The purpose of this paper is to compare the advantages and disadvantages of teaching language to nonverbal children. The content of the paper will explore in depth of three methods of teaching language to nonverbal children: Gestures, Sign Language and Augmentative Alternative Communication (AAC). Each of the methods will be thoroughly researched and information will be obtained regarding history, background, populations that are affected, methods of teaching language to nonverbal children, evaluations, family involvement in the process of teaching language to nonverbal children, advantages and disadvantages of using each method. The information on the three methods of teaching language to nonverbal children will be gathered by researching on the following electronic databases: American Speech Language Hearing Association (ASHA), CINAHL and Cochran. Each journal article will contain recent findings and will be peer reviewed. The paper will also discuss the findings of research on the three methods of teaching language to nonverbal children.
Keywords: Nonverbal communication, gesture, augmentative alternative communication, sign language, speech language pathologist, evaluations, language acquisition, language development.
According to the American Speech Language Hearing Association (ASHA), it is estimated that between 0.8–1.2% of the total US population experience communication difficulties due to language and communication impairments, and, therefore, may require additional supports to supplement their spoken communication (American Speech-Language-Hearing Association (ASHA, 2005). Populations include Autism Spectrum Disorder (ASD), deaf/hard of hearing, acquired and congenital disabilities. Individuals who are nonverbal need supplementary tools that will enhance functional communication skills. For instance, gestures, sign language and augmentative alternative communication. The purpose of this review is to compare the advantages and disadvantages of teaching language to nonverbal children.
Gestures are defined as actions used to intentionally communicate, expressed either by the hands, facial expressions, or body movements (Iverson & Thal, 1998). As mentioned by Bates & Dick (2002), Gesture and language both involve the use of symbols to convey meaning intentions, and close relationships have been found between language and gesture milestones children from 6 months onwards. Even early in their development, infants use pointing gestures to initiate joint attention and to communicate their intentions (Liszkowski, 2011; Mundy et al., 2007). According to Goldin-meadow:
Even before young children begin to use words, they gesture. Moreover, gesture does
not disappear from a young child’s communicative repertoire after the onset of speech. Rather, it becomes integrated with speech, often serving a communicative function in its own right. For example, a child says, “open,” while pointing at a box––gesture makes it clear which object the child wants open. Thus, at certain times in development, gesture can extend a child’s range of communicative devices. Importantly, there is variability across individual children in the way they use gesture, and this variability can be used to predict differences in the children’s onset of linguistic milestones (Goldin-Meadow, 2003).
In addition, successful use of communicative gestures requires the integration of several developmental skills related to social, cognitive and motor abilities (Wray, Norbury & Alcock, 2016). Gestures are important because it is a foundation for language acquisition before developing the ability to produce words to communicate. It is a way for a child to communicate their wants and needs by just pointing, making eye contact and making sounds. It shows that there is an intentionality to communicate with the caregivers and others. Nonverbal children such as children with autism are minimally verbal, it can be concluded that one of the red flags for this population is that they do not attend to joint attention, eye contact or initiate gestures to communicate. According to Liszkowski (2011), when infants begin to point communicatively around their first birthdays, infants vary not only in the amount of pointing gestures but also in the hand shape they use when pointing. Initially, infants will use their whole hand to point to objects and to direct the attention of their communication partners (Lock, Young, Service, & Chandler, 1990).
Not only can we predict the size of children’s spoken vocabulary from looking at the size of their early gesture vocabulary, but we can also predict which particular words will enter a child’s spoken vocabulary by looking at the objects that child indicated using deictic gestures several months earlier (Iverson & Goldin-Meadow, 2005). Iverson and Goldin-Meadow (2005) provided an example, a child who does not know the word “dog,” but communicates about dogs by pointing at them is likely to learn the word “dog” within three months. In the study that Iverson and Goldin-Meadow conducted, the findings were consistent with the hypothesis that gesture plays a facilitating role in early language development. Child gesture has the potential to influence language learning in a direct way by giving children an opportunity to practice producing particular meanings by hand at a time when those meanings are difficult to produce by mouth (Iverson & Goldin-Meadow, 2005). Additional findings from another study have mentioned:
Gesture can alert listeners (parents, teachers, clinicians) to the fact that a child is ready to learn a particular word or sentence; listeners might then adjust their talk, providing just the right input to help the child learn the word or sentence. For example, a child who does not yet know the word “cat” points at it and his mother obligingly responds, “yes, that’s a cat.” Because they are finely tuned to a child’s current state (cf. Vygotsky’s, 1986; zone of proximal development), parental responses of this sort can be effective in teaching children how to express a particular idea in the language they are learning (Goldin-Meadow, Goodrich, Sauer, & Iverson, 2007; Golinkoff, 1986; Masur, 1982, 1983).
