Gestures Expressed by Children Who Are Congenitally Deaf-Blind: Topography, Rate, and Function

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1 Gestures Expressed by Children Who Are Congenitally Deaf-Blind: Topography, Rate, and Function Susan M. Bruce, Allison Mann, Chelsea Jones, and Mary Gavin Abstract: This descriptive study examined the topography, rate, and function of gestures expressed by seven children who are congenitally deaf-blind. Participants expressed a total of 44 conventional and idiosyncratic gestures. They expressed 6-3 communicative functions through gestures and 7 functions through a single type of gesture. They also expressed idiosyncratic gestures and used specific gestures for functions other than those that are typically associated with those gestures. Gestures are actions that are produced with the intent to communicate. They may be expressed by the hands, head, or entire body (Crais, Douglas, & Campbell, 4). A strong relationship between the level of gesture and language has been found in children with typical development, but few studies have examined this connection in children with delayed development (McLean, Brady, McLean, & Behrens, 999). Furthermore, few studies of special populations have examined the expression of specific functions through gestures (Crais et al., 4). This descriptive study provides detailed information about the topography of gestures, frequency of gestural expression, and functions of gestures expressed by seven children who are congenitally deaf-blind in a school setting. The growing complexity of gestures The achievement of expressive gestures is a developmental process that is rooted in action. Initial gestures often incorporate contact with oneself, another, or an object. Many early gestures are highly individualized and may be understood only by those who know a child well (Marschark, 994). Over time, gestures become increasingly complex. THE ROOT OF GESTURES IN OBJECT MANIPULATION AND ACTION Early gestures develop from children's interactions with objects. Acredolo, Goodwyn, Horobin, and Emmons (999) examined the gestures of hearing children and categorized them as those that emerged from parent-child interaction and those that emerged from a child's experiences with objects. They found that the vast majority of gestures are representations of actions that are performed with objects. Such gestures are based more on the actions performed with an object than on the object's perceptual characteristics (Goodwyn, Acredolo, & Brown, ; Wetherby, Reichle, & Pierce, 998). These early gestures that resemble actions 7 AFB, All Rights Reserved Joumal of Visual Impairment & Blindness, October

2 performed on objects are one type of motor reenactment (Bruce, 5). Over time, gestures become increasingly different from the actions performed upon objects (van Dijk, 965), with later gestures bearing a similarity to the perceptual characteristics of objects (Marschark, 994). CLASSIFYING THE COMPLEXITY OF GESTURES There are two ways of broadly classifying gestures as either primitive and conventional or as contact and distal but these classification systems are not precisely parallel in nature. Primitive gestures usually include the physical manipulation of oneself and others, such as pushing or pulling another (Ogletree, Fischer, & Turowski, 996). Conventional gestures are less idiosyncratic to a child's experiences, which makes them more interpretable (Preisler, 995). Conventional gestures are decontextualized (Ogletree et al., 996), which means that a child can express them in a variety of contexts. McLean, Snyder-McLean, Brady, and Etter (99) found that children and adults with disabilities who expressed themselves through conventional gestures communicated more often and produced more frequent communicative repairs. McClean et al. (99) classified gestures as being either contact or distal, preferring not to use the term primitive because early gestures remain important to communication even after conventional gestures are achieved. Contact gestures involve physical contact with objects and people. McLean et al. (999) found that individuals who used only contact gestures initiated communication less often, had lower rates of communication, and communicated fewer functions through gestures. McLean et al. (99) found that adults with severe disabilities frequently used contact gestures even when they had achieved distal gestures, which suggests that contact gestures may be more appropriate in some situations. They also found that individuals who used only contact gestures communicated primarily to obtain or request or to protest or reject objects or actions. Distal gesturers are able to gesture about objects, people, and events that are at a distance from their bodies. The development of distal gestures infiuences other aspects of communication. McLean et al. (99) found that three of the four distal gesturers they studied had higher rates of expressive communication and initiated communication more often than did the contact gesturers. Communicating through distal gestures may be an important marker of the growth toward symbolic communication (McLean et al., 999). This suggestion is consistent with data that revealed the coemergence of distal pointing and the production of words in typically developing toddlers (Bates, Bretherton, Shore, & McNew, 983). The ability to express oneself through distal gestures is associated with the development of symbolic expression and play (Rowland & Stremel-Campbell, 987; Yoshinaga-Itano, Snyder, & Day, 998). Once a child can communicate symbolically, the rate and function of gestures change. Typically developing children experience a decline in gestural communication rates from to months as they become more proficient in language (Marschark, 994). The concept of distancing is important for understanding the growing complexity of gestures. Werner and Kaplan's Journal of Visual Impairment & Blindness, October 7 7 AFB, All Rights Reserved

