23 The Use of Bliss Symbols as a First Step into Literacy with Four Children with Down Syndrome Erna Alant Centre for Augmentative and Alternative Communication Department of Communication Pathology, University of Pretoria,Pretoria ABSTRACT This study describes the use of Bliss symbolics as a first step into literacy with four children with Down syndrome in a preschool setting. Initial stages of the intervention programme are discussed as well as the children's ability to read Bliss symbols six months after commencement of the programme. Symbol errors are analyzed and implications for further research discussed. OPSOMMING Hierdie studie beskryfdie gebruik van Bliss-simbole as eerste stap tot geletterdheid by vier kinders met Downsindroom in 'n voorskoolse opset.Inisiele stadiums van die intervensieprogram is bespreek asook die kinders se vermoe om die Bliss-simbole te lees ses maande na aanvang van die program. Simboolfoute is geanaliseer en implikasies vir verdere navorsing bespreek. Literacy is an important skill which facilitates the integration of disabled people into society. This is not only because of the print-dominant society we live in, but also because exposure to print enriches the indi- vidual's language and facilitates further conceptual and metalinguistic abilities (Blackstone, 1989; Koppenhaver & Yoder 1992; Van Kleeck| 1992). Traditionally children who had no or limited verbal expression were involved in speech/language pro- grammes and not in reading programmes as it was be- lieved that they did not have sufficient language skills to read (Koppenhaver & Yoder, 1992). A consequence of this has been limited exposure of cognitively handi- capped children to reading instruction, particularly in cases where children have a specific language learning deficit, for example Down syndrome (Stoel-Gammon, 1990). Recently, however, researchers have opposed this view, for example, Raver & Dwyer (1986) who demon- strated a relationship between the reading and language ability of the 5 preschool mentally handicapped chil- dren involved in a conversational approach to teaching. They argued that although it was typically believed that reading instruction must be postponed until a child's expressive language is "ready", the results of their study did not support this assumption. Apart from limited exposure to instruction, the suc- cess of teaching literacy to cognitively handicapped peo- ple has been limited. The reasons for this failure are multiple, including, poor teaching strategies (Kuntz, Carrier & Hollis, 1978; Raver & Dwyer, 1986), children's limited language ability (Hern, Smith & Fuller, 1992; Stoel-Gammon 1990), limited level of abstraction and poor concentration (Jeffree, 1981; Matson & Mulick, 1991). Wishart (1990:250) maintained that many pro- fessionals still hold outdated conceptions of the nature of Down syndrome and of its developmental implications and indicated that "sufficient evidence has already ac- cumulated to suggest that with the appropriate sup- port and input, children with Down syndrome in future generations will undoubtedly fare better than previ- ously". The nature of the support needed, however, con- stitutes a major point of controversy which has led to a critical review of present methods used to enhance lit- eracy development. The methodology of teaching literacy to cognitively handicapped individuals has focused mainly on the teaching of sight vocabulary in order to give entrance into as broad a vocabulary of written words as possible. The underlying assumption is that auditory and visual processing of the cognitively handicapped person are delayed and that they would not be able to cope with the complex skills of analyses and syntheses in reading (for example word attack skills). Cognitively handi- capped people will therefore learn to read in the same way as cognitively-able people although at a slower rate with little focus on word attack skills. The teaching of sight vocabulary limits the person's reading to a number of words which is, however, no longer sufficient. Folk & Campbell (1978) pointed out that trainers must find techniques that will allow trainable cognitively handi- capped children to read recipes, newspaper items, movie schedules, vocation information, store signs and so forth. "The question is not whether trainable level students Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 41, 1994 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) 24 Erna Alant are competent enough to acquire basic reading skills, but whether we as special educators are competent enough to teach them." (Folk & Campbell, 1978:322). Alternative teaching strategies are particularly impor- tant in view of the heterogeneity in language perform- ance found in cognitively restricted children where a single systematic pattern of language and cognitive de- velopment is highly unlikely ( Miller & Chapman, 1984). Kangas & Lloyd (1988:211) support this argument by stating " ..a model of child development may not be a sufficient framework for selecting goals of intervention for children and adults who experience severely disa- bling conditions and who are functioning at early levels with respect to developmental norms". Wishart (1990) agrees with this notion and stresses that particularly in the case of Down syndrome, early learning styles dif- fer fundamentally from those seen in non-handicapped children. The pathways and processes used to process infor- mation by the child are thus