointed out by Higginbotham, Fulcher and Seale in Chapter 9, device design must be informed by individual needs, but also by the possible roles a device may be required to fulfill: teaching and learning tool, interaction tool and message transmission tool. Clearly, there are exciting emerging developments in the design of user-device interface, including eye tracking and Brain-Computer-Interface (Käther, Kübler, & Halder, 2015). However, if importance is given to the role of this Silent Partner in conversation, then device design must also consider the needs of all participants across communication interactions. This perspective prompts questions such as how will physical access enhancements impact on the face-to-face communication experience from the point of view of both communication participants? How can the formulation stage of message construction become a shared communicative space? Who is relevant to consider in

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that communicative space and how can those participants be supported to maximize success in reaching shared understandings? What needs to be learned, by whom and to what end? Addressing these kinds of questions requires pulling together many different research perspectives, drawing on the insights offered by fields as diverse as conversational analysis, theoretical linguistics, social, developmental and cognitive psychology and engineering. From its earliest days, the field of aided communication has spread its net wide. Many of its most important insights and exciting innovations have been made possible because of these collaborative efforts and because of the energetic involvement of people who use aided communication as key participants in defining what should be considered the important issues that need to be tackled (e.g., McNaughton et al., 2008; O’Keefe, Kozak, & Schuller, 2007; Rackensperger, Krezman, McNaughton, Williams, & D’Silva, 2005; Williams, Krezman, & McNaughton, 2008). Complex problems require inputs from many different perspectives. There is an old Irish proverb, níl neart go cur le chéile, which roughly translated means without togetherness, there is no strength. The themes discussed across this volume suggest that this inter-dependence will continue to define the field.

References Aitchison, J. (2012). Words in the Mind: An Introduction to the Mental Lexicon, 4th ed. London: WileyBlackwell. Binger, C., Kent-Walsh, J., Ewing, C., & Taylor, S. (2010). Teaching educational assistants to facilitate the multisymbol message productions of young students who require augmentative and alternative communication. American Journal of Speech-Language Pathology, 19, 108–120. Calculator, S.N. (1997). Fostering early language acquisition and AAC use: Exploring reciprocal influences between children and their environments. Augmentative and Alternative Communication, 13(3), 149–157. Clarke, M. & Wilkinson, R. (2009). The collaborative construction of non-serious episodes of interaction by non-speaking children with cerebral palsy and their peers. Clinical Linguistics and Phonetics, 23(8), 583–597. Doi: 10.1080/02699200802491132 Goodwin, C. (2013). The co-operative, transformative organization of action and knowledge. Journal of Pragmatics, 46, 8–23. Doi: http://dx.doi.org/10.1016/j.pragma.2012.09.003 Käther, I., Kübler, A., & Halder, S. (2015). Comparison of eye tracking, electrooculography and an auditory brain-computer interface for binary communication: A case study with a participant in the locked-in state. Journal of Neuroengineering and Rehabilitation, 12(76), 1–11. Doi: 10.1186/s12984-015-0071-z Kent-Walsh, J., Binger, C., & Hasham, Z. (2010). Effects of parent instruction on the symbol communication of children using augmentative and alternative communication during storybook reading. American Journal of Speech-Language Pathology, 19, 97–107. Doi:10.1044/1058-0360(2010/09-0014) Kent-Walsh, J. & McNaughton, D. (2005). Comunication partner instruction in AAC: Present practices and future directions. Augmentative and Alternative Communication, 21(2), 195–200. McNaughton, D., Rackensperger, T., Benedek-Wood, E., Krezman, C., Williams, M.B., & Light, J. (2008). “A child needs to be given a chance to succeed”: Parents of individuals who use AAC describe the benefits and challenges of learning AAC technologies. Augmentative and Alternative Communication, 24(1), 43–55. Doi: 790439451 [pii] 10.1080/07434610701421007

Conclusion

Nelson, N. (1992). Performance is the prize: Language competence and performance among AAC users. Augmentative and Alternative Communication, 8, 3–18. O’Keefe, B., Kozak, N., & Schuller, R. (2007). Research priorities in Augmentative and Alternative Communication as identified by people who use AAC and their facilitators. Augmentative and Alternative Communication, 23(1), 89–96. Doi: 10.1017/S0305000913000512 Rackensperger, T., Krezman, C., McNaughton, D., Williams, M.B., & D’Silva, K. (2005). “When I first got it, I wanted to throw it off a cliff ”: The challenges and benefits of learning AAC technologies as described by adults who use AAC. Augmentative and Alternative Communication, 21(3), 165–186. Williams, M.B., Krezman, C., & McNaughton, D. (2008). “Reach for the stars”: Five principles for the next 25 years of AAC. Augmentative and Alternative Communication, 24(3), 194–206.

