file · Web viewUniversity of Gloucestershire. BA (Hons) Education Studies

University of Gloucestershire

BA (Hons) Education Studies

May 2014

An exploration into the Total Communication approach when

supporting the communication difficulties in children with an

Autism Spectrum Disorder: a case study

Name: Michelle Oak

Student number: xxxxxxxxx

Dissertation Tutor: Richard Millican

Presented as part of the requirement for an undergraduate award within the

Academic Regulations for Taught Provision at the University of

Gloucestershire.

1

Declaration

DECLARATION: This dissertation is the product of my own work and does

not infringe the ethical principles set out in the University’s Guidelines for

Research Ethics. I agree that it may be made available for reference and

photocopying at the discretion of the University.

Signed: M. L. OAK

Name: Michelle Oak

Date: 1st May 2014

Word count: 10, 844

i

Acknowledgements

I would like to take this opportunity to offer my gratitude to my

dissertation tutor, and my placement mentor. This dissertation would not

have been completed without their invaluable advice and guidance.

ii

Abstract Page This study provides an exploration into the how the Total

Communication approach supports the communication difficulties of children

on the Autistic Spectrum. It also explores how the Total Communication

approach is tailored to the individual child. There was a wealth of literature

surrounding the topic, comprising mainly positive aspects of the Total

Communication approach, and the strategies used within. This case study

was conducted within a local Special school, with the principle focus on four

children who have a formal diagnosis of autism, all whom have a variety of

difficulties with their communication. The research methods used to collect

primary data were through observations of the four children, and through

interviews of four practitioners that work closely with the children. The

findings illuminated how the Total Communication was a successful

approach and how it was used for all children in a global sense, as well as

how it was tailored to support the children individually. Suggested

implications for education included understanding the child’s communication

difficulties to enable an individualised version of the approach, as well as

possibly implementing the approach for non-autistic children, whom have

communication difficulties, such as with people with are deaf or have learning

disabilities.

iii

Contents

Declaration....................................................................................................... i

Acknowledgements......................................................................................... ii

Abstract Page................................................................................................. iii

List of Figures.................................................................................................vi

Introduction.....................................................................................................1

Literature Review............................................................................................3

Introduction..................................................................................................3

Overview of Autistic Spectrum Disorder......................................................3

Communication and Autism.........................................................................9

Total Communication Approach................................................................14

Outcome of Literature................................................................................17

Methodology..................................................................................................18

Context......................................................................................................18

Paradigm...................................................................................................18

Data Collection..........................................................................................19

Reliability and Validity................................................................................22

Ethical considerations................................................................................23

Data Analysis and Presentation of Findings..................................................24

Introduction................................................................................................24

Data Analysis Process...............................................................................24

Overall Findings.........................................................................................26

Findings for Child J....................................................................................29

Findings for Child J.M................................................................................32

Findings for Child L....................................................................................34

iv

Findings for Child N...................................................................................36

Conclusion.................................................................................................38

Discussion.....................................................................................................39

Introduction................................................................................................39

Discussion of Child J.................................................................................41

Discussion of Child J.M.............................................................................42

Discussion of Child L.................................................................................43

Discussion of Child N................................................................................44

Conclusion....................................................................................................47

Critique on the research process...............................................................48

Implications for future practice...................................................................50

Implications for further study.....................................................................51

Bibliography..................................................................................................52

Appendices...................................................................................................63

Contents of appendices:............................................................................63

v

List of Figures Figure 1: Continuum of ASD...........................................................................4

Figure 2: Overall observational findings for all children.................................26

Figure 3: Overall type of responses given for all children.............................27

Figure 4: Overall observational findings for Child J.......................................29

Figure 5: Overall type of responses given by Child J....................................30

Figure 6: Overall observational findings for Child J.M...................................32

Figure 7: Overall type of responses given by Child J.M................................33

Figure 8: Overall observational findings for Child L.......................................34

Figure 9: Overall type of responses given by Child L....................................35

Figure 10: Overall observational findings for Child N....................................36

Figure 11: Overall types of responses given by Child N...............................37

vi

Introduction

Autism is a neurodevelopmental disorder which includes the trio of

impairments in social interaction, social imagination and social

communication (Mackenzie, 2008, p19). Communication difficulties are

universally present in individuals with autism (Tavalari, 2004, p13), where

usually a child with autism has difficulties with their receptive and expressive

communication, as well as the difficulty of having the understanding of non-

verbal communicative behaviours (American Psychiatric Association, 1994).

Therefore, communication in children with autism can be seen as a

common difficulty that they encounter. These difficulties will need to be

supported in an education setting, thus practitioners will need to use

strategies and approaches to enable this support (Hollander et al, 2011,

p550). One such approach that could be used is called the Total

Communication approach (Bell, 2011). This approach comprises the

principles of the Communication Bill of Rights 1992 (ASHA, 2014), where

communication is a right to everyone. It enables the child to use a

combination of alternative modes of communication to allow for

communication, thus supporting their communication difficulties (Sanderson,

2011, p6; NHS Cambridgeshire, 2013). Thus, using the Total Communication

approach means ‘a willingness to supplement the spoken word by using

objects, photographs, line drawings, symbols or sign’ (Sanderson, 2011, p6).

However, it is commonly known that children with autism exhibit

difficulties and needs in their communication in various ways, to various

degrees (Kenny, 2012; NHS, 2012). The extent of their difficulties could be

1

seen as a spectrum, where some experience more difficulties than others.

So, the children with these varying difficulties will need an approach that can

be tailored to the individual, to enable for their difficulties to be supported on

an individual basis (Waldock, 2014). It was in the researcher’s interest to

explore whether the Total Communication approach can provide the flexibility

to utilise the approach differently according to the individual’s needs; creating

a person centred approach. This will be conducted in the Special school

setting where the researcher works, to ascertain the value of this approach

with four selected children, whom have a formal diagnosis of autism.

Therefore, the overall aim of this study is to explore the Total

Communication approach, and how this supports and develops the

communication difficulties in children with autism. Accordingly, there are two

specific aims within this study;

1. To explore how the Total Communication approach supports children

with communication difficulties on the Autistic Spectrum.

2. To explore how the Total Communication approach is adapted and

modified to support these children individually.

This dissertation will follow a case study design, providing a review of

literature on autism, communication difficulties with autism, and the Total

Communication (TC) approach. This dissertation will also provide a

methodology outline, an analysis of the findings, and a discussion on these

findings coupled with a conclusion of the study.

2

Literature Review

Introduction

In this section, the literature surrounding autism and the

characteristics that depict autism will be explored. This will then filter down to

autism and communication difficulties, and finally the TC approach.

Overview of Autistic Spectrum Disorder

Definitions and overview

The National Autistic Society (NAS, 2014) and the National Health

Service (NHS, 2012) define autism as ‘a lifelong developmental disability that

affects how a person communicates with, and relates to, other people’. It is

also defined by Landa (2007, p16) as ‘a neurodevelopmental disorder

defined by impairments in social and communication development,

accompanied by stereotyped patterns of behaviour and interest’. It is on the

Autism Spectrum and it is commonly referred to as an Autism Spectrum

Disorder (ASD) (NAS, 2014). The term ‘spectrum’ is used because, while all

people with autism share certain difficulties, ‘the condition affects them

differently’ (NHS, 2012). Autism also shares certain difficulties with

Asperger’s Syndrome, Pervasive Development Disorder – Not Otherwise

Specified and Child Disintegrative Disorder.

3

Figure 1 below illustrates the continuum of ASD:

Figure 1: Continuum of ASD

The NHS highlight that it is a lifelong developmental disability, not a learning

disability or a mental health problem. However, people with autism can have

accompanying learning disabilities and mental health problems (NHS, 201 2).

Prevalence of autism

Statistics from the latest prevalence studies indicate that around 1.1%

of the UK population may have autism (The National Autistic Society, 2014).

This equates to over 695,000 people in the UK (The National Autistic Society,

2014), and around 100,000 of these people are children (The Office of

National Statistics, 2005). These statistics were taken from two relatively

recent prevalence studies on adults (Brugha et al, 2009) and on children

(Baird G et al, 2006, p210). To support this, The Office of National Statistics

(2005) states ‘Autism now affects about one in 100 children… with around

half a million family members directly affected by the condition’. Even though

this was reported in 2005 by the ONS, it can be seen from the triangulation of

research how common autism was previously and in the present.

Alongside this, interestingly, there are ‘five times as many males as

females who are diagnosed with autism’ (The National Autistic Society,

2014). Supporting this Carter (2007, p86) states ‘Autism is three to five times

4

more common in males than in females’. The most recent study by

Fombonne (et al, 2011, p904) found a mean of 5.5 males to 1 female in their

research paper.

