Communication, symbolic play, and play-extension in pre-school hearing-impaired children Denise Ε Segal, MA (Speech Pathology) (Witwatersrand) Speech Therapy Department Hillbrow Hospital, Johannesburg ABSTRACT * ^ ' ^ e d , pre-school munication modalities during play a^anZ^tll^LZ tl°U™°fdeveloP™»<· ^e children's use of their corn- materials, was assessed. The same cZdreTZdbLnnlTT ° , ^ b e y 0 n d t h e ^diacy of the play independent °f communication^lwe^^i!^s^em terms of symbolic and non-symbolic ̂ lay activities based approach was adopted, with pelrLLeVm^Z^ J PJT obse™'io™1 ™d ethplogically- 'move away from'the immediate p b ^ ^ ^ S ^ ^ ^hUdren attained no tion is important during play, subsequen^to tte omet tfsmboUm pl°y-It was suggested that communica- issues pertaining to the relationship between langZeZTcogntZnί ί ί ^ Γ 7*"* " °f helical sign language. Clinical suggestions and U n p J L T ^ Z ^ ^ Z ^ T " ' ^ *» approach versus OPSOMMING mumkasiemodahteUe tydens spelen lerTspetLZsie^ontwikkelmg geneem. Die kinders se gebruik van hulle kom- is beoordeel. Dieselfde kinders is J Z ^ n t Z e v l n i l ^ " ^ ™ ° n m i d d e l l i k e spelmateriaal te voer, munikasie) beoordeel. Hierdie b e J ^ T a s T ^ Z ^ t i Z m n i e ^ i e s e spelaktiwiteite (onafhanklik van kom- ing is gehandhaaf waar gedrag b e U ^ ™ g ^ i ^ j j ^ ' ^ en etologiese benader- spelkonteks kan wegbeweeg nie alhoZl hulle ZnS s ^ e t l ' ^ Τ ' Τ ^ g l a d ™ ™ d i e onmiddellike spelsituasie belangrik is, Lar slegs n a l ^ ^ J ^ ^ ^ w' ^ ™ ^ ^mmunikasie in die SOOS die verhouding tussen taal en kognisie die rol in ZhnTJZ „ ? 8 ^ d i e U« v a n t e o r e t i e s e »enke en implikasies vir verdere Zo^ggentZ^g " ^ ^ ^ ^ ^ c u W h f " Γ ° f P l 3 y b 0 t h a C r O S S S P e c i e s a n d across v S ? n H , ° n g r e c ° i n i ^ d . Play has been viewed as a r e c e n ^ ' r 1 " 3 " 1 3 C t i v i t y o f ^ h o o d . ' However, only " ' Γ F e g a r d e d 3 8 3 P ° S S i b l e c l u e to " " d e r s t a n - 'ng h u m ^ b e h a v i o u r ' * * * * * ^ Th t h e l i c ° Z e 1 t a J l y j h e a r i n g " i m p a i r e d c h i l d h a s continually been children h f a C ! i C C ° n j e C t U r e · hearing-impaired their hearin regarded 3 8 behaviourally equivalent to these c h i l i ? ^ ^ 3 m ° V e 3 W a y f r o m t h e e a r l i e r that educatbnalkK Τ T ^ ° Γ c o n c r e t e - b o u n d - However, impai^en h 3 C k n ° w l e d g e P ^ u n d effect that hearing consequent ^ d e V e l o P m e n t o f v e r b a l language and majority J ^ development of communication.5 The have i n L l n f , ( S U c h a s b y ^ r and Quigley)" gression N e v , ! ' t ' ^ ^ d i f f e r e n t l i n g u i s t i c P">- in>Ponanf - e r t h e l e s s ' the extent to which verbal language is C O g m t l v e development remains contentious, and Suid-Afrikaa ® SASHA 1983 " " T y d s k r i f v i r fofwnikasieafwykings, Vol. 30, 1983 there have been comparatively few studies of cognition and its relation to language and play in this population group. Symbolic play and gesture are believed to be derived from the same developmental r o o t s , ^ w i t h s y m b o l i c p l a y a s sion from early gestures and an integral part of communica- tion development. The close association between play, verbal language and gesture during the course of development highlights the importance of assessing symbolic play in hearing-impaired children. Researchers, for example, Goldin- Meadow and Feldman,' have concluded that the visual modality equals the auditory modality as a medium for language learning and that the hearing-impaired child favours the visual modality. Recent investigations have tended to support Piaget's hypothesis'2 which emphasizes that cognition forms the basis tor all intelhgent behaviour including language. Piaget argues that language is not an essential prerequisite for symbolic play 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) • 42 development.12 However, Vygotsky's position2' in relation to that of Piaget has not been clarified and it suggests that language may assume an important role subsequent to the onset of symbolic play. Studies with older hearing-impaired children (for example that by Pruning and Skarakis)" have generally indicated a parallel performance on cognitive tasks in which verbal language is not an inherent part of the task itself. Relatively few studies of this nature have investigated the pre-operational period even though symbolic play, being observable, lends itself to investigation. The hearing-impaired child is particularly difficult to assess because the majority of play scales include language, whether directly or indirectly » The hearing-impaired child may use gesture or sign language during play, similar to the hearing child's use of language (ex- cept that the play sequence would be temporarily interrupted by a gestural movement). For this reason, a play analysis has either to exclude language altogether, or, to include all com- munication modalities and not verbal language alone The hearing-impaired child's use of any compensatory modality other than that of verbal language would suggest that verbal i m p o r t a n t a t e a r l y s t a g e o f c o g n i t i v e The term 'Symbolic Play' was applied in accordance with Piaget to refer to a behaviour in which assimilation predominates over accommodation allowing for "the defor- m f i , 1 0 " a n d . S U b 0 r d i n a t i 0 n o f reality to the desires of the self It is implicit that the behaviour occurs out of context and that the child is aware of the distortion of reality The pre- sent researcher applied the term only to that which was obser- vable from the child's performance, drawing no inferences about his competence. The term Play-Extension' was coined by the present researcher18 to refer to the process of "going beyond the in- formation given"2 within the narrow context of play This refers to the process of 'moving away from' the play materials within the play situation, rather than moving away from the play situation itself. Play-extension is viewed along a con- tinuum with 'immediacy' providing the earliest stage and nonimmediacy' the most advanced stage.8 It is argued that verbal language may play an important role during the pre- operational stage of development, subsequent to the onset of symbolic play, rather than as a prerequisite for the emergence of symbolic play. If symbolic play is assessed independently of communication in hearing-impaired children, a finding of delayed or different play performance would suggest either that verbal naming, specifically, is required for the onset of symbolic play, or that a gestural or signing method is not as efficient as verbal naming in this process. The present researcher was concerned with the qualitative changes that occur in play and communication and with their continual interaction during the course of development A quantitative measure was considered to be too broad to reflect he subtle changes which are important for clinical practice " in addition, ,t was aimed to use passive observation and description as an aid to diagnosis and therapy for the hearing- impaired child in conjunction with findings from the study of normal children, rather than relying upon the latter alone It must be emphasised that the early effects of congenital hearing impairment on verbal language complicate the separation of Denise S. Segal general experiential differences from the effect of communica tion differences, on subsequent development.22 For this reason, in the theoretical questions posed, the role of verbal language necessarily implies the factor of general experience as well. On the basis of the above, the present study investigated plav- extension, that is, the child's use of communication modalities during play. Prior to this, symbolic play was assessed in terms of play type and play complexity along a scale derived from Piaget s"2 categories and along the Lunzer* scale, respectively This preliminary study is not included in the present paper However, in summary, it was found that, at a non-verbal level' where any form of communication was excluded from the analysis of play, the hearing-impaired children demonstrated equivalent play complexity to their hearing peers with a delay in symbolic play activities.'8 This then served as the basis for analysis of play-extension. The purpose of the present study was to determine whether the hearing-impaired child uses his communication modalities during play and, if so, whether he uses communication to ex- tend play beyond the immediacy of the play materials Clinically, this study aimed to assist speech and hearing therapists by providing therapeutic insights into the general play behaviour, aspects of communication and abstracting abilities (that is, ability to 'move away from' the immediate context) of the small sample of hearing-impaired children Furthermore, it aimed to clarify some of the vagueness sur- rounding the field of play as well as attempting some elucida- tion of the ill-understood relation between verbal language and cognition. 