AAC

American Annals of the Deaf, Volume 160, Number 4, Fall 2015, pp. 368-384 (Article)

DOI: 10.1353/aad.2015.0035

For additional information about this article

http://muse.jhu.edu/journals/aad/summary/v160/160.4.bruce.html

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Bruce, S. M., & Borders, C. (2015). Communication and language in learners who are deaf and hard of hearing with disabilities: Theories, research, and practice. American Annals of the Deaf, 160(4), 368–384.

COMMUNICATION AND LANGUAGE IN LEARNERS WHO ARE DEAF AND HARD OF HEARING WITH DISABILITIES: THEORIES, RESEARCH, AND PRACTICE

Keywords: communication, language, deaf, hard of hearing, disability, deaf with disabilities, deafplus, deaf with additional disabilities, deaf with multiple disabilities, multiply disabled deaf

Delays in communication and language development may result in isolation, frustration, and reduced quality of life (Rispoli, Franco, van der Meer, Lang, & Camargo, 2010; Romski & Sevcik, 2005; Snell et al., 2010). Language develop- ment in D/deaf and hard of hearing (DHH) children is often delayed because of reduced access to language, including a lack of opportunities for

those whose first language is American Sign Language (ASL), to experience exposure to fluent models (Beal-Alvarez & Huston, 2014). Communication and language development is even more likely to be delayed in children who are DHH with one or more disabilities (DWD; Davis, Barnard-Brak, Dacus, & Pond, 2010). Learners who are DWD may struggle with attention, need addi- tional time to process information, and may require augmentative and alterna- tive communication (AAC; T. W. Jones, J. K. Jones, & Ewing, 2006). In the pres- ent article, we discuss the identification and prevalence of three disabilities in

INDINGS ARE PRESENTED from communication intervention research in three areas related to deafness with disability (DWD): D/deaf and hard of hearing (DHH) with (a) intellectual disability, (b) autism spectrum dis- orders, (c) deafblindness. Early identification, prevalence, theoretical perspectives, and evidence-based practices are discussed. Developmen- tal theory, behavioral theory, and social-interactionism theory undergird many assessment and intervention practices in communication. The tri- focus framework and the four aspects of communication are useful frameworks. While communication research is a relative strength in the deafblindness field, a dire need exists for research in the other two DWD areas. Across all DWD areas there is a need for interventions addressing receptive language. Effective communication and language intervention can only occur when children who are DWD are identified early, placed in individually suitable classrooms with appropriately pre- pared professionals, and provided with services that build on their strengths and meet their needs.

SUSAN M. BRUCE AND CHRISTY BORDERS

BRUCE IS A PROFESSOR, DEPARTMENT OF TEACHER EDUCATION, SPECIAL EDUCATION, CURRICULUM, AND INSTRUCTION, BOSTON COLLEGE, CHESTNUT HILL, MA. BORDERS IS AN ASSOCIATE PROFESSOR, DEPARTMENT OF SPECIAL EDUCATION, ILLINOIS STATE UNIVERSITY, NORMAL.

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children who are DHH, theoretical per- spectives, and evidence-based prac- tices. Only theories and practices that are specific to addressing the commu- nicative needs of children who are DHH with an intellectual disability (DHH-ID) or autism spectrum disor- ders (DHH-ASD) and children who are deafblind are discussed. Select evi- dence-based practices from the three disability areas that may also be effica- cious with children who are DHH with one of these disabilities are presented.

Identification of Children Who Are DWD Identification of children who are DWD includes diagnosis of the presence of hearing loss coupled with diagnosis of a disability. Wiley and Meinzen-Derr (2012) have estimated that 30%–40% of children who are DHH have at least one additional disability and that disability is more likely to be identified later in a DHH child than in a hearing child.

Children Who Are DHH-ID Found in 8.8% of children and youth who are DHH, intellectual disability (ID) is the most commonly identified disability in this population (Gallaudet Research Institute, 2013). The Diagnos- tic and Statistical Manual of Mental Disorders(DSM-5; American Psychiatric Association, 2013) requires that identi- fication of an ID be based on evidence from intelligence tests and clinical assessments. Assessment findings must indicate deficits in a variety of cogni- tive functions, such as thinking and problem solving, as well as deficits in adaptive functioning that affect the achievement of personal independence and the individual’s ability to take on typical social responsibilities. Further- more, the onset of ID must occur in the developmental period, and the individ- ual must score at least two standards deviations from the mean on an assess- ment instrument with a mean of 100,

standard deviation of 15, and standard error of measurement of +/– 5 (e.g., a score of 65–75). DSM-5 describes levels of ID based on adaptive functioning in the conceptual, social, and practical domains. Weak assessment procedures can

result in misidentification of ID in children who are DHH (Knoors & Vervloed, 2011). Identification of ID in DHH individuals must include consid- eration of the individual’s perform- ance in comparison with other DHH persons. Language delays that may occur due to deafness must be consid- ered; such delays must not simply be attributed to ID (Pollack, 1997). An interdisciplinary team approach that utilizes teacher measures and stan- dardized assessment instruments to identify additional disabilities in DHH children is recommended (Pollack, 1997). Children who are DHH-ID will experience developmental delays across all domains of learning that will have an impact on both academic and functional or adaptive skills. Unidentified hearing loss in individ-

uals who are DHH-ID may interfere with communication development and attainment of optimal life out- comes (Herer, 2012). Assessment of hearing loss in individuals with ID may require more time (Carvil, 2001), and even additional preparation, to enable participation in some forms of test- ing, such as play audiometry. A team approach, involving members with expertise in audiology, audiometry, and performance testing of individuals who are DHH–ID, will support appropriate evaluation procedures and accurate diagnoses, and will be instrumental in avoiding the need for brain stem test- ing, which requires anesthesia (Carvil, 2001; Knoors & Vervloed, 2011; Pollack, 1997). The implementation of universal infant hearing screening means it is now likely that identification of hearing loss in children with ID will occur early.

The impact of hearing loss in combina- tion with ID will vary, depending on the type, severity, and age at onset (Carvil, 2001), and the level of ID. Etiologies of hearing loss with ID

may be different from the etiologies of DHH alone. For example, hereditary causes are twice as likely for individu- als who are DHH than for individuals who are DHH-ID (Knoors & Vervloed, 2011). Down syndrome is an example of a genetic cause of ID and hearing loss. Roizen (2013) has estimated that nearly two thirds of children with Down syndrome have sensorineural and/or conductive hearing losses. Among children, prematurity is the most frequent cause of hearing loss with ID (Knoors & Vervloed, 2011). This may be attributed to reduced mortality among very low birth weight and premature infants born prior to 25 weeks gestational age (Picard, 2004).

Children Who Are DHH-ASD Szymanski, Brice, Lam, and Hotto (2012) have estimated that 1 in every 59 DHH students also exhibits an ASD. Children with ASD are also found to have a greater prevalence of hearing loss than is found in the general public (Carvil, 2001; Guardino, 2008; Rosen- hall, Nordin, Sandström, Ahlsén, & Gill- berg, 1999). Identification of hearing loss in children with ASD (or the reverse) can be problematic since both hearing loss and ASD are associated with challenges in communication, lan- guage development, and socialization (Knoors & Vervloed, 2011). “That is, quantitatively, autism and deafness show overlapping characteristics such as delays in language acquisition, pecu- liarities in word use, and (sometimes or under certain conditions) social diffi- culties in peer relations” (Knoors & Vervloed, 2011, p. 85). Characteristics of children with

an ASD are described in multiple sources, though relatively few studies

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or descriptions of children who are DHH-ASD are available in the litera- ture base. Much of this may be due to the overlapping characteristics of hearing loss and ASD (Knoors & Vervloed, 2011). When considering the characteristics of ASD, it is impor- tant to look at the diagnostic criteria set forth for clinical assessment. DSM- 5 outlines the primary deficit areas demonstrated in individuals with an ASD as being a deficit in social com- munication or social interaction and demonstrate restrictive or repetitive behavior. DSM-5 also delineates diag- nosis across three different levels of severity. Differences in developmental patterns of communication are evi- dent in DHH children who also have an ASD (Beals, 2004; Shield & Meier, 2012; Wiley & Innis, 2014). There is deep concern about diag-

nostic procedures used with students who are DHH-ASD. The complexities of this population of students may make assessment more difficult. As a result, several teams of researchers have made suggestions that may lead to more thorough assessment of indi- viduals who are DHH and display char- acteristics of ASD: J. Carr, Xu, and Yoshinaga-Itano (2014); Hoevenaars- van den Boom, Antonissen, Knoors, and Vervloed (2009); Kellogg, Thrasher, and Yoshinagao-Itano (2014); Mood and Shield (2014); and Szarkowski, Flynn, and Clark (2014). Because etio- logical debates abound in the field of autism, it is inappropriate to suggest eti- ologies for children who are DHH-ASD.

Children Who Are Deafblind The Code of Federal Regulations defines deafblindness as “concomitant hearing and visual impairments, the combination of which causes such severe communication and other developmental and educational needs that they cannot be accommodated in special education programs solely for

children with deafness or children with blindness” (Title 34, Sec. 300.8 [c][2]). In its national survey report for 2011–2012, the Gallaudet Research Institute (2013) estimated that 1.2% of the DHH population was actually deaf- blind. GRI further estimated that 1.4% were legally blind, 3.6% had low vision, and 0.2% had Usher syndrome, an eti- ology of deafblindness. All four of these categories should be considered when the incidence of deafblindness is being determined, although individu- als may be counted in more than one category. According to the deafblind national child count released by the National Center on Deaf-Blindness in 2013, there were 9,452 children who were deafblind in the United States, with the most common etiologies being hereditary syndromes (espe- cially CHARGE syndrome1) and com- plications of prematurity. The impact of deafblindness cannot be under- stood by adding up the effects of visual impairment and the effects of hearing loss because both distance senses are involved. Children who are deafblind are a highly heterogeneous group of learners who vary on the basis of their needs in the areas of vision, hearing, academic perform- ance, adaptive behaviors, and com - munication. Identification of visual impairment and hearing loss tends to happen early in life, in part due to awareness of the absence of visual skills that are typically exhibited by age 6 months (such as fixating and track- ing) and to universal newborn hear- ing screening (Chen, 2004). Early identification is critical to providing appropriate augmentation of vision and hearing to optimize development (Parker, McGinnity, & Bruce, 2012). Since the vision and/or hearing losses of children who are deafblind may be mild, such children are the subgroup most at risk of being missed by early identification efforts.

Theories and Frameworks In the present section, we discuss three theories and two intervention frameworks that have greatly influ- enced research and evidence-based practices of speech-language patholo- gists, teachers, and other school pro- fessionals serving children who are DHH-ID, DHH-ASD, or deafblind. We selected developmental theory and behavioral theory because of their influence on communication assess- ment and interventions across disabil- ities. Additionally, behavioral theory grounds applied behavior analysis (ABA), a common approach to autism that may be applied with children who are DHH-ASD. While developmental and behavioral principles are applica- ble to children who are deafblind, the field has long valued child-guided approaches to assessment and inter- vention (Silberman, Bruce, & Nelson, 2004). Social-interactionism (Paul, 2001) is a theory from the field of deaf- ness that encompasses child-guided approaches in deafblindness.

