Tangible Object Symbols: A Case Study with an Adult with Multiple Disabilities

For special educators and speech-language pathologists who work among adults with multiple disabilities, tangible object symbols may be an appropriate avenue for communication enhancement. Many of these adults use presymbolic communicative actions (Cascella, 2005), and these symbols may enable them to transition from presymbolic into symbolic communication. Collateral evidence for this transition comes from promising results of tangible symbol applications among children who also have presymbolic communication actions (Parker, Banda, Davidson, & Liu-Gitz, 2010; Rowland & Schweigert, 2000; Sigafoos et al., 2008; Trief, Cascella, & Bruce, 2013). Yet, there is a paucity of research on tangible symbol treatments among adults. To address this gap, the paper presented here describes a case study (A-B treatment design) where a tangible object symbol was introduced to an adult (pseudonym Frank) with multiple disabilities and visual impairment at his day habilitation program. The tangible object symbol was introduced in a functional manner, so that it related specifically to Frank's interests and motivation, as well as the interpersonal characteristics (that is, daily activities, partner expectations) of his environment. Two questions were addressed: Would a tangible object symbol enhance Frank's communication skills? and How quickly might Frank learn to use the tangible object symbol? METHODS Participant Frank was a 53-year-old man with a history of profound intellectual disability, autism spectrum disorder, and severe visual impairment (also known as severe low vision or legal blindness) of a degenerative nature the onset of which occurred more than five years before the initiation of the intervention. Notably, Frank did not tolerate vision testing and he does not wear eyeglasses. Three years of reports (nursing, social work, psychology, and speech-language pathology) indicated no prior or recent exposure to tangible object symbols, graphic symbols, or voice-output technology. Records indicated that Frank had functional hearing, some independent ambulation in known environments, and generally good physical health. Frank attended an adult day habilitation program where there were consistent morning activities (a beverage, arts and crafts, puzzle activities, simple meal preparation, and lunch) and afternoon events (looking at magazines, watching a news program, shopping at local businesses, going to a park, and having another beverage before departure). Frank required intermittent support to engage in activities, and his instructors (one lead, one assistant) reported that he was cooperative during daily routines and sometimes preferred being left on his own when occupied by an activity. The case study presented here began after Frank's lead instructor inquired about whether Frank could learn to more directly communicate that he wanted a drink. The instructor reported that Frank would stand up at his seat, but not directly approach or call out to a staff member, when he wanted a drink. After discussion, it was decided to introduce Frank to a tangible object symbol and a voice-output communication device (BIG-Mack Communicator). To address the methodological challenges of tangible object symbol research cited by Sigafoos et al. (2008), the case study presented here includes a detailed description of the baseline and methodology (for evaluation and replication) but not a matched control or videotape sampling, since these would have been impractical in this setting. The City University of New York Institutional Review Board (IRB) approved this study. Frank's communication status at prebaseline Two tools were used to assess Frank's communication status prior to baseline, the Communication Matrix (Rowland, 2004) and the Functional Communication Profile (Kleinman, 2003). Though nonstandardized, these tools document communication forms and functions via interview with a familiar staff member, a technique that has proven useful when compared to direct structured sampling tasks (Cascella, 2005). …