6 6 METHODOLOGY SUBJECTS A total of ten white children of middle class South African families, aged between 15 and 41 months, served as subjects The experimental group comprised 5 hearing-impaired children who presented with severe congenital hearing losses and who had been fitted with hearing aids between 8 and 12 months of age. Five hearing children were matched with the experimental subjects for chronological age and sex (see Table I). It must be emphasised that this sample of hearing children did not comprise a control group. Rather, it constituted a sam- ple from which to ascertain guidelines for a developmental se- quence for play-extension. No attempt was'made in analysis to compare individual hearing-impaired subjects with the associated hearing peer. From Table I below it can be seen that an age bias always favoured the hearing-impaired children. The age range includ- ed the 18-month level for the onset of symbolic play as well as the 3-4 year peak of development.12 All children were of average intelligence and presented with no primary emotional problem or concomitant neurological or physical handicap. Impairment of language or hearing was rul- ed out with regard to the 'normal' subjects. All h e a r i n g - impaired subjects were attending the Unit for Hearing- I 7 a ' r e d C W l d r e n - University of the Witwatersrand, which afforded daily speech and language therapy, auditory training and parent counselling. Children taught sign language would The South African Journal of Communication Disorders, Vol. 30, 1983 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) Communication, Symbolic Play, and Play-extension Table 1 Age and Sex Characteristics of the Subjects \ HEARING IMPAIRED Subject A Age 16 months Sex F Predominant Communication Modality Vocal Vocal Vocal and gesture Verbal and gesture Vocal and gesture Β 18 months Μ Predominant Communication Modality Vocal Vocal Vocal and gesture Verbal and gesture Vocal and gesture C D Ε Average age = 27 months 34 months 41 months 27,2 months Μ Μ F Predominant Communication Modality Vocal Vocal Vocal and gesture Verbal and gesture Vocal and gesture = 2,3 years HEARING Subject F Age 15 months Sex Μ Predominant Communication Modality Vocal Verbal Verbal Verbal Verbal G Η I J Average age = 18 months 22 months 34 months 36 months 25 months Μ Μ Μ F Predominant Communication Modality Vocal Verbal Verbal Verbal Verbal 2,1 years have been communicating at a level equivalent to that of nor- mal children using verbal language.5 For this reason, it was necessary to investigate children taught by oral-aural means in order to be able to answer the question concerning the role of verbal language in symbolic play RATING SCALES A rating scale for play-extension was compiled on the basis of observation of the sample of hearing and hearing-impaired children. An ethologically-oriented approach3 was adopted in that categories were formulated to describe the observed behaviours rather than 'squeezing' the behaviours into previously devised categories. The subjectivity of the behaviours themselves, and of the rating by a single judge, are recognised as limitations. All behaviours involving language only, play only, or extension beyond the situation itself (versus play-extension) were assigned a score of 0 since only the simultaneous occurrence of play and communication was of interest. A score of 0 therefore implies a lower level only with regard to the interest,'of the present investigator and to the nature of the behaviours being investigated. Levels 1-5 accord with die broad category of 'immediacy' indicating that the child is bound to the immediate context. Levels 6-8, the broad category of 'non-immediacy',8 indicates that there is a 'move away from' that which is immediately present. From level 5 Mehrabian's framework8 was found to be no longer ap- plicable since it describes development of communication per se, thereby deviating from the emphasis in the present study, oral, verbal and gestural means of communication are in- cluded in the scale.18 PROCEDURE Each child, alone with his/her mother was videotaped from setti 3 ° n e " w a y m i r r o r i n a n unstructured nursery school ng at the University of the Witwatersrand Unit for recnrH m p a i r e d C h i l d r e n · A Sony Betamax video cassette prleH fin ° d e l S L 8 0 ° 0 ) W a S u s e d ' T h e environment com- fccilitaf , f l e c t i o n o f materials which was designed to materi 1 S e l f ~ l m t i a t e d ' spontaneous child activity. The play ais comprised commercially available objects as well as J " K material. Thre ' Γ ε ε 5 6 5 5 1 0 1 1 5 Per child were recorded at two-month intervals Die Suid-Afriν jnKaanse Tydskrif vir Kommunikasieafwykings, Vol. 30, 1983 so as to tap peak periods in development as well as the progres- sion over time. The experimenter then described the ongoing play behaviours from the