3 (988) theory of symbolic development describes the importance of distancing through gestures to the development of symbolism. Distancing in gestures occurs as a child produces gestures that are increasingly different from the motor actions that are imposed on objects or the physical features of objects. This process is known as denaturalization. As decontextualization occurs, the child is able to express gestures in a different time and space from where the original experience with the referent (the thing being referenced) occurred (Rowland & Stremel- Campbell, 987; van Dijk, 965). Denaturalization and decontextualization occur in tandem as a child's use of gestures as symbols increases. POINTING Pointing is generally regarded as a distal gesture, but it can also be a contact gesture, such as when one points out a characteristic of an object while touching it. Distal pointing represents a pivotal point in development because there is distance between the communicator and the object being referenced (McLean et al., 999). Visual awareness of objects and people in distant space motivates a child to display the distal point even though initial pointing may not be paired with eye gaze, which Franco and Wishart (995) found was achieved by months in sighted children. Franco and Wishart suggested that later distal pointing is different from other gestures because it serves the purpose of establishing mutual attention to an object or event. The achievement of distal pointing may even change the response of others. Wetherby et al. (998) found that mothers' responses to communicative attempts increased when the frequency of their children's shift in gaze, paired with distal pointing, increased. Impact of disability on the development of gestures It is generally believed that gestural development is as important for the development of language in children with disabilities as it is for the development of language by typically developing children. Research on the effects of deafness and blindness is included in this section because few studies have been devoted to the gestural development of children who are congenitally deaf-blind. Although the effect of deaf-blindness cannot be understood by adding up the effects of blindness and deafness, the deafness section is particularly relevant to children who are deaf and have a mild vision loss, and the blindness section is particularly relevant to children who are blind and have a mild or moderate hearing loss. GESTURES BY CHILDREN WHO ARE DEAF Deafness alone does not appear to interfere with the development of gestures and may actually encourage the expression of gestures. Children who are deaf and bom to deaf parents produce signs at about the same time or even earlier than hearing children produce their first words (Cheek, Cormier, Repp, & Meier, ). Children who are deaf use more gestures than do hearing children (Marschark, 994) and point more often. Curtiss, Prutting, and Lowell (979) found that preschoolers who are deaf make use of visual gaze, vocalization, pointing, and gestures for communicative purposes. Children who are deaf develop gestures even when they are not exposed to a formal sign language system, such as American Sign Language 7 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, October

4 or Signed English (Goldin-Meadow, Butcher, & Mylander, 99). Goldin- Meadow, Butcher, Mylander, and Dodge (994) found that the children who were deaf whom they studied gestured in ways that are conventional to language, such as combining gestures into sentence structures. Hearing parents of children who are deaf use fewer signs than do deaf parents but more gestures than hearing parents of hearing children (Marschark, 994). Gestures appear to bridge the communication gap between hearing parents and children who are deaf. were congenitally blind and found that they more often gestured in near space because of vision loss and used early speech when their sighted counterparts used gestures. Although there are differences between the gestures expressed by sighted children and children who are blind, Iverson et al. stated that vision is not necessary for the development of gestures. They suggested that since the children they studied did not have delayed language, gesture may not be as critical to the language development of children who are blind as it is to the language development of sighted children. GESTURES IN CHILDREN WHO ARE BLIND Gestural development is facilitated by watching others interact with objects and by watching others gesture. Children who are blind gesture less frequently and express fewer distal gestures than do sighted children because they cannot visually access models of gestures, information about events and objects at a distance, and the attentional shifts that are expressed through eye gaze (Iverson, Tencer, Lany, & Goldin-Meadow, ). Some researchers have found that children who are blind differ not only in their expression of distal gestures, but in their expression of conventional gestures. Rowland (983) studied three infants who were blind and found that they did not express conventional gestures, such as giving and reaching. In a longitudinal study of seven children who were blind, Preisler (995) found that although the children lacked conventional gestures, such as pointing, they expressed substitute gestures, such as pointing with their heads or upper bodies, in response to sound. Iverson et al. () studied the expressive gestures in young children who GESTURES IN CHILDREN WHO ARE CONGENITALLY DEAF-BLIND Children who are deaf-blind often struggle to make the transition from primitive to conventional gestures and have been described as having a limited repertoire of conventional gestures (Rowland & Stremel- Campbell, 987). Rowland and Schweigert () suggested that one-to-one correspondence, representational ability, and memory are barriers to the development of these more complex gestures. Daleman, Nafstad, Rodbroe, Souriau, and Visser () emphasized the role of affect and movement in the development of gestures in children who are congenitally deaf-blind, as did van Dijk (965). They stressed the importance of bodily emotional traces the memories of the body in motion in tandem with the associated emotional experience to the development of gestures. According to these researchers, emotionally charged movement experiences inspire the expression of gestures. Some children who are congenitally deaf-blind also have delayed fine-motor development. Fine-motor deficits interfere 6 4 Journal of Visual Impairment & Blindness, October 7 7 AFB, All Rights Reserved