A disadvantage of most studies of gestures findings concluded that further research is necessary to obtain additional information. For an example, there was a study that examined how individual gestures may be influenced by other areas of development (Manwaring, Mead, Swineford & Thurm, 2017). The study used different methods such as parent report form and observation form. The population for this study was children with autism spectrum disorder and typically developing children. This type of study had been conducted previously. The previous study did not examine gestures using different methods but rather just one method to obtain information. The findings of this study found that age was correlated with gesture items and was added as a controlled variable for further analysis (Manwaring et al., 2013).
The study mentioned that there were limitations and that in the future, additional information can be obtained by specifying gesture- –language relationships based on varying degrees of language development and specific chronological age groups (e.g., a narrower range of Typically developing toddlers (Manwaring et al., 2013). A strength of this study was the implementation of multiple measures and methods of data collection, including parent report and direct observation. But it is important to note that for future studies to utilize measures of gesture that have a wider range of scores and involve more naturalistic assessments of child gesture (Manwaring et al., 2013). Overall, findings from this study support theories promoting developmental relationships of motor and nonverbal communication strategies as important in early language learning (Manwaring et al., 2013).
American Sign Language (ASL) is a language indigenous to the United States and parts of Canada, typically used among individuals who are deaf and hearing people who interact in the deaf community. It is a language with vocabulary and grammatical features different from English, which can be as effective as the spoken language used by individuals who hear (Klima & Bellugi, 1979). According to Schein (1989), in the United States, over 90% of deaf children are born to hearing parents who do not use sign language. As a result, deaf children are often exposed to sign language as a first language at a range of ages well beyond infancy (Mayberry, 2007). Research has shown that many deaf children are at risk for language delay (Schick, De Villiers, De Villiers, & Hoffmeister, 2007). In rare cases, some deaf individuals are isolated from all linguistic input until adolescence when they start receiving special services and begin to learn sign language through immersion (Morford, 2003).
Most deaf children are born to hearing parents who do not know any signed language at least initially (Mitchell & Karchmer, 2004). Although more hearing parents have learned some form of signed language in recent years, it is unknown whether hearing parents learn and use the language well and succeed in creating a rich signing environment at home for deaf children (Marschark, 2001). With that being said, it is important that early intervention is key and to expose language to children as early as possible. With this type of method of teaching language to nonverbal children, there are disadvantages when it comes to seeking out additional services. To work with a signing deaf client, a typical speech language pathologist might select one of two choices: communicating directly with the patient via limited signed language or utilizing an ASL-English interpreter (Ferguson & Armstrong, 2004). According to Williams and Abeles (2004), there are identified several limitations that might arise from conducting therapy through an interpreter. For an example:
First, interpreters are not experts in all fields, nor are they secondary experts on information about the client. Second, introducing a third person into the therapeutic relationship does not instantly solve communication problems; language difficulties may still occur, and many relationship factors are changed with the addition of a third person (Williams & Abeles, 2004).
It can be concluded from this study that there is a gap between ASL and speech language pathologists. In order to provide appropriate services, a speech language pathologist would have to attend additional training. These findings also mentioned that interpreter might not be an expert in the field, therefore how can they translate to the client appropriately.
Augmentative and Alternative Communication
According to ASHA, Augmentative and alternative communication (AAC) is an area of clinical practice that addresses the needs of individuals with significant and complex communication disorders characterized by impairments in speech-language production and/or comprehension, including spoken and written modes of communication (Augmentative and Alternative Communication: Overview, 2018).AAC is another supplementary tool that are utilized by children who are nonverbal. Populations that are affected are individuals who have severe communication disorders that are characterized by impairments in speech, language, reading and writing (Augmentative and Alternative Communication: Key issues, 2018).AAC users fall into two categories: congenital and with acquired disabilities, Congenital disabilities include: autism spectrum disorder (ASD), cerebral palsy, developmental disabilities, intellectual disability, developmental apraxia of speech and genetic disorders (Augmentative and Alternative Communication: Key Issues, 2018). Acquired disabilities include: cerebrovascular accidents, traumatic or acquired brain injuries, neurodegenerative diseases (amyotrophic [ALS], supranuclear palsy, primary progressive aphasia, and apraxia), disability following surgeries (glossectomy, laryngectomy) and temporary conditions (intubation) for patients in critical care settings (Augmentative and Alternative Communication: Key issues, 2018).