Historical context

Autism was first identified by Leo Kanner in a paper published in 1943

entitled ‘Autistic disturbances of effective contact’ (Boucher, 2009, p4;

Mccallister, 2010, p23). He was the first scholar to identify many features of

autism and he ‘captured the three core features of what later came to be

called Autism Spectrum Disorders’ (Thompson, 2007, p2). It was defined as

disturbances of social relationships, limited use of language to communicate

and fixed repetitive routines and interests (Thompson, 2007, p2).

Autism was formally recognised as a condition in 1980, when the third

edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-III)

was published. It was known as ‘Infantile Autism’ and the core impairment

was seen to be language (Boucher, 2009, p10). As autism was thought of in

terms of a physical illness, Kanner would apply autism to the medical model

(Boucher, 2009, p4), where it was thought it was the person’s ‘problem’ and it

should be fixed (Moore, 2002, p402).

Causes of autism: Neurological/ biological and socio environmental causes

‘There is no known single cause for autism, but it is generally accepted

that it is caused by abnormalities in the brain structure or function’ (Autism

Society, 2013). Autism Society (2013) describes how brain scans have

shown differences in the shape and structure of the brain in children with

5

autism, compared to neuro-typical children. A neuro-typical person means

someone who is not on the Autistic Spectrum (Webster, 2010).

Autism also could be holistically developed through links among

heredity, genetics and medical problems (Autism Society, 2013). Sometimes,

there can be patterns of autism or related disabilities within families, which

supports the phenomenon that it could be hereditary causes, and that it has

genetic foundations (Autism Society, 2013). Supporting this, (Bailey et al,

1995) states approximately 92% of identical twins and 10% of fraternal twins

will also have autism (Dodd, 2005, p20). Following on this Dodd (2005, p20)

highlights ‘these findings support the hypothesis that there is a strong genetic

basis to Autism’.

There has been considerable speculation about whether autism could

be caused by ill-parenting (Whitman, 2004, p102). Kanner (1943 in Whitman,

2004, p102) observed parental behaviour with children with autism, and they

appeared to be ‘cold and aloof’. This is known as the ‘Refrigerator Mother

Theory’ (Bernier & Gerdts, 2010, p46). They were more preoccupied with

occupational and personal pursuits than their children, and according to

Bettelheim (in Bernier & Gerdts, 2010, p46), ‘it is the mothers’ coldness that

ultimately results in the child turning inward and retreating to Autism’.

However, there is little evidence to currently support this theoretical stance,

as parents with autistic children are variable in their parenting styles and

characteristics (Whitman, 2004, p102). Also, this does not account for the

parents who have neuro-typical siblings for the child with autism (Bernier &

Gerdts, 2010, p48). Although, Whitman (2004, p102) states that ‘it is not

unreasonable to assume that parents can exert considerable influence on the

6

general development of their children’. The parents who are proactive and

knowledgeable about autism may influence a better development that those

who are less involved. Therefore, this could cause the child with autism to

develop in a different way (Whitman, 2004, p102).

How is autism diagnosed?

Autism is diagnosed based on the features that the individual child is

showing. A team of professionals would carry out assessments on the child

(NHS Choices, 2014). They would be assessed on physical aspects,

behavioural aspects, language aspects and cognitive aspects, as well as

their interaction patterns (NHS Choices, 2014). Once this process is

complete, a diagnosis of ASD would be confirmed (NHS Choices, 2014).

Cure for autism

Currently, there is no known ‘cure’ for autism (TNAS, 2014). However,

interventions can be put in place to help. As more research increases our

understanding of autism, ‘more interventions will undoubtedly become

available’ (TNAS, 2014).

Due to the variable factor of severity in autism, individuals’ intervention

plans should be put in place, which ‘should be tailored to address specific

needs’ (Hutchings, 2013). These intervention plans can involve behavioural

treatments, medicines or both (Hutchings, 2013). Some of these intervention

programmes include playgroups, nursery classes for special needs and

speech and language therapy (TNAS, 2014).

7

Characteristics of Autism

Autism impacts the development of the brain in the areas of

communication skills, social interaction, and cognitive function (National

Autism Association, 2013). Individuals with autism typically have difficulties in

verbal and non-verbal communication, social interactions, and leisure or play

activities (National Autism Association, 2013).

Wing and Gould in 1979 (in Dodd, 2005, p2) created the term ‘triad of

impairments’ to describe a person with autism, as a result of a study they had

conducted on children with autism. The study concluded the three distinctive

impairments of autism as;

An impairment of social interaction/relationships

An impairment of social communication and

An impairment of social imagination

(Dodd, 2005, p2)

Not only did Wing (in Davis, 2013) define autism by categorising the

three characteristics, but she also looked at the behaviours, interests and

activities of people with autism too.

Social Interaction/relationships

The impairment in social interaction and relationships means that the

person with autism will have deficits in understanding how to behave and

interact with other people (Brookdale, 2011). They will have difficulty

recognising and understanding people’s feelings and managing their own

feelings (NHS, 2012). This is supported by the ‘Mind Blindness Theory’ by

8

Baron-Cohen (1997, p1), where he viewed a person with autism as being

‘aware of physical things but were blind to the existence mental things’

(Baron-Cohen, 1997, p1).

Social Imagination

Impairment in social imagination for people with autism will mean a

deficit in ‘flexible thinking regarding interests, routines, perspectives and

rules’ (Brookdale, 2011). They will have difficulty predicting other people’s

behaviours and intentions, as well as imagining situations that are outside of

their routine (NHS, 2012).

Behaviours, interests or actions

Wing (in Davis, 2013) described how people with autism may display

some ‘abnormal behaviours’. Examples of these behaviours could be;

becoming obsessed with a certain topic or object, focusing on routines and

rituals which have no practical function, extra sensitive or under sensitive to

smells, sounds, tastes or textures, as well as repeating actions, like hand

flapping (Davis, 2013).

Communication and Autism

Alongside social interaction, social imagination and behaviours, the

deficits in social communication could be crucial to how a person with autism

interacts, communicates and live their lives on a daily basis. Before exploring

the difficulties that a person with autism may experience when

communicating, it is significant that it is understood what communication

means and how we begin to communicate.

9

What is communication?

The definition of communication has always been unclear and

according to Steinberg (2007, p39), ‘there is little agreement among

communication scholars about a definition’. Communication could be defined

as:

‘Any act by which one person gives to or receives from another person

information about that person's needs, desires, perceptions, knowledge, or

affective states. Communication may take linguistic or nonlinguistic forms,

and may occur through spoken or other modes’

(National Joint Committee for the Communicative Needs of Persons with

Severe Disabilities, 1992, in Matson, 2011, p168)

Additionally, communication could be based on two views: a

technical view and a meaning-centred view (Steinberg, 2007, p39). ‘From a

technical point of view, communication can be defined as the transmission of

messages from one person to the other’ (Steinberg, 2007, p39). This is seen

as the physical act of communicating. Whereas, from the meaning-centred

view of communicating, alongside the transmission of the messages is the

interpretation and meaning. From this perspective, communication can be

defined as ‘a dynamic process of exchanging meaningful messages’

(Steinberg, 2007, p39).

When looking at this view of communication, though the lens of the

definition of autism, it is clear how people with autism can find difficulty

communicating. The definition states how people with autism have deficits in

communicating with people and relating to other people, so in regards to the

10

technical view of communication they may find difficulty with the physical act

of communicating. Additionally, in regards to the meaning-centred view,

people with autism tend to have difficulty understanding and recognising

other peoples’ feelings, as well as understanding what the meaning is

actually put across in a conversation. An example of this could be when

someone is using sarcastic language or if they are metaphorically speaking,

where the person with autism may take what is said literally (Miller, 2006,

p146).

When does communication start?

‘Communication begins long before we learn to talk’ (The Hanen

Centre, 2011). Babies show their interest in communicating by listening

intently, looking at people’s faces when they talk, and engaging in babbling

games with their parents, all in the first few months of life (The Hanen Centre,

2011). These exchanges of sounds and facial expressions are the first

conversations between a baby and parent, ‘even though the baby has never

uttered a word’ (The Hanen Centre, 2011). Infants start to imitate their

parents’ single words and actions, followed by the child starting to use their

first words on their own. Their language acquisition then leads onto two and

three word sentences (The Hanen Centre, 2011).

Verbal and Non-verbal communication and Autism

Having autism can affect communication through the means of verbal

and nonverbal communication to varying degrees. To support this, a study

shows that ‘some children with autism have normal language skills; for other

11

children, their language skills are significantly below age expectations’

(Kjelgaard and Flusberg, 2001, p287).