5 with gestural development (Smith & Bryson, 998). Since it is difficult for children with physical limitations to initiate and control movement, they may be reluctant to produce gestures without clear functional or social benefits. This reluctance may be explained by "matching theory," which states that the likelihood of a behavior being produced is influenced by the immediacy, rate, and quality of reinforcement and the physical effort that is required (Cress,, p. 3). Functions expressed in gestures Gestures are expressed for specific functions; for example, a hand extended with the palm up is often used to express a request. In sighted, typically developed children, gestures to show objects, to gain attention, and for instrumental action emerge at about 9- months, giving gestures emerge at months, and pointing emerges at about 3 months (Marschark, 994). Such children use the reach gesture when expressing a request and the point gesture when declaring (Franco & Wishart, 995). Few studies have examined the functions of communication acts expressed by children with developmental delays (McLean et al., 99). Cirrin and Rowland (985) studied the gestures of 5 children, aged -8, with severe disabilities who were nonverbal and found that most of the children's spontaneously produced gestures were for the functions of requesting objects and requesting action. McLean et al. (99) found that individuals with severe disabilities who were nonverbal used contact gestures to express the functions of obtain or request and protest or reject. Primitive gestures are often used to request objects and actions and to protest, and conventional gestures are often used to direct the attention of another to objects, actions, and people (Ogletree et al., 996). Method RESEARCH DESIGN This descriptive study is within the tradition of conversational analysis. Such studies focus on elements of communication, including those expressed in alternative forms to verbalization (such as vocalization and gesture) (Brantlinger, Jimenez, Klingner, Pugach, & Richardson, 5). The purpose of this study was to capture detailed descriptions of the gestures of children with congenital deafblindness, determine the rates of gestural expression, and identify the functions expressed through gestures. PARTICIPANTS The participants were seven children, aged 4-8, who are congenitally deafblind and attended a private school serving only children with disabilities. The teachers identified students who were appropriate for this study after administrators and teachers consented. The Communication Matrix (Rowland, ) was used to assess each child's level of communication for all four functions of communication (refuse, obtain, social interactions, and provide or seek information). All the participants communicated between Levels III and VII of the Communication Matrix, which are defined as follows: Level III: intentional communication (presymbolic and nonconventional), Level IV: conventional communication (intentional and presymbolic). 7 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, October 7 6 4

6 Level V: concrete tangible symbols (an optional level experienced by only some children), Level VI: single abstract symbols (Rowland, ), and Level VIl: combinations of two to three abstract symbols. Most of the children communicated at different levels according to the function that was assessed. Colin had no vision and a moderate-profound hearing loss and communicated at levels V-VI. Sidney's acuity was /, and she had a moderate hearing loss in her left ear and near-normal hearing in her right ear; she communicated at Level V. Sierra had cortical visual impairment (no acuity given), optic atrophy, field loss, strabismus, a mild-moderate hearing loss, and communicated at Levels III-IV. Dean's acuity was /6; Dean had a severe-profound hearing loss and communicated at Levels IV-VI. Amy had no vision and a severe hearing loss and communicated at Levels IV-V. Mason was monocular in functioning with no acuity given; he also had a visual field loss, esotropia, a severe hearing loss, and communicated at Level VL Tyler's acuity was /6, but Tyler also had a visual field loss, nystagmus, a severe hearing loss, and he communicated at Levels IV-VIl. PROCEDURES Data collection and coding Each child was observed and videotaped for six hours in multiple settings in the school (including the therapy rooms although some therapies were integrated into the classroom setting and the playground) across 3-9 days on dates and times of the teacher's choosing. The primary researcher's role was as a passive observer. The school professionals were asked to engage in their normal everyday lessons and not to change the setting, materials, peer arrangements, or adult-andpeer partners for the sake of filming. A Sony digital camcorder with a timer that measured to / of a second was used to record the observations. The primary researcher prepared a coding sheet that included different types of gestures, although gesture (nodding) was not observed. A priori categories of gestures were developed on the basis of previous studies of gestures by Blake, O'Rourke, and Borzellilno (994); Cirrin and Rowland (985); Franco and Wishart (995); Iverson et al. (); and McLean et al. (99). Twenty-four additional gestures were identified as the researcher coded the videotapes. The coding accounted for all gestures expressed with a high level of specificity to capture subtle differences in gestures and to identify unique gestures that children who are deafblind may use in place of conventional distal gestures. In addition to the type of gesture, the coding sheet provided a place to record the time that the gesture was expressed, the function of the gesture, the communication partner, and the lesson. Interrater reliability Two coraters were trained by the primary researcher, who provided written and verbal directions for coding gestures. The coraters were trained to differentiate intentional communication from intentional behavior. The written directions included definitions of the types and functions of gestures. The coraters practiced using the coding sheet both with the primary researcher and independently before they 6 4 Journal of Visual Impairment & Blindness, October 7 7 ATO, All Rights Reserved