videotape onto a tape recorder while two raters simultaneously rated these behaviours. An index of inter-rater consistency was established by summ- ing those categories that were rated the same by both judges and by computing the ratio of these judgements to the total number of judgements made. Values above 0,8 were con- sidered to reflect high consistency. Measures obtained were 0,86; 0,92; 0,81; 0,83; 0,93; and 0,81. The verbal description was transcribed in written form and checked for objectivity and accuracy by another independent observer. This served as the data for derivation of the play- extension scale. Separate scales were drawn up for verbal, vocal and gestural modalities, which were subsequently co- ordinated. A time-sampling procedure was favoured despite its 'unnatural' quality, since event-sampling is problematic when rating vocal behaviour18. Every ten-second period constituted a unit of analysis, and each behaviour within a ten-second period was analysed into type and extension categories. Communication is frequently of brief duration, however dura- tion bears no relation to play-extension. As an example, a brief utterance such as, "they're home", may alter an entire se- quence of behaviours and imply a complex extension. Time- sampling was a suitable compromise to overcome some of these difficulties. Since many levels may occur within any one play event, only the focal behaviour for any ten-second period was scored.10 At the higher levels of play-extension in which events are difficult to separate into isolated units, cohesion was afforded by means of this procedure. Lower levels, if not focal, were excluded in rating. Whether or not one is able to accurately interpret what a child is attempting to express in his play, is questionable. It is evi- dent that the researcher is limited to that which the child chooses to display overtly or to communicate. For this reason, the present study was concerned exclusively with perfor- mance. An example which will serve to highlight these dif- ficulties is evident when one is presented with two children, one of whom has adequate verbal facility and the other, a non- verbal child. When both children draw circles, the verbal child 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) 44 •ο Φ σ> ce Ο) C LU Φ Έ ® σ> « c φ ο ι ιοοΗ 90|~ 80| 7 0 60 5 0 4 0 3 θ Ι 20 10 Graph I Subject F 1 0 0 ^ 9 0 h 8 0 •D Φ Ο) 7 0 (0 σ> c LU 6 0 Φ Ε 5 0 Ρ Φ Ο) 4 Of « C φ 3 0 £ 2 0 | 1 0 Ι Ι 0 J — 1 1 2 3 4 5 6 7 ~ t Play-Extension Graph III Subject Η 2 3 4 5 6 ? 1 Play-Extension Graph V Subject J Play-Extension 100 9 0 s 80 I 7 0 S 60 I 5 0 ® Λ Λ. Ι 5 4 0 c 8 3 0 20 1 £ ϊ •ο φ σ> ce σ> c LU Φ Έ Φ Ο) « c Φ ο I 100Γ 9 0 L 8 θ ί 7 0 ί 6θ(~ 5θ(~ 4 0 Γ 3 0 , 2 0 * 10 Denise S. Sega Graph II Subject G 2 3 4 5 6 7 8 Play-Extension Graph IV Subject I 1 2 3 4 5 6 7 8 5 6 ~ 7 ~ έ ~ Play-Extension X axis: 0,6cm = 1 unit of play-extension Y axis: 0,6cm = ioo/0 0f total time Play-Extension 0 = Play only; communication only = Non-denotational = Denotational = Naming = Play + communication accompaniment = Play anticipation = Play extension = Play through communication + action = Play replacement by means of communication Figure 1 2 S T · " Μ " " " β W , < i n P ' a ! M M e n S i 0 n combined ,o, ,he hearing,.paired The South African Journal f Communication Disorders, Vol. 30 1983 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) Co ι iinmunication, Symbolic Play, and Play-extension Graph I Subject A •o ® σ> a σ> c LU Φ ε f © σ> a «·* c φ υ φ α l O O h 90- 80 70 60 50| 40 30! 3 1001" 9 0 h 80L· 7ol· 2 3 4 5 6 7 8 Play-Extension Graph III Subject C Ό Φ σι η σι £ 60 » Ε Φ σ> « Έ Φ 2 0) 0. 5 0 40 30 20 Ί Ο 1 J ! 2 3 4 5~ 6~7 Play-Extension Graph V Subject Ε - L 8 JA 1 0 0 ^ 90r „ 8 0 Φ i 70 c LU φ Ε Graph II Subject Β Φ σ> <5 c Φ ο £ 60 5 0 40r 3 0 2 0 1 0 1 2 3 4 5 6 7 8 Play-Extension 1 0 0 f 9 0 ( - •D 8 0 ( -Φ Ο) (β 7 0 - Ο) c LU 6 0 ' 9 but it must be kept in the term 'imaginative play" as used in the present Die Suid-Afrikn jnKaanse Tydskrifvir Kommunikasieafwykings, \bl. 30, 1983 47 study, is not equivalent to Vygotsky's original use of the term, since the latter occurred within a Soviet framework. Even in the early cognitive stages, the hearing-impaired children did not attain levels comparable to their hearing peers and the cumulative effects of delayed and different perfor- mance with further development, cannot be ignored. Further- more, the acquisition of processes in the 'different' child may not be as linear as that for the 'normal' child with regard to stages.15 The disagreements between the different educational ap- proaches to hearing-impaired children