Research Supplement Exploring Sign Use in Two Settings

Nicola Grove, Sine McDougall

Nicola Grove, speech /language therapist, and Sine McDougall, psychologist, from the Division of Psychiatry of Disability, Department of Mental Health Sciences, St. George's Hospital Medical School, London, explore use of Makaton signs in teacher-directed and free play settings by children with severe learning difficulties.

Introduction The use of sign language to supplement or replace speech for pupils with severe communication difficulties is now common practice in special schools. Reid, Jones and Kiernan (1983) reported that 82 per cent of the schools in their final survey were using some form of 'augmentative communication' system, one of the most common being the Makaton Vocabulary (Walker, 1977; Grove and Walker, 1990).

Over the past 20 years, there have been numerous studies which have investigated sign acquisition in children with learning difficulties. However, the majority are concerned with proving the viability of signs as an alternative to speech, in experimentally controlled settings, and there is a lack of systematic information about how children who have been taught to sign actually use this mode of communication in everyday life (Kiernan, Reid and Jones, 1982; Udwin and Yule, 1990). Reports suggest that although pupils may successfully learn vocabulary through nonverbal modes, they may have difficulties in generalising this skill outside formal teaching sessions (Bryen, Goldman and Quinlisk-Gill, 1988; Faw, Reid, Schepis, Fitzgerald and Welty, 1981; Udwin and Yule, 1990). Until these issues are addressed, educators may continue to question the utility of teaching signing. Lynas (1988), for example, argues that 'There is no clear-cut evidence that the use of sign as a vehicle of communication actually promotes communication and language acquisition'.

The aim of this study was therefore to explore everyday use of Makaton signs in a group of children with severe learning difficulties, by contrasting their behaviour in two settings - language teaching, and free play. A central concern was that sign use should be viewed in relation to the total complex of communicative behaviour. We approached the task by taking first a 'wide angle' perspective. With whom did the children interact? What was their communication like? Only then did we focus on their modes of communication, to determine the extent of sign use in each setting, to identify which children showed definite preferences for one mode or the other, and to examine possible influences on sign use.

The specific questions addressed in the study were 1 Were there systematic differences between the patterns of communication produced in the two settings? 2 Was it possible to identify any factors which predicted sign frequency in either setting?

The method Subjects Forty-nine children, from 12 special schools in London, took part in the study. There were 30 boys and 19 girls, ranging in age from four years seven months to 12 years Ilmonths, with a n average age of eight years seven months. All had been referred by teachers as reliant on signs as their main means of communication. Twelve of the group had Down's Syndrome, six had cerebral palsy and 10 a variety of genetic/chromosomal conditions. Aetiology was unknown for the remainder.

Additional problems reported for 26 children included physical disabilities, hearing loss, epilepsy and challenging behaviour. All except 11 children came from English-speaking families.

Results of standardised tests of language and non-verbal ability indicated that all had severe learning difficulties but a wide range of abilities was represented in the sample, including some children who were unable to complete all the tests (see Table I ) . The majority of the group members were functioning at the single word/sign level. The length of time they had been learning Makaton proved difficult for teachers and therapists to estimate, particularly if children had transferred schools. For 32 of the group, learning time was known, and was estimated to range from six months to seven years nine months (SD = 20.92m).

Two ways of determining the amount of vocabulary known by the children were used (Table I ) . Teachers and speech/language therapists completed checklists to estimate receptive and expressive vocabularies, in both sign and speech. A picture test representing 80 concepts drawn from stages 1-4 of the Makaton Vocabulary provided a more formal measure of the children's ability to recall vocabulary in a naming task.

Table 1 Char~c~eristics af the children

Vocabulary: Assessmeot 180 picturosl

0 8 0 34 4.73 41

Meart leneth Utterance

T O settiriyi rslglls & wo.ds 1 , 1 7 l.2.tit; 0 . 3 % 18

Procedures Measures of communication were obtained through direct observation in the classroom and were amplified by teacher ratings of the extent of sign use by the children. Additionally, the researchers rated sign use in the classroom environments.

Classroom observations A method known as 'low structured observation' (Coggins, Olswang and Guthrie, 1987) was used to ensure that the

Research Journal of Special Education, Vo1.18, No.4 Research Supplement pp.149-156 December 1991 149

observation settings approximated as closely as possible to the children’s everyday experience.

