Standardized Tangible
Symbols
Ellen Trief,EdD
Primary Research Questions
Will students with multiple disabilities and
visual impairment benefit from the use of a
universal set of tangible symbols for
communication?
Which student characteristics will be
predictive of student mastery of tangible
symbols?
The Settings
Four schools in New York City
Lavelle School for the Blind
The Jewish Guild for the Blind
The Lighthouse
Helen Keller Services
Student Characteristics
Intentionality/Symbolism
Vision
Hearing
Ambulation
Play
Characteristics
Gender Ages
Numbers Male=
in Each 23
Category
Female
=21
3-5.11
y.=16
English/ Vision
Bilingua
l
English= TB=19
26
6-11.11y Bilingual VI= 18
=14
=18*
12-20
y. =14
CVI=7
Motor
Hearing Play
Ambul.
=16
Funct.
Isolated Vocal.
Hearing =35
=26
=25
Ambul.
With
assist.
=8
NonAmbul.
=18
With
Parallel= Non Hearing 5
vocal=1
aid=1
8
No Data No data
available available
=2
=18
Sp.
Assoc. Verba
or Coop. l< 5
4
words=
4**
Pre and Post Testing
Speech and language pathologists from
Hunter College administered the pre and
post tests for the study under the direction
of Dr. Paul Cascella.
The symbols were used as pre and post
test measures.
The Intervention
Teachers and therapists chose at least 5
symbols which would be introduced to
each child during the errorless learning
phase.
Two weeks of exposure to each of the five
symbols at the beginning, during and at
the end of each activity.
Gradually built up to introducing more
symbols during the seven months.
Training the Teachers and
Therapists
A scripted task analysis was given to each
teacher and therapist
A training session using video clips was
done at each school prior to the
intervention.
Follow-up visits were made to each site to
ensure that the protocol was being
consistently implemented (fidelity
measure)
The Probe
After an activity was completed, the
teacher/therapist showed a choice of two
symbols to the child.
The symbols were presented on a board
and the order of the symbols was changed
over two or three trials
Data was recorded on simple data sheets.
What We Have Found
44 of the 51 children enrolled in the study
positively responded to the symbols when
probed. Three showed no response and 5
yielded a 10% or less response.
The range of percentage correct during
the probe phase of the study was 10.1%92%.
Percentage of Correct
Responses by Month
Total Trials
# of correct
responses
% of correct
responses
Oct.
2,433
640
26%
Nov.
3,724
1,116
30%
Dec.
3,709
1,359
37%
Jan.
4,594
2,082
45%
Feb.
4,448
2,107
47%
Mar.
April
7,513 3,799
3,584 1,696
48%
45%
What We have Found So Far
The only significant difference across groups
when we ran an ANOVA was ambulation.
Children who had some ambulatory skills
learned more tangible symbols than those who
were non-ambulatory.
The mean difference between the nonambulatory and the ambulatory with assistance
and ambulatory group was significant at the .05
level.
What Does This Mean?
Paul, Susan and I thought that level of
communication development would be the
strongest predictor in learning the tangible
symbols, but in fact the only statistically
significant predictor was mobility.
Vision, hearing and play showed no statistical
significance in the acquisition of the symbols.
What We Have Learned
On the pre test and post test data the children in
the study showed no significant gain in scores.
However, the post test was not given in context
to the activity.
The children in the study had 6 months of
practice with the symbols in context.
Unfamiliar people administered the pre and post
tests.
What Does this Mean?
Outside and unfamiliar testing might not
measure progress for this population.
Taking the task out of context and out of the
natural environment during the actual activity
made it difficult for the children to understand the
question
Qualitative Analysis
Post Interviews of teachers (21) & speech
therapists (8)
Teachers licensed in severe disabilities or
visual impairment
Speech therapists licensed
All above had a Masters degree
Interview Questions
How do you feel tangible symbols helped the
children in the study?
What do you see as a future direction in your
classroom for the use of tangible symbols?
Do you feel that the symbols should be sent
home to parents?
If so, How can we encourage the parents to use
the symbols in their home?
Do you have any comments or suggestions for
future use of the symbols?
Qualitative Analysis
Interviews videotaped in entirety
Fully transcribed
Coded using constant comparative (Glaser & Strauss,
1967) & word-by-word in vivo coding (Charmaz, 2006).