at the basis of the differ- ent methods and systems in teaching language and lit- eracy skills. McNaughton (1992) discusses that process- ing differences occur between children who are able- bodied and those who have speech and physical impair- ments and hypothesizes that the different pathways make a difference to the way in which they process in- formation and thus influence their learning to read. Children who use a visual system instead of speech for communication may be able to compensate for the limi- tations they face in speech production domains. This suggests that severely communicatively handicapped children can get access to reading through a different symbolic pathway than that of normal children as this may provide an easier transition to normal orthogra- phy (Romski, Sevcik, Pate & Rumbaugh, 1985). Various authors have suggested that "bridging" be- tween pictures and print seem to be an effective teach- ing strategy with cognitively handicapped individuals (Jeffree, 1981; McNaughton, 1992). Apart from the chil- dren learning to read words quicker, more reading flu- ency is achieved with resulting positive confidence with the task (Jeffree, 1981). Different symbol systems have been used to enhance literacy skills in cognitively handicapped children by providing a "bridge" to normal orthography, e.g., Rebus, Makaton, Bliss. The use of Bliss symbols for entrance into literacy have been propagated particularly in view of the extensive vocabulary and range of symbols avail- able that can be combined to create new concepts (Burroughs, Albritton, Eaton & Montague, 1990; Shep- herd & Haaf, 1992). Although Bliss has been used ex- tensively with cognitively handicapped children, there is little doubt that these symbols are more difficult to learn than some of the other symbol systems e.g., Pics and Rebus (Mizuko, 1987). This feature which refers to the more abstract nature of some of the symbols could be seen as part of the reason why this system is an ap- propriate bridge into literacy. The combination of sym- bols also creates the opportunity for analysis and syn- thesis skills to develop on a visual level before these skills are required in normal orthography. There have, however, not been any studies done on the association between analysis and synthesis skills on a conceptual level (for example, Bliss) and reading ability. At most this relationship could be defined as loose, although the basic concept of analysis and synthesis in relation to reading is introduced before facilitating these skills in normal orthography. One could argue that the teaching of a conceptually based symbol system before teaching normal orthogra- phy could delay the actual reading process. Superfi- cially, this may seem to be the case, as the child will take longer before "reading" normal orthography. The extended world knowledge and exposure to concepts will, however, contribute to easier and more extensive ac- cess to reading once exposed to the process. Similarly, it could be said that exposure to Bliss symbols and nor- mal orthography simultaneously could lead to cognitive overload as children may have problems in retaining two symbol systems (Light & Lindsay, 1991). As one system is conceptually based, while the other is letter based, however, they refer to two different functional systems which may facilitate information processing (Underwood, 1978). The process of reading instruction with symbols can be described in three phases: phase 1, the teaching of symbols; phase 2, the sequencing of symbols; and phase 3, the fading of symbols to expose normal orthography only (Kuntz et al., 1978). This study aims to describe the initial phase of teaching new symbols to four chil- dren with Down syndrome, followed by a description of the sentence reading they were doing 6 months later. A qualitative description of symbol errors is made and discussed in order to shed some light on the symbol ac- quisition of the children. METHOD The goals of this study were firstly to describe four cognitively handicapped children's ability to learn Bliss symbols within a ten week period in order to use Bliss symbolics as an entrance into literacy. The subgoals were threefold: firstly to study the process of learning Bliss symbols in terms of recognition and labelling, sec- ondly to investigate the children's conceptual ability in relation to symbols taught during this period and thirdly, to describe the children's Bliss reading six months after the final training period. Finally a quali- tative description of the symbol errors is made. \ SUBJECTS: | j Four children with Down syndrome enrolled at a nursery school for disabled children in Pretoria were included in the study. All the children were in the same class in the preschool specifically geared to the needs of children with Down syndrome (see Table 1 for a descrip- tion of the subjects). Table 2 gives more detail on the present communica- tion abilities of the children. PROCEDURE: The Bliss symbols were taught as part of the regular preschool curriculum. The teacher selected the sym- bols according to the theme for the particular period. The number of symbols used each period varied ac- cording to the need identified by the teacher (see Table 3). The South African Journal of Communication Disorders, Vol. 41, 1994 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) The Use of Bliss Symbols as a First Step into Literacy Teaching of symbols: Each theme was introduced in the same manner