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Index access 2, 3, 8, 20, 21, 22, 25, 29, 36, 37, 38, 39, 55, 60 65, 120,128, 131, 133, 135, 159, 162, 168, 169, 184, 191, 204, 205, 210, 213, 215, 220, 222 234, 239, 242, 248, 281, 284, 286, 290, 291 accessibility 29 239, 240, 290 adult(s) 1, 2, 7, 8, 9, 10 18, 19, 20, 22, 23, 24, 25, 26, 27, 28, 29, 39, 46, 69, 71, 75, 77, 92, 96, 97, 99, 100, 104, 110, 121, 122, 124, 125, 128, 129, 130, 132, 133, 134, 143, 144, 145, 146, 148, 149, 150, 153, 155, 159, 180, 191, 193, 202, 215, 231, 233, 247, 258, 259, 248, 253, 258, 259, 260, 261, 262, 263 271, 287, 290 agency 249, 251, 253, 261, 262 aided communication 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29 35, 36, 37, 38, 38, 40, 42, 43, 44, 46, 47, 49, 50, 51, 52, 53, 55, 56, 57, 58, 60, 61 65, 69, 70, 108, 109, 110, 111 119, 120, 121, 123, 124, 126, 127, 128, 129, 132, 133, 134, 135 141, 151, 153, 159, 161, 162, 163, 164, 165, 167, 168, 169, 170 180, 229, 230, 231, 232, 233, 234, 235, 239, 240, 241, 243, 244, 245 247, 250, 260, 263, 270, 271, 272, 273, 274, 275, 276, 277, 278, 281, 282, 283, 284, 285, 286, 287, 289, 290, 291, 292 aided communicator 6, 9, 19, 20, 22, 23, 24, 25, 26, 28, 247, 248, 251, 252, 253, 257, 259, 260, 261, 262, 263 271, 272, 274, 284 aided language input 124, 125, 126, 135 aided output 270, 286 Amyotrophic Lateral Sclerosis (ALS) 199, 200, 202, 206, 210, 212, 213, 275, animated 74, 76, 279 arbitrary symbols 65 articulatory speech 168 association 66, 69, 70, 72, 73, 74, 75, 76, 77, 78, 79, 81, 82, 83, 84, 85, 86, 87, 88,89, 90, 91, 94, 95, 97, 101, 102, 103, 106, 109 178 asymmetry 6, 23, 178, 179, 181, 182, 187, 193, 212, 270, 271, 273, 275 Augmentative and Alternative Communication (AAC) 1, 8 17, 28, 36, 38, 39, 51, 52, 53, 55, 59, 65, 70, 84, 91, 109, 111, 119, 120, 121, 122, 124, 125, 126, 127, 128, 129, 130, 132, 133, 134, 135 148, 150, 151, 153, 154, 155, 167, 177, 178, 179, 180, 181, 182, 184, 186, 187, 188, 189, 190, 191, 193, 204, 205, 219, 221, 229, 234, 247, 249, 259, 263, 282, 283, 284, 285, 286, 288 AAC mediated 150, 152, 179, 180, 182, 184, 187, 188, 190, 191, 193