Verbal communication

Verbal communication can be divided into two main parts; expressive

(output) and receptive language (input). ‘Expressive language is our ability to

convey our thoughts into words with meaning, basically our ability to talk’

(Marrs, 2013). On the other hand, ‘our receptive language is our

understanding of what is being said to us’ (Marrs, 2013) and both of these

skills are needed to become an effective communicator (Marrs, 2013). A

study showed that in pre-schoolers with autism, there was a ‘greater

impairment in receptive compared with expressive language abilities’ (Hudry

et al, 2010, p681). This may possibly be because people with autism tend to

not understand the message that others put across in conversation, and lack

the ability to understand feelings and emotions (NHS, 2012). However,

according to Marrs (2013), ‘very often expressive language is impacted to a

greater degree than receptive language’ in people with autism. Additionally,

they may experience abnormal speech production, difficulty with intonation

and prosodic cues, may not respond to verbal cues, and have a difficulty with

meanings, prepositions, verbs and adjectives (NDCCD, 1998; Loita, 2002).

Supporting the concept of people with autism having expressive and

receptive communication deficits, a study showed that children diagnosed as

autistic had a more deviant language development than non-autistic children,

as well as having a more severe comprehension defect, a more extensive

language disability and also showed a defect in the social usage of the

language they possessed (Bartak et al, 1974, p127).

12

Non-verbal communication

Non-verbal communication involves all behaviours that are not in the

form of words (Guerrero and Floyd, 2006, p4). These behaviours could be

eye contact, body language, gestures and facial expressions (Tassoni, 2003,

p103; Ekman and Frieson, 1969 in Mehrabian, 2009, p1). This mode of

communication could arguably be the most important form. Mehrabian

(1967) created the Communication Model (Mehrabian, 2009, p182). This

shows that communication comprises of 7% of messages pertaining to

feelings and attitudes are words that are spoken. 38% of messages are

paralinguistic (the way that the words are said) and 55% of messages are is

in facial expression. Therefore, ‘facial expressions are the most dominant,

the vocal component ranks second and words are least significant’

(Mehrabian, 2009, p182). Thus, in relation to a child with autism, they may

experience great difficulty when non-verbally communicating, when having to

use eye contact or facial expressions. Tassoni (2003, p103) supports this by

stating ‘Some children with Autism may have difficulties understanding the

non-verbal signs that people send out’.

Supporting the niche of non-verbal deficits in people with autism, Stone

(et al, 1997, p677) conducted a study on children with autism and non-verbal

behaviours. They found that children with autism were less likely to point,

show objects, or use eye contact to communicate, but were more likely to

directly manipulate the examiner's hand. This showed that the children with

autism were less concerned about socially interacting, but were more

concerned to use communication as a tool to fulfil their needs

How do people with Autism communicate?

13

According to The National Autistic Society (TheNAS, 2014), a child

with autism may use different ways to communicate with others. Some of

these methods of communicating include; crying, looking at an object they

desire, reaching, and using pictures, taking an adults hand to the object they

desire and echolalia (TheNAS, 2014).

Echolalia is ‘the repetition of other people’s words and is a common

feature of the child with ASD’ (TheNAS, 2014). According to Roberts (1988)

(Dodd, 2005, p63) it should be seen as a language acquisition strategy, and

research suggests that echolalia is used to assist communication – to make

sense of what others say and to develop functional language skills. Initially,

when the child uses echolalia, it is likely that they are not aware of the

communicative content of the words that they are repeating, however it is

significant to recognise that it is a sign of emerging linguistic awareness, and

not an undesirable behaviour (Dodd, 2005, p63). When in a rich language

environment, the child ‘will begin to use the repeated words and phrases to

communicate something significant’ (TheNAS, 2014), therefore shifting to the

use of the meaning-centred communicative perspective.

Total Communication Approach

As people with autism primarily have deficits with communication,

there are ways to support this. One way could be using the Total

Communication approach (TC). The TC approach is going to be explored, as

well as the research surrounding TC and autism.

What is Total Communication?

14

The TC approach is defined as ‘an approach that requires the

incorporation of appropriate aural, manual and oral modes of communication

to ensure effective communication’ (Northern and Downs, 2002, p366). This

approach was found based on the principles of The Communication Bill of

Rights 1992 (ASHA, 2014), where everyone has a right to communicate

(ASHA, 2014). It ‘involves using any means of communicating’ (NHS

Cambridgeshire, 2013) and requires the use of a range of methods of

communication, as a combination, where some of these methods are

stressed differently for different people depending on their strengths and

weaknesses. A child’s communication needs will change over time, and will

benefit from different modes of communication as a result (NHS

Cambridgeshire, 2013). Supporting this, Waldock (2014) presents the view

that ‘Total Communication means using different ways of communicating

according to each situation and person’. These tools of communication can

be both verbal and non-verbal:

Speech and spoken language

Non-verbal cues: gesture, body language

Makaton signing

Photographs

Symbols: pictures, line drawings and objects

Written words

Song

(NHS Cambridgeshire, 2013; TC, 2014)

‘Makaton signing is a language programme using signs to help people

to communicate’ (The Makaton Charity, 2014). It is used to support spoken

15

language, through a combination of auditory and visual input, and the signs

are used in spoken word order (The Makaton Charity, 2014). Over time, as

the child’s speech develops, they can start to drop off some signs used to

support their speech. Additionally, Makaton can be flexibly used to support

individual needs (The Makaton Charity, 2014). Aarons & Gittens (2001, p73)

suggest that using Makaton signing is good for children with autism, as they

normally respond well to visual strategies, as well as reducing the pressure to

respond verbally.

Additionally, symbols are a way of visually communicating with the

child with autism, and it is recommended that the symbols should be

accompanied by the verbal expression when shown (TC, 2014). They can be

in the form of pictures, objects or line drawings (TC, 2014). They can be used

to develop language, as TC (2014) states ‘using symbols increases language

stimulation and gives a purpose for communication’.

Also, photographs are a visual method of communication with the

child, which is normally used in unison with speech, and sometimes written

words (Hawthorn, 2005). As well as this, song is used as a main purpose to

communicate the start and end of activities to develop awareness (Hawthorn,

2005).

‘50% of persons with autism has insufficient speech to meet their daily

communicative needs’ (Wing & Atwood, in Matson & Minshawi, 2006, p83)

so the ‘mixing and matching of communication methods should be

encouraged to produce optimal communication skills’ (ibid). Studies indicate

that Total Communication results in faster and more complete receptive

16

and/or expressive vocabulary acquisition than does using speech alone, in

children with autism (Yoder & Layton, 1988 in Mirenda, 2003, p204;

Remington, 1983, in Mirenda, 2003, p204). Additionally, the TC approach

appears to be particularly effective with low-verbal children with ASD, who

have poor verbal imitation’ (Lubetsky et al, 2011, p182). A further study

demonstrates the effects of TC in all areas of development, such as

academic, linguistic and psychosocial (Vernon & Andrews, 1990, p10).This

indicates how TC can be used as a successful method for developing

communication

However, the TC approach may have some limitations. Kurtz (2008,

p108) states that while some children with autism learn more easily when

using signed speech, others have trouble associating auditory with visual

symbols, and are best taught using sign alone. Also, another study suggests

that the TC may result in less developed speech skills (Geers and Moog,

1992, p1384).

Outcome of Literature

Reviewing this literature has given the knowledge basis to enable the

identified aims to be fulfilled. It has given a strong theoretical basis and

conceptual framework to work from in regards to autism, communication and

the Total Communication approach. All three entities are going to be

explored in relation to another with the participants of the study

17

Methodology

Introduction

This chapter will outline the context, the participants, the research

paradigm, the research methods, the reliability, validity and the ethical

considerations within this study.

Context

This research project will be conducted within a local special school.

The researcher works within an Early Years class, with eight pupils who have

a formal diagnosis of autism with communication difficulties. Four of these

children have been chosen to participate in this study. Therefore, the non-

probability purposive sampling method to select the participants has been

used for this study (Blankenship, 2010, p86). According to Blankenship

(2010, p86), this type of sampling provides ‘a focused effort in gathering rich

data to answer the research question’… it allows the researcher to identify

specific individuals who have the answer to the research question’

(Blankenship, 2010, p86; Adler & Clarke, 2011, p132). This sampling method

was also used for the four practitioners being interviewed in this study,

because they work closely with the four participants. The profiles of the

participants are in the appendices (Appendix Two).