7 began coding for the study. The primary researcher coded all seven children, and the coraters divided the videotapes, with one coding four children and the other coding three children. Each corater randomly selected 5% of each day's videotape for each child. Interrater reliability was calculated for agreement on the occurrence of gestures for each child. The rate of agreement was calculated by counting the number of gestures on which there was agreement (for both the type of gesture and its function) divided by the total number of gestures that were coded. Overall interrater agreement was.9, with a range of.86 to.94, for all the children. Specific interrater agreement rates by child were as follows: Colin,.86; Dean,.86; Amy,.87; Tyler,.9; Sidney,.9; Sierra,.93; and Mason,.94. Results TYPES OF GESTURES EXPRESSED Table presents the gestures that were coded and the frequency at which each gesture expressed different functions. Forty-four different gestures were expressed by the participants. All but one of the a priori categories (nodding) were expressed, and an additional 4 types of gestures emerged during the coding process. The participants varied in the gestures they produced, with the following number of different gestures produced by each child: Amy, ; Colin, ; Tyler, ; Mason, 9; Sierra, 9; Dean, 5; and Sidney,. The participants expressed primitive or contact gestures more frequently than conventional or distal gestures. The following gestures were expressed by all the participants: push a person's hand and reach (one-handed and two-handed). All but one child expressed the following gestures: push an object, lean toward, and some form of clapping. Colin, Dean, Mason, and Tyler expressed point or point approximation (contact and distal). Mason and Tyler, the two participants with relatively higher expressive communication (and low vision), displayed point or point approximations that incorporated distancing. Sidney, the child with the most hearing, produced the fewest different gestures. The children with the most severe vision loss (Colin and Amy, who had no vision, and Sidney, who had an acuity of /) produced some gestures that did not involve contact and were expressed in near space. In addition to contact gestures, Colin expressed the following gestures: turn away, lean toward, lean and reach, and reach with one hand and two hands. In addition to contact gestures, Sidney expressed both onehanded and two-handed reaches and raising her hand (a gesture that was taught in school). Amy expressed the following gestures (in addition to contact gestures): take a person to, reach with one hand and two hands, palm up (to request a clapping game), more, and reach with a foot (to put on a shoe, a motor-reenactment gesture that she had learned through routines). The children produced idiosyncratic gestures and used conventional gestures in unexpected combinations. A few examples follow: During morning circle, the children sniffed a bottle of cinnamon that would be used afterward in a cooking lesson. Just after dismissal from morning circle, Colin gestured with his hand under his nose (a motor reenactment of the same hand position 7 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, October

8 Table Frequency of gestures and functions, by child. Gestures or functions Colin Sidney Sierra Dean Amy Mason Tyler Push a person Push a person's hand" Pull a person's hand" Push an object Pull an object Hand an object to another^ Touch or tap a person Touch or tap an object Take another's hands" Put another's hand on Take a person to Motor reenactment Motor reenactment with distance Position a hand shape" Shape more than hands" Clapping" 8-P -P -CA -RO -CO -CA -A -RA -CO -CA -D -P -RA 4-P -P -P 7-P -CA -RO 3-C 49-RA 4-A -CO -RO 5-CA -RA -RA -CA 5-RA 8 46-A 9-CA 4-U -CO -C -U -RO -U -DA 6-P 6-CA -P -CO -U -P 4-D -DA 6-D -C -P 4-P -U 6-RO -U -C 3-U* -RA -U -RO 5-C -RO -U -D 3-D -CA -C -D -P -U 3-RO 9-RA -D -P 3-C 4-P -RA -U 5-RO -RO -SH 6-RA -D -D -CA -U 3-P 7-P 6-RA -CA -P 4-RA -C -RO -CA 7-RO -C 3-3-U 7-RA -SO -RO Coactive clapping" Pound one's chest" Pat one's head" Hug Turn away" Lean toward" Lean and reach" Lean and lick" Reach one hand -P 3-P -APA -AF -SH 5-RA 4-C -U -A 6-RA -RO -CA -AF -SH -AF 3-C 8-RO 7-A -AF -P (w-voc) -CH -RO -RA -DA 56-RA -A 9-AF 4-AF 5-G 3-C 3-RO 3-AF 4-AF -RO 7-RO 7-C 6-RA -AF -AF 3-RO -RA 3-U (Continued) Journal of Visual Impairment & Blindness, October 7 7 AFB, All Rights Reserved