and the same school routine was used during the eight weeks of implementation. In the teaching of the symbols, particular steps were followed by the teacher which will be discussed below.All of these steps included teaching within a group setting.The daily routine during the eight weeks was as follows: with Four Children with Down Syndrome 25 * Day 1: Experiencing the concepts. - All the children of the school went on an outing which was related to the theme of that week [see Table 3 for an outline of the themes], - The aim of the outings was to provide the children with the real experience and to bring them into con- tact with the actual objects.The teacher focused the Table 1. Description of subjects (N=4) Characteristics Subject 1 Subject 2 Subject 3 Subject 4 Chronological age [years & months] 7,2 5,7 5,5 3,7 Mental age [years & months] 4,0 2,11 3,8 2,6 Home language Afrikaans Afrikaans Afrikaans Afrikaans Syndrome Down Down Down Down Hearing Normal Normal Normal Normal Previous exposure to Bliss [months] 18 3 12 3 Socio-economic status Middle Middle Middle Middle Gender Male Male Male Female Table 2. Communication and visual perceptual abilities of the children Evaluation Measurement tools Subject 1 Subject 2 Subject 3 Subject 4 Chronological age (CA) [CA:86 months] [CA:67 months [CA:65 months] [CA:43 months] Receptive vocabulary *PPVT extremely poor extremely poor extremely poor - Receptive language *TACL Sub tests: - word'classes and relations - grammatical morphemes - elaborated sentences 1 *RDLS comprehension 49-53 months 42-45 months 56-58 months 33 months 30-31 months 29-31 months 28-31 months 31 months Expressive language *MLU J •Predicted chronological age j >6 >58.3 months 2.00 26.9 months 5.6 55.2 months 1.9 26.1 months Pragmatic behaviour •Checklist of pragmatic behaviour. Good Average Average Poor Cognitive development *DASI 2 developmental age 48 months 35 months 44 months 30 months Visual perception •Developmental test of visual perception •Developmental test of visual motor integration 57.2 months 35.6 months 52.7 months not available PPVT: Peabody Picture Vocabulary Test; Afrikaans translation by Gouws (1975). TACL: Test of Auditory Comprehension of Language; Afrikaans translation by Kritzinger (1985). CA: Chronological age. RDLS: Reynell Developmental Language Scales (Reynell & Huntley, 1985). MLU: Mean Length of Utterance; Computation according to Miller, 1981. Pragmatic behaviour: Good: 60-100% of communicative intents and conversational devices were observed; Average: 30-60% Poor: 0-30% DASI 2: Developmental Activities Screening Inventory (Fewell & Langley, 1984). Developmental test of visual perception (Frostig, 1963). Developmental Test of Visual Motor Integration (Beery, 1967). Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 41, 1994 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) 26 Erna Alant children's attention on concepts which were to be in- cluded in training and provided language stimula- tion throughout the outing. A video recording was made by one of the teachers, which was used in teach- ing later on in the week. - No formal work was done on day 1, as the children left for home after the outing. No Bliss symbols were thus introduced on day 1. * Day 2:Introduction of pictures, objects and symbols. On day 2 the class was introduced to the interest table. This table contained objects and/or toys of the vocabulary to be taught.The teacher and the children had an informal discussion about the objects and re- lated it back to their outing. New concepts were ex- plained, demonstrated and acted out where necessary, in order to highlight the meanings of the concepts. This table was displayed in the classroom throughout the day.After this the interest board was introduced con- taining the symbols and pictures.Pictures were matched to the objects on the object table and then put onto the interest board, followed by the Bliss symbol for that particular object/picture. - The Blissymbol-interest board was displayed in the classroom throughout the week.This procedure was followed with all the symbols to be taught. - The Bliss symbols were presented as follows: * global presentation of the Bliss symbol on a flashcard * naming of the symbol * association of the symbol with the objects and pictures * identification of indicators [plural and action indicators] * As soon as all the new symbols were introduced, the teacher made short sentences with the Bliss symbols and the children had to read them. New and old symbols were used in the sentences.The teacher also asked comprehension questions, where children had to match the correct picture to the sentence. - Drill practise: After the groupwork, the teacher worked with the children individually for approximately 10 minutes a day in order to reinforce the meaning of the symbols.The work done in school was sent home and it was expected of the parents to reinforce the sen- tences at home. - The same procedure was followed for the remainder of the time period in which the theme was used.New symbols were introduced every day and objects/toys on the object board were added on a daily basis. - Testing of symbols for the study: * Each child was tested individually on the differ- ent occasions at school. The symbols were taught over an extended period of 10 weeks, but due to school and public holidays the period of exposure varied for each theme. During this time some chil- dren were also absent for a number of days due to illnesses