Teacher-directed (TD) setting. Teachers were asked to involve the children in any activity appropriate to the teaching of language skills which formed part of their usual curriculum. Forty-one of the children were observed in groups, and eight individually. Typical activities involved picture and object descriptions, but the content and materials varied.

Free play (FP) setting. Teachers were asked to provide the children with preferred play materials, in the company of one or two familiar peers, in the classroom.

Observations lasted between 20 and 30 minutes in each setting, with differences in the observation times being taken into account in the statistical analysis. A non-continuous, partial- interval recording procedure was used, with the children’s behaviour alternately observed for periods of 10 seconds, and recorded for periods of five seconds. Observation and recording intervals were signalled by pre-recorded prompts delivered via personal stereo equipment.

Coding the communication The total communicative events recorded in the study were an aggregate of vocalisations and signs which the researchers considered were intentionally directed to adults, peers or self, using the guidelines provided by Bates, Benigni, Bretherton, Camaioni and Volterra (1979) and Coggins and Carpenter (1981). A number of aspects were coded simultaneously: Direction, Mode, Quality and Uses of communication (see Appendix 1).

Direction of communication (adult, peer, self). This provided a record of who the children interacted with in each setting.

Quality of communication. At this level of analysis, a distinction was drawn between signs and vocalisations which communicated a clear, novel message - which were termed propositional - from those which were unintelligible, repetitive, stereotypical or exclamatory.

Uses of communication (pragmatic functions). Propositional language was categorised into pragmatic functions, exemplifying the uses to which children put their language, based on categories proposed by Dore (1977) and Leonard, Camarata, Rowan and Chapman (1982).

Mode of communication (signs, word, sign + word). The children either signed or spoke, or used the two modes simultaneously. The category of sign was drawn fairly widely to include mimed actions, certain conventionalised gestures and communicative pointing. There are problems in determining the boundaries between natural gesture, sign, and mime in a study of this nature. It seemed reasonable to include inventive mimes with clear referential meaning. The gestures included were those which are taught as signs in the Makaton Vocabulary and/or are recognised non-manual components of sign language (such as head nods/shakes, and waving goodbye). Points which clearly indicated objects, people or events were glossed as they would be in sign language as this/that; herehhere; me/you; him/her. To exclude these would logically have entailed the exclusion of their spoken equivalents. However, a separate measure, excluding points, was used for specific analyses. Inter-rater reliabilities were

established through joint observation of eight children (TD) and seven children (FP), in four different schools, at regular intervals during the observation period. Mean percentage agreements calculated on a subject-by-subject basis, were as follows: Event occurrence (83 per cent T D and FP); Direction (94 per cent TD; 95 per cent FP); Mode (95 per cent TD; 94 per cent FP); Functional category (the pragmatic and quality categories) (86 per cent TD; 84 per cent FP).

Each of the above categories was expressed as a proportion of the overall total of signs and vocalisations produced by the children, except for pragmatic functions, which were calculated as proportions of the sub-category of propositional communication.

Teachers’ ratings of sign use Questionnaires completed by teachers included background information on histories, and ratings of the children’s functional use of signs in different settings, with different people, and for different communicative purposes. Each question was rated on a four-point scale (very f requen t/often/occasional/never).

Analysing signs in the environment Two measures were used to determine the extent and consistency with which signs were used to the children. To begin with, Teacher sign frequency was measured during the first five minutes of the observation period. This provided an indication of the number of signs used by the teacher in the immediate situation. In addition, an attempt was made to rate the frequency and consistency with which signs were used by teachers and classroom assistants, using a signing environment scale (see Table 2), developed during the pilot phase of the study, through discussions with teachers and therapists.

Results and Discussion Communication in the two settings We began by comparing the amount of communication by the children in each setting and then explored patterns of direction, quality and uses.

Total amount of communication The average number of communicative events recorded was 67.2 in the teacher-directed (TD) setting (SD = 36.25), ranging from 7.9 to 187.2. In the free play (FP) setting, the average was 66.41 (SD = 49.9, ranging from 0, in the case of one child, to 203.4. There was therefore no difference in the overall

150 Research Supplement December 1991

frequency of communication in the two situations. The results are comparable to the totals quoted by Crystal, Fletcher and Garman (1976) for language samples elicited from children under two years, and are higher than the frequencies elicited by Udwin and Yule (1990). Compared to non-disabled peers however, the average frequency of communication is much reduced (Wagner, 1985).