Paradigm

According to Basit (2010, p14) ‘paradigms are models, perspectives or

conceptual frameworks that help us to organise our thoughts, beliefs, views,

and practices into a logical whole and consequently inform our research

18

design’. There are two types of paradigms in research; the normative

paradigm, and the interpretive paradigm (Basit, 2010, p14; Wimmer and

Dominick, 2013, p11; Kwanjai, 2013).

The normative paradigm focuses on ‘observing, experimenting on, or

interrogating a large number of subjects, resulting in findings that can be

statistically analysed, and therefore believe to be generalizable’ (Basit, 2010,

p14). Alternatively, the interpretive paradigm focuses on ‘smaller and in depth

analysis of human behaviour and perceptions, acknowledging differences as

well as similarities’ (Basit, 2010, p14), usually through the dominant methods

of observations and interviews (Golafshani, 2003, p600).

For this dissertation, the interpretive paradigm has been selected for

research. The justification for this being that this case study will be focusing

on a smaller and in depth analysis of behaviour and perceptions.

Data Collection

The case study approach within the qualitative approach has been

selected for this study. A case study is defined by Yin (2009, p18) as

‘empirical inquiry that investigates a contemporary phenomenon in depth

within its real-life context’. As well as this, a qualitative research approach

could be described as ‘any kind of research that produces findings not

arrived at by means of statistical procedures or other means of quantification’

(Strauss and Corbin, 1990, p. 17). This selection was made to allow for

qualitative research methods to enable the collection of empirical, primary

data. The methods selected for this case study are observations (of the

19

children) and interviews (with the practitioners). Selecting both of these

methods has enabled the findings in this study to gain triangulation.

According to Flick (et al, 2004, p178), ‘the term triangulation is used to

refer to the observation of the research issue from at least two different

points’. The observations will be of the TC approach in practice, and the

interviews will be with the practitioners in the setting who work closely with

the four children. This will display different perspectives of the research

conducted. Golafina (2003, p600) supports the concept of triangulation by

stating, ‘triangulation is typically a test for improving the validity and reliability

of research… it strengthens a study by combining methods’.

Observations

Observations will be taken over a five week period, where all four

children will be observed weekly, equating to twelve observations per child.

Clough and Nutbrown (2012, p54) define observations as simply ‘looking’.

This means ‘looking critically, looking openly and looking for information’

(Clough and Nutbrown, 2012, p54). Using this data collection tool will enable

the ‘opportunity to gather live data from naturally occurring social situations’

(Cohen at al, 2007, p397). This means the researcher will be able to observe

the children communicating and responding to communication methods in

their natural setting.

The observational approach that will be adopted is the ‘inactive and

unknown’ approach, in a naturalistic setting (Newby, 2010, p268). This

means that the data collection will be non-interventionist, as it ‘will not seek to

manipulate the situation or subjects’ (Adler and Adler, 1994 in Cohen at al,

20

2010, p397). The children will be observed in their classroom setting, where

the researcher will be completely detached from the situation. The

justification for this observational approach is to attempt to minimize the

‘Hawthorn Effect’, which means that participants may adjust their behaviour

because they are being observed (Jamison, 2006, p27; Newby, 2010, p122).

The observations will be semi-structured which means that these

observations ‘will have an agenda of issues, but will gather data to illuminate

these issues in a far less predetermined manner’ (Cohen at al, 2010, p397).

The researcher will be looking for communicative engagement with the

strategies used within the TC approach between the practitioner and each

child. These will be recorded through taking field notes which are ‘brief notes

during the observation, and then later expand the account of the observation

as field notes’ (Ary et al, 2013, p463).

Interviews

Interviews will be conducted with the practitioners following the five

week observation period. This method has been selected because it could

‘be used to collect facts… the questions seek to elicit information about

attitudes and opinions, perspectives and meanings’ (Hannan, 2007).

The chosen four practitioners, who work closely with the four children,

will be interviewed using a semi-structured interview. This means that there

will be a set list of questions (Appendix Three), with the ability to allow for

flexibility of additional questions or topics to be raised and discussed

(Hannan, 2007). These interviews will be recorded using an audio recording

21

device, which the participants will be made aware of before the interview

commences.

Reliability and Validity

According to Cohen (et al, 2007, p133), ‘validity is an important key to

effective research… if a piece of research is invalid then it is worthless’, thus

it is a requirement to any body of research. Validity could be defined as the

extent to which a research procedure measures what it is supposed to

measure, through the honesty, depth, richness and scope of the data

achieved, the participants approached and the extent of triangulation (Cohen

et al, 2007, p133; Bronfenbrenner, 1979, p29). In attempt to build out

invalidity, precautionary measures were taken. Firstly, the appropriate

qualitative research methods were selected for collecting data to answering

the research questions. Also, a multi-method approach will be used, to

triangulate findings. Additionally, appropriate clear aims have been selected

for the study (Cohen et al, 2007, p144).

Alongside this, the reliability of research is significant. Lincoln and

Guba (in Cohen et al, 2003, p148) prefer to replace the term ‘reliability’ in

qualitative research with ‘credibility’ or ‘dependability’. This is because

LeCompte and Preissle (in Cohen et al, 2003, p148; Thompson, 2010)

suggest that the canons of reliability for quantitative research may be simply

unworkable for qualitative research, as in qualitative research we are not

looking at scientific and statistical findings, but meanings instead. It has been

attempted to enhance the credibility of this research study by attempting to

standardise the data collection techniques. Also, by using the same basic

22

question protocol for the semi-structured interviews, and using the same

conceptual framework when observing the participants.

Ethical considerations

Good ethical practice and principles are a vital part to any form of

research. According to the University of Gloucestershire ‘the primary

responsibility for the conduct of ethical research lies with the researcher’

(University of Gloucestershire, 2008). Thus, to ensure ethical research,

ethical guidelines were present throughout the planning, implementing and

analysing procedures of this research project. It was vital that adherence to

the British Educational Research Association (2011) and University of

Gloucestershire guidelines (2008) ethical guidelines was ensured.

Under these guidelines, there are general responsibilities towards the

participants within ethical research. This includes; obtaining informed

consent, ensuring confidentiality and anonymity, informing the participant of

the ability to withdraw at any time and fully informing the participant on the

research to avoid deception (University of Gloucestershire, 2008).

It was the responsibility of the researcher to conduct a letter of

consent to obtain informed consent from the parent or guardian of the four

children (Appendix Four). A letter of consent was also conducted for the

practitioners in the setting to be interviewed (Appendix Five). This letter

displayed all of the relevant ethical guidelines applicable to this study.

23

Data Analysis and Presentation of Findings

Introduction

In this chapter, there will be a representation of the findings from the

observations and interviews that were conducted in this study. The global

observational findings of all children will be presented in graphs first, coupled

with a description of the findings. Then, the global interview findings of all

children will be described secondly. Following this, the totalled observational

findings will be presented in graphs and the interview findings will be

displayed individually for each child.

Data Analysis Process

Observations

It is important to gain an insight of the analysis process of the

observation data. Firstly, raw data was collected through field notes and

these were written up into twelve separate observations for each child, for

examples, see appendix six. Following this, these observations were coded

using a framework of strategies within the TC approach. These were:

Makaton signing, speech, symbols, photographs, non-verbal cues, written

words and song. In this study, the ‘symbols’ strategy was the use of basic

drawings to symbolise something, for example a drawing of a toilet. Also,

non-verbal cues included using gesture, hand/body movements, eye-contact,

facial expression and pointing (Tassoni, 2003, p103). The coding was

carried out for two purposes: to examine how many times the practitioner

used each strategy, and to see how many times the child would engage with

24

each strategy. This coding was then accumulated for each individual child, to

provide the overall representation that child.

Secondly, the type of responses from each child was explored. This

was to see how the child would respond to the strategies. This was coded by

the type of response the child gave which fell into three categories: verbal,

non-verbal and song. Verbal was identified as any form of speech used. Non-

verbal communicative behaviours included any form of gesture, body

movement, eye-contact, facial expression or pointing that indicated the child

was engaged. Also, song was identified as any form of singing that displayed

the child’s engagement.

Finally, the both sets of coded data were then accumulated for all

children, to provide a global perspective of the engagement of all children

and the general type of response that all the children gave.

Interviews

For the interviews, the data analysis process is as follows. Firstly, raw

data was collected from the practitioners, through four semi-structured

interviews, using an audio recording instrument to document this. These

interviews were targeted to the individual, through asking the same set of

questions, but with a focus on a particular child. These interviews were then

transcribed, followed by the needless data being rejected, revealing the main

findings of the interviews. The principal findings were extracted from the

interviews as an overall depiction, as well as looking at the findings for each

individual child.