Developmental Theory Developmental theorists view human development as being either continu- ous or discontinuous, or occurring in developmental stages. Piaget described four stages of development: sensori- motor, preoperational, concrete-oper- ational, and formal-operational. In the sensorimotor stage, the infant acts upon objects, based on their character- istics, but does not think about them. During the preoperational stage, the child thinks about objects and actions and develops symbolism in com - munication and play. In the concrete- operational stage, the child’s thought becomes more logical, and play/explo- ration schemas are more complex while thought is more flexible. In the formal-operational stage, the child gen- eralizes operations performed on one set of materials to others and can gen-

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eralize ideas learned from those expe- riences to novel situations. Addition- ally, abstract thought is refined in the formal-operational stage and general- ized across contexts. For Piaget, lan- guage was an offshoot of thought, and the development of thought was grounded in interaction with the phys- ical environment (Gray, 2011; F. White, Hayes, & Livesey, 2012). Others chal- lenged this view. For example, Vygotsky believed that language development was grounded in interactions with oth- ers and that language spurred higher- order thinking (Gray, 2011). The definition of different stages of

communication and language develop- ment, including the symbolization process, is grounded in developmental theory (Werner & Kaplan, 1988). Some communication assessment instru- ments, such as the Communication and Symbolic Behavior Scales (Wetherby & Prizant, 2003) and the Communication Matrix (Rowland, 2011), reflect the developmental perspective. Cognitive development theorists emphasize the role of pivotal milestones (such as imitation or means-end) to specific communication achievements. The relationship between cognition and communication development is appar- ent in the controversy over the relative importance of mental representation to the mastery of symbols by children who have disabilities (Paul, 2001). Developmental theory provides a

well-researched sequence of commu- nication development that is applied to assessment and instruction. While the communicative achievements of learners with disabilities are often compared to those of children with- out disabilities of the same chronolog- ical or mental age, there is debate about whether performance differ- ences can be attributed to develop- mental delay, differences in the sequence of development, or both (Thomas et al., 2009). It is possible that

developmental theory has greater rel- evance to children with a single dis- ability. For example, it is known that the developmental sequence of typical language acquisition is more relevant to DHH children who have experi- enced consistently accessible language models from infancy than to DHH chil- dren with additional disabilities (Leder- berg, Schick, & Spencer, 2013). The impact of autism on joint attention and imitation is particularly relevant to com- munication and language development (Whalen, Schreibman, & Ingersoll, 2006). The developmental trajectories of children who are deafblind may vary across areas of development (with per- haps strikingly greater gains in one area of development over others in a single year), but developmental theory serves as a guide for communication interven- tions and for consideration of early cog- nitive milestones that are viewed as being related to communication com- petencies (Bruce, 2005).

Behavioral Theory Behavioral theorists (behaviorists) concentrate their work on what is observable and contend that what is observable is objective (Paul, 2001). While they do not deny the existence of mental processes, they believe that behavior can be explained without consideration of these processes (Gray, 2011). Behaviors are learned through direct experiences, and if rein- forced, they are more likely to occur without consideration of the impact of social learning or social contexts (Ban- dura, 2011). Key contributions include the research of John Watson and Ivan Pavlov on classical conditioning in ani- mals, and B. F. Skinner’s work in the area of operant conditioning. Behav- ioral concepts that are applied in teaching today include reinforcement, shaping, extinction, and fading, among many others. In behavioral theory, communication and language skills are

gained because of the influence of behavioral principles, such as rein- forcement. One of the strongest criti- cisms of the power of behavioral theory to explain communication and language development is that it does not recognize the role of the child’s knowledge and experiences in com- munication development (Paul, 2001). Principles from behavioral theory

are relevant to efforts to influence the development of all children. Modeling, shaping, prompting systems, and rein- forcement are examples of behavioral principles used in communication intervention. The Picture Exchange Communication System (PECS; Bondy & Frost, 1994), grounded in behavioral theory, was originally used with chil- dren who had autism and was later adapted for use with children with other disabilities. The visual nature of PECS coupled with its systematic approach to intervention makes it a strong option for some DWD students.

Social-Interactionism Theory Social-interactionism theory recog- nizes that children actively process information during interactions with communication partners who shape their development. “Social-interaction- ists view language acquisition as a com- plex, reciprocal, dynamic interplay between the child and the social- linguistic environment” (Paul, 2001, p. 109). Through interaction with oth- ers, children learn the structural and functional aspects of language. With the support of adult communication partners the child’s communication matures, with more sophisticated inter- actions being a result. Social-interactionism theory can be

applied to individuals who are DWD. This theory encompasses the transac- tional model of communication devel- opment in the field of ID that addresses the quality of reciprocal interactions (Warren et al., 2008). Two bodies of

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European research in deafblindness grounded in social-interactionism are the Conversational Method (Nelson, van Dijk, Oster, & McDonnell, 2009; van Dijk, 1967) and the Diagnostic Interven- tion Model (Janssen, Riksen-Walraven, van Dijk, Ruijssenaars, & Vlaskamp, 2007). Van Dijk (1965, 1967) con- tributed a framework for interaction that emphasized nonverbal dialogues and highly responsive, child-guided communication interactions. The re - search of Janssen, Riksen-Walraven, and van Dijk (2002, 2003a, 2003b, 2004) clarified the role of the adult communi- cation partner, who must be attuned to the child’s affective state and engage in harmonious interactions as the founda- tion for communication development and conversation. Both the Conversa- tional Method and the Diagnostic Inter- vention Model ground communication development and intervention in the context of quality interactions between adult communication partners and the child.

Tri-focus Framework The tri-focus framework, developed by Siegel-Causey and Bashinski (1997), articulated instructional strategies that fit within three foci for intervention with learners who are pre- or nonsym- bolic and who have severe and multi- ple disabilities, the three foci being the learner, the partner, and the environ- ment. The five broad strategies that are associated with this framework— enhancing partner sensitivity (to the learner’s expressions), augmenting (speech) input, utilizing routines, increasing communication oppor - tunities for the child, and modifying the communication environment to enhance communication—are also rel- evant to many individuals who are DWD. Enhancing partner sensitivity includes partner responses to the learner’s expressive communication efforts across forms (including the

communicative function of behavior) and levels of alertness. Augmenting input involves the addition of other forms (e.g., objects, signs, or pictures) to augment the speech of the commu- nication partner. In the tri-focus frame- work, routines are regarded as critical to eliciting anticipation and commu- nicative attempts from early communi- cators. The communication partner is responsible for creating opportunities for expression by considering the indi- vidual’s interests, reducing the use of directives, and applying the correct amount of wait time. Modifications of the communication environment include making changes to character- istics such as lighting, sound levels, stimulation levels, and materials.

Four Aspects of the Communication Framework The four aspects of communication constitute a commonly used frame- work for organizing communication interventions for children with severe and multiple disabilities, including deafblindness (Bruce, 2002; Miles & Riggio, 1999). The four aspects are form (mode), function (the communi- cation partner’s interpretation of the child’s intent), content (message), and context (including the physical envi- ronment, individual characteristics, the communication partner, and activ- ities and routines). Communication programming will address the aspect of form through the selection and appropriate use of expressive and receptive modes and all required materials and devices. While some learners who are DWD will develop speech, others will require augmenta- tive and alternative communication forms, such as gestures or pictures (Mirenda, 2015). Individuals who are DWD require adult communication partners who will create opportunities for them to express a variety of func- tions, not just requests (Olson, Miles,

& Riggio, 1999). Thus, the communica- tion partner thoughtfully elicits these varied functions that may be expressed in more than one form (such as protest- ing through vocalization or through the sign “no”). Content (message) is fairly simple for learners who express themselves in speech or sign language, but quite complex for learners with more severe disabilities. Often the message is less clear and subject to interpretation, requiring those who know the individual best to educate others about potential meanings. Con- sideration of the aspect of content calls on professionals to carefully consider how vocabulary for instruction is selected, with consideration of what messages would be most valuable and motivating to each individual (Down- ing & Chen, 2015). Learners with severe disabilities are dependent on others to create contexts that are con- ducive to communication. The four aspects framework calls

on professionals to recognize how the individual’s characteristics, both disability related and non–disability related, affect communication. Activi- ties set the stage for what types of mes- sages and functions are likely to be expressed, and within- and between- activity routines are important con- texts for creating communication opportunities (Bruce, 2002). Like the tri-focus framework, the four aspects framework recognizes the importance of the physical environment and com- munication partners.

Research and Evidence- Based Practices In the present section, we present evi- dence-based practices identified in intervention studies. Key themes in descriptive research and the broader literature on communication and lan- guage are included. The focus of this section is on educational or therapeu- tic approaches rather than medical

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interventions; therefore, research on the impact of cochlear implantation is not included. Due to the lack of inter- vention studies on DHH children with ASD or ID, we also discuss a few key evidence-based practices in each of the three disability areas that may also apply to children who are DWD.

Research on Children Who Are DHH-ID Two empirical studies on communi- cation were explicit about including children who were DHH with an intel- lectual disability (DHH-ID) or devel- opmental delay (DD). It is likely that studies on the communication of indi- viduals with specific etiologies (such as Down syndrome) included individ- uals who were hard of hearing with ID, but this is very difficult to deter- mine from participant descriptions. Cupples et al. (2014) studied how

audiological and family variables re - lated to speech, language, and func- tional auditory outcomes in 3-year-olds who were DHH or DWD (N = 113). Multiple regression analysis revealed that children with DD, ID, cerebral palsy, or ASD (Group A) had weaker outcomes than those with visual impairment, speech impairment, or syndromes not associated with ID or medical disorders (Group B). In addi- tion to the disability group predictor, postsecondary maternal education was a predictor of more positive out- comes in speech, language, and func- tional hearing. The child’s home communication form did not emerge as a predictor variable, most likely because it was masked by the group- ings, with 52.7% of Group A using sign and speech and 73.3% of Group B using speech only. Surprisingly, degree of hearing loss was not a significant predictor of language outcomes for Group A—a finding that perhaps speaks to the impact of the disability. While the practice of writing notes

is common among DHH individuals when communicating with those who do not share their expressive form, limited reading and writing skills may restrict this option for students who have an ID. Allgood, Heller, Easter- brooks, and Fredrick (2009) developed a notepad intervention that used line- drawing symbols to facilitate students’ learning of the meaning and spelling of employment-specific vocabulary to support note writing. Five DHH stu- dents with mild to moderate ID (ages 17–20 years) were provided with mod- eling, guided practice, and independ- ent practice opportunities in this multiple-baseline probe design study. The systematic instructional approach (grounded in behavioral theory) uti- lized the system of least prompts (pro- viding the least intrusive prompt that will evoke the desired behavior). All five students met the criteria for initi- ating requests by writing messages with the support of the line drawings. Two students also improved their spelling of the target vocabulary with- out direct spelling instruction. Allgood et al. found that although ID may have a negative impact on language out- comes, systematic instruction may support improved outcomes.