AAC system design 119, 127, 129, 135 authentic 26, 155, 248, 261, 263 autobiographical memory 141, 143 autonomy 2, 29, 290 Blissymbols 23, 36, 37, 55, 60, 72, 73, 74, 76, 77, 78, 79, 80, 82, 88, 89 Cerebral Palsy 21, 75, 86, 88, 89, 134, 165, 181, 184, 189, 191, 247, 261, 262, 263, 283 children with disability 182 co-constructed 4, 8, 123, 150, 153, 178, 179, 180, 191, 193, 251 co-construction 1, 18, 20, 29, 39, 55, 121, 122, 126, 141, 145, 146, 155, 178, 179, 180, 181, 191, 193, 229, 289 cognitive demands 38 cognitive effects 231, 232, 244 common nouns 88, 89 communication efficiency 212 communication functions 283 communication partners 1, 2, 3, 8, 9, 20, 21, 22, 27, 28, 29, 36, 39, 46, 120, 121, 122, 124, 125, 126, 127, 134, 135, 150, 153, 178, 179, 181, 186, 193, 212, 229, 231, 245, 255, 290, 291 communication resources 1, 270, 281, 287 communicative 1, 2, 3, 4, 7, 8, 17, 18, 20, 22, 23, 24, 25, 26, 27, 28, 29, 43, 77, 87, 121, 124, 127, 150, 153, 159, 165, 177, 178, 181, 182, 188, 193, 194, 199, 202, 203, 206, 231, 232, 233, 234, 243, 247, 248, 249, 251, 253, 255, 260, 262, 263, 271, 272, 273, 283, 286, 290, 291, 292 competence 2, 3, 4, 7, 18, 20, 23, 24, 25, 26, 27, 28, 29, 60, 61, 66, 125, 127, 128, 143, 153, 154, 194, 247, 248, 258, 260, 261, 262, 263, 277 complementary 99, 180, 181 complexity 4, 7, 24, 27, 46, 54, 55, 57, 60, 74, 81, 125, 126, 145, 147, 154, 194, 230, 233, 243, 290 comprehension 27, 35, 73, 82, 83, 86, 97, 102, 109, 124, 125, 135, 160, 161, 162, 165, 166, 167, 168, 169, 212, 215, concepts 37, 49, 53, 54, 55, 70, 71, 73, 75, 77, 84, 88, 89, 109, 124, 177, 229, 239, 244 construction 1, 3, 17, 20, 24, 26, 27, 36, 42, 54, 55, 57, 59, 96, 97, 98, 99, 102, 103, 104, 107, 121, 128, 131, 146, 147, 159, 177, 189, 232, 235, 245, 248, 249, 250, 255, 259, 276, 289, 290, 291

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The Silent Partner?

co-construction 1, 18, 20, 29, 39, 55, 120, 121, 122, 126, 141, 145, 146, 155, 178, 179, 180, 181, 191, 193, 229, 289 Conversation Analysis (CA) 6, 177, 178, 181, 182, 186, 188, 193, 226, 229 conversation repair 278 conversational asymmetry 273 conversational narrative 145, 146, 147, 148, 151 Conversation(al) partner/s 7, 37, 38, 39, 43, 46, 51, 52, 55, 59, 60, 147, 150, 154, 182, 187, 234, 244, 245, 247, 251, 252, 255, 256, 259, 260, 261, 262, 263, 275, 282 conversational style 248, 263, 286, 291 conversational turn/s 178, 253, 271, 279 co-operative principle 230 creativity 6, 194, 239, 242, 245 decisions 8, 49, 70, 130, 233, 234, 235, 238, 271 decoding 4, 160, 161, 162, 163, 166, 167, 168, 169 decomposing 278, 279 delay/s, delayed 7, 24, 35, 43, 89, 135, 160, 167, 179, 180, 184, 187, 188, 193, 206, 208, 210, 212, 213, 215, 219, 220, 222, 230, 231, 233, 263 discourse/s 82, 129, 141, 142, 143, 148, 149, 150, 153, 178, 229, 249, 250, 252, 253, 257, 259, 261, 262, 263, 276, 278 Discourse Analysis (DA) 8 229, 247, 248, 262 distributional approaches 177, 178, 180, 181, 193 dyadic interactions 8, 271 dynasyms 83, 84, 88, 89 dysfunction/al 181, 182, 193, efficiency 38, 120, 126, 127, 128, 131, 212, 220, 234, 238, 242, 243 efficient communication 130, 239, 247 encode/d 7, 8 168, 229, 232, 233, 235, 239, 240, 244 encoding 160, 161, 166 environment/s 2, 4, 17, 18, 19, 20, 21, 22, 23, 24, 25, 29, 42, 55, 65, 67, 70, 71, 74, 82, 92, 93, 104, 120, 123, 127, 134, 135, 165, 166, 169, 188, 259, 290 executive functions (EF) 38, 46, 49, 51, 52, 60, 61 expansion/s 18, 26, 27, 260 explicit/ly 5, 6, 7, 18, 19, 24, 25, 66, 67, 68, 69, 78, 92, 99, 101, 104, 108, 123, 134, 135, 148, 153, 155, 159, 168, 177, 180, 186, 240, 244, 245, 277, 279, 289 explicit instruction 25, 68, 134, 135 exploration 24, 36, 65, 66, 97, 243, 247, 262 expressive 1, 2, 4, 12, 20, 21, 35, 76, 108, 125, 126, 151, 154, 161, 199, 200, 202, 206, 221, 291 familiarization 73, 74, 76, 77, 78, 79, 80, 85, 86, 87, 94, 96, 98, 109 formulaic sequences 128, 129 function 17, 19, 23, 25, 26, 29, 38, 39, 51, 55, 65, 66, 67, 68, 69, 88, 97, 103, 109, 120, 125, 130, 131, 134, 136, 142, 143, 144, 146, 177, 178, 180, 181, 182, 188, 221, 259, 278, 283