25

Overall Findings

Overall observational findings

Firstly, the accumulated findings from all of the observations are

presented in Figure 2 below;

26

Figure 2 illustrates that the method used mostly within the Total

Communication approach was speech at 186 times. This received 126

responses (68%). Secondly, non-verbal cues were the second most used

method for communicating; it was used 104 times by the practitioners and

was responded to 82 times. In comparison to speech, this received a high

engagement rate of 79%. Thirdly, Makaton signing was the third most used

method of communication; it was used 42 times overall. This method

received engagement 34 times (81%).

Also, written words, photos and symbols were mainly used in unison

with each other, which all received a high response rate. Written words were

used 11 times, and were responded to 10 times, thus an engagement rate of

90%. Photos were used 10 times, and were responded to 9 times; giving an

engagement rate of 90%. Also, symbols were used to aid communication 12

times and received a response rate of 11 times; so again, this strategy

received a response rate of 90%. Additionally, song was used 5 times as a

method of communication, and received a response rate of 90%, thus it was

unsuccessful in one situation.

Therefore, it appears that speech, non-verbal cues and Makaton

signing were the main methods of communication used by the practitioner,

followed by symbols, written words, photos and song. The engagement rates

were high for most methods, apart from speech. However, speech is used in

27

unison with most methods, thus possibly meaning that using speech

independently as a method is not engaging for the children.

Figure 3 below illustrates the type of response that the child

participants gave to the methods used by the practitioner in Figure 2;

There were a total of 276 responses to 370 situations from the entire

48 observations from all child participants; thus a 75% response rate from all

children. These were divided into verbal responses, non-verbal responses

and responses by singing. Firstly, the child participants mostly responded to

the methods in Figure 2 non-verbally; 72% of the time. Secondly, the child

participants responded to the methods using verbal expression; 27% of the

time. Additionally, in one instance a child participant responded using song.

Overall interview findings

28

Figure 3: Overall type of responses given for all children

When examining the four interviews for general principal findings, the

themes that have emerged are: the effectiveness of the TC approach when

using it with the children, what methods are used to support the children’s

communication difficulties, and how this develops the communication skills of

the children.

All four interviewees appear to communicate positive aspects of the

TC approach, and the significance of it ‘I think it (TC) is essential really, if

we’re going to communicate’ (Interviewee Three). Additionally, all

interviewees highlight that a range of methods are used, which are

differentiated and adapted to suit the needs of the child ‘TC takes in every

aspect of the child’s communication and it is about us changing what we do

which is led by the individual child’ (Interviewee Two). They all appear to be

in agreement that it is a mixed method approach used, where some methods

are stressed more or less depending on the child ‘obviously we do use

gesture, Makaton signing, it’s because they’re visual learners’ (Interviewee

Two), also ‘it could be methods of communication like speech, using

symbols, signing, gesture, and it also depends on each child with what

method you use’ (Interviewee Four). They highlighted the importance of the

methods used to enable appropriate support for each child, depending on

their communication requirements. They all also relish on how the TC

approach has successfully supported the children, enabling progression and

development in their communication ‘more speech is being used now’

(Interviewee One) and ‘we have seen big progress’ (Interviewee Two).

Findings for Child J

Observational findings

29

Figure 4 illustrates the observational findings for Child J; this includes

the practitioner use of the methods within the TC approach and how many

times the participant displayed engagement to these methods.

30

Figure 4: Overall observational findings for Child J

Figure 4 illustrates that Child J responded to speech 30 out of 47

times, this was 63% of the time. Non-verbal cues were the second most used

method, where Child J displayed engagement 20 out of 30 times; this was

66% of the time. Following this, Makaton signing was the thirdly most used

method by the practitioner, where Child J responded 12 out of 14 times, thus

a high response rate of 86%. Additionally, following this was song, where he

responded both times that it was used, and then symbols were the least used

method of communication, where he responded to the one situation it was

used.

Figure 5 displays the type of responses given to the methods in Figure

4. Child J gave 66 responses, and these are divided into verbal, non-verbal

and song. Child J mainly used non-verbal means of communication as a

31

Figure 5: Overall type of responses given by Child J

response to the practitioner, as he used this method 60% of the time. Child J

also would respond using verbal expression at 38%. Child J also responded

by singing on one occasion (2%).

Interview findings

Principal findings that have been extracted from the interviews are his

communication needs and difficulties, how his needs are supported, and the

effectiveness of the TC approach when supporting and developing his

communication.

The interviewees highlighted that he has communication difficulties as

a result of both his formal diagnosis of autism, as well as using English as an

additional language (EAL) (DEECD, 2013), ‘Child J’s first language isn’t

English, so it has been quite difficult to understand what he wants’

(Interviewee One), and that his expressive abilities are particularly poor due

to his autism and the ‘barrier of language’ (Interviewee Four). It was

highlighted that the TC is essential for communicating with him, ‘it’s essential

to get any joint understanding and co-operation with Child J’ (Interviewee

Three), and that methods used were very visually based ‘Child J responds

well to picture materials, symbols, photographs, facial expression and

gesture’ (Interviewee Three). They state how the approach has been shifted

to a more language rich environment where ‘I have used increasingly more

language’ (Interviewee Three) to develop his expressive abilities where he is

listening, understanding and using speech more now. Although, the speech

is usually imitating practitioner’s words, and very minimal language use. The

Total Communication has been essential for his language development as

32

‘he is using more speech now’ (Interviewee One) and ability to communicate,

‘his communication has definitely developed’ (Interviewee Four).

Findings for Child J.M

Observational findings

Figure 6 illustrates the observational findings for Child J.M; this

includes the practitioner use of the methods within the TC approach and how

many times the participant displayed engagement to these methods.

Figure 6 illustrates that the practitioner uses speech as a main mode

of communication with Child J.M, where he showed engagement 35 out of 43

times; thus a response rate of 81%. Secondly, non-verbal cues received

engagement 26 out of 31 times, thus a response rate of 84%. Additionally,

Makaton signing was received engagement 10 out of 15 times; thus

33

Figure 6: Overall observational findings for Child J.M

engagement rate of 67%. Also, song received engagement 2 out of 3 times

and symbols were successful in its one use.

Figure 7 illustrates how Child J.M responded to the methods outlined

in Figure 6. Child J.M mainly used non-verbal expression 65% of the time as

a response. In comparison, Child J.M used verbal expression 35% of the

time as a response. Therefore, this demonstrates that Child J.M could be

very non-verbal based in this communication to the practitioner.

Interview findings

Main findings that have been extracted from the interviews about Child

J.M are his communication difficulties, how his difficulties are supported, and

the effectiveness of the TC approach when supporting and developing his

communication.

The interviewees appear to be aligned when expressing their thoughts

on Child J.M’s communication difficulties. He firstly had poor expressive

abilities when he joined the school, where ‘his speech was unclear and quite

34

Figure 7: Overall type of responses given by Child J.M

difficult to understand’ (Interviewee One), and as a result the practitioners

‘halved the amount of language used, emphasised sounds, and got his

listening primed for sounds’ (Interviewee Three). They found this approach to

be effective as ‘he uses a lot more clear speech now’ (Interviewee Four)

since starting school.

It was also found that Child J.M has poor receptive abilities ‘he has

issues with storing things in his head and understanding’ (Interviewee Three).

Thus, the interviewees highlighted that they give him time to digest

information, and time to respond ‘he always needs time to think about it, to

process it’. This has been successful when supporting his communication

difficulties because when asked, Interviewee One and Three agreed that it

has supported and developed his communication skills.

Findings for Child L

Observational findings

Figure 8 illustrates the observational findings for Child L; this includes

the practitioner use of the methods within the Total Communication approach

35

and how many times the participant displayed engagement to these

methods.

Figure 8 illustrates that Child L responded to speech 37 out of 63

times, which was 59% of the time. Non-verbal cues were the second most

used method, which were responded to almost every time at 90%. Then,

Makaton signing was the next most used method, which was responded to

also at 90% of the time.

Figure 9 illustrates the type of responses that Child L gave as a

response to the methods used by the practitioners in Figure 8. Child L mainly

used non-verbal cues as a communicative response 83% of the time. This

means that he used verbal expression only 17% of the time as a response.

Interview findings

36

Figure 9: Overall type of responses given by Child L

Main findings that have been extracted from the interviews about Child

L are his communication difficulties, how his difficulties are supported, and

the effectiveness of the TC approach when supporting and developing his

communication.