Interventions for Children With ID That May Be Applicable Research and literature on communi- cation interventions for students with DD or ID may also apply to students who are DHH-ID. Since DHH learners are typically visual learners, interven- tions that are visual in nature would be most applicable to learners who are DHH-ID, excepting those with signifi- cant visual impairments. Much of the research and literature from the field of ID focuses on AAC, which can be divided into two broad categories, unaided forms and aided forms. Unaided forms are natural, nonspeech

forms such as gestures and signs. Aided forms utilize some external support or device, such as line draw- ings, objects, or a speech-generating device (SGD). Single and multimes- sage switches are the simplest form of SGD. A review of 58 studies showed that there was empirical evidence to support use of communication inter- ventions that employed SGDs with individuals with ID/DD (van Der Meer et al., 2012). In a review of intervention approaches applied with SGDs across 35 studies involving individuals with ID/DD, Rispoli et al. (2010) identified the use of interventions grounded in behavioral theory, such as discrete trial training and milieu teaching, among others. The instructional targets were functions (requesting and labeling) and social and receptive language. The voice quality of SGDs has improved, but because the generated speech may not be audible in noisy environments (Beukelman & Mirenda, 2013), teams should carefully consider the acousti- cal environment when using SGDs with students who are DWD. AAC should not be denied to individuals with ID because of their disability characteristics or because of a lack of prerequisite skills (Romski & Sevcik, 2005). Research has demonstrated that the provision of AAC does not hinder speech development (Millar, Light, & Schlosser, 2006; Romski & Sevcik, 2005). Prior to 1990, communication inter-

vention research with individuals with ID focused on the expression of a lim- ited number of signs or the use of sign language, with mixed results and evi- dence of limited spontaneous use of signs (Beukelman & Mirenda, 2013). Research on the mastery of early signs by DHH children, on topics such as the role of sign iconicity in sign mas- tery, was helpful to these efforts. Still, there are no empirical guidelines for the instruction of sign with children

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who have an ID or are DHH/ID. Picture representations may support the acqui- sition of speech or sign in children who are DHH-ID or DHH-ASD (Pollack, 1997). Comprehension of pictorial rep- resentations may be enhanced by iconicity, frequency of practice, familiar- ity of referent, representation of whole images (not parts), use of color, and specific features that draw attention, such as color and size (Beukelman & Mirenda, 2013). Research on the role of communi-

cation partners may also be applied to DHH children with ID. This re - search addresses what Buekelman and Mirenda (2013) have called “opportunity barriers” (p. 209). Such research includes teaching the child, peers, and adult partners specific be - haviors to enhance conversation. These may include strategies such as increasing responsiveness, appro- priate pacing, and the use of pause. Examples of this type of research are described above, under “Children Who Are Deafblind.” Three evidence-based interventions

from the field of ID that have also been successful with learners with ASD are the PECS, functional communication training (FCT), and milieu communi- cation teaching. PECS and FCT are discussed below, under “Suggested Interventions for Children With ASD.” Milieu communication teaching in - cludes prelinguistic milieu teaching (PMT), which targets the increase in intentional communication at the prelinguistic level as a foundation for later language development, and milieu teaching (MT) for linguistic learners (Fey, Yoder, Warren, & Bredin- Oja, 2013). PMT involves direct instruc- tion in the naturalistic environment. Elements of PMT include carefully arranging the physical environment, following the child’s interests, and cre- ating opportunities for self-expression for the child. An important component

of PMT involves educating parents on responsiveness, a process known as responsivity education (Fey et al., 2006). MT is a naturalistic intervention that blends some elements of be - haviorism. It is based on the child’s interests; utilizes incidental teaching methods, such as mand-modeling (the adult models the correct expression while creating a request for the child to communicate); and includes adult pro- vision of contingent responses from the natural environment (Kaiser, Hem- meter, Ostrosky, Alpert, & Hancock, 1995; Kaczmarek, Hepting, & Dzubak, 1996). More than 50 studies have been conducted establishing MT as an evidence-based practice (Kaiser, Roberts, Oetting, & Loeb, 2013). Communication and language de -

lays often result in frustration that may lead to problem behaviors. Interven- tions such as FCT, visual daily sched- ules, and choice making grounded in preference assessment may reduce frustration. Joint action routines (Snyder-McLean, Solomonson, McLean, & Sack, 1984), also known as scripted routines (Keen, Sigafoos, & Woodyatt, 2001), and planned dialogues (Siegel & Wetherby, 2000) provide a script of what the partner and the child will do, includ- ing the use of prompts and pauses. Such predictability may also reduce communication frustration. While most studies of ID/DD have

focused on expressive communica- tion, some recent research has focused on interventions related to receptive experiences, notably Aided Language Stimulation (Goossens, 2010), the System for Augmenting Language (Romski & Sevcik, 2003), and Aided Language Modeling (Binger & Light, 2007). Each of these interventions involves communication partners who provide receptive examples of how the learner is expected to express, such as adult communication partners point- ing to line drawings or other symbols

and pairing this action with speech and/or voice output from an SGD. The National Joint Committee for

the Communication Needs of Persons With Severe Disabilities (NJC; Snell et al., 2010) reviewed communication intervention research conducted with individuals with severe ID over a 20- year period from 1987 to 2007 (116 studies involving 461 participants). This review showed that positive results occurred in 95.7% of the stud- ies that had the general objective of improving expressive communi cation or interaction. Interventions included PECS, FCT, interaction models, MT, and visual, object, and movement cues. Single-case experimental designs were most common (67.2% of the studies). About 50% of the studies included a generalization measure, and about 30% a treatment fidelity measure. Snell et al. (2010) asserted the need to improve descriptions of participants and intervention compo- nents, intensity, and duration. The NJC recently updated its 1992 bill of com- munication rights and guidelines for communication interventions for use with individuals who have severe dis- abilities (Brady et al., in press). These documents are applicable to DWD learners with ID, ASD, or deafblindness.

Research on Children Who Are DHH-ASD Over the past 15 years, interest in the convergence of deafness and ASD has grown. This is clearly evidenced by the increase in literature seen over the past several years, including special issues on the topic in Odyssey: New Directions in Deaf Education (2008) and Seminars in Speech and Lan- guage (2014), as well as a webinar series by Advanced Bionics (2014). A few studies have been conducted

on the use of communication/language interventions with students who are DHH with ASD. A review of the litera-

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ture reveals four studies related to communication/language interventions with this population (see Banda, Griffin-Shirley, Okungu, Ogot, & Meeks, 2014, which includes a review of three of them). Two of the studies (Easter- brooks & Handley, 2005/2006; Mace, Pratt, Prager, & Pritchard, 2011) ad - dressed problem behaviors known to affect communication and language, while the others (Malandraki & Okali- dou, 2007; Shield & Meier, 2012) addressed communication directly. Easterbrooks and Handley (2005/

2006) conducted a case study in which the use of prompts was successful in reducing self-stimulatory behavior (crossing and squeezing arms) in a 6-year-old student with a degenerative hearing loss and pervasive develop- mental disorder (PDD). The addition of a positive social reinforcer (wink and nod) led to maintenance of the skill by the student. Easterbrooks and Handley “hypothesized that applied behavior analysis could serve as a ‘best practice’ for teachers of the deaf who serve students with the dual disability of deafness and ASD/PDD” (p. 405). Mace et al. (2011) evaluated three

different methods of saying “no” in a 13-year old student with both Waar- denburg syndrome (Type 1) and high- functioning ASD. The student had exhibited negative (or target) behav- iors when denied computer time, including saying “no,” loudly vocaliz- ing or screaming, physically disrupting the classroom environment, and being physically aggressive. All behaviors de - creased when the student was given an alternate choice (e.g., playing foot- ball) and when given the option to play on the computer following 5 minutes of a nonpreferred academic task. Malandraki and Okalidou (2007)

conducted a case study with a 10-year old DHH student with ASD. They dis- cussed the movement of this student through all six stages of PECS over a

4-month period. PECS instruction involves six phases: (1) how to com- municate; (2) distance and persist- ence, that is, how to get needs met when the communication partner is not in front of you; (3) discrimination, that is, how to communicate your specific request; (4) how to use sentences; (5) how to responsively request; (6) how to comment (Bondy & Frost, 1994). Maintenance data were also included to show that the student had maintained increased communi- cation following the conclusion of the intervention sessions. Prior to the introduction of PECS, the student had very few communication skills. Following this 4-month intervention, he spontaneously requested desired items using three-word sentences, made eye contact with communication partners, spontaneously used sign lan- guage vocabulary, and responded to basic questions. His negative behaviors of screaming or moving his head were also extinguished following the inter- vention phase. The results were main- tained over 6 months, and he was noted to have an increase in his use of sign language. Shield and Meier (2012) described

differences in palm orientation among deaf students who also had ASD and used sign as their native language. Their study found that “children with ASD showed a tendency to reverse palm orientation on signs specified for inward/outward orientation” (p. 439). Given the similarities in palm reversal and gestural imitation in hearing chil- dren with ASD, Shield and Meier sug- gested that “self-other mapping is a domain-general process that subserves the learning of linguistic and non- linguistic stimuli” (p. 450) for these students. They also suggested that (a) assessment instruments for diagnos- ing ASD in DHH children be examined to reflect the error pattern and that (b) teachers or therapists working with

a student with this error pattern con- sider seating arrangements (next to rather than across from) to aid com- prehension. Much of the available literature pro-

vides descriptions of common charac- teristics of students with ASD for readers who may be more familiar with deafness (Leach & LeBeau, 2014; Mor- ton, 2008; Szymanski & Brice, 2008; Vernon & Rhodes, 2009). Critical to understanding this population of young people who are DWD, several case studies are available that describe the characteristics and struggles of individuals with ASD and their families (Easterbrooks & Handley, 2005/2006; Ellis-Gonzales, 2008; Kellogg et al., 2014; Malandraki & Okalidou, 2007; Meinzen-Derr et al., 2014; M. Miller & Funayama, 2008; Myck-Wayne, Robin- son, & Henson, 2011; Szarkowski, Mood, Shield, Wiley, & Yoshinaga- Itano, 2014; Vernon & Rhodes, 2009; Wiley & Innis, 2014; Yeh-Kennedy, 2008). This much-needed literature clarifies many characteristics seen in this particular population of students. Communication and language are

crucial for all students and are of greater concern for individuals who are DHH with ASD. As little research has been conducted to clearly identify interventions for this specific popula- tion, informed suggestions are noted in the literature for how to increase communication and language based on what is currently known about the influence of both disabilities on learning (Bradley, Krakowski, & Thiessen, 2008; Steinberg, 2008), including the use of AAC devices (Davis et al., 2010) and PECS (Malan- draki & Okalidou, 2007). The use of behavioral approaches such as struc- tured supports (Szymanski & Brice, 2008), ABA (Mace et al., 2011; Vernon & Rhodes, 2009), and functional behavioral analysis (Borders & Bock, 2014; Zane, Carlson, Estep, & Quinn,

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2014) is recommended as well. Differ- ences in palm orientation and perspec- tive taking (Shield, 2010, 2014; Shield & Meier, 2012) and awareness of facial cues (Denmark, Atkinson, Campbell, & Swettenham, 2014) in signing students who are DHH with ASD are also noted.