generalization 26, 77, 78, 79, 82, 83, 84, 87, 90, 91, 167, glosses (glossed) 271 grapheme/s 165, 167, 168, 169 graphic language learning 35 graphic language representations 36, 53 graphic symbol/s 3, 7, 8, 9, 12, 17, 19, 20, 23, 24, 25, 26, 43, 49, 51, 53, 54, 55, 59, 61, 65, 66, 67, 68, 69, 70, 71, 72, 74, 78, 79, 80, 88, 91, 92, 93, 94, 96, 97, 98, 99, 101, 102, 104, 105, 107, 108, 109, 110, 111, 131, 132, 179, 232, 233, 235, 239, 244, 269, 271, 278, 289 greetings 128, 259 grid display 87 Gricean (maxims) 229, 230, 231, 242, 278 grounding 7, 202, 203, 205, 206, 208, 219, 220, 221 guesses 200, 208, 270 guided 23, 25, 84, 86, 144, 162, 251 iconic (iconicity) 37, 53, 54, 55, 67, 69, 111 identity 8, 73, 141, 142, 249, 250, 251, 253, 254, 255, 257, 259, 260, 261, 284 illocutionary acts 179 implicit/ly 3, 5, 6, 65, 66, 69, 142, 177, 191, 231, 240, 277 in-person interaction 202, 203, 206, 212, 220, 221 input 23, 24, 36, 86, 89, 102, 103, 104, 119, 120, 124, 125, 126, 135, 169, 231, 232, 243, 244, 292 installments 206, 208, 212, 219, 220 instrumental 26, 205 interaction(al)/s 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 17, 22, 23, 25, 26, 27, 28, 29, 36, 37, 38, 39, 42, 46, 52, 53, 55, 60, 61, 96, 120, 121, 123, 124, 126, 127, 129, 134, 141, 142, 143, 145, 146, 149, 150, 155, 161, 165, 177, 178, 179, 180, 181, 182, 184, 187, 188, 189, 191, 193, 199, 200, 202, 203, 205, 206, 207, 208, 210, 212, 215, 216, 218, 219, 220, 221, 222, 226, 229, 230, 231, 232, 233, 234, 235, 239, 240, 243, 244, 245, 247, 248, 249, 250, 251, 253, 255, 256, 257, 258, 259, 260, 261, 262, 263, 270, 271, 272, 274, 275, 276, 277, 278, 279, 281, 282, 283, 284, 286, 287, 289, 290, 291 intent to represent 66, 68, 101, 108, 110 interactions involving aided communication 5, 6, 7, 26, 37, 38, 39, 61, 234, 243, 245, 271, 275, 276, 278, 289 interaction policy 212, 219 interactional slots 184 interactional turns 180 interpersonal interaction 247, 249 intervention 1, 3, 17, 23, 24, 25, 26, 27, 28, 29, 35, 80, 92, 110, 119, 133, 134, 135, 136, 153, 154, 155, 162, 166, 167, 168, 169, 182, 234, 247 in-time 206, 220 joint attention 10, 17, 38, 43, 46, 220 joint orientation 276, 277 judgement/al 42, 68, 81, 91, 127, 231, 257, 259

