Symbols! Symbols!

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Symbols, Symbols What to use????
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Clinical Scenario

• Why do Speech Pathologists make use of graphic
  symbols?
• Graphic symbols may take many forms

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baby
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High degree of resemblance Abstract
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How our question developed?
A members personal experience She asked Why?
What is the evidence for this?
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Clinical Question In people who use AAC are
coloured photographs easier to comprehend than
line drawings?
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Level of evidence Study design Number of articles
3ii Narrative reviews 2
4 Case series 2
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Key Findings

• Evidence found of lower level suggestive only
• Population included in studies individuals who
  were basically non-verbal and had intellectual
  disability (varying /severe) autism

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Finding (cont.).

• Sevcik Romski (1986)
• 8 participants between ages of 9 -22years all
  had severe intellectual disability
• Participants with functional language skills were
  able to match objects to photographs and line
  drawings. They performed better on matching tasks
  than those with non-functional language skills
• Participants with no functional language and
  limited comprehension of words could match
  objects to photos but not objects to line
  drawings

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Findings (cont.)

• Mirenda and Locke (1989) Study on symbol
  transparency
• 40 participants non-verbal with varying degrees
  on intellectual disabilities age range 4 21
  non speaking
• A greater number of non-verbal people in the
  study identified photographs more easily than a
  range of symbols and line drawings

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Mirenda an Locke (cont.)

• Included 8 participants with severe intellectual
  disabilities who had poor comprehension of spoken
  language. None could match non- identical
  objects, only 3 able to match photographs to
  objects and only 1 could match line drawings to
  objects. This groups performance was much worse
  than that of participants with functional
  language

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Finding (cont.)

• Kozleski (1991b) compared acquisition rates of a
  variety of abstract to more iconic symbols,
  including coloured photographs and line drawings,
  for requesting function across four individuals
  with autism fewer sessions were needed for
  highly iconic symbols.

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Clinical Bottom Line

• There is insufficient high level evidence to
  conclusively inform choice of one graphic symbol
  set over another.
• Some minimal level of language skill may make the
  use of certain symbol types easier to learn
• Consider CAT limitations

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CAT Limitations

• Clinical question very narrow
• Our inclusion/exclusion criteria did we
  restrict ourselves too much?
• Recognition of pictures and using pictures as
  symbols are different skills

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Clinical implications

• In absence of strong evidence
• Monitor the integrity of our intervention
• Define interventions in observable terms
• Outcome measures
• Data collection sheets

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Possible other variables to consider when
people are learning to use picture symbols

• Spoken word comprehension
• Reinforcement value
• Symbol experience
• Understanding of intent
• Setting

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(cont.)

• Instruction
• Support
• Generalization
• Available resources
• Stakeholders

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References

• Sevcik, RA and Romski, MA (1986). Representation
  matchings skills o persons with severe
  retardation. Augmentative and Alternative
  Communication. 2(4), 160-164
• Mirenda and Locke (1989). A comparison of symbol
  transparency in non-speaking person with
  intellectual disabilities. Journal of Speech and
  Hearing Disorders. 54, 131-149.
• Schlosser, RW and Sigafoos, J (2002). Selecting
  graphic symbols for an initial request lexicon
  Integrative review. Augmentative and Alternative
  communication. 18, 102-123
• Stephenson (2009). Iconicity in the Development
  of Picture Skills Typical Development and
  Implications for Individuals with Severe
  Intellectual Disabilities Augmentative and
  Alternative Communication. 25 (3), 187-201

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AAC EBP Group Natalie Albores Alana Bain Anna
Bech Lauren Chaitow Mary-ann Dowsett Haley
Gozzard Jenny Lee Cecillia Rossi Nitha
Thomson David Trembath Angela Vass Jenny Wood
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