Major themes identified & all interview comments
organized within 2nd document
2nd document organized by themes & included in vivo
Counting of comments made within each theme
Second rater coded 1st document, making comments
Third document integrated coding, still within themes &
with in vivo
Major Themes Identified
Student Learning Benefits
Attributions about Student Learning: Supports
and Barriers (unsolicited by questions)
Adult Learning (also unsolicited by questions)
Future Directions-includes use in the home &
suggestions for future interventions (in their
classroom and beyond), and suggestions to
improve the intervention
Benefits
Benefits Cited by Teachers & Therapists
–
–
–
–
–
–
–
–
Learned meaning of symbols
Improved behavior/socialization
Ancillary (unexpected)
Learning schedule/routine
Improved transitions
Express in new forms
Meet needs/wants
Making choices
Educator Quotes on Benefits
Allie’s behaviors went down and I think that’s what was
the biggest progress with her. At first she would yell,
throw herself, tantrum. But once she learned, “When I
want to eat, all I have to do is touch that eat cue,” her
tantrums went down and the screaming went down.
When she wanted to listen to her favorite music, all she
had to do was go and touch that music cue. With her, it
just minimized [the behaviors] and realizing, “Hey, I can
actually let them know what I want at this moment.”
Attributions: Supports
Attributions About Student Learning: Supports
–
–
–
–
–
–
–
–
Frequent opportunities to practice
Symbols selected were for highly preferred activities
Structured protocol
Customizing/individualizing select & naming of
symbols
Cognitively more aware
Optimal alertness states are more frequent
Higher level of communication
Iconicity of symbols
– Pairing with voice output communication devices
(VOCD)
– Tactually distinct symbols (from each other)
– Adult consistency with protocol
Educator Comments about
Supports
Educators often spoke about the importance of
the intervention’s structure and opportunities for
students to practice the use of the tangible
symbols
– “The student that I had the most progress with, was
the student that I had every day, was seeing the
symbols every day, over and over and over again.”
Attributions: Barriers
Attributions about Student Learning: Barriers
–
–
–
–
–
–
–
–
Early adult resistance
Physical & medical issues
Protocol-Probe (children not seeing the point)
Student Absenteeism
Tactile defensiveness
Behaviors with symbols (tossing, fiddling)
Frequent non-optimal alertness states
Irritability/moodiness
–
–
–
–
–
–
–
Lack of auditory feedback
Symbol size
Abstract symbols were not mastered (by some)
Child needs more time to learn symbols
Bilingualism
Reaching errors
Adult implementation errors
Adult Learning
Three educators initiated comments on their
own learning
– “I mean, in the beginning, I wasn’t sure about the
whole thing. Because when you think about
communication systems, you think about what’s the
most relevant to each student individually. So, having
this universal system, well, it seemed like a great
idea. It kind of seemed like, how are these kids going
to understand this if they don’t have any relationship
to the symbol? But having gone through it, you know,
and seeing some real progress, you know, I think it,
for me, it seems like it is about consistency.”
Future Use
All 29 reported they would use tangible symbols
in the future
Many wanted their current students to learn
additional symbols
Lack of current student success did not deter
teachers from using the symbols in the future
They talked about individualization-by selection
of symbols from the set & thoughtful naming
Several talked about pairing with VOCDs (if the
child already was a VOCD user)
All 29 agreed tangible symbols should be
used in the home setting (“definitely,”
“absolutely”...
– “I definitely feel that the cues should be sent home so
they’ll be carrying over and so that the student can
use it in a naturalistic setting and so you’ll see more
progress in the use of the tangible cues.”
Educators agreed that parents would need
some preparation (observation in school,
group & individual trainings, DVD…)
Suggestions for the Symbols &
Intervention
Suggested additional tangible symbols
Duplicate sets were requested
Size & portability
Changes in use of the probe-less frequent
Additional training on indicating responses
Suggestions for ELLs-labeling in Spanish
Parent materials in their primary language
Respecting the Importance of
Saliency
Select a tangible symbol from a universal or
standardized set ONLY if that symbol is a good
choice for that child (matches what is most
salient to the child about a given activity or
setting)
Universal sets do NOT replace the need to make
some tangible symbols
Individualization also occurs by wise selection of
a NAME for each symbol
Use the selected name (for each tangible
symbols) consistently
Dissemination Efforts
Five articles were generated from this
study.
– The Development of a Universal Tangible
Symbols System (JVIB, July, 2009)
– The Selection of Tangible Symbols by
Educators of Students with Multiple
Disabilities and Visual Impairment (JVIB,
August, 2010)
Dissemination Efforts
– Comparing Parent and Teacher Ratings of
the Frequency and Diversity of
Communication among Children with Severe
Disabilities (2012)
– Article on quantitative findings regarding the
benefits of tangible symbols to children who
are visually impaired with multiple
disabilities(May, 2013)
– Teachers’ and therapists’ perceptions about
the efficacy and future directions of a tangible
symbols intervention (September, 2011)