Direction of communication Figure 1 illustrates the amount of language directed to adults, peers and self in each setting. The majority of the children related predominantly to adults in both settings but significantly more so in T D than in F P (p < .001). Peer-directed language was more common in F P than in T D settings (p < .001) but still accounted for under a quarter of the children’s communication. Self-directed language was likewise significantly more common in FP than T D settings (p < .001).

I t was predictable that the children would interact almost exclusively with adults in the teacher-directed setting, and that the play setting would show an increase in the proportions of language addressed to peers and to self. What was less obvious was the fact that the majority seemed to direct their language to adults, even when the adults were not directly engaged in play. This pattern of behaviour seems to be typical of children with severe learning difficulties in special schools (Detraux, 1987; Romski, Sevcik, Reumann and Pate, 1989; Vyse et al, 1984). For example, Guralnick and Weinhouse (1984) found extremely low frequencies of socially directed behaviour, and Field (1980)

Figure 1: Directionality

n I

I I

notes that interaction with peers is impaired relative to cognitive development in children with learning difficulties. Peer interactions may be more common in adolescence and adulthood. Beveridge and Evans (1978) found more initiations in senior than junior special school classrooms.

I t seems plausible that, a t least for the children in this study, the lack of peer interactions may be related to the children’s expressive language abilities. At single word level, young children depend heavily on adults to infer meaning, and support conversations (Foster, 1982; Scollon, 1979). The high frequencies of unintelligible language, and the predominance of single words and signs, probably decreased the likelihood of effective communication with the peer group. Direct intervention is indicated to promote the interactive use of augmentative systems between peers. Successful strategies could include dialogue scripts (Keogh, Whitman, Beeman and

Halligan, 1987), peer tutoring (Hooper and Bowler, 1991), and direct instruction, modelling and role play (Lopes and Launer, 1986; Musselwhite, 1986). Additionally, partner training of non-disabled peers has proved successful in integrated classrooms (Goldstein and Ferrell, 1987; Horner, James and Egel, 1986).

Quality and uses of language Figure 2 illustrates the proportions of propositional, unintelligible, and repetitive language produced in each setting. Stereotypes and exclamations accounted for under two per cent of the communication in each context. In the TD setting children were more likely to use propositional language than in the F P setting (p < .001); and used twice as many repetitions (p< .01). In F P settings, unintelligible signs and words are more frequent (p < .001), and under 40 per cent of communication acts were intelligible and novel.

Pragmatic functions of communication were analysed by determining how many children used each function at least once, and putting the results in rank order. Teacher-directed settings were dominated by comments (used by all children), and labels and acknowledgments (confirmations, denials) which were used by 60 per cent of the children. Thereafter, functions were used infrequently, and by fewer children. By comparison, the F P setting showed no dominant functions. No single function was used by all the children but a greater range of functions looked to be accessible to the group.

The predominant use of labels, comments and acknowledgements is probably a reflection of the language tasks presented to the children and would appear to be typical at the level of single word communication (Coggins et al., 1983; Leonard et al., 1982; Wetherby and Prutting, 1984; Udwin and Yule, 1991a). Nevertheless, as Udwin points out, the lack of functional differentiation severely limits the range of potential conversations, and suggests the need to expand teaching strategies:Arguments have consistently been advanced for child-centred approaches to develop more creative language use with learning disabled children (Coupe and Goldbart, 1987; Harris, 1984; Kiernan, Reid and Goldbart, 1987; Martin, McConkey and Martin, 1984). It must, however, be emphasised that particular pressures affect interactions with students whose language is severely limited and that teachers and caregivers may need considerable training, support and resources to modify their dialogues and to create more

Research Supplement December 1991 151

opportunities for the expression of requests and commands, problem solving and inquiry (Bryen and Wheeler, 1976; Light, Collier and Parnes, 1985; Rieke and Lewis, 1984; Wood, McMahon and Cranstoun, 1980).

Patterns of sign and word use Frequency of mode use The analysis of mode use began with a comparison of the frequency with which signs, words, and sign + word (simultaneous use of both modes) occurred in the T D and FP settings. Figure 3 shows the proportions of propositional and unintelligible communication which were signed and spoken.