The interviewees were all in alliance when discussing Child L’s

communication needs, and how these are supported. When Child L started

school, his expressive abilities were poor, ‘when he first came to class, he

wasn’t using any language’ (Interviewee One), but Interviewee Three states

how they used visual based methods to ‘allow him to have options, which has

taken the pressure off his verbal expression’ (Interviewee Three). She also

claims that by using this approach, it has ‘caused him to use more language’

(Interviewee Three). As a result of this increasing verbal communication,

Interviewee Three states how they ‘are using less gesture, less Makaton

signing and increasing the use of verbal communication’.

Findings for Child N

Observational findings

Figure 10 illustrates the observational findings for Child N; this

includes the practitioner use of the methods within the Total Communication

37

approach and how many times the participant displayed engagement to

these methods. Figure 11 displays the type of responses given.

Figure 10 illustrates that Child N responded to speech 24 out of

33 times giving a response rate of 73%. Alongside this, non-verbal cues were

responded to 8 out of 12 situations (67%), as well as written words was

responded to 10 out of 11 times (90%). Also, symbols and photos were both

responded to 9 out of 10 times (90%). Makaton signing was a successful

method of communication, as this received a response rate of 100%.

Figure 11 illustrates the type of responses that Child N gave as a

response to the methods used by the practitioners in Figure 10. Out of 66

responses, Child N gave a total of 53 non-verbal responses (80%), and 13

verbal responses (20%). This demonstrates that Child N can be very non-

verbal in his communication.

Interview findings

38

Figure 11: Overall types of responses given by Child N

Principal findings that have been extracted from the interviews about

Child N are his communication difficulties, how his difficulties are supported,

and the effectiveness of the TC approach when supporting and developing

his communication.

Interview findings state that Child N has difficulties with his non-verbal

communication, as well as his expressive communication abilities ‘he was a

child, who used no language, and he would scream or take us to what he

needed’ (Interviewee Two). So, to support these difficulties, the interviewee

stated ‘we are using a mixture of photos, symbols and written words, as well

as gesture and Makaton signing, because he is a visual learner’ (Interviewee

Two). This approach has enabled him ‘to use a lot of language now, so it

(TC) works very well’ (Interviewee Two). Therefore, the TC approach has

been very effective for him ‘we have seen big progress from Child N, and it’s

through using the Total Communication approach’ (Interviewee Two), and

has enabled him to verbalise more ‘he is verbalising more, and he

understand a lot more vocal language’ (Interviewee Two).

Conclusion

To conclude, this section has offered a representation of the

observational data, displaying the findings from the child participants globally,

and on an individual basis. This chapter has also offered an insight to the

findings from the interviews for the children on an individual basis. These

findings have given the evidential basis to pursue further with a discussion on

each child participant with regards to the aims set out in the study.

39

Discussion

Introduction

This chapter is going to present a discussion, which will synthesise the

findings and the relevant literature in relation to the initial aims set out in the

study. It will follow the format of discussing the children globally; by looking at

the TC as a universal concept with all of the children. Following this, this

chapter will provide a discussion of the children individually, and how the TC

is differentiated and adapted to the children on an individual basis.

Global discussion of the TC approach with all four children

Whilst all children presented a variety of communication difficulties,

the TC approach appears to be a successful universal approach for all of the

four children. This is reflected in all four interviews, where the practitioners

tend to express the positive aspects of the TC approach, and how it has been

successful for all four children, ‘we have seen big progress, it’s through using

the Total Communication approach’ (Interviewee Two). This aligns with the

suggestion by Yoder and Layton (in Mirenda, 2003, p204), who indicate how

TC can be used as a successful method for developing communication in all

children with autism.

It is apparent that the practitioners use a similar framework of the TC

approach to support all of the children, which is then adapted to suit the

child’s needs. From drawing in the observation data, as well as the interview

findings, it is evident that all four children receive a mixed method approach,

where methods are stressed more or less depending on their individual

circumstances (NHS Cambridgeshire, 2013). This is essential as Wing and

40

Attwood (in Matson and Minshawi, 2006, p83) state ‘the mixing of

communication methods should be encouraged to produce optimum

communication skills’, which can be both verbal and non-verbal (Waldock,

2014). This is something that the practitioner’s viewed as an essential part of

TC, which then relieves the pressure to communicate using just verbal

expression (Interviewee Three) which aligns with the suggestion by (Aarons

& Gittens 2001, p73).

It is also apparent that all of the practitioners use a language rich

environment, something that The National Autistic Society (2014) endorses.

Additionally, it is also evident that the TC approach is very visually based for

all four children. This is reflected in the observational data, where all children

particularly receive Makaton signing, as well as other visual strategies (child

dependant). This aligns with the interview findings as Interviewee Two states

‘the children are visual learners’. To support this, Aarons and Gittens (2001,

p73) suggest that using Makaton signing is good for children with autism, as

they normally respond well to visual strategies.

Thus, it appears that the practitioners use the TC approach as a

successful method to support the children’s communication difficulties in a

global sense, where a similar framework is used for all children. Therefore,

this part of the discussion fulfils the first aim of this study ‘to explore how the

TC approach supports children with communication difficulties on the Autistic

Spectrum’.

However, it is also evident from the findings in this study that the TC

approach is adapted and modified to support these children individually,

41

which supports the notion by Waldock (2014), ‘TC means using different

ways of communication according to each situation and person’. The

discussion will now progress onto looking at the children’s difficulties and

how they are supported individually.

Discussion of Child J

Child J presents difficulties with his communication, as a result of two

factors: he has a formal diagnosis of autism, and he is Polish, so English is

used as an additional language (EAL) (DEECD, 2013). He mainly has

difficulties with his verbal communication, in both subsets of receptive and

expressive language, but particularly his expressive language, which are

both skills needed to be an effective communicator (Marrs, 2013). This is

reflected in the observation findings, where his type of response was mainly

non-verbal (66%).

The expressive difficulties presented in Child J are supported through

the use of the TC approach. The practitioners have used a mixed-method

approach with Child J, mainly focusing on speech, song, Makaton signing

and non-verbal cues. Non-verbal cues and Makaton signing were particularly

stressed for him as reflected in the observations, which consequently have

attempted to support his impaired expressive abilities (TheNAS, 2014).

The practitioners described in the interview how they used a very

visual based approach with Child J, but have recently moved onto creating a

more language rich environment for him. Thus, as a result of his progression,

they have adapted the methods used to support his communication

difficulties (Waldock, 2014).

42

As a result, Child J’s language developed, where his verbal

expressions were presented usually as one word sentences and through

using very simple language, usually as a result of imitation of the practitioner.

Therefore, Child J was demonstrating the use of echolalia, which is ‘a

common feature of a child with ASD’ (TheNAS, 2014). Thus, this has enabled

Child J to communicate through the technical view of communication, where

he can transfer a message to another (Steinberg, 2007, p39). This aligns with

the view by Lubetsky (et al, 2011, p182), where the TC approach is

particularly effective with low-verbal children.

Discussion of Child J.M

Child J.M principally presents communication difficulties with his

expressive and receptive abilities, which are both delayed. His expressive

abilities are greater than his receptive abilities however, which aligns with the

study conducted by Hudry (et al, 2010, p681).

In theory, due to his poor receptive abilities, Child J.M may have

difficulty communicating with a meaning, thus through the meaning-centred

view of communication, he may not understand communicative messages

(Steinberg, 2007, p39). However, the observational findings suggest

otherwise, as Child J.M responded 74 times to 93 communicative situations.

This means that he is demonstrating possibly good receptive abilities. This

may be as a result of the change in the approach used by the practitioners to

support him. Interview findings suggest that Child J.M had poor receptive

abilities when he joined the school, so the practitioners halved the language

used, and presented more processing and response time for Child J.M, thus

supporting and improving his receptive abilities. Additionally, they used

43

Makaton signing and non-verbal cues strategies in unison with speech to

reinforce ‘optimal communication skills’ as a result of a mixed-method

approach (Wing and Atwood, in Matson and Minshawi, 2006, p83).

Additionally, Child J.M’s expressive delay is evident in the

observational findings. Out of 93 communicative situations with the

practitioner, Child J.M responded using speech only 26 times. This may

mean that his expressive abilities are still developing. When he uses speech,

it is usually very minimal and unclear, by mainly using two or three word

sentences and this is an important stage of a child’s language acquisition

(The Hanen Centre, 2011). To support his expressive communication

development, the practitioners used a very verbal based approach, using

only literal speech, with his listening primed for clear sounds. This aligns with

the statement by Loita (2002), that children with autism have difficulty with

non-literal speech. As found in the interviews, this has been successful for

supporting his speech, as the practitioners expressed that he is using more

clear speech now. Thus, a verbally based mixed-method approach is a

supportive approach to communicating with Child J.M, and for supporting and

developing his communication difficulties.