or personal reasons. See Table 3 for de- tail about exposure time. * Baseline testing (before intervention) : In the be- ginning of a new training period, each child was evaluated to determine if he/she was familiar with the concepts that were to be taught and whether he/she recognized or was able to label the Bliss symbols that were going to be taught. Three pic- tures or symbols were presented and the child was requested to point to the specific picture or sym- bol. As the speech of some of the children was un- intelligible, the evaluation of the ability to label Bliss symbols had to be adapted. The symbol was presented and the child was asked to label it or to match it with the picture. A choice of three pic- tures was given once again. Items that were indi- cated by trial and error were repeated in order to increase reliability. At the end of each period of teaching, the same pro- cedure was followed to evaluate the number of concepts learned as well as the children's ability to recognize and label newly taught symbols (middle evaluation). A fi- nal evaluation (two weeks after intervention stopped) of all the concepts and symbols taught since the begin- Table 3. Symbols taught during each period Period 1 Period 2 Period 3 Period 4 Theme: Wild animals Insects Birds Good habits Period of exposure (days): 6 days 6 days 8 days 8 days Bliss symbols: nouns elephant monkey lion giraffe rhinoceros hippopotamus bee butterfly grasshopper museum duck owl ostrich parrot dentist teeth hair vegetables fruit milk verbs swing sit run bath is fly jump swim y brush eat drink other big small on high fast I my The South African Journal of Communication Disorders, Vol. 41, 1994 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) The Use of Bliss Symbols as a First Step into Literacywith Four Children with Down Syndrome 27 ning of the period was conducted to determine how much was retained over this period. Finally, an analysis was made 6 months later to de- termine progress in terms of Bliss reading. RESULTS AND DISCUSSION Figures 1, 2, and 3 represent the global results of all 4 c a n d i d a t e s over the eight weeks as regards their scores on the baseline, middle and final evaluations of the con- cepts introduced, ability to recognize and label Bliss symbols. From this diagram it is clear that all four children showed an increase in their understanding of the con- cepts over the 8 weeks. It is interesting that two of the c a n d i d a t e s , subject 2 and 3, showed slightly less under- standing (9% and 8%) in the final evaluation than in the middle evaluation. This decrease could be because concepts were not internalized well enough before pro- ceeding to the new concepts resulting in the elimina- tion from short term memory. From figure two it is evident that 2 candidates did not recognize any symbols before training started, while two candidates recognized 32% and 40% respectively. Once again, it is clear that all the candidates scored better in the final evaluation. As in the previous figure, candidates 2 and 3 again showed a slight decrease (2% and 7 %) in performance from the middle to final evalu- ation. Although a smaller decrease than in the concep- tual evaluation, this could be explained against the background of information processing models, whereby recognition is seen as a much easier skill in the infor- mation processing process (Light & Lindsay, 1991). A similar pattern is observed in figure 3 where all the subjects showed an increase in the labelling of Bliss symbols over the total period. Although a labelling re- sponse was not only scored on a verbal level (the child could also label by matching the picture to the symbol), it was interesting to note that there was an increase of verbal labelling from one of the candidates. Once again, however, subjects 2 and 3 as well as subject 1 in this case, showed a decrease in scores from the middle to the final evaluations. Labelling, (being the most diffi- cult of the three skills in terms of information process- Figure 2. Overall recognition of Bliss symbols in baseline, medial and final evaluations. % 100 - 90 - 80 - 70 - 60 - 50 - 40 - 30 - 20 - 10 - |= T/ I / 'A / / ̂ / / / i= |= A * / L / / 1 0 I 1 1 2 I 3 4 baseline medial final 40 97 100 0 95 93 32 100 93 0 84 96 Subject baseline 7ΖΆ medial I I 1 1 I 1 1 II 1 final Figure 1. Overall conceptual performance of the subjects. Subject • baseline ΈΖΆ medial W final Figure 3: Overall labelling of Bliss symbols in base- line, medial and final evaluations % 100 90 80 70 60 50 40 30 20 1 0 0 baseline medial final 29 95 8 2 baseline 7ΖΆ medial I I I | I 1 1 1 1 1 final 0 95 85 I I / 29 100 83 Subject 0 78 83 Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 41, 1994 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) 28 Erna Alant ing and production) was most affected by the two week time lapse before final testing. Although Bliss symbols have been criticized for be- ing more difficult for children to learn than other sym- bol systems e.g., Pics and Rebus ( Goosens, 1983; Hurlbut, Iwata & Green, 1982), most of the children in this study were able to learn the different symbols. The retention of concepts and symbolic skills over eight Table 4. Qualitative description of subjects' symbol errors MORE COMPLEX - LESS COMPLEX LESS COMPLEX - MORE COMPLEX is Λ Φ say A 0 jump A r v grasshopper A A A r > run Λ walk A eat A 0 A drink sit L Λ ~Ί chair | ^ eat
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