Suggested Interventions for Children With ASD Because of the lack of research on students who are DHH-ASD, it is important to consider research that establishes the use of practices from the field of ASD alone and then con- sider potential modifications to these established interventions. Visually based interventions have been effec- tive for learners with ASD and also with learners who are DHH; thus, interven- tions that rely on relative strengths in the use of vision should be considered for learners who are DHH-ASD and have typical vision. Professionals in the field of ASD have compiled a list of evidence-based practices for children, youth, and young adults with ASD. In a report by the National Professional Development Center on Autism Spec- trum Disorder (2014), 27 practices were identified that had sufficient research support to be considered evi- dence-based practices addressing the area of communication across ages from birth to 22 years. In the present article, we provide information on two (FCT and PECS) of those 27 interven- tions, which may be less familiar to individuals who have training in deaf- ness alone. FCT (Functional Communication

Training) is a means of replacing inap- propriate behavior by teaching a more socially appropriate communication act. FCT was established as an evi- dence-based practice based on 12 sin- gle-case design studies that included individuals with ASD (Brown et al., 2000; Buckley & Newchok, 2005;

Casey & Merical, 2006; Falcomata, Roane, Feeney, & Stephenson, 2010; Fisher, Kuhn, & Thompson, 1998; Gib- son, Pennington, Stenhoff, & Hopper, 2010; Kuhn, Hardesty, & Sweeney, 2009; Mancil, Conroy, Nakao, & Alter, 2006; Olive, Lang, & Davis, 2008; Schindler & Horner, 2005; Tiger, Fisher, Toussaint, & Kodak, 2009; Volk- ert, Lerman, Call, & Trosclair Lesserre, 2009). FCT is designed to follow data collected during the functional behav- ior assessment process (Borders & Bock, 2014; Mace et al., 2011; Zane et al., 2014) to ensure that the skill being taught serves the same function as the inappropriate behavior. For example, if a student throws items and yells when he or she wants a particular item, the replacement communication should serve to convey a request for the desired item. Conversely, if a student throws items and yells when rejecting an item, the replacement communi - cation should serve to convey an appropriate rejection. It is critical for teachers, parents, and professionals to understand that the same behavior can serve multiple functions for the child, and therefore should be carefully ana- lyzed through the functional behavior assessment process to ensure the suc- cess of FCT. The use of PECS (Picture Exchange

Communication System) with stu- dents who are DHH-ASD has been reviewed above, with reference to the study by Malandraki and Okalidou (2007), under “Children Who Are DHH With Autism Spectrum Disor- ders.” PECS has been established as an evidence-based intervention within the field of ASD to increase communi- cation acts within a social context through two group-design and four single-case-design studies (Ali, MacFar- land, & Umbreit, 2011; Angermeier, Schlosser, Luiselli, Harrington, & Carter, 2008; D. Carr & Felce, 2007; Dogoe, Banda, & Lock, 2010; Howlin,

Gordon, Pasco, Wade, & Charman, 2007; Jurgens, Anderson, & Moore, 2009).

Children Who Are Deafblind Ferrell, Bruce, and Luckner (2014) conducted a review of research in 12 topical areas in the fields of visual impairment, DHH, and deafblindness to identify the level of evidence for the instructional practices according to standards established by the Collabora- tion for Effective Educator Develop- ment, Accountability, and Reform (CEEDAR) Center, University of Florida. Ferrell and colleagues found that com- munication intervention is one of the most researched topics in deafblind- ness education. The reader is referred to the CEEDAR Center for definitions of the four levels of evidence: emerg- ing, limited, moderate, and strong (see http://ceedar.education.ufl.edu/tools/ innovation-configurations/). Five evidence-based practices in

communication intervention in deaf- blindness were calculated to be at the limited or moderate level of evidence (Ferrell et al., 2014). They are listed here and then discussed below:

• Child-guided approaches can be applied to promote communica- tion development and dialogue (limited evidence).

• Systematic instructional ap - proaches can promote an increase in the rate of com - munication and in the variety of expressed intents/functions (mod erate evidence).

• Adult communication partner interaction behaviors can be improved with intervention (lim- ited evidence).

• Tangible representations are a viable form of communicat - ion for prelinguistic students who are deafblind (moderate evidence).

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• Tactile approaches and strategies can improve communication in learners who are deafblind (moderate evidence).

The field of deafblindness has pro- duced research evidence of the effi- cacy of both child-guided approaches (grounded in social-interactionism theory) and systematic approaches (grounded in behavioral theory). Most notable among child-guided ap - proaches is the van Dijk Conversa- tional Approach, also known as the van Dijk Curricular Approach and Move- ment-Based Language Theory (Mac- Farland, 1995; Wheeler & Griffin, 1997; Writer, 1987), which has a strong devel- opmental grounding as well. Child- guided approaches include strategies such as establishing trust with the child; responding to the child’s inter- ests, emotions, and communicative attempts expressed in any form; select- ing representations that are salient to the child (that represent the child’s perspective on what is being repre- sented); nonverbal dialogues; and coactive teaching techniques (Crook, Miles, & Riggio, 1999b; Hodges, 2002; Horsch & Scheele, 2011; Janssen et al., 2002, 2003a, 2003b, 2004; MacFarland, 1995; Nelson et al., 2009; Olson et al., 1999; Pease, 2002; Pittroff, 2011; Rod- broe & Souriau, 1999; van Dijk, 1965, 1967; Wheeler & Griffin, 1997). Sys- tematic instructional approaches have been effective in increasing both the rate of expressive communication in learners who are deafblind and the variety of intents or functions expressed (Brady & Bashinski, 2008; Heller, Allgood, Davis, et al., 1996; Heller, Allgood, Ware, Arnold, & Castelle, 1996; Heller, Allgood, Ware, & Castelle, 1996; Heller, Ware, Allgood & Castelle, 1994; Sigafoos et al., 2008). A rapidly growing body of European

research has demonstrated that inter- vention can improve the attunement

and responsiveness of communication partners, as well as the length and quality of their conversations with indi- viduals who are deafblind. These inter- ventions include demonstrations of desired adult behaviors and the coach- ing of these behaviors in the context of daily interactions with children and adults who are deafblind. Janssen and colleagues’ research on the Contact intervention program (including har- monious interactions), and the Diag- nostic Intervention Model (with interventions building on findings from the previous model) are central to this research effort (see Janssen et al., 2002, 2003a, 2003b, 2004, 2007; Janssen, Rik- sen-Walraven, van Dijk, Huisman, & Ruijssenaars, 2011; McLetchie & Riggo, 1997). Since the time of the review by Ferrell et al. (2014), Damen, Janssen, and others have continued this work through research on high-quality com- munication, which includes a focus on developmental levels of intersub- jectivity and meaning making (Damen, Janssen, Huisman, Ruijssenaars, & Schuengel, 2014; Damen, Janssen, Schuengel, & Ruijssenaars, 2015).

Tangible symbols, a term intro- duced by Rowland and Schweigert (1989), may be two-dimensional (as in photographs or line drawings) or three-dimensional (as in whole or par- tial objects). Thus, tangible symbols may be iconic or symbolic. Several research teams have demonstrated that tangible symbols are an effective form of expressive communication for prelinguistic individuals who are deafblind (Bruce, Trief, & Cascella, 2011; Cascella, Trief, & Bruce, 2012; Murray-Branch, Udavari-Solner, & Bai- ley, 1991; Rowland, 1990; Rowland & Schweigert, 1989, 2000; Trief, 2007, 2013; Trief, Bruce, & Cascella, 2010; Trief, Bruce, Cascella, & Ivy, 2009; Trief, Cascella, & Bruce, 2013). While there is more literature on the use of tangible symbols as an expressive form, these

representations can also be used to support receptive communication, in which case they may be called tangi- ble cues. A variety of tactile approaches,

strategies, materials, and instructional methodologies have been demon- strated to be effective in promoting communication development in learners who are deafblind (Chen & Downing, 2006; Chen, Downing, & Rodriguez-Gil, 2001; Downing & Chen, 2003; Klein, Chen, & Haney, 2000; Mathy-Laikko et al., 1989; Murray- Branch et al., 1991; Rowland & Schweigert, 1989, 2000; Sigafoos et al., 2008). Learning through touch has been addressed by Miles (2003), who explained how hands function as eyes for individuals who are deafblind. The effectiveness of tactile sign has been established, as well as the use of touch cues as a receptive strategy. Object cues and touch cues provide impor- tant receptive information. An exam- ple of a touch cue would be an adult touching the back of the learner’s hand and then holding her hands out in readiness for the learner to locate, as opposed to taking the learner’s hands and placing them on an object. Following the analysis of research,

we examined the literature in deaf- blindness as part of the review. This review identified themes such as the importance of highly individualized communication intervention in the context of daily interactions in natural contexts, interventions that were customized to the child’s level of communication, and the need for interventions that considered form, function, content, and context—the four aspects of communication (Bashin- ski, 2011; Crook, Miles, & Riggio, 1999a, 1999b; Goodall & Everson, 1995; McKenzie, 2009; E. K. Miller, Swanson, Steele, S. J. Thelin, & J. W. Thelin, 2011; M. T. White, Garrett, Kearns, & Grisham-Brown, 2003).

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The CEEDAR review also examined literacy practices for children and youth who are deafblind but found an emerging level of evidence for just two practices: expanded view of literacy and literacy-rich environments. The field of deafblindness appears to be adopting an expanded view of literacy that extends beyond traditional read- ing and writing and that is inclusive of all learners, including those who are prelinguistic (McKenzie & Davidson, 2007; Miles, 2005); begins at birth (Parker & Pogrund, 2009); and uses materials and media that differ highly across learners and may involve tech- nologies such as SGDs (Emerson & Bishop, 2012). Communication is perceived as being either supportive of or a part of literacy (McKenzie & Davidson, 2007). Daily schedules (also known as anticipation shelves or calendar systems), story boxes (boxes with objects that correspond to story content within either com - mercially produced or personalized books), personalized experience books, and choice-making opportunities are among the literacy lessons of impor- tance to prelinguistic learners who are deafblind (see Blaha, 2001, 2002; Bruce & Conlon, 2005; Bruce, Randall, & Birge, 2008; Crook & Miles, 1999; Mac- Farland, 1995; Swanson, 2011).

Need for Additional Research There is a dire need for research on communication, language, and literacy (with consideration of expanded defi- nitions of literacy) for students who are DWD. Of the three DWD areas addressed in the present article, the field of deafblindness has generated the strongest evidence base in com- munication and language intervention. Most of the communication research across disability areas has focused on expression, not receptive language or comprehension (Sevcik, 2006). There

is a need to expand research on aug- mented input as a receptive interven- tion to support understanding of symbols or representations. There is also a need for further research that examines how children acquire an understanding of symbols, including the relative importance of iconicity (Sevcik, 2006). There is a need to modify interven-

tions that have been found to be effec- tive with individuals who are DHH for learners who are DWD. One example might be repeated exposure to ASL- signed stories for vocabulary and sign acquisition. In this research, the child is provided with a word in sign and print, an example and nonexamples of its meaning, and its use in text (Beal- Alvarez & Huston, 2014; Cannon, Fredrick, & Easterbrooks, 2010; Guardino, Cannon, & Eberst, 2014). Additionally, communication interven- tions that have been found to be suc- cessful with individuals with disabilities may be modified to suit the needs of various DWD populations. Methodological considerations are

important in producing high-quality DWD research. Clear participant descriptions will help researchers ascertain whether the participants (such as those with Down syndrome) were DWD. Snell et al. (2010) have suggested that researchers define par- ticipants in more standard ways (to allow for study comparisons and repli- cation), provide more complete descriptions of settings and the inter- vention, and employ generalization and maintenance measures. Warren, Fey, and Yoder (2007) have suggested that the next wave of communication intervention should address differen- tial intervention intensity. In their study, they described a more precise measure of treatment intensity that encompasses the precise definition of a teaching episode (to reduce vari- ants), the number of times the inter-

vention was correctly delivered (dose), the form of the dose (precisely how it was delivered), the dose within a spe- cific time frame, and the total duration of the intervention.