Discussion of Child L

Child L presents communicative difficulties with mainly his expressive

abilities, which is not unusual in children with autism (Marrs. 2013). He only

uses language in a minimal sense to convey his needs, and initially it was not

for any social purposes (Bartak et al, 1974, p127).

44

To support his poor expressive abilities, the practitioners used a very

visual approach (Interviewee Three), as evident also in the observational

findings. They mainly used Makaton signing and non-verbal cues in unison

with speech. They also had previously used symbols and pictures, before his

language started to develop, which are methods that have now been faded

(Interviewee Three). This aligns with the suggestion of how methods should

be adapted to suit the individual’s need (Waldock, 2014) which will enable

development. They then moved on to creating a language rich environment

for him, thus exposing him to more sounds and vocabulary (The National

Autistic Society, 2014). Interviewee Three also stated how they dropped off

some Makaton signs, to be replaced with speech, which is seen as a

developmental progression (The Makaton Charity, 2014).

The adapted TC approach, where the practitioners moved from a

heavily visual based approach, to an approach which is now dominantly

speech, Makaton signing and non-verbal cues, is a successful way to support

Child L’s communication difficulties. He now uses more verbal expression,

where he uses speech to communicate for more reasons than to just fulfil his

needs (Interviewee Three). Thus, he is now communicating through the

meaning-centred view of communication (Steinberg, 2007, p39), with some

social elements to his communication.

Discussion of Child N

Child N principally presents difficulties with his non-verbal

communication, and with his expressive abilities. This means that not only

does he have difficulty with verbal expression, but he has difficulty

communicating with non-verbal cues and behaviours, which is arguably the

45

‘most important form of communication’ (Mehrabian 1967). This comprises

55% of all communication according to the Communication Model by

Mehrabian (1967). Thus, Child N may have difficulty communicating

meanings (Steinberg, 2007, p39; Tassoni, 2003, p103), and instead will

manipulate the practitioner’s hand to his needs (Interviewee Two). This aligns

with the study by Stone (et al, 1997, p677).

To support these communication difficulties, it is evident that the

practitioners use a wider range of methods within the TC approach to

communicate with him, to accommodate both his poor non-verbal

communication and his expressive abilities. The practitioners used some

methods in unison, to reinforce meanings and aid understanding (TC, 2014),

such as written words, symbols and photographs (Interviewee Two). The

practitioners also used Makaton signing, speech and non-verbal cues with

Child N. Thus, his approach is very visually based with the support of some

language. Interviewee Two states that this approach is progressive, and so

when Child N develops more language, then some methods will be dropped,

as the child’s communicative needs will have changed (NHS

Cambridgeshire, 2013).

This methodological approach with Child N has been a successful way

to support and develop his communication skills, particularly his expressive

abilities (Interviewee Two). The mixture of methods has offered him both

verbal and non-verbal means of communicating to encourage him to

‘produce optimal communication skills’ (Wing and Attwood, in Matson and

Minshawi, 2006, p83). Also, his development aligns with the statement by

46

Lubetsky (et al, 2011, p182), where this approach is particularly effective with

low-verbal children with ASD.

Therefore, it is evident that the children have all moved through

progressive stages at different degrees, when being supported by the TC

approach. It is clear that all of the children were initially supported heavily

through visual based strategies to enable them to communicate through

alternative ways to speech, which consequently has enabled them to develop

their verbal abilities alongside using visual aids. It can be seen how this is

done on an individual basis for each child, where the TC is modified and

differentiated to support the individual. Therefore, this part of the discussion

fulfils the second aim of this study ‘to explore how the Total Communication

approach is adapted and modified to support these children individually’.

47

Conclusion

The purpose of this chapter is to offer a summary of the study and

examine the understanding that has been gained, as well as to relate back to

the identified aims. This chapter will then offer a critique on this research

process, by examining the strengths and limitations that may have impacted

on the research. Following this, there will be an insight of the implications for

future professional practice and the implications for further study.

This case study aimed to explore the Total Communication approach,

and how this approach supports the communication difficulties in children

with autism. Accordingly, this led to two specific aims within the study:

1. To explore how the Total Communication approach supports the

children with communication difficulties on the Autistic Spectrum

2. To explore how the Total Communication approach is adapted and

modified to support these children individually.

It is felt that the aims in this research study have been achieved. The

findings in this study have offered an evidential basis to suggest that the TC

approach has been positively effective when supporting the communication

difficulties of the four children in this case study, and this has also been

explored into how this approach supports the children globally, thus

achieving the first specific aim. Additionally, the findings of this case study

enabled the exploration of the four children with an individual focus, by

looking at how the TC approach is modified and adapted to differentiate

between the four children, and to support their communication difficulties on

48

an individual basis. Therefore, this has enabled the second specific aim of

this study to be achieved.

This research process has offered the understanding that the TC

approach is an appropriate approach to enable children with autism, whom

have an array of communication difficulties, to communicate in a variety of

ways. The offer of alternative modes of communication appears to have a

positive effect on supporting the individual’s communication difficulties, which

has consequently developed all four of the children’s communication skills to

separate extents. Thus, conclusions could be drawn that the TC approach

could be an effective method to use when supporting the communication

difficulties in children with autism, something that is strongly reflected in the

surrounding literature (Yoder and Layton, in Mirenda, 2003, p204;

Remington, 1983, in Mirenda, 2003, p204; Wing and Atwood, in Matson and

Minshawi, 2006, p83). Using the TC approach to support communication

difficulties in children with autism could also be a recommendation as a result

of this research project.

Critique on the research process

This small scale case study was chosen to focus on four children who

had the formal diagnosis of autism, whom all have a variety of

communication difficulties. Adopting the case study method has enabled the

collection of unique data, to explore a particular phenomenon (Wallace,

2006, p161). However as the research was conducted on a small scale due

to time restraints, the collection of in depth data is questionable (Hodkinson

and Hodkinson, 2001, p9). Using a case study approach also lends itself to

the lack of ecological validity, meaning that the findings are not generalizable

49

in a conventional sense, and typical claims cannot be made (Hodkinson and

Hodkinson, 2001, p9). Although, it is possible to generalise that the TC

approach may be a suitable approach to adopt for all children with

communication difficulties, regardless of whether they have a formal

diagnosis of autism or not.

The first research instrument to gather data was observations. The

main strength of using this method was ‘the direct access to the social

phenomena under construction’ (University of Strathclyde, 2014). This

enabled the collection of first hand raw primary data. Additionally, using the

observational ‘inactive and unknown’ approach (Newby, 2010, p268) ensured

the limitation of the ‘observer effect’, where the ‘Hawthorn effect’ (Jamison,

2006, p27; Newby, 2010, p122) was minimised due to the unobtrusive nature

of the observations.

However, the principal limitation of using this research method is that

the data is susceptible to observer bias, where the observer may display

subjectivity (Szarkowicz, 2006, p22). This can undermine the reliability of the

data collected, and thus impact on the validity of the findings (University of

Strathclyde, 2014).

The second research method to gather data was semi-structured

interviews. The main strength of using this method was the flexibility of

questioning that enabled the exploration of more in-depth answers (Mitchell

and Jolley, 2007, p302; Hannan, 2007). This allowed for elaboration and

further investigation, however, this further exploration is susceptible to

interviewer bias, where the interviewer can have an influence on the

50

participants answering (Mitchell and Jolley, 2007, p291). Therefore, the

reliability of the findings may have been affected, which may have had an

impact on the validity of this study.

Therefore, the research process behind this case study holds both

strengths and limitations, which may have impacted on the reliability and

validity of this research body. The combining of the two research instruments

have enabled triangulation on the findings, and thus, this has attempted to

build out the unreliability and invalidity of this research, by offering different

data perspectives (Golafina, 2003, p600; Flick et al, 2004, p178).

Implications for future practice

Firstly, this research project offers the literature to enable a

practitioner an understanding on autism, and the characteristics that manifest

themselves in children with autism. The literature also offers an insight to the

array of communication difficulties that children with autism may exhibit.

Carrying out this research has highlighted the importance of supporting

children with autism, whom have communication difficulties (ASHA, 2014),

and how this can be supported; through the TC approach. Thus, this

research project offers an insight to how the TC approach is used to support

the children, and how it is differentiated to support the children’s individual

needs. It can be hoped that this study is a valuable addition to the existing

body of research in this field.