9 Table (Continued) Gestures or functions Colin Sidney Sierra Dean Amy Mason Tyler Reach two hands Palm up Raise one's hand" High five" Point (contact approximation) Point (contact) Point (distal approximation) Point (distal) Shake one's head Wave Self-gesture" "More" gesture" Flapping arms" Fingers wiggling in face" Reach with a foot or a leg" Driving motion" Pull other's hand and reach" Stamp one's foot" Kiss kiss" 3-RA -C -U 5-A -CO -CA 4-RA -A 6-RA -RO -A -A 4-AF -G -CH -P -C -CA -A -G -A 8-L -CA -A -U -G 6-RA -A -P -Exc. -A 8-C 8-RO 4-RA -G -A -AF 7-RA (game) -U -RO -Exc. -U -A -G -SO -AF -RO -RA -C -U -A -DA -RO -DA -Exc. -U -RO -C -RO 3-DA 3-D* 4-G (all init) 5-Exc 4-RA -P 8-AF Note: C (calling), G (greeting), P (protest), SO (show object), CH (choice), RO (request object), RA (request action), A (answer), AF (affection), CO (comment on object), CA (comment on action), D (directive), DA (direct attention), SH (show higher interest), Exc (express excitement), L (label), I (inform), U (unable to code). The second cell under Colin's name reads "8P." This means that Colin used the gesture of "push a person's hand" for the function of protest on 8 occasions. ^ Indicates post hoc types of gestures. used when he held the cinnamon bottle under his nose). Sierra used the "self-gesture" to label herself, to answer when her name was called, and to request a turn. She also used the self-gesture when she felt successful, but then she produced it at a much faster rate and with greater repetition. 7 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, October

10 Amy engaged in contact clapping games using a horizontal positioning of the hands. She directed turn-taking roles by positioning the teacher's hands to be in the receiving mode (palm up) when she wanted to lead. When she was ready for the teacher to lead, she placed the teacher's hands palm down. When offered a choice of two food items (two snack bags placed on a slant board to enhance his use of vision), Dean partially left his seat, leaned forward, and licked the snack of his choice. His teacher confirmed that this choice was his favorite. Tyler had a unique gesture for affection that was named the "kiss kiss" gesture (the American Sign Language sign for "and" placed on the adult's cheek). This gesture was taught by adults as a contact gesture to substitute for actual kisses on the cheek. FREQUENCY OE GESTURAL EXPRESSION The participants expressed the following number of gestures over the six hours of observation: Sierra, 36; Amy, 74; Mason, 7; Tyler, 4; Colin, ; Dean, 4; and Sidney, 38. It should be noted that these were their rates of expressive gestures, not the overall expressive rate of communication. The gestural frequencies for Sierra (36) and Amy (74) were much higher than those for the other children. These two children had relatively lower ratings (in the sample) on the Communication Matrix (Sierra at Levels III-IV and Amy at levels IV-V). Colin and Amy had no vision, yet they did not have the lowest rates of expressive gestures. Sidney, the child with the highest level of hearing and an acuity of /, produced the fewest types of gestures, had the lowest gesture rate, and expressed the fewest functions through gestures. The most frequently produced gesture varied by child, with the following results (frequency of that gesture out of the total gestures produced): Colin, contact point (5 out of ); Sidney, pat own head ( out of 38); Sierra, touch or tap an object (66 out of 36); Dean, push an object ( out of 4); Amy, coactive clapping (78 out of 74); Mason, reach with one hand (46 out of 7); and Tyler, reach with one hand (3 out of 4). Reaching was another gesture that was commonly expressed by all the children. The rates of reaches (one-handed and two-handed) are combined and presented with the total gesture rate: Colin: 5 out of, Sidney: 6 out of 38, Sierra: 47 out of 36, Dean: 3 out of 4, Amy: 56 out of 74, Mason: 53 out of 7, and Tyler: 3 out of 4. FUNCTIONS EXPRESSED THROUGH GESTURE Table shows the frequency at which each function was expressed across all the gestures. The participants expressed 6-3 functions across their repertoire of gestures, with the following number of functions per child: Sidney, 6; Colin, 9; Dean, ; Amy, ; Sierra, ; Tyler, ; and Mason, 3. Four children used gestures most often to express the function of requesting an action, two most frequently used gestures to request an object (but their second highest-frequency gesture was to request an action), and the final Journal of Visual Impairment & Blindness, October 7 7 AFB, All Rights Reserved

11 Table Frequency of each function across all types of gestures. Function Colin Sidney Sierra Dean Amy Mason Tyler Calling (C) Greeting (G) Protest (P) Show an object (SO) Choice (CHf Request an object (RO) Request an action (RA) Answer (A) Affection (AF) Comment on object (CO) Comment on action (CA) Directive (D) Direct attention to an object (DA) Show higher interest (SHf Express excitement (Exc)^ Label (L) Inform ()^ Unable to code the function (U) ' Indicates post hoc functions of gestures. child most frequently used gestures to protest. All the participants used gestures to protest, request action, request objects, and comment on an action. All but one child expressed affection and answered through a gesture. Only Tyler gestured to inform others. The participants expressed as many as seven functions through a single gesture, and these functions were understood by their adult communication partners. The different functions that were expressed through the same gesture were distinguished by modulation of the gesture (as in the modulation of signs for emphasis); by pairing gesture with another form, such as vocalization; or by pairing two gestures at the same time. For example, Amy (a child with no vision) used the one-handed reach to greet, to call attention to (after an initial greeting had occurred), to request objects that she knew were available, and to answer. Sierra performed a single clap paired with vocalization to call attention, but did not use this combination for other functions. One cannot assume that a particular gesture fulfills the same function for all children. For example, while Sierra and Tyler used "push a person" only as a protest. Mason used the same gesture to direct an adult physically. Discussion The participants expressed a wide variety of different gestures and combinations of gestures. They persisted in using primitive gestures even though they knew and used conventional gestures, in agreement with McLean et al.'s (99) findings. Although not all the children pointed, they each had a way to gain and direct an adult's attention, including reaching, directing the adult's hand or body, taking a 7 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, October