Propositional language constituted 50 per cent of the total language output in the TD setting, and 37 per cent in the F P setting. In the TD setting there was no difference in the frequency with which signs and words were used but, in FP, significantly more words than signs were propositional ( p < .01). Sign + word occurred less frequently in both contexts. When the two settings were compared, there was n o difference in the proportions of word use but sign use was significantly more frequent in TD than FP for both signs (p < .001) and signed words (p < .005). The pattern of distribution for unintelligible signs and words was rather different. In TD, 28 per cent of the total language output was unintelligible, and four per cent of this was signed. In FP, 48 per cent of the communication was unintelligible, and one per cent was signed. Hence the pattern of mode use was similar in both settings, with significantly more words than signs being unintelligible (p < ,001).

Figure 3%: Mode use: Propositional

’ i?L

r5 plu M#&

B6WS Bwwds usrfJ&2#r&

Figure 3b: Mode use: Unintelligible

Taken together, the results on quality and mode of language suggest how signs contribute to the effectiveness of communication. In T D settings, the children were more likely to make use of signs and more of their language was understandable. In play, the children were heavily dependent on the vocal mode and hence much of their communication was unintelligible to observers. They used a similar proportion of propositional words in each setting, but they did not use signs in play to clarify their messages. Possibly they were using their hands to handle toys or they had no adult models to cue them or they did not have a sign vocabulary appropriate to their needs when they were at play.

Teachers’ views of sign use Another perspective on the functional communication skills of the children in the study was provided by the teachers’ ratings of the frequency of Makaton sign use across settings, with different people, and for different purposes. Whereas the observations provided single ‘snapshots’ of the children’s performance at a particular point in time, the teacher ratings may reflect more established patterns of behaviour.

Settings. Most frequent use was reported for formal teaching sessions with the speech therapist o r class teacher. Over 70 per cent of the sample were said to use signs often, or very frequently, in class generally, and over 50 per cent in lessons outside the classroom. Outside lesson times, the most favourable settings for Makaton use appeared to be dinner time (65 per cent) and outings (50 per cent). Use in the playground, at school events and on transport was reported as occasional, or never for the majority of the sample.

People. Again, use was reported to be most frequent with the child’s own teacher and the speech therapist (81 per cent oftenhery frequent), followed by the classroom assistant (68 per cent). Use with other teachers was reported as often, or very frequent, for around half the sample but with other assistants and peers, for only about 40 per cent. Use with other groups of people, such as dinner ladies and domestic staff, and other professionals, was infrequent.

Functions. The most commonly reported functions were labelling (88 per cent), social, such as greetings; ‘please’ and ‘thank you’ (74 per cent) and requests (71 per cent). Thereafter, functional use appeared more limited. The majority of children were thought to make little use in sign of comments or descriptions, commands, confirmations, denials, refusals, protests, and questions. Since teachers were specifically asked to rate the functional use of signs in these contexts, i t is not clear from the data whether children failed to employ these categories of language at all or whether they used spoken language to d o so.

Taken together, the results from the observations and the questionnaires suggest that the typical context of sign use is lesson-based, with familiar adults - a pattern also found by Udwin and Yule (1991b), the survey by Kiernan, Reid and Jones (1982) and Bryen, Goldman and Quinlisk-Gill(1988). These findings confirm the impression that considerable effort may be needed to encourage spontaneous use of signs in natural contexts.

Bsqls @Verb - 152 Research Supplement 1)rcemher 1991

Consistency of mode use Another way of looking at sign use was to see if the same children were signing in each setting. Experimental research suggests that students with learning difficulties may show strong mode preferences, for either signs or speech, depending on underlying, neurologically determined, strengths and weaknesses (Alpert, 1980; Bowler, 1984; Bowler and Kiernan, 1987; Hamre-Nietupski, Nietupski and Rathe, 1986; Reid, 1984). This study, however, revealed a shifting, dynamic balance of sign and speech use by most of the children. Although the sample was originally selected on the basis that signs were their primary means of communication, their scores on the vocabulary assessment had indicated considerable variance in sign use. There appeared to be a continuum from children who were totally sign dependent for communication purposes, to children who - whatever their dependence on signs had been in the past -were now effectively speakers.

The question that arose was how consistently the children used their preferred mode across situations. This was explored by calculating the ratio of signs to words (propositional, excluding finger points), in the vocabulary assessment and the classroom settings. Children with a score near to 1 were highly sign dependent, and children with a score near to 0 were highly speech dependent. ‘Signers’ and ‘speakers’ were defined as those children for whom 75 per cent or more of propositional communication was in one mode or the other. There were significant differences in the average mode dependence between settings. The children relied most on signs during the vocabulary assessment, where 17 children were ‘signers’, and five were ‘speakers’. In the TD setting, there were 11 children in each group. However, in the FP setting, only five children were ‘signers’ and 21 were ‘speakers’. Rank order correlations indicated positive associations (0.4-0.5) across the three contexts, which were significant at the .001 level. At either end of the spectrum, there appeared to be children who showed strong dependence on one mode or the other, whatever the situation; however, there was a population in the middle whose mode dependence shifted across contexts.