Index

lamination 278, 279, 283, 289 language environment 17, 18, 19, 20, 21, 22, 24, 25, 134 language group 21 language support/ive 17, 22, 68, 71, 72, 74, 76, 78, 80, 82, 83, 84, 86, 89, 92, 94, 96, 98, 109 language-supportive 17, 22 lifelong 247, 249, 287 linguistic/ally 1, 2, 3, 4, 18, 22, 36, 38, 52, 60, 73, 108, 109, 120, 124, 127, 128, 131, 132, 133, 134, 136, 141, 143, 145, 148, 149, 151, 152, 153, 155, 160, 166, 170, 202, 205, 208, 220, 229, 234, 239, 240, 241, 242, 243, 244, 248, 249, 250, 253, 254, 256, 261, 262, 263, 271, 287, 290, 292 literacy acquisition 160, 163, 164, 165, 166, literacy skills 4, 159, 160, 162, 163, 165, 16, 167, 169, 235, 242, 284, 290 looking behaviour 38, 39, 46, 81, 190, 191 loose use 8, 240, 244, 245, 290 maintenance 18, 42, 72, 73, 74, 78, 81, 87, 105, 106, 146, 148, 154, 257 matching 68, 73, 77, 81, 83, 84, 85, 86, 87, 88, 89, 90, 91 means of access 36 media 203 medium 203, 208, 212, 247, 248 memory 38, 46, 49, 48, 51, 60, 71, 88, 89, 91, 104, 111, 128, 141, 143, 144, 145, 160, 161, 163, 164, 165, 169, 248, 287, 289, 290 memory demands 287 mental representations 37 Minspeak 9, 37, 38, 43, 54, 55, 57, 59, 83, 84, 87 mode/s (modality) 1, 2, 4, 5, 6, 7, 19, 20, 21, 23, 25, 27, 28, 36, 127, 128, 132, 142, 164, 180, 181, 202, 220, 221, 222, 229, 232, 234, 249, 256, 260 modality-specific hypothesis 132 morphology 3, 119, 125, 127, 130, 131, 135 morphology prediction 131 motivation 7, 167, 168, 179, 248, 258, 260 multimodal 6, 7, 8, 39, 60, 180, 181, 189, 193, 221, 229, 249, 250, 258, 276, 290, 291 multimodality 7, 180, 181, 188, 193, 229, 276 multi-word 24 119, 155 mutually manifest 238 narrative/s 3, 23, 26, 27, 141, 142, 143, 144, 145, 147, 148, 149, 150, 151, 239 narrative assessment 148 narrative intervention 153, 155 natural speech 8, 9, 19, 20, 24, 25, 26, 51, 52, 55, 70, 169, 179,180, 186, 232, 235, 260, 272, 275, 287 navigation 37, 49, 60, 135 normality 252, 255, 259