12 person's hands (often a request for interaction, founded in their coactive sign experiences), and positioning a hand shape (into a reenactment of a position associated with a specific activity or a sign). So, while sighted children often use gaze to establish joint attention, the children in this study called and directed attention through touch. Given that many of the interactions they share occur through touch, specifically coactive gestures and signs, it makes sense that they would establish joint attention through physical contact with the hands. As Iverson et al. () suggested, perhaps pointing is not so important to the language development of children who are blind because they have found other ways to communicate the same functions that are usually accomplished by pointing. Some gestures emerged out of a child's emotional state (such as wiggling the fingers and flapping the arms in excitement), in keeping with Daleman et al.'s () concept of the importance of emotion and movement to gesture. Some gestures were repetitions of previous actions that were caught on videotape, such as the example of Colin and the cinnamon. Sierra and Amy communicated at relatively lower communication levels, but had the highest frequencies of gestures. Gestures were a particularly important form of expression for them. The lower gestural rates expressed by the children with larger sign language vocabularies may be parallel to the decline in expressive rates that Marschark (994) reported in hearing and sighted children when speech emerged. The children in this study communicated most often for the functions of requesting action, requesting an object, and protesting, in agreement with the findings of Cirrin and Rowland (985) and McLean et al. (99). They paired gestures, gestures with signs, and gestures with vocalizations, and these combinations sometimes altered the function of the gestures. Ozcaliskan and Goldin- Meadow (5) found that typically developing children paired a gesture with a spoken word before they combined words into sentences. It is possible that gesturesign multiple-symbol expressions play an important role in the acquisition of language in children who are deaf-blind. LIMITATIONS This study examined the gestures of only seven children who are congenitally deafblind in a school setting. It is not possible to use these findings to predict the gestural expression of other children who are deaf-blind, especially given the idiosyncratic nature of the gestures that were expressed. IMPLICATIONS FOR RESEARCH Future studies with larger samples are needed to build the research base on the gestures of children who are deaf-blind and on instructional strategies that would promote gestural development. Research on the importance of modeling, responsivity, and adults' use of child-produced gestures is needed. Studies from the field of deafness should be replicated with children who are deaf-blind to determine the influence of gestural babbling on the later acquisition of sign language. The findings of this study raise several points of caution for future research on gestures in this population. First, since many of the gestures may be unique to a child, including some that are based on Journal of Visual Impairment & Blindness, October 7 7 AFB, All Rights Reserved

13 motor reenactments, it is important not to study a few conventional types of gestures and then conclude that children who are deaf-blind have few gestures. Researchers can fully capture the richness of gestures expressed by children who are deaf-blind only if they are willing also to code types of gestures that emerge during the study. It may also be inappropriate to consider contact gestures as a more primitive form of gesture in children who are blind. Second, researchers must not apply preconceived notions about the functions of particular gestures on the basis of the gestural functions of children without disabilities. Rather, they need to allow the function of a particular gesture to be determined by each interaction, using context clues, the child's affect, the communication partner's interpretation, and the child's subsequent response as support for coding functions. Third, joint attention is often used as a necessary condition for the coding of intentional communication acts (including gestures), with joint attention defined by eye contact and gaze shift. This visualbased definition does not support researchers who wish to identify intentional communication acts in children who are blind or have low vision. This discrepancy has a drastic effect on the coding of expressive rates (including rate of gestures) of children who are blind or have low vision. Blake, McConnell, Horton, and Benson (99) and Franco and Wishart (995) found that sighted children do not necessarily establish eye contact when they gesture. This finding is indicative of the need to refine the definitions of joint attention and intentional communication acts to include nonvisual means, such as those used by the children in this study. IMPLICATIONS FOR PRACTICE Intervention in gestural development does not impair other forms of expression, such as verbalization. Goodwyn et al. () found that hearing children who participated in a gestural intervention (as opposed to a speech intervention) produced not only more gestures, but more verbalizations. Adults may begin instruction by using signals that are placed in contact with a child's body (van Dijk, 986). The literature on deaf-blindness includes extensive documentation of the use of touch cues and object cues. Over time, adults may gradually replace some of these cues with gestural cues, making sure that the child has visual or tactile access to the gestural cues (Rowland & Stremel-Campbell, 987). Adults support a child's expression through movement by being highly responsive and by correctly interpreting the meaning of the child's gesture (Rowland & Stremel-Campbell, 987), since initial gestures expressed by children with physical limitations may be highly idiosyncratic. The adults need to express themselves using the child's specific gestures, rather than immediately modeling more typically appearing gestures. Once the child has established a repertoire of gestures, the adults may shape some of these gestures. For example, if the child reaches toward an object of desire, the adult may shape the reach to a distal point. Care must be taken not to do so too early, since premature shaping (to a more conventional or distal gesture) could result in reduced gestural efforts by the child. Another strategy that may elicit gestures is to 7 AFB, All Rights Reserved Joumal of Visual Impairment & Blindness, October