The fact that many of the children in the study had functional speech confirms reports from surveys that signing is not confined to non-speakers (Kiernan et at., 1982). Some reports, indeed, suggest that sign teaching may aid speech development (Kouri, 1989; Udwin, 1986; von Tetzchner, 1984), but in this \tudy i t was not clear from the children’s histories whether or not speech had developed after signing. The study does, however, suggest that use of signs did not inhibit speech production, as is sometimes feared. All the children vocalised to some extent, even if they were sign-dependent, although with varying degrees of intelligibility. The notion that students with communication difficulties may shift between vocal, gestural and graphic modes is by now well accepted (Hooper, Connell and Flett, 1Y87; Kraat, 1985; McDonald, 1984) and i t is 5uggested that these modes should be viewed as complementary to one another, rather than as mutually exclusive alternatives.

Can sign use be predicted? A number of factors outside the immediate teaching context and the children’s own mode preference/dependence may be thought to intluence their functional use of signs and the number of signs they know. Length of time learning signs, I‘requency of teaching, and use of signs by the family, have all been tound relevant (Bonvillian and Nelson, 1978; Daniloff

and Shafer, 1981; Kiernan e ta / . , 1982; Udwin and Yule, 1990-1991). In this study, similar information was collected through the questionnaires but no significant associations were found, possibly because the results depended on estimates only.

One other obvious source of variation was the extent of signing in the classroom environment. This was explored by calculation of the relationships between the frequency with which the children signed (sum of propositional signs + signed words, excluding finger points), teacher sign frequency and sign environment rating.

Teacher sign frequency ranged from 0 to 66.3, with a mean of 15.6 (SD 15.4). There was a significant but weak positive association between teacher and child sign frequency.

Sign environments. With the use of the rating scale illustrated in Table 2, classrooms were divided into High (HSE) and Low (LSE) signing environments. The children were divided into high and low signers, by the splitting of the group at the median in each setting, and the association between the two variables was tested by use of the Chi-square procedure. Frequency of signing by children in the T D setting was positively associated with the quality of the signing environment (p< .01).

Caution needs to be exercised in interpreting these results, since the scale is relatively crude. In general terms, they indicate that high signing children were more likely to be found in high signing classrooms. What is unclear, however, is the direction of the influence. Do high signing teachers produce high signing children or is the reverse true?

Some indications of the underlying dynamics are revealed by looking at the low signing, as well as the high signing children. The low signing group included: a children who were exceptionally poor communicators in whatever mode and b children who were effectively speakers - relatively good communicators in speech who made only occasional use of signs. Low signing environments seemed to be associated with the presence of these two sub-groups, and no high signers. In high signing environments there were both high and low signing children.

I t looks as though there is an interaction between the behaviour of teachers and children, as has been reported elsewhere (Beveridge and Hurrell 1980; Conti-Ramsden and Taylor, 1990; Fay and Leonard, 1983; Gremaud and Lambert, 1984; Wells, 1981; Wulbert, Inglis, Kriegsmann and Mills, 1975). Teachers may find i t easier to maintain high levels of signing in the presence of children who respond well to their efforts. This suggestion was supported by comments volunteered by some of the teachers. I t was not possible to quantify the effects of staff signing on child signing, although at least one high signing child was observed to reduce his use of signs when he moved temporarily from a high to a low signing environment. Other children, who were committed signers, seemed to maintain relatively high sign levels in whatever situation they found themselves.

A number of other variables may influence the extent of teacher signing, among them the teacher’s attitudes to, and experience of, augmentative communication, and the policy on sign use operated throughout the school. Attitudes of personnel involved in sign teaching have been investigated in deaf education (Brennan, 1978; Erting, 1985; Wickham and

Kesearc h Supplement December 1991 153

Kyle, 1987) but there have been few systematic explorations to date of teacher and parent attitudes to signing with learning disabled children, despite widespread recognition of its importance (Bryen and Joyce, 1985; Lombardino, Willems and MacDonald, 1981).