297

object/s 2, 23, 43, 66, 67, 68, 69, 74, 75, 77, 78, 81, 84, 85, 87, 94, 95, 96, 98, 132, 133, 134, 169, 177, 181, 192 operational demands 36, 37, 39, 46, 48, 51, 59, 60 optimal relevance 232, 243, 244 organizational 36, 37, 54, 55, 57, 59, 148, 177, 250, 289 orthographic (orthographically) 9, 160, 232, 234, 238, 239, 240, 244, 289 output 3, 4, 8, 9, 23, 24, 36, 57, 60, 77, 80, 83, 84, 85, 92, 102, 103, 119, 124, 130, 141, 167, 168, 179, 180, 204, 205, 210, 213, 218, 219, 230, 232, 233, 234, 235, 236, 237, 238, 239, 240, 242, 244, 249, 251, 270, 271, 278, 286, 291 pace 127, 255, 270, 276, 281, 286 parent/s 18, 22, 23, 25, 26, 27, 28, 29, 120, 121, 123, 124, 129, 134, 144, 145, 155, 159, 162, 165, 169, 178, 261, 262, 277 Picture Communication Symbols (PCS) 36, 37, 72, 73, 75, 76, 78, 79, 83, 84, 85, 86, 88, 89, 92, 93, 94, 107, 111, 236 phoneme/s 160, 164, 165, 166, 167, 168, 169, 233 phonological/phonologically 49, 51, 88, 89, 160, 161, 163, 164, 165, 166, 167, 168, 169, 233, 279 phonological awareness 160, 161, 163, 164, 165, 166, 167, 168, 169 photograph/s 36, 67, 68, 69, 73, 81, 87, 96, 97, 98, 99, 101, 102, 108, 132, 149, 168 phrase-completions 270 picsyms 76, 79, 88, 89 pictorial 24, 67, 81, 87, 233, 239, 240, 243, 244 picture/s 3, 5, 12, 25, 26, 36, 37, 39, 40, 42, 43, 45, 46, 47, 50, 51, 52, 54, 55, 56, 58, 66, 67, 68, 69, 72, 74, 81, 83, 84, 85, 89, 91, 92, 93, 94, 104, 111, 128, 130, 132, 148, 149, 150, 151, 152, 162, 163, 169, 185, 233, 234, 235, 236, 237, 238, 239, 242, 244, 282, 284, 285 politeness 251, 253, 258, 259 portability 210 pre-beginnings 188, 191 precise communication 126, 128 pre-stored message/s 128, 240, 241, 242, 244 problem-solving 244, 280, 281 processing costs 231, 232 progressivity 187, 188, 258 quadratic focus 46, 182 quantitative distributional analysis quantity 43, 124, 153, 230, 278 rate 43, 72, 81, 120, 125, 126, 127, 128, 166, 220, 230, 231, 234, 276, 277, 284, 286 reading 4, 24, 26, 27, 102, 103, 105, 120, 142, 148, 152, 159170, 190, 210, 213, 215 recapping 123 recycling (of prior talk) 3, 278 reference 9, 26, 53, 60, 61, 66, 67, 69, 70, 73, 82, 99, 101, 104, 108, 109, 110, 144, 145, 186, 248, 255, 260, 278

298

The Silent Partner?

referent/s 20, 43, 46, 61, 66, 67, 68, 69, 72, 78, 81, 82, 86, 91, 101, 103, 104, 110, 126, 200, 233 relevance 6, 9 42, 54, 129, 150, 168, 190, 193, 229, 230, 231, 232, 234, 238, 239, 240, 242, 243, 244, 263, 278, 281, 290 relevance framework 187, 188 Relevance Theory 9, 229, 231, 239, 242, 243, 245 repair/s 150, 190, 191, 216, 222, 239, 240, 242, 243, 278 representation/s 8, 12, 19, 22, 36, 37, 38, 42, 43, 49, 52, 53, 54, 55, 57, 59, 60, 61, 65, 66, 68, 69, 70, 71, 72-78, 81, 83, 84, 86-92, 97, 99, 101, 104, 105, 108-111 130, 131, 144, 159, 160, 161, 164, 169, 231, 232, 233, 238, 247 representation(al) forms 9, 36, 37, 52, 60, 130, 290 representational systems 37, 38, 53, 54, 55, 60, 61, 160 responsibility 6, 7, 22, 25, 28, 274, 275, 286, 291 responsivity 120, 276, 277, 281 restricted 3, 22, 23, 71, 131, 161, 163, 281, 284 retention 77, 79, 81, 85, 88, 90, 91 routine/s 23, 27, 43, 46, 120, 147, 191, 203, 251, 253, 256, 259 scaffold 20, 22, 24, 29, 39, 153, 154, 290 scaffolding 9 18, 20, 22, 23,25-29, 39, 69, 122, 145, 153, 155, 219 self 8, 75, 142, 143, 181, 190, 191, 203, 220, 248, 249, 253, 260, 271, 284, 285 semantically 54, 55, 57, 89, 271 semantic processing 49 sense of self (expression) 271, 284 sequences 6, 37, 52, 53, 70, 83, 88, 89, 92, 94, 95, 97-101, 103, 105, 107, 108, 110, 111, 128, 129, 133, 143, 147, 179, 180, 182, 187, 250, 251, 259, 260, 261 sequentiality 182, 187 sequential alignment 184, 186 signifier 19 single symbols 70, 88, 91, 93, 94, 110, 111 small group interaction/s 274 social control 251 social interaction/s 26, 28, 143, 205, 221, 222, 247, 260 social support 68, 69, 70, 72-79, 80, 81, 83, 84, 87, 88, 89, 92, 94, 96, 98, 107, 109, 110 speech act/s 177, 178, 179 Speech Act Theory 177 Speech Generating Device (SGD) 6, 7, 10, 121, 150, 180 182188, 191, 193, 198, 199-206, 208, 209, 210, 212, 213, 215, 221, 249, 289 speech synthesis 98, 168 spelling 9, 52, 127, 128, 159-169, 213, 234, 241, 242, 258, 277, 281, 282, 283, 284, 286 spoken sentence 12, 23, 96-99, 102, 105, 107, 108, 111, 125, stimuli 7, 38, 49, 51, 71-75, 84, 85, 86, 88, 89, 95-102, 111, 231, 232, 243, strategies 7, 8, 18 20, 22, 26, 27, 28, 36, 38, 39, 46, 51, 53, 57, 59, 60, 121, 127, 128, 131, 132, 134, 135, 150, 153, 166, 167, 169, 202, 205, 208, 212, 219, 244, 257, 260, 262, 270, 271, 286, 291