14 create distance between the child and an object or person of desire within wellestablished routines (McLean et al., 99). Adults can also attend to activities that evoke movement paired with emotion, paying special attention to hand movements that may develop into gestures. They can later reproduce these movements to trigger memories of the emotionally charged events (Daleman et al., ). Conclusion All the children in this study, regardless of their level of communication, used a variety of gestures and combinations of gestures to express their thoughts. This study demonstrated that children who are deaf-blind may use a single gesture to express multiple functions, including functions that are not typically associated with that gesture in children who are hearing and sighted. Children who are deafblind do not have the same level of access to models of distal gestures or to people and objects at a distance; thus, they may use contact gestures to accomplish functions that hearing and sighted children perform by distal gestures. The central role of tactile experiences, including coactive exploration, gesture, and sign language, influences the topography and functions of gestures in children who are congenitally deaf-blind. References Acredolo, L. P., Goodwyn, S. W., Horobin, K. D., & Emmons, Y. D. (999). The signs and sounds of early language development. In C. Tamis-Lemonda & L. Baiter (Eds.), Child psychology: A handbook of contemporary issues (pp. 6-4). New York: Psychology Press. Bates, E., Bretherton, I., Shore, C, & Mc- New, S. (983). Names, gestures, and objects: The role of context in the emergence of symbols. In K. E. Nelson (Ed.), Children's language (Vol. 4, pp. 59-4). New York: Gardner Press. Blake, J., McConnell, S., Horton, G., & Benson, N. (99). The gestural repertoire and its evolution over the second year. Early Development and Parenting,, Blake, J., O'Rourke, P., & Borzellilno, G. (994). Form and function in the development of pointing and reaching gestures. Infant Behavior and Development, 7, Brantlinger, E., Jimenez, R., Klingner, J., Pugach, M., & Richardson, V. (5). Qualitative studies in special education. Exceptional Children, 7, Bruce, S. (5). The impact of congenital deafblindness on the struggle to symbolism. International Journal of Disability, Development, and Education, 5, Cheek, A., Cormier, K., Repp, A., & Meier, R. (). Prelinguistic gesture predicts mastery and error in the production of early signs. Language, 77, Cirrin, F., & Rowland, C. M. (985). Communicative assessment of nonverbal youths with severe/profound mental retardation. Mental Retardation, 3(), 5-6. Crais, E., Douglas, D. D., & Campbell, C. C. (4). The intersection of the development of gestures and intentionality. Journal of Speech, Language, and Hearing Research, 47, Cress, C. (). Expanding children's early augmented behaviors to support symbolic development. In J. Reichle, D. Beukelman, & J. Light (Eds.), Exemplary practices for beginning communicators: Implications for AAC (pp. 9-7). Baltimore, MD: Paul H. Brookes. Curtiss, S., Prutting, C. A., & Lowell, E. L. (979). Pragmatic and semantic development in young children with impaired hearing. Journal of Speech and Hearing Research,, Daleman, M., Nafstad, A., Rodbroe, I., Souriau, J., & Visser, T. (). Congenitally deafblind 6 5 Journal of Visual Impairment & Blindness, October 7 7 AFB, All Rights Reserved

