A team of researchers led by Nancy Brady, PhD, a speech and hearing scientist at the University of Kansas, has developed a new way to assess the communication capability of individuals with severe intellectual and developmental disabilities who often communicate with gestures, body movements and vocalizations instead of spoken words (American Journal of Speech Language Pathology, February 2012).
The Communications Complexity Scale (CCS) is a tool for researchers and clinicians to measure the communication development of both children and adults with disabilities as diverse as autism spectrum disorders (ASD), deaf-blindness and cerebral palsy for the purposes of assessment and intervention.
"Understanding the communication status of individuals with severe intellectual and developmental disabilities is difficult because they often communicate in ways that may not be readily recognized, even by clinicians," said Dr. Brady, assistant professor of speech, language, hearing sciences and disorders and associate research professor at the Life Span Institute of the university. She pioneered a communication assessment and intervention for children with deaf-blindness.
The CCS is based on the well-established continuum of "presymbolic" stages of communication development in typically developing children from birth, beginning with an infant crying or smiling, followed by eye gaze, gesturing and vocalizing directed at another person, to using symbolic communication - typically, spoken words.
These developmental changes, which have been studied and documented for individuals with different types of disabilities, were incorporated into the CCS.
Children with ASD infrequently use gestures, for example, while those with Down syndrome often gesture to communicate. Individuals with deaf-blindness may show interest in objects but have difficulty showing shared interest with another person, a milestone in communication development, through eye gaze or gesturing.
A major goal of the CCS was a measure that would provide a summary score that would reflect an individual's current status on the communications continuum, rather than a particular chronological age or other comparison group, which is a drawback of many existing measures.
Additionally, the measure was designed to be more sensitive to change over time as well as to an individual's response to behavioral and medication interventions.
The CCS has 11 levels of behaviors associated with the stages of communication development. It was developed, tested, and refined by two teams of researchers at the University of Kansas and a third at the University of Washington. The study focused on three groups of 178 participants who represented a variety of ages, diagnoses, exposure to languages (other than English), and motor and sensory abilities, including ASD, Down syndrome and motor impairments. None could express more than 20 words of speech, signs or symbols.
The CCS scores were compared to those of standardized tests of language and were highly correlated. They also were compared to reports from family members and other caregivers. Scores from informant reports tended to place children at higher levels of communication than the CCS scores.
Other team members were Kandace Fleming, assistant scientist, and Kathy Thiemann-Bourque and Muriel Saunders, assistant research professors, at the University of Kansas, and Lesley Olswang, PhD, professor of speech and hearing sciences, and Patricia Dowden, PhD, CCC-SLP, clinical assistant professor of speech and hearing sciences, at the University of Washington.
The research was supported by grants from the National Institute of Child Health & Human Development and the National Institute on Deafness and Other Communication Disorders.