Conclusion Identification of disabilities that may occur with deafness, particularly ID or ASD, as well as deafblindness, is essen- tial to appropriate service provision. Understanding of all factors influenc- ing a student’s ability to access and learn communication and language, including the influence of etiology, is required. Additional research into and dissemination of appropriate assess- ment practices is needed. The goal should be to produce communication and language intervention research with a strong theoretical grounding and clear implications for practice. Communication and language are

of paramount concern for profession- als working with students who are DWD. Very little research has been conducted with this unique popula- tion of learners. Additional research on communication assessment and inter- vention is greatly needed and may stem from the extension of modified evidence-based practices with stu- dents who are DWD. Communication is one of the most researched areas in the field of deafblindness, with evi- dence for interventions grounded in both systematic instruction and child- guided conversational approaches. The visual and auditory accessibility of AAC remains a critical consideration for the DWD population, making some popular SGDs inappropriate. Framing research in the context of

various theoretical perspectives may be helpful to readers. Developmental theory, behavioral theory, and social- interactionism theory may assist read- ers by offering alternative perspectives on the learning of communication and language for learners who are DWD.

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Frameworks for intervention, such as the tri-focus and the four aspects of communication, can support teams in developing individually appropriate communication programming for stu- dents who are DWD. Effective educa- tional services, including services in communication and language, can only occur when children who are DWD are identified early, put in an appropriate placement (with appro- priately prepared professionals), and provided with services that recognize their strengths and meet their needs (Guardino, 2008).

Note 1. CHARGE is an acronym for colo - boma, heart defects, atresia of the nasal choanae, retarded growth and de - velopment, genital hypoplasia, and ear anomalies. Deafness is also sometimes included.

References Advanced Bionics. (2014). Advanced Bionics

webinar series: Perspectives on deafness with autism: Changing how we think. Retrieved from http://www.advancedbionics.com/ca/en/ professionals/training_library/deafness_and _autism.html

Ali, E., MacFarland, S. Z., & Umbreit, J. (2011). Effectiveness of combining tangible symbols with the Picture Exchange Communication System to teach requesting skills to children with multiple disabilities including visual impairment. Education and Training in Autism and Developmental Disabilities, 46, 425–435.

Allgood, M. H., Heller, K. W., Easterbrooks, S. R., & Fredrick, L. D. (2009). Use of picture dic- tionaries to promote functional communica- tion in students with deafness and intellectual disabilities. Communication Disorders Quar- terly, 31, 53–64. doi:10.1177/152574010832 7078

American Psychiatric Association. (2013). Diag- nostic and Statistical Manual of Mental Dis- orders: DSM–5. Washington, DC: American Psychiatric Association.

Angermeier, K., Schlosser, R. W., Luiselli, J. K., Har- rington, C., & Carter, B. (2008). Effects of iconicity on requesting with the Picture Exchange Communication System in children with autism spectrum disorder. Research in Autism Spectrum Disorders, 2, 430–446. doi:10.1016/j.rasd.2007.09.004

Banda, D. R., Griffin-Shirley, N., Okungu, P. A.,

Ogot, O. P., & Meeks, M. K. (2014). A review of intervention studies conducted with indi- viduals with autism and sensory impair- ments. Journal of Visual Impairment and Blindness, 108, 299–309.

Bandura, A. (2011). Social cognitive theory. In P. A. M. Van Lange, A. W. Kruglanski, & E. Tory Higgins (Eds.), Handbook of theories of social psychology (Vol. 1, pp. 349–373). Los Angeles, CA: Sage.

Bashinski, S. M. (2011). Assessment of prelin- guistic communication of individuals with CHARGE. In T. S. Hartshorne, M. A. Hefner, S. L. Davenport, & J. W. Thelin (Eds.), CHARGE syndrome (pp. 275–294). San Diego, CA: Plural Publishing.

Beal-Alvarez, J. S., & Huston, S. G. (2014). Emerging evidence for instructional practice: Repeated viewings of sign language models. Communication Disorders Quarterly, 35, 93–102. doi:10.1177/1525740113514437

Beals, K. (2004). Early intervention in deafness and autism: One family’s experiences, reflec- tions, and recommendations. Infants and Young Children, 17, 284–290.

Beukelman, D. R., & Mirenda, P. (2013). Aug- mentative and alternative communication: Supporting children and adults with com- plex communication needs (4th ed.). Balti- more, MD: Brookes.

Binger, C., & Light, J. (2007). The effect of aided AAC modeling on the expression of multi- symbol messages by preschoolers who use AAC. Augmentative and Alternative Com- munication, 23, 30–43. doi:10.1080/0743610 600807470

Blaha, R. (2001). Calendars for students with multiple impairments including deafblind- ness. Austin: Texas School for the Blind and Visually Impaired.

Blaha, R. (2002). Using calendar systems with chil- dren with deafblindness. In L. Alsop (Ed.), Understanding deafblindness; Issues, per- spectives, and strategies(Vol. 1, pp. 467–481). Logan: Utah State University, SKI-HI Institute.

Bondy, A. S., & Frost, L. A. (1994). The Picture Exchange Communication System. Focus on Autism and Other Developmental Disabili- ties, 9, 1–19.

Borders, C., & Bock, S. J. (2014, December 15). Core strategies for supporting children with deafness and autism spectrum disorder: Part 1 [webinar]. In Advanced Bionics webinar series. Retrieved from Audiology Online website: http://www.audiologyonline.com/ articles/core-strategies-for-supporting-chil dren-13116

Bradley, L. A., Krakowski, B., & Thiessen, A. (2008). With little research out, there it’s a matter of learning what works in teaching students with deafness and autism. Odyssey: New Directions in Deaf Education, 9(1), 16–18.

Brady, N. C., & Bashinski, S. M. (2008). Increas- ing communication in children with concur-

rent vision and hearing loss. Research and Practice for Persons With Severe Disabilities, 33, 59–70.

Brady, N. C., Bruce, S., Goldman, A., Erickson, K., Mineo, B., Ogletree, B. T., et al. (in press). Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. American Journal on Intellectual and Developmen- tal Disabilities.

Brown, K. A., Wacker, D. P., Derby, K. M., Peck, S. M., Richman, D. M., Sasso, G. M., et al. (2000). Evaluating the effects of functional communication training in the presence and absence of establishing operations. Journal of Applied Behavior Analysis, 33, 53–71. doi:10.1901/jaba.2000.33-53

Bruce, S. (2002). Impact of a communication intervention model on teachers’ practice with children who are congenitally deaf- blind. Journal of Visual Impairment and Blindness, 96, 154–168.

Bruce, S. M. (2005). The impact of congenital deafblindness on the struggle to symbolism. International Journal of Disability, Devel- opment, and Education, 52, 233–251.

Bruce, S. M., & Conlon, K. (2005). Colby’s daily journal: A school-home effort to promote communication development. TEACHING Exceptional Children Plus, 2(1), article 3. Retrieved from http://journals.cec.sped.org/ tecplus/

Bruce, S. M., Randall, A., & Birge, B. (2008). Colby’s growth to literacy: The achievements of a child who is congenitally deafblind. TEACHING Exceptional Children Plus, 5(2), article 6. Retrieved from http://journals.cec .sped.org/tecplus/vol5/iss2/art6

Bruce, S. M., Trief, E., & Cascella, P. W. (2011). Teachers’ and speech-language pathologists’ perceptions about a tangible symbols inter- vention: Efficacy, generalization, and recom- mendations. Augmentative and Alternative Communication, 27, 172–182. doi:10.3109/ 07434618.2011.610354

Buckley, S. D., & Newchok, D. K. (2005). Differ- ential impact of response effort within a response chain on use of mands in a student with autism. Research in Developmental Disabilities, 26, 77–85. doi:10.1016/j.ridd .2004.07.004

Cannon, J. E., Fredrick, L. D., & Easterbrooks, S.R. (2010). Vocabulary instruction through books read in American Sign Language for English Language Learners with hearing loss. Communication Disorders Quarterly, 31, 98–112. doi:10.1177/1525740109332832

Carr, D., & Felce, J. (2007). The effects of PECS teaching to phase III on the communicative interactions between children with autism and their teachers. Journal of Autism and Developmental Disorders, 37, 724–737. doi:10.1007/s10803-006-0203-1

Carr, J., Xu, D., & Yoshinaga-Itano, C. (2014). Language Environment Analysis Language

VOLUME 160, NO. 4, 2015 AMERICAN ANNALS OF THE DEAF

379

18811-AAD160.4_Fall2015 10/7/15 3:57 PM Page 379

and Autism Screen and the Child Develop- ment Inventory Social Subscale as a possible autism screen for children who are deaf or hard of hearing. Seminars in Speech and Language, 35, 266–275. doi:http://dx.doi .org/10.1055/s-0034-1389099

Carvil, S. (2001). Sensory impairments, intellec- tual disability, and psychiatry. Journal of Intel- lectual Disability Research, 45, 467–483.

Cascella, P. W., Trief, E., & Bruce, S. M. (2012). Par- ent and teacher ratings of communication among children with severe disabilities and visual impairment/blindness. Communica- tion Disorders Quarterly, 33, 249–251. doi:10.1177/1525740112448249

Casey, S. D., & Merical, C. L. (2006). The use of functional communication training without additional treatment procedures in an inclu- sive school setting. Behavioral Disorders, 32, 46–54.

Chen, D. (2004). Young children who are deaf- blind: Implications for professionals in deaf and hard of hearing services. Volta Review, 104, 273–284.

Chen, D., & Downing, J. (2006). Tactile learning strategies: Interacting with children who have visual impairments and multiple disabil- ities. New York, NY: AFB Press.

Chen, D., Downing, J., & Rodriguez-Gil, G. (2001). Tactile learning strategies for children who are deaf-blind: Concerns and consider- ations from Project Salute. Deaf-Blind Per- spectives, 8(2), 1–6. Retrieved from http:// www.projectsalute.net/Learned/Learnedhtml/ TactileLearning/Strategies.html

Crook, C., & Miles, B. (1999). Developing basic language forms. In B. Miles & M. Riggio (Eds.), Remarkable conversations: A guide to developing meaningful communication with children and young adults who are deafblind (pp. 180–213). Watertown, MA: Perkins School for the Blind.

Crook, C., Miles, B., & Riggio, M. (1999a). Devel- oping early communication and language. In B. Miles & M. Riggo (Eds.), Remarkable conversations: A guide to developing meaningful communication with children and young adults who are deafblind (pp. 146–179). Watertown, MA: Perkins School for the Blind.