The findings from this research could be applied in professional

settings to advise practitioners of the importance of offering alternative

modes of communication (NHS Cambridgeshire, 2013) when supporting the

51

communication difficulties of children. The findings could also possibly reach

out to supporting children who do not have a formal diagnosis of autism, but

do have communication difficulties, such as deaf people (Branson and Miller,

2002, p215), EAL children or people with learning difficulties (Cameron and

Murphy, 2002, p105). Additionally, the understanding gained from this

research could offer advice on how to implement the TC approach on an

individual basis for children, where their communicative needs are targeted

and supported.

Implications for further study

As this research process was conducted over a short period of time, it

can only offer a small scale insight of the developmental process of the

children’s communication. Thus, if the opportunity for further study on this

research project was available it would be interesting to explore the TC

approach over a larger scale of time, to examine the true benefits of the

approach when supporting the children, and to explore the developmental

extent of the children as a result of this support.

52

Bibliography Aarons, M & Gittens, T (2001). The Handbook of Autism: A Guide for

Parents and Professionals. 2nd ed. London: Routledge. p73.

Adler, E & Clarke, R (2011). An Invitation to Social Research. USA:

Wadsworth Cengage Learning. p132.

American Psychiatric Association (1994): Diagnostic and Statistical

Manual of Mental Disorders, American Psychiatric Association. 4th

edition, Washington DC:

Ary, D. Jacobs, L. Sorenson, C & Walker, D (2013). Introduction to

Research in Education. 9th ed. London: Cengage Learning. p463.

ASHA. (2014). Communication Bill of Rights. Available:

http://www.asha.org/NJC/bill_of_rights.htm. Last accessed 19th Jan 2014.

Autism Society. (2013). Causes. Available: http://www.autism-

society.org/about-autism/causes/. Last accessed 6th Jan 2014.

Baird, G. et al. (2006) Prevalence of disorders of the autism spectrum in a

population cohort of children in South Thames: the Special Needs and

Autism Project (SNAP). The Lancet, 368 (9531), pp. 210-215.

Baron-Cohen, S (1997). Mind Blindness. USA: The MIT Press. p1.

Bartak, L, Cox, A & Rutter, M. (1975). A Comparative Study of Infantile

Autism and Specific Developmental Receptive Language Disorder. The

British Journal of Psychiatry. 126 (10), 127-145.

53

Basit, T (2010). Conducting Research in Educational Contexts. London:

Contiuum Books. p14.

Bell, I. (2011). Providing a Total Communication Approach. Available:

http://ianpbell.files.wordpress.com/2011/08/article-2.pdf. Last accessed

26th Apr 2014.

Bernier, R & Gerdts, J (2010). Autism Spectrum Disorders. California:

ABC-CLIO. p46-48

Blankenship, D (2010). Applied Research and Evaluation Methods. USA:

Human Kinetics. p86.

Boucher, J (2009). The Autistic Spectrum: Characteristics, Causes and

Practical Issues. London: SAGE Publications. p4.

Branson, J and Miller, D. (2002). Damned for their Difference. USA:

Gallaudet University Press. p215

British Educational Research Association. (2011). Ethical Guidelines for

Educational Research. Available: http://www.bera.ac.uk/. Last accessed

25th Jan 2014.

Bronfenbrenner, U (1979). The Ecology of Human Development::

experiments by nature and design. USA: Harvard College. p29.

Brookdale. (2011). What is Autism?. Available:

http://www.brookdalecare.co.uk/what-is-autism. Last accessed 8th Jan

2014.

54

Brugha, T. et al (2009) Autism spectrum disorders in adults living in

households throughout England: report from the Adult Psychiatric

Morbidity Survey, 2007. Leeds: NHS Information Centre for Health and

Social Care. Available to download at

http://www.hscic.gov.uk/catalogue/PUB01131 [Accessed 10/05/2013]

Cameron, L. & Murphy, J. (2002). Enabling young people with a learning

disability to make choices at a time of transition. British Journal of

Learning Disabilities, 30, p105-112.

Carter, A.S, et. al. (2007, January). Sex differences in toddlers with

autism spectrum disorders. Journal of Autism and Developmental

Disorders, 37 (1): 86-97.

Clough, P and Nutbrown, C (2012). A Student's Guide to Methodology.

3rd ed. London: SAGE Publications. p41-54

Cohen, L. Manion, L and Morrison, K (2007). Research Methods in

Education. Oxon: Routledge. p133 - 397.

Davis, D. (2013). Autism Defined. Available:

http://calgaryautism.com/defined.htm. Last accessed 13th Jan 2014.

Dodd, S (2005). Understanding Autism. Australia: Elsevier Australia. p2-

20

Flick, U. Kardorff, E & Steinke, I. (2004). A Companion to Qualitative

Research. London: SAGE Publications. p178.

55

Fombonne, E. Young Shin, K. Leventhal, B. Laska, E. Lim, E. Cheon, K.

Kim, S. Kim, Y. Lee, H. Grinker, R & Song, D. . (2011). Prevalence of

Autism Spectrum Disorders in a Total Population Sample. The American

Journal of Psychiatry. 168 (9), p904-912.

Geers, A and Moog, S. (1992). Speech Perception and Production Skills

of Students With Impaired Hearing From Oral and Total Communication

Education Settings. Journal of Speech, Language, and Hearing

Research. 35, p1384.

Golafshani, N. (2003). Understanding Reliability and Validity in Qualitative

Research. The Qualitative Report. 8 (4), p600.

Guerrero, L and Floyd, K. (2006). Nonverbal Communication in Close

Relationships. New Jersey: Lawrence Erlbaum Associates. p4.

Hannan, A. (2007). Interviews in Education Research. Available:

http://www.edu.plymouth.ac.uk/resined/interviews/inthome.htm. Last

accessed 2nd Feb 2014.

Hawthorn, M. (2005). Dismantling the Barriers: Giving a Voice to Disabled

Young People in Care. Facing Forward: Residential child care in the 21st

century. p57-68

Hodkinson, P and Hodkinson, H. (2001). The Strengths and Limitations of

Case Study Research. Learning and Skills Development Agency. p2-9.

Hollander, E. Kolevzon, A. Coyle, T. (2011). Textbook of Autism

Spectrum Disorders. USA: American Psychiatric Publishers. p550.

56

Hudry K, Leadbitter K, Temple K, Slonims V, McConachie H, Aldred C,

Howlin P, Charman T. (2010). Preschoolers with autism show greater

impairment in receptive compared with expressive language abilities.

Centre for Research in Autism and Education. 45 (6), p681.

Hutchings, J. (2013). How Is Autism Treated?. Available:

http://www.autismspeaks.org/what-autism/treatment. Last accessed 7th

Jan 2014.

Jamison, J (2006). Research Methods in Psychology. Lincoln: iUniverse.

p27.

Kenny, T.. (2012). Autism Spectrum Disorders. Available:

http://www.patient.co.uk/health/autistic-spectrum-disorders. Last

accessed 26th Apr 2014.

Kjelgaard, M and Flusberg, H. (2001). An Investigation of Language

Impairment in Autism: Implications for Genetic Subgroups. National

Institutes of Health. 16 (2-3), p287

Kurtz, L (2008). Understanding Controversial Therapies for Children with

Autism, Attention Deficit Disorder & Other Learning Difficulties. London:

Jessica Kingsley Publishers. p108.

Kwanjai, M. (2013). Research Paradigms. Available:

http://khwanjaiphd.blogspot.co.uk/2013/08/research-paradigm.html. Last

accessed 30th Jan 2014.

57

Landa, R. (2007). Early communication development and intervention

with children with autism. Mental Retardation & Developmental

Disabilities Research Reviews, 13 (1): p16-25.

Loita, M. (2002). Autism and Communication. Available:

http://autism14.tripod.com/. Last accessed 9th Jan 2014.

Lubetsky, M. Handen, B and Mcgonigle, J. (2011). Autism Spectrum

Disorder. Oxford: Oxford University Press. p182.

Mackenzie, H (2008). Reaching and Teaching the Child with Autism

Spectrum Disorder. London: Jessica Kingley Publications. p19.

Marrs, I. (2013). How Autism Affects Speech, Language and Eating.

Available: http://www.speechlanguagefeeding.com/autism-affects-speech-

language-eating/. Last accessed 9th Jan 2014.

Matson, J & Minshawi, N (2006). Early Intervention for Autistic Spectrum

Disorders. Oxford: Elsevier Ltd. p83.

Matson, J (2011). Clinical Assessment and Intervention for Autism

Spectrum Disorders. Oxford: Academic Press. p168.

Mccallister, J (2010). A Needs Assessment of Autism. Florida: Boca

Raton. p23.