Furthermore, Augmentative Alternative Communication (AAC) is a supplementary tool that nonverbal children utilize for everyday functional communication. There are two main types of AAC devices: aided and unaided. Aided systems use supplementary materials, including graphic symbols such as picture books, texture-based systems such as Braille, and speech-generating devices (SGD) that produce digitalized speech (AAC devices) (Brignell, 2018). Unaided systems use manual signs and graphic gestures; these may be formal such as sign language and key word signs, or informal such as idiosyncratic movements (Brignell, 2018). Depending on the individual and their needs, aided and unaided systems will be considered when choosing a device. In 2001, ASHA defined the “roles, knowledge base and skills deemed necessary for SLPs to provide a continuum of services to individuals with limited natural speech and/or writing” (ASHA, 2001, p. 420). AAC devices are often carefully chosen by a speech language pathologist and there is an evaluation process. The speech language pathologist will start off with utilizing a program called the Picture Exchange Communication Program (PECS) to gauge the student’s language abilities and personal lexicon.
According to Bondy, The Picture Exchange Communication System (PECS) includes six phases of teaching; the child moves up the hierarchy as they make progress and in the first phase the child is physically prompted to make specific requests for items, they want using pictures, and in the final, most advanced phase, the child uses the pictures to communicate independently (Bondy, 1998).
Then, the speech language pathologist will carefully assess the child’s abilities and determine which AAC device will best enhance the child’s communication abilities. According to Rush & Helling (2013), Speech-language pathologists (SLPs) are accustomed to the process of traditional speech and language evaluations. Evaluations focus on three areas: describing the nature and extent of the communication disability; estimating prognosis for treatment and recovery; and designing an initial framework for intervention (Rush & Helling, 2013). There are also areas extended to include determining current communication capabilities; identifying a symbol system for an external means of language representation; and evaluating assistive devices to aid in the access and operation of the AAC system (Rush & Helling, 2013).
After completing the evaluation of determining which AAC device is appropriate for the child, it is important to involve the family in the evaluation process of an AAC device. It would help families communicate with their child about their needs and increase functional communication skills. Not only that but, families play a vital role to carry over goals from speech therapy or classroom goals at home. The child’s family would practice using the AAC device with the child at home which will also provide a natural setting to communicate. It is important to educate to the family what type of device is being utilized for the child and how to appropriately use it. Service providers must keep in mind that AAC success depends on making sure that children and families have AAC strategies that they have chosen and to which they can be committed (Cress, 2004). If the clinician does not provide those AAC strategies or educate the parents, then the device will most likely will not be utilized.
In addition, School settings such as general education and special education are often the places that support the use of AAC devices for students who are nonverbal. Children who are nonverbal does not vocally interact with their peers and can use other means (i.e,AAC) such as pictures or voice output devices to ensure they have adequate opportunities to engage in social communication, self-advocate, and exhibit mastery of curricular content alongside their peers (Chazin, Barton, Ledford & Pokorski, 2018).Notably, it is important that communication with peers should be encouraged in a school setting. Teachers, teacher aides should have general knowledge on how to use the device and model how to use the device when the student is having trouble doing so. A disadvantage of having an AAC device is that it may not sound like natural speech, it is digitized and that not many people have been exposed to an AAC device.
An advantage to teaching nonverbal children with an AAC device is that it allows the individual to have a voice and the ability to express themselves independently with a device. An AAC device is customizable to the individual’s needs, a speech language pathologist is able to program custom phrases and add a personal lexicon. It is important to keep in mind to have careful consideration of the AAC user, their communication needs and environments, and their communication partners is warranted to ensure that an AAC system is appropriately selected (Helling & Minga, 2014).Helling and Minga (2014) stated, it is imperative that the SLP and AAC evaluation team have a solid foundation of and respect for the best practices that will ultimately provide the basis for clinical decision making and positive outcomes in AAC service delivery can only be made on the basis of both clinical and patient-centered values.
For each of the three methods: gestures, sign language and augmentative and alternative communication that are utilized for teaching language to children who are nonverbal, there are advantages and disadvantages. For gestures, many findings have concluded that gesture is an early indicator of language acquisition and that it is vital for language. Sign language is another method to teach language to nonverbal language, but studies have found that there is a gap between ASL and speech language pathologists. Augmentative and alternative communication findings focused on how to improve the overall communication abilities of the individual with considerations of what the family needs as well. Furthermore, more studies need to be conducted in order to obtain additional information for each of the three methods.