Crook, C., Miles, B., & Riggio, M. (1999b). Selec- tion of communication modes. In B. Miles & M. Riggio (Eds.), Remarkable conversations: A guide to developing meaningful commu- nication with children and young adults who are deafblind (pp. 126–145). Water- town, MA: Perkins School for the Blind.

Cupples, L., Ching, T. Y., Crowe, K., Seeto, M., Leigh, G., Street, L., et al. (2014). Outcomes of 3-year-old children with hearing loss and different types of additional disabilities. Jour- nal of Deaf Studies and Deaf Education, 19, 20–39. doi:10.1093/deafed/ent039

Damen, S., Janssen, M., Huisman, M., Ruijsse- naars, A. J., & Schuengel, C. (2014). Stimulat-

ing intersubjective communication in an adult with deafblindness: A single-case exper- iment. Journal of Deaf Studies and Deaf Education, 19, 366–84. doi:10.1093/deafed/ enu006

Damen, S., Janssen, M.., Schuengel, C., & Ruijs - senaars, A. J. (2015). Communication between children with deafness, blindness, and deafblindness and their social partners: An intersubjective developmental perspec- tive. International Journal of Disability, Development, and Education, 62, 215–243.

Davis, T. N., Barnard-Brak, L., Dacus, S., & Pond, A. (2010). Aided AAC systems among indi- viduals with hearing loss and disabilities. Journal of Developmental and Physical Dis- abilities, 22, 241–256. doi:10.1007/s10882- 009-9180-6

Denmark, T., Atkinson, J., Campbell, R., & Swet- tenham, J. (2014). How do typically devel- oping deaf children and deaf children with autism spectrum disorder use the face when comprehending facial expressions in British Sign Language? Journal of Autism and Other Developmental Disorders, 44, 2584–2592. doi:10.1007/s10803-014-2130-x

Dogoe, M. S., Banda, D. R., & Lock, R. H. (2010). Acquisition and generalization of the Picture Exchange Communication System behaviors across settings, persons, and stimulus classes with three students with autism. Education and Training in Autism and Developmental Disorders, 45, 216–229.

Downing, J. E., & Chen, D. (2003). Using tactile strategies with students who are blind and have severe disabilities. Teaching Excep- tional Children, 36, 56–60.

Downing, J. E., & Chen, D. (2015). Beginning steps in communication intervention. In J. E. Downing, A. Hanreddy, & K. D. Peckham- Hardin (Eds.), Teaching communication skills to students with severe disabilities (3rd ed., pp. 107–136). Baltimore, MD: Brookes.

Easterbrooks, S. R., & Handley, C. M. (2005/ 2006). Behavior change in a student with a dual diagnosis of deafness and pervasive developmental disorder: A case study. American Annals of the Deaf, 150, 401–407. doi:10.1353/aad.2006.0001

Ellis-Gonzales, S. D. (2008). Selah, a precious mosaic: A mother’s journey through autism with her deaf child. Odyssey: New Directions in Deaf Education, 9(1), 20–25.

Emerson, J., & Bishop, J. (2012). Videophone technology and students with deaf-blindness: A method for increasing access and commu- nication. Journal of Visual Impairment and Blindness, 106, 622–633.

Falcomata, T. S., Roane, H. S., Feeney, B. J., & Stephenson, K. M. (2010). Assessment and treatment of elopement maintained by access to stereotypy. Journal of Applied Behavior Disorders, 43, 513–517. doi:10 .1901/jaba.2010.43-513

Ferrell, K. A., Bruce, S., & Luckner, J. L. (2014).

Evidence-based practices for students with sensory impairments (Document No. IC-4). Retrieved from University of Florida, Col- laboration for Effective Educator, Develop- ment, Accountability and Reform Center website: http://ceedar.education.ufl.edu/ tools/innovation-configurations/

Fey, M. E., Warren, S. F., Brady, N., Finestack, L. H., Bredin-Oja, S. L., Fairchild, M., et al. (2006). Early effects of responsivity educa- tion/prelinguistic milieu teaching for chil- dren with developmental delays and their parents. Journal of Speech, Language, and Hearing Research, 49, 526–547. doi:10 .1044/1092-4388(2006/039)

Fey, M. E., Yoder, P. J., Warren, S. F., & Bredin-Oja, S. L. (2013). Is more better? Milieu communi- cation teaching in toddlers with intellectual disabilities. Journal of Speech, Language, and Hearing Research, 56, 679–693. doi:10.1044/ 1092-4388(2012/12-0061)

Fisher, W. W., Kuhn, D. E., & Thompson, R. H. (1998). Establishing discriminative control of responding using functional and alternative reinforcers during functional communica- tion training. Journal of Applied Behavior Analysis, 31, 543–560. doi:10.1901/jaba .1998.31-543

Gallaudet Research Institute. (2013). Regional and national summary report from the 2011–2012 Annual Survey of Deaf and Hard of Hearing Children and Youth. Washing- ton, DC: Gallaudet University.

Gibson, J. L., Pennington, R. C., Stenhoff, D. M., & Hopper, J. S. (2010). Using desktop video- conferencing to deliver interventions to a preschool student with autism. Topics in Early Childhood Special Education, 29, 214–225. doi:10.1177/0271121409352873

Goodall, D., & Everson, J. M. (1995). Communi- cation instruction and support strategies for young adults who are deaf-blind. In J. M. Everson (Ed.), Supporting young adults who are deaf-blind in their communities: A tran- sition planning guide for service providers, families, and friends (pp. 203–226). Balti- more, MD: Brookes.

Goossens, C. (2010, July). Aided language stim- ulation update. Paper presented at the bien- nial conference of the International Society for Augmentative and Alternative Communi- cation, Barcelona, Spain.

Gray, P. (2011). Psychology (6th ed.). New York, NY: Worth Publishers.

Guardino, C. (2008). Identification and place- ment for deaf students with multiple disabil- ities: Choosing the path less followed. American Annals of the Deaf, 153, 55–64. doi:10.1353/aad.0.0004

Guardino, C., Cannon, J. E., & Eberst, K. (2014). Building the evidence base of effective read- ing strategies to use with Deaf English Lan- guage Learners. Communications Disorders Quarterly, 35(2), 59–73. doi:10.1177/15257 40113506932

VOLUME 160, NO. 4, 2015 AMERICAN ANNALS OF THE DEAF

380

DHH WITH DISABILITIES: COMMUNICATION AND LANGUAGE

18811-AAD160.4_Fall2015 10/7/15 3:57 PM Page 380

Heller, K. W., Allgood, M. H., Davis, B., Arnold, S. E., Castelle, M. D., & Taber, T. (1996). Pro- moting non-task–related communication at vocational sites. Augmentative and Alterna- tive Communication, 12, 169–178. doi:10 .1080/07434619612331277618

Heller, K. W., Allgood, M. H., Ware, S., Arnold, S. E., & Castelle, M. D. (1996). Initiating requests during community-based vocational training by students with mental retardation and sensory impairments. Research in Developmental Disabilities, 17, 173–184. doi:10.1016/0891-4222(95)00040-2

Heller, K. W., Allgood, M. H., Ware, S., & Castelle, M. D. (1996). Use of dual communication boards at vocational sites by students who are deaf-blind. RE:view, 27, 180–190.

Heller, K. W., Ware, S., Allgood, M. H., & Castelle, M. (1994). Use of dual communication boards with students who are deaf-blind. Journal of Visual Impairment and Blind- ness, 88, 368–376.

Herer, G. R. (2012). Intellectual disabilities and hearing loss. Communication Disorders Quarterly, 33, 252–260. doi:10.1177/15257 40112448214

Hodges, L. (2002). Effective teaching and learn- ing. In S. Aitken, M. Buultjens, C. Clark, J. T. Eyre, & L. Pease (Eds.), Teaching children who are deafblind: Contact communica- tion and learning (pp. 167–199). London, England: David Fulton.

Hoevenaars-van den Boom, M. A., Antonissen, A. C., Knoors, H., & Vervloed, M. P. (2009). Differentiating characteristics of deafblind- ness and autism in people with congenital deafblindness and profound intellectual dis- ability. Journal of Intellectual Disability Research, 53, 548-558. doi:10.1111/j.1365 -2788.2009.01175.x

Horsch, U., & Scheele, A. (2011). Empirical education research in a dialogue paradigm: The process of early childhood and the dia- logue between parent and child. In U. Horsch & A. Scheele (Eds.), Com- pendium of CHARGE syndrome (pp. 133–155). Heidelberg, Germany: Median– Verlag von Killisch–Horn.

Howlin, P., Gordon, R. K., Pasco, G., Wade, A., & Charman, T. (2007). The effectiveness of Pic- ture Exchange Communication System (PECS) training for teachers of children with autism: A pragmatic, group-randomised con- trolled trial. Journal of Child Psychology and Psychiatry, 48, 473–481. doi:10.1111/j.1469 -7610.2006.01707.x

Janssen, M. J., Riksen-Walraven, J. M., & van Dijk, J. P. (2002). Enhancing the quality of interac- tions between deafblind children and their educators. Journal of Developmental and Physical Disabilities, 14, 87–108.

Janssen, M. J., Riksen-Walraven, J. M., & van Dijk, J. P. (2003a). Contact: Effects of an interven- tion program to foster harmonious interac- tions between deafblind children and their

educators. Journal of Visual Impairment and Blindness, 97, 215–229.

Janssen, M. J., Riksen-Walraven, J. M., & van Dijk, J. P. (2003b). Toward a diagnostic interven- tion model for fostering harmonious interac- tions between deafblind children and their educators. Journal of Visual Impairment and Blindness, 97, 197–214.

Janssen, M. J., Riksen-Walraven, J. M., & van Dijk, J. P. (2004). Enhancing the interactive compe- tence of deafblind children: Do intervention effects endure? Journal of Developmental and Physical Disabilities, 16, 73–94.

Janssen, M. J., Riksen-Walraven, J. M., van Dijk, J. P., Huisman, M., & Ruijssenaars, W. A. (2011). Fostering harmonious interactions in a boy with congenital deaf-blindness: A sin- gle-case study. Journal of Visual Impairment and Blindness, 105, 177–183.

Janssen, M. J., Riksen-Walraven, J. M., van Dijk, J. P., Ruijssenaars, W. A., & Vlaskamp, C. (2007). Team interaction coaching with edu- cators of adolescents who are deaf-blind: Applying a diagnostic intervention model. Journal of Visual Impairment and Blind- ness, 101, 677–689.

Jones, T. W., Jones, J. K., & Ewing, K. M. (2006). Students with multiple disabilities. In D. F. Moores & D. S. Martin (Eds.), Deaf learners: Developments in curriculum and instruc- tion (pp. 127–143). Washington, DC: Gal- laudet University Press.

Jurgens, A., Anderson, A., & Moore, D. W. (2009). The effect of teaching PECS to a child with autism on verbal behaviour, play, and social functioning. Behavior Change, 26, 66–81. doi:10.1375/bech.26.1.66

Kaiser, A. P., Hemmeter, M. L., Osrosky, M. M., Alpert, C. L., & Hancock, T. B. (1995). The effects of group training and individual feedback on parent use of milieu teaching. Communication Disorders Quarterly, 16, 39–48.