are highlighted in the present findings. The hearing-impaired children may have failed to use language to extend play because gesture is not as efficient a medium as verbal language in this regard. Sign language may be a suitable medium for play-extension or, it may afford the child a modality for increased communication during play but not for play-extension (that is, verbal language may be the necessary modality for play-extension). Further research is required to elucidate this issue. Arising from the above discussion, the findings and methodologies of previous researchers require additional consideration.8·23 The previous emphasis on the ease of ac- quisition of actions in symbolic play versus language appears to be less enlightening with regard to the hearing-impaired child than the gestural link between symbolic play and communication. The hearing-impaired child's delayed rather than different performance and his ability to engage in sym- bolic play, seems to negate the possibility of a general representational deficit. The present findings support the view outlined by Arnold,1 that verbal language is not required for cognitive development in hearing-impaired children. However, the cumulative effects of delayed language may con- tribute to later difficulties at the level of logical operations. Cognizance must be taken of the close relation existing be- tween language, symbolic play and gesture when dealing with all 'language-different' children. Play, being both nonverbal and observable, appears to be a useful clinical tool affording differential diagnosis of language abilities. (For detailed diagnostic and therapeutic implications, see Segal20). Play- extension may provide a means of conveying the principle of abstracting to hearing-impaired children with regard to both the play context and the use of language. Qualitative analysis affords the derivation of a clinical profile of each child's cognitive, communicative and play-extension abilities, and provides for therapeutic direction.20 The relation between communication and play is still relative- ly unexplored in normal children as evidenced in a com- prehensive review of the field of play by Fein.4 The few studies that have dealt with language, communication, or metacommunication and play (for example, Nicolich and Raph"), have not used scales equivalent to that of play- extension. In relation to hearing-impaired children, this field remains in its infancy. Implications for future research include longitudinal investigations of play and communication with large samples of normal and hearing-impaired children to af- ford detailed comparisons across groups; pertinent diagnostic indicators separating groups, for example, language-impaired from hearing-impaired children (using play analysis as the 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) 48 major assessment tool); similarities and differences between verbal language and sign language in relation to play; and test- retest reliability measures. In addition, longitudinal studies wou d indicate whether symbolic play and play-extension parallel each other in development thereby giving rise to two branches in the cognitive sphere which may affect different logical processes at a later stage.18 In a relatively unexplored field of research, it is hoped that this study will serve as an incentive for subsequent investigations. ACKNOWLEDGEMENTS This paper is based in part on a section of a Masters disserta- tion submitted to the University of the Witwatersrand, Johan- nesburg. The writer expresses her gratitude to Prof Μ L Aron and Dr. C. Penn who served as supervisor and informal adviser respectively. In addition, the writer wishes to acknowledge the financial assistance received from The University of the Witwatersrand, the Human Sciences " o n ° U n C i l a n d ^ S ° U t h 3 n d REFERENCES 1. Arnold ρ P h . D . ( 1 9 7 9 ) chang.ng Views of the Deaf Child. Journal of the British Association of Teachers of the Deaf 5(6), 178-192. 2. Bnaner, J. S. (1966). On Cognitive Growth I, II. Chaps 1 and 2 in Studies in Cognitive Growth, Bruner J S Olver ν f ^ G r e e n f i e l d ' R M · (Eds.), John'Wiley, New York, Pp. 1-67. 3. Eibl-Eibesfeldt, I. (1970). Ethology: The Biology of Behaviour. Holt, Rinehart, Winston, New York 4. Fein, G. G. (1981). Pretend Play in Childhood: An In- tegrative Review. 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Symbol Formation: An Organismic-Developmental Approach to Language and the Expression of Thought. John Wiley, New York. The South African Journal of Communication Disorders, Vol. 30, 1983 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)