structured units 187 subject 88, 94, 96, 98, 105, 128, 132, 133, 154, 167, 202, 203, 255, 257 subvocal rehearsal 169 success 2, 4, 6, 8, 21, 26, 39, 46, 54, 61, 68, 81, 104, 105, 168, 200, 203, 231, 244, 245, 275, 281, 291 supplementary 22, 180, 181 selective attention 38, 42, 43 sustained attention 38, 39, 42, 43 symbol sequences 37, 70, 88, 92, 94, 98, 99, 101, 102, 103, 105, 108, 110, 111 symbol vocabulary 281 symbolic function 65, 66, 68, 69, 97, 101, 103, 104, 109, 110, 289 symbolic representation 60, 65, 66, 67, 70, 71, 81, 82, 88, 97, 104, 109, 110, 111, 130 symbolization 52, 53, 54 symbolism 52, 53, 54 syntactic unit 271 syntax 119, 120, 121, 123, 125, 127, 132, 135, 251, 278 synthesized speech 12, 99, 218, 219, 220 talk 23, 65, 77, 83, 84, 85, 143, 144, 145, 146, 182, 186, 188, 198, 200, 202, 203, 206, 207, 208, 212, 217-222, 230, 247251, 258, 260, 269, 270, 271, 275-279, 282, 284, 285, 287 talk-in-interaction 219, 221 technology design 221 temporal constraints 206, 212 temporal order 148, 215, 219, 220, 222 temporal-sequential order 218 time 202, 203, 205, 206, 207, 208, 210, 212, 213, 215, 216, 219, 220, 221, 222 timestream 203 tone 234, 259, 283, 284, 286 topic introduction 274 training 22, 24, 25, 26, 29, 68, 69, 72-80, 101-106, 109, 111, 134, 159, 168, 244, 245, 291 transposition hypothesis 132 turn taking 43, 177, 203, 210, 275, 276, 277, 281 utterance/s 3, 4, 8, 12, 18, 19, 24, 25, 26, 27, 28, 46, 54, 55, 57, 92, 94, 98, 111, 119, 120, 124, 125, 127, 128, 129, 131, 132, 148, 149, 154, 198, 205, 206, 208, 212, 215, 220, 221, 222, 232, 239, 242, 243, 244, 248, 249, 261 verbal label/s 67, 68, 72, 73-79, 80, 83-86, 89, 92, 93, 104, 107, 233, 244 verbal model 95, 98, 103, 106, 143, 154 visual scene 37, 77, 85, 87 vocabulary 7, 17, 19, 23, 24-29, 36, 37, 49, 53, 71, 74-77,8286, 89, 97, 99, 108, 109, 120, 125, 127, 133, 146, 148, 154, 159, 160, 161, 165, 167, 191, 204, 230, 231, 235, 237, 239, 240, 248, 260, 261, 281-285

Index

voice output 8, 36, 77, 80, 83, 84, 85, 92, 167, 168, 230, 232, 234, 240, 243, 244, 249, 251, 278 Voice Output Communication Aid (VOCA) 183, 248, 251, 252, 253, 256 VOCA-mediated 253, 254, 256, 257, 259 wayfinding 200, 208, 210, 212, 213, 215, 216, 219 word order 20, 53, 94, 95, 97, 98-101, 106, 107, 108, 119, 130, 132, 133 word prediction 83, 127, 204, 213, 217, 220 working memory 46, 48, 49, 51, 60, 161, 164

299