Kaiser, A. P., Roberts, M. Y., Oetting, J., & Loeb, D. (2013). Parent-implemented enhanced milieu teaching with preschool children who have intellectual disabilities. Journal of Speech, Language, and Hearing Re - search, 56, 295–309. doi:10.1044/1092 -4388(2012/11-0231)

Kaczmarek, L. A., Hepting, N. H., & Dzubak, M. (1996). Examining the generalization of milieu language objectives in situations requiring listener preparatory behaviors. Topics in Early Childhood Special Educa- tion, 16(2), 139–167. doi:10.1177/0271121 49601600203

Keen, D., Sigafoos, J., & Woodyatt, G. (2001). Replacing prelinguistic behaviors with functional communication. Journal of Autism and Developmental Disorders, 31, 385–398.

Kellogg, E. C., Thrasher, A., & Yoshinaga-Itano, C. (2014). Early predictors of autism in young children who are deaf or hard of hearing:

Three longitudinal case studies. Seminars in Speech and Language, 35, 276–287. doi: 10.1055/s-0034-1389100

Klein, M. D., Chen, D., & Haney, M. (2000). Pro- moting learning through active interaction: A guide to early communication with young children who have multiple disabili- ties. Baltimore, MD: Brookes.

Knoors, H., & Vervloed, M. P. (2011). Educa- tional programming for deaf children with multiple disabilities: Accommodating spe- cial needs. In M. Marschark & P. E. Spencer (Eds.), The Oxford handbook of deaf stud- ies, language, and education. (2nd ed., Vol. 1, pp. 82–96). New York, NY: Oxford University Press. doi:10.1093/oxfordhb/978 0199750986.013.0007

Kuhn, D. E., Hardesty, S. L., & Sweeney, N. M. (2009). Assessment and treatment of exces- sive straightening and destructive behavior in an adolescent diagnosed with autism. Journal of Applied Behavior Analysis, 42, 355–360. doi:10.1901/jaba.2009.42-355

Leach, M., & LeBeau, V. (2014, November 17). Deafness with autism: A school -age commu- nication perspective [webinar]. In Advanced Bionics Webinar Series. Retrieved from Audi- ology Online website: http://www.audiology- online.com/articles/deafness-with-autism-sc hool-age-13001

Lederberg, A. R., Schick, B., & Spencer, P. E. (2013). Language and literacy development of deaf and hard-of-hearing children: Suc- cesses and challenges. Developmental Psy- chology, 49, 15–30.

Mace, F. C., Pratt, J. L., Prager, K. L., & Pritchard, D. (2011). An evaluation of three methods of saying “no” to avoid an escalating response class hierarchy. Journal of Applied Behavior Analysis, 44, 83–94. doi:10.1901/jaba.2011 .44-83

MacFarland, S. Z. (1995). Teaching strategies of the van Dijk curricular approach. Journal of Visual Impairment and Blindness, 89, 222–228.

Malandraki, G. A., & Okalidou, A. (2007). The application of PECS in a deaf child with autism: A case study. Focus on Autism and Other Developmental Disabilities, 22, 23–32. doi:10.1177/10883576070220010301

Mancil, G. R., Conroy, M. A., Nakao, T., & Alter, P. J. (2006). Functional communication train- ing in the natural environment: A pilot inves- tigation with a young child with autism spectrum disorder. Education and Treat- ment of Children, 29, 615–633.

Mathy-Laikko, P., Iacano, T., Ratcliff, A., Villarruel, F., Yoder, D., & Vanderheiden, G. (1989). Teaching a child with multiple disabilities to use a tactile augmentative communication device. Augmentative and Alternative Com- munication, 5, 249–256.

McKenzie, A. R. (2009). Emergent literacy sup- ports for students who are deaf-blind or have visual impairments: A multiple-case study.

VOLUME 160, NO. 4, 2015 AMERICAN ANNALS OF THE DEAF

381

18811-AAD160.4_Fall2015 10/7/15 3:57 PM Page 381

Journal of Visual Impairment and Blind- ness, 103, 291–302.

McKenzie, A. R., & Davidson, R. (2007). The emergent literacy of preschool students who are deaf-blind: A case study. Journal of Visual Impairment and Blindness, 101, 720–725.

McLetchie, B. A., & Riggio, M. (1997). Competen- cies for teachers of learners who are deaf- blind. Watertown, MA: Perkins School for the Blind.

Meinzen-Derr, J., Wiley, S., Bishop, S., Manning- Courtney, P., Choo, D. I., & Murray, D. (2014). Autism spectrum disorders in 24 children who are deaf or hard of hearing. Interna- tional Journal of Pediatric Otorhinolaryn- gology, 78, 112–118. doi:10.1016/j.ijporl .2013.10.065

Miles, B. (2003). Talking the language of the hands to the hands: The importance of hands for the person who is deafblind. Retrieved from National Information Clear- inghouse on Children Who Are Deaf-Blind website: http://documents.nationaldb.org/ products/hands.pdf

Miles, B. (2005). Literacy for persons who are deaf-blind. Retrieved from National In - formation Clearinghouse on Children Who Are Deaf-Blind website: http://documents .nationaldb.org/products/literacy.pdf

Miles, B., & Riggio, M. (1999). Remarkable con- versations: A guide to developing meaning- ful communication with children and young adults who are deafblind. Water- town, MA: Perkins School for the Blind.

Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49, 248–264. doi:10 .1044/1092-4388(2006/021)

Miller, E. K., Swanson, L. A., Steele, N. K., Thelin, S. J., & Thelin, J. W. (2011). Forms and func- tions in communication. In T. S. Hartshorne, M. A. Hefner, S. L. H. Davenport, & J. W. The- lin (Eds.), CHARGE syndrome (pp. 295–313). San Diego, CA: Plural Publishing.

Miller, M., & Funayama, E. S. (2008). Life after high school for deaf youth with autism: Chal- lenges for students, parents, and profession- als. Odyssey: New Directions in Deaf Education, 9(1), 32–37.

Mirenda, P. (2015). Considerations in develop- ing and acquiring communication aids. In J. E. Downing, A. Hanreddy, & K. D. Peckham-Hardin (Eds.), Teaching commu- nication skills to students with severe dis- abilities (3rd ed., pp. 137–162). Baltimore, MD: Brookes.

Mood, D., & Shield, A. (2014). Clinical use of the Autism Diagnostic Observation Scale–sec- ond edition with children who are deaf. Sem- inars in Speech and Language, 35, 288–300. doi:http://dx.doi.org/10.1055/s-0034-1389101

Morton, D. D. (2008). Deafness and autism. Odyssey, 9(1), 4–5.

Murray-Branch, J., Udavari-Solner, A., & Bailey, B. (1991). Textured communication systems for individuals with severe intellectual and dual sensory impairments. Language, Speech, and Hearing Services in Schools, 22, 260–268.

Myck-Wayne, J., Robinson, S., & Henson, E. (2011). Serving and supporting young chil- dren with a dual diagnosis of hearing loss and autism: The stories of four families. American Annals of the Deaf, 156, 379–390. doi:10.1353/aad.2011.0032

National Center on Deaf-Blindness. (2013). National deaf-blind child count maps. Retrieved from https://nationaldb.org/child count

National Professional Development Center on Autism Spectrum Disorder. (2014). Evidence- based practices for children, youth, and young adults with autism spectrum disorder. Retrieved from http://autismpdc.fpg.unc.edu/ sites/autismpdc.fpg.unc.edu/files/imce/docu ments/2014-EBP-Report.pdf

Nelson, C., van Dijk, J., Oster, T., & McDonnell, A. P. (2009). Child-guided strategies: The van Dijk approach to assessment for understand- ing children and youth with sensory impair- ments and multiple disabilities. Louisville, KY: American Printing House for the Blind.

Olive, M. L., Lang, R. B., & Davis, T. N. (2008). An analysis of the effects of functional com- munication and a voice output communica- tion aid for a child with autism spectrum disorder. Research in Autism Spectrum Dis- orders, 2, 223–236. doi:10.1016/j.rasd.2007 .06.002

Olson, K., Miles, B., & Riggio, M. (1999). Environ- ments that encourage communication. In B. Miles & M. Riggio (Eds.), Remarkable con- versations: A guide to developing meaning- ful communication with children and young adults who are deafblind (pp. 76–93). Watertown, MA: Perkins School for the Blind.

Parker, A. T., McGinnity, B. L., & Bruce, S. M. (2012). Educational programming for stu- dents who are deafblind: A position paper of the Division on Visual Impairments. Retrieved from Council on Exceptional Chil- dren website: www.cec.org

Parker, A. T., & Pogrund, R. L. (2009). A review of research on the literacy of students with visual impairments and additional disabili- ties. Journal of Visual Impairment and Blindness, 103, 635–648.

Paul, P. (2001). Language and deafness (3rd ed.). San Diego, CA: Singular.

Pease, L. (2002). Creating a communicating envi- ronment. In S. Aitken, M. Buultjens, C. Clark, J. T. Eyre, & L. Pease (Eds.), Teaching chil- dren who are deafblind: Contact communi- cation and learning (pp. 350–382). London, England: David Fulton.

Picard, M. (2004). Children with permanent hearing loss and associated disabilities: Revis- iting current epidemiological data and causes of deafness. Volta Review, 104, 221–236.

Pittroff, H. (2011). Development of communi- cation in children with CHARGE syndrome. In U. Horsch & A. Scheele (Eds.), Com- pendium on CHARGE syndrome (pp. 213–236). Heidelberg, Germany: Median– Verlag von Killisch–Horn.

Pollack, B. J. (1997). Educating children who are deaf or hard of hearing: Additional learning problems (ERIC Digest No. 548). Retrieved from ERIC database. (ED414666)

Rispoli, M. J., Franco, J. H., van der Meer, L., Lang, R., & Camargo, S. P. (2010). The use of speech-generating devices in communica- tion interventions for individuals with devel- opmental disabilities: A review of the literature. Developmental Neurorehabilita- tion, 13, 276–293. doi:10.3109/17518421 003636794

Rodbroe, I., & Souriau, J. (1999). Communica- tion. In J. M. McInnes (Ed.), A guide to plan- ning and support for individuals who are deafblind (pp. 119–149). Toronto, Canada: University of Toronto Press.

Roizen, N. J. (2013). Down syndrome (trisomy 21). In M. L. Batshaw, N. J. Roizen, & G. R. Lotrecchiano (Eds.), Children with disabili- ties (7th ed., pp. 307–318). Baltimore, MD: Brookes.

Romski, M. A., & Sevcik, R. A. (2003). Augmented input: Enhancing communication develop- ment. In J. C. Light, D. R. Beukelman, & J. Reichle (Eds.), Communicative compe- tence for individuals who use AAC: From research to effective practice (pp. 147–162). Baltimore, MD: Brookes.

Romski, M. A., & Sevcik, R. A. (2005). Augmen- tative communication and early intervention: Myths and realities. Infants and Young Chil- dren, 18, 174–185.

Rosenhall, U., Nordin, V., Sandström, M., Ahlsén, G., & Gillberg, C. (1999). Autism and hearing loss. Journal of Autism and Developmental Disorders, 29, 349–357.