Wide variation in school use of signs has been reported (Kiernan et al., 1982; Reid, 1981; Udwin and Yule, 1991b). In this study there is an advance on the situation reported in 1982 as the majority of children were exposed to signs throughout the school day, and many children were reported to use signs in situations outside the classroom. A few schools had an active policy of encouraging sign use by all staff and children throughout the day, with high signing environments in all classes. However, further research is needed to establish causal relationships between teacher and child signing and to extend our understanding of which factors are critical to the maintenance of ‘total communication environments’ (Kopchick etal., 1975). Two recent papers report on successful programmes to increase everyday use of signs by staff (Spragale and Micucci, 1990; h e d i n g , Zangari and Lloyd, 1990).

Conclusion The study focused on a description of patterns of classroom use of Makaton signs in children with severe learning difficulties. A wide range of communication skills was displayed by the 49 students involved. The most able had sign and word repertoires of between 100 and 200 signs and words, and used signs and speech successfully to interact with peers and adults. At the other extreme were children with very limited skills, who knew only a few signs and whose communication was severely restricted.

Whatever their level, however, there were marked differences between the two settings. Teacher directed settings were associated with more use of propositional language and repetitions, and of signs. Pragmatically the main functions used were labels, comments, and yes/no acknowledgements. By contrast, in free play settings, there was more unintelligible communication, and less sign use, but a more varied range of pragmatic functions. In both settings, most of the language, whether signed or spoken, was addressed to adults. Mode dependence was context-sensitive and an association was demonstrated between the level of signing in the environment, and signing by children.

Implications for practitioners and researchers Signing was undoubtedly of value to the group in providing a means of interaction without which many were dependent on physical acts and unintelligible vocalisation. There was reassuring evidence that teaching children signs does not inhibit their use of speech. All the children were observed to be ‘multi-modal’ communicators, though with varying degrees of success.

The use of signs in everyday life is shown to relate to other aspects of a student’s communicative experience - who is being addressed, the nature of the setting and the level of reinforcement provided by teachers in the classroom environment. Sign use seemed to be characteristically adult- oriented, lesson-based, and used for labels, comments and acknowledgements. This suggests that the teaching of signs needs to be embedded in a creative approach to communication which encourages peer interaction, and incorporates genuinely functional goals. More active promotion of signing around a

school may be needed if it is to be really useful for individuals. The association between levels of signing in the classroom and frequency of signing by students needs further clarification but the study suggests that the provision of sign models may be a powerful factor in the development of successful use of an augmentative system. The fact that sign dependence is context sensitive suggests that any formal assessment of sign and speech skills should be supplemented by records of situational use.

As regards research, there is a need for longitudinal studies to elucidate changes in mode dependence and to explore the contribution of contextual and environmental factors to sign acquisition. Finally, the study has methodological implications. Sign and speech channels seem to be intimately connected for most students and sign use needs to be analysed not in isolation but as part of the total communication profile of an individual.

This article is based on An Exploration of the Communication Skills of Makaton Students; Part 1: The Children (1988); Part 2: Interviews with Teachers and Speech Therapists (1989) by Nicola Grove and Sine McDougall. This is their final report to the Leverhulme Trust, available from the Division of Psychology of Psychiatry, Department of Mental Handicap Sciences, St. George’s Hospital Medical School, London.

Acknowledgements This research was supported by a grant from the Leverhulme Trust, under the direction of Professor Joan Bicknell. The authors gratefully acknowledge the assistance and advice provided by Professor Bicknell, Dr Michael Berger, Mrs Margaret Walker, Mr Ashok Bhat and Dr Jim Stephenson; the work on data programming and analysis carried out by Ms Bindi Sanjani; and the cooperation and interest shown by the children, and their teachers, speech therapists, and families. We should also like to thank the reviewers for their helpful comments on an earlier draft of this paper.

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Persorial

Social

Repetitions

Stereotypes

Exprsssives

Definition

ctions

signs or words which could not be understood by the researLhers

r e p e m a precedtng word o r sign within one time intcwal

signs or words which recur a s part uf the typrcsl Lschaviout without reference to ongoing topics of conversation

exclamattons and accompaniments t O play

Examples

car, dinfterrmr! it's Jackre red, down, swimming

cow, horse, pigs referring to farm vislf

drink, please swing, come here

swimming7 what's this? ANtef fookf herel

rnrner don't, stopt

haNo, goodbye rhsnk you, please good no y yes, no, OK, don '1 know

yeah) hooray' brrm' miaotr

156 Research Supplement 1)ccemher 1991