15 persons and the emergence of social and communicative interaction. Phase III: The formation of meaning (Communication Update Series, No. ). Dronninglund, Denmark: Nordic Staff Training Centre for Deafblind Services. Franco, F., & Wishart, J. (995). Use of pointing and other gestures by young children with Down syndrome. American Journal on Mental Retardation,, 6-8. Goldin-Meadow, S., Butcher, C, & Mylander, C. (99). Beyond the input given: The child's role in acquisition of language. Language, 66, Goldin-Meadow, S., Butcher, C, Mylander, C, & Dodge, M. (994). Nouns and verbs in a self-styled gesture system: What's in a name? Cognitive Psychology, 7, Goodwyn, S., Acredolo, L., & Brown, C. (). Impact of symbolic gesturing on early language development. Journal of Nonverbal Behavior, 4, 8-3. Iverson, J., Tencer, H., Lany, J., & Goldin- Meadow, S. (). The relation between gesture and speech in congenitally blind and sighted language leamers. Joumal of Nonverbal Behavior 4, 5-3. Marschark, M. (994). Gesture and sign. Applied Psycholinguistics, 5, McLean, L., Brady, N., McLean, J., & Behrens, G. (999). Communication forms and functions of children and adults with severe mental retardation in community and institutional settings. Joumal of Speech, Language, and Hearing Research, 4, 3-4. McLean, J. E., Snyder-McLean, L. K., Brady, N. C, & Etter, R. (99). Communication profiles of two types of gesture using nonverbal persons with severe to profound mental retardation. Journal of Speech and Hearing Research, 34, Ogletree, B., Fischer, M., & Turowski, M. (996). Assessment targets and protocols for nonsymbolic communicators with profound disabilities. Focus on Autism and Other Developmental Disabilities, (), Ozcaliskan, S., & Goldin-Meadow, S. (5). Gesture is at the cutting edge of early language development. Cognition, 95(38), B-B3. Preisler, G. M. (995). The development of conmiunication in blind and in deaf infants Similarities and differences. Child: Care, Health and Development,, 79-. Rowland, C. (983). Patterns of interaction between three blind infants and their mothers. In W. Wills (Ed.), Language acquisition in the blind child (pp. 4-3). London: Croom Helm. Rowland, C. (). Communication Matrix. Portland: Design to Leam Products, Oregon Health Sciences University. Rowland, C, & Schweigert, P. (). Tangible symbols, tangible outcomes. AAC Augmentative and Alternative Communication, 76(), Rowland, C, & Stremel-Campbell, K. (987). Share and share alike: Conventional gestures to emergent language for leamers with sensory impairments. In L. Goetz, D. Guess, and K. Stremel-Campbell (Eds.), Innovative program design for individuals with dual sensory impairments (pp ). Baltimore, MD: Paul H. Brookes. Smith, I., & Bryson, S. (998). Gesture imitation in autism I: Nonsymbolic postures and sequences. Cognitive Neuropsychology, 75(6-8), lal-. van Dijk, J. (965). The non-verbal deaf-blind and his world: His outgrowth toward the world of symbols. Proceedings ofthe Jaasrverslag Instituut Voor Doven, (pp. 73-). St. Michielgestel, the Netherlands: Instituut Voor Doven. van Dijk, J. (986). An educational curriculum for deaf-blind multi-handicapped persons. In D. Ellis (Ed.), Sensory impairments in mentally handicapped people (pp ). San Diego, CA: College-Hill Press. Wemer, H., & Kaplan, B. (988). On developmental changes in the symbolic process. In M. Franklin & S. Barten (Eds.), Child 7 AFB, All Rights Reserved Joumal of Visual Impairment & Blindness, October 7 6 5

16 language: A reader (pp. 7-9). New York: Oxford University Press. Wetherby, A., Reichle, J., & Pierce, P. (998). The transition to symbolic communication. In S. Warren & J. Reichle (Series Eds.) and A. Wetherby, S. Warren, & J. Reichle (Vol. Eds.), Communication and language intervention series: Vol. 7. Transitions in prelinguistic communication (pp. 97-3). Baltimore, MD: Paul H. Brookes. Yoshinaga-Itano, C, Snyder, L., & Day, D. (998). The relationship of language and symbolic play in children with hearing loss. Volta Review,, Susan M. Bruce, Ph.D., associate professor. Lynch School of Education, Boston College, Campion Hall, 4 Commonwealth Avenue, Chestnut Hill, MA ; <susan. bruce@bc.edu>. Allison Mann, M.A., Lynch School of Education, Boston College; <allimander47@hotmail.com>. Chelsea Jones, M.A., Lynch School of Education, Boston College; <jonesbn@bc.edu.> Mary Gavin, M.A., Lynch School of Education, Boston College; e- mail: <mmgavin3@yahoo.com>. How to Contact JWe SUBMIT To submit an article, Research Report, or Practice Report for peer review, it to Dr. Duane R. Geruschat, editor in chief, JVIB: <jvib@ jhmi.edu>; or mail it to Lions Vision Center, 55 North Broadway, 6th Floor, Baltimore, MD 5. Inquiries should be sent to: <j afb.net>. CONTRIBUTE To offer information on a program, conference, product, or promotion for possible publication in From the Field, News, or Calendar, contact: Rebecca Burrichter, senior editor, AFB Press, Penn Plaza, Suite 3, New York, NY ; fax: ; <rebeccab@ afb.net>. ADVERTISE To advertise in JVIB or to receive information on advertisement rates, contact: Sharon Baker-Harris, marketing manager, AFB Press, American Foundation for the Blind, Peachtree Street, Suite 6, Atlanta, GA 333; fax: ; <sharonb@afb.net>. SUBSCRIBE To subscribe to JVIB, contact: AFB Press, P.O. Box, Sewickley, PA 543; phone: or ; fax ; e- mail: <afbsub@abdintl.com>; web site: < SEARCH To find JVIB, on the web, visit: < 6 5 Journal of Visual Impairment & Blindness, October 7 7 AFB, All Rights Reserved

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