Rowland, C. (1990). Communication in the class- room for children with dual sensory impair- ments: Studies of teacher and child behavior. Augmentative and Alternative Communi- cation, 6, 262–274.

Rowland, C. (2011). Using the Communication Matrix to assess expressive skills in early communicators. Communication Disorders Quarterly, 32, 190–201. doi:10.1177/152574 0110394651

Rowland, C., & Schweigert, P. (1989). Tangible symbols: Symbolic communication for indi- viduals with multisensory impairments. Aug- mentative and Alternative Communication, 5, 226–234. doi:10.1080/074346189123312 75276

Rowland, C., & Schweigert, P. (2000). Tangible symbols, tangible outcomes. Augmentative

VOLUME 160, NO. 4, 2015 AMERICAN ANNALS OF THE DEAF

382

DHH WITH DISABILITIES: COMMUNICATION AND LANGUAGE

18811-AAD160.4_Fall2015 10/7/15 3:57 PM Page 382

and Alternative Communication, 16, 61–78. doi:10.1080/07434610012331278914

Schindler, H. R., & Horner, R. H. (2005). Gener- alized reduction of problem behavior in young children with autism: Building trans- situational interventions. American Journal on Mental Retardation, 110(1), 36–47.

Sevcik, R. A. (2006). Comprehension: An over- looked component in augmented language development. Disability and Rehabilitation, 38, 159–167. doi:10.1080/0963828050007 7804

Shield, A. (2010). The signing of deaf children with autism: Lexical phonology and per- spective taking in the visual-spatial modal- ity (Unpublished doctoral dissertation). University of Texas, Austin.

Shield, A. (2014). Preliminary findings of similar- ities and differences in the signed and spo- ken language of children with autism. Seminars in Speech and Language, 35, 309–320.

Shield, A., & Meier, R. P. (2012). Palm reversal errors in native-signing children with autism. Journal of Communication Disorders, 45, 439–454. doi:10.1016/j.jcomdis.2012.08.004

Siegel, E., & Wetherby, A. (2000). Nonsymbolic communication. In M. Snell (Ed.), Instruc- tion of students with severe disabilities. (5th ed., pp. 409–451). Columbus, OH: Merrill.

Siegel-Causey, E., & Bashinski, S. M. (1997). Enhancing initial communication and responsiveness of learners with multiple dis- abilities: A tri-focus framework for partners. Focus on Autism and Other Developmental Disabilities, 12, 105–120. doi:10.1177/10883 5769701200206

Sigafoos, J., Didden, R., Schlosser, R., Green, V. A., O’Reilly, M. F., & Lancioni, G. E. (2008). A review of intervention studies on teaching AAC to individuals who are deaf and blind. Journal of Developmental and Physical Dis- abilities, 20, 71–99. doi:10.1007/s10882-007 -9081-5

Silberman, R., Bruce, S., & Nelson, C. (2004). Children with sensory impairments. In F. Orelove, D. Sobsey, & R. Silberman (Eds.), Educating children with multiple disabili- ties: A collaborative approach. (4th ed., pp. 425–528). Baltimore, MD: Brookes.

Snell, M. E., Brady, N., McLean, L., Ogletree, B. T., Siegel, E., Sylvester, L., et al. (2010). Twenty years of communication intervention research with individuals who have severe intellectual and developmental disabilities. American Journal on Intellectual and Developmental Disabilities, 115, 364–380. doi:http://dx.doi.org/10.1352/1944-7558-115 -5.364

Snyder-McLean, L. K., Solomonson, B., McLean, J. E., & Sack, S. (1984). Structuring joint action routines: A strategy for facilitating communication and language development in the classroom. Seminars in Speech and Language, 5, 213–228.

Steinberg, A. G. (2008). Understanding the need for language: An Introduction to the Odyssey special edition on autism and deafness. Odyssey: New Directions in Deaf Education, 9(1), 6–9.

Swanson, L. A. (2011). Communication: The speech and language perspective. In T. S. Hartshorne, M. A. Hefner, S. L. H. Daven- port, & J. W. Thelin (Eds.), CHARGE syn- drome (pp. 253–274). San Diego, CA: Plural Publishing.

Szarkowski, A., Flynn, S., & Clark, T. (2014). Dually diagnosed: A retrospective study of the process of diagnosing autism spectrum disorders in children who are deaf and hard of hearing. Seminars in Speech and Lan- guage, 35, 301–308. doi:10.1055/s-0034 -1389102

Szarkowski, A., Mood, D., Shield, A., Wiley, S., & Yoshinaga-Itano, C. (2014). A summary of current understanding regarding children with autism spectrum disorder who are deaf or hard of hearing. Seminars in Speech and Language, 35, 241–259. doi:http://dx.doi .org/10.1055/s-0034-1389097

Szymanski, C. A., & Brice, P. J. (2008). When autism and deafness coexist in children: What we know now. Odyssey: New Direc- tions in Deaf Education, 9(1), 10–15.

Szymanski, C. A., Brice, P. J., Lam, K. H., & Hotto, S. A. (2012). Deaf children with autism spec- trum disorders. Journal of Autism and Developmental Disorders, 42, 2027–2037. doi:dx.doi.org/10.1007/s10803-012-1252-9

Thomas, M. C., Annaz, D., Ansari, D., Scerif, G., Jarrold, C., & Karmiloff-Smith, A. (2009). Using developmental trajectories to under- stand developmental disorders. Journal of Speech, Language, and Hearing Research, 52, 336–358.

Tiger, J. H., Fisher, W. W., Toussaint, K. A., & Kodak, T. (2009). Progressing from initially ambiguous functional analyses: Three case examples. Research in Developmental Dis- abilities, 30, 910–926. doi:10.1016/j.ridd.2099 .01.005

Trief, E. (2007). The use of tangible cues for chil- dren with multiple disabilities and visual impairment. Journal of Visual Impairment and Blindness, 101, 613–619.

Trief, E. (2013). STACS: Standardized tactile augmentative communication symbols. Louisville, KY: American Printing House for the Blind.

Trief, E., Bruce, S., & Cascella, P. (2010). The selection of tangible symbols by educators of students with multiple disabilities and visual impairment. Journal of Visual Impairment and Blindness, 104, 499–504.

Trief, E., Bruce, S., Cascella, P., & Ivy, S. (2009). The development of a universal tangible symbol system. Journal of Visual Impair- ment and Blindness, 103, 425–430.

Trief, E., Cascella, P., & Bruce, S. (2013). A field study of a standardized tangible symbols sys-

tem for learners who are visually impaired and have multiple disabilities. Journal of Visual Impairment and Blindness, 107, 180–191.

Van der Meer, L., Kagohara, D., Achmadi, D., O’Reilly, M. F., Lancioni, G. E., Sutherland, D., & Sigafoos, J. (2012). Speech-generating devices versus manual signing for children with developmental disabilities. Research in Developmental Disabilities, 33, 1658–1669. doi:10.1016/j.ridd.2012.04.004

Van Dijk, J. (1965). The first steps of the deaf- blind child toward language. In Proceedings of the Conference on the Deaf-Blind (pp. 47–50). Watertown, MA: Perkins School for the Blind.

Van Dijk, J. (1967). The nonverbal deaf-blind child and his world: His outgrowth towards the world of symbols. In Proceedings of the Jaarverslag Instituut Voor Doven, 1964–1967 (pp. 73–110). St. Michielsgestel, Netherlands: Instituut Voor Doven.

Vernon, M., & Rhodes, A. (2009). Deafness and autistic spectrum disorders. American Annals of the Deaf, 154, 5–14. doi:10 .1353/aad.0.0072

Volkert, V. M., Lerman, D. C., Call, N. A., & Trosclair Lasserre, N. (2009). An evaluation of resurgence during treatment with functional communication training. Journal of Applied Behavior Analysis, 42, 145–160. doi:10.1901/ jaba.42-145

Warren, S. F., Fey, M. E., Finestack, L. H., Brady, N. C., Bredin-Oja, S. L., & Fleming, K. K. (2008). A randomized trial of longitudinal effects of low-intensity responsivity educa- tion/prelinguistic milieu teaching. Journal of Speech, Language, and Hearing Research, 51, 451–470.

Warren, S. F., Fey, M. E., & Yoder, P. J. (2007). Differential treatment intensity research: A missing link to creating optimally effective communication interventions. Mental Retar- dation and Developmental Disabilities, 13, 70–77. doi:10.1002/mrdd.20139

Werner, H., & Kaplan, B. (1988). On develop- mental changes in the symbolic process. In M. Franklin & S. Barten (Eds.), Child lan- guage: A reader (pp. 7–9). New York, NY: Oxford University Press.

Wetherby, A. M., & Prizant, B. M. (2003). Com- munication and symbolic behavior scales (CSBS). Baltimore, MD: Brookes.

Whalen, C., Schreibman, L., & Ingersoll, B. (2006). The collateral effects of joint atten- tion training on social initiations, positive affect, imitation, and spontaneous speech for young children with autism. Journal of Autism and Developmental Disorders, 36, 655–664. doi:10.1007/s10803-006-0108-z

Wheeler, L., & Griffin, H. C. (1997). A movement- based approach to language development in children who are deaf-blind. American Annals of the Deaf, 142, 287–390. doi:10 .1353/aad.2012.0300

VOLUME 160, NO. 4, 2015 AMERICAN ANNALS OF THE DEAF

383

18811-AAD160.4_Fall2015 10/7/15 3:57 PM Page 383

White, F., Hayes, B., & Livesey, D. (2012). Devel- opmental psychology: From infancy to adulthood. (3rd ed.). Melbourne: Pearson Education Australia.

White, M. T., Garrett, B., Kearns, J. F., & Grisham- Brown, J. (2003). Instruction and assess- ment: How students with deaf-blindness fare in large-scale alternate assessments. Re - search and Practice for Persons With Severe Disabilities, 28, 205–213. doi:http://dx.doi .org/10.2511/rpsd.28.4.205

Wiley, S., & Innis, H. (2014). Supporting families of children who are deaf or hard of hearing

with an autism spectrum disorder. Seminars in Speech and Language, 35, 260–265. doi:dx.doi.org/10.1055/s-0034-1389098

Wiley, S., & Meinzen-Derr, J. (2012). Use of the Ages and Stages Questionnaire in young chil- dren who are deaf/hard of hearing as a screening for additional disabilities. Early Human Development, 89, 295–300. doi:10 .1016/j.earlhumdev.2012.10.005

Writer, J. (1987). A movement-based approach to the education of students who are sensory impaired/multihandicapped. In L. Goetz, D. Guess, & K. Stremel-Campbell (Eds.), Inno-

vative program design for individuals with dual sensory impairments (pp. 191–223). Baltimore, MD: Brookes.

Yeh-Kennedy, M. (2008). Brady, our first born son, has autism. Odyssey: New Directions in Deaf Education, 9(1), 26–30.

Zane, T., Carlson, M., Estep, D., & Quinn, M. (2014). Using functional assessment to treat behavior problems of deaf and hard of hearing children diagnosed with autism spectrum disorder. American Annals of the Deaf, 158, 555–566. doi:10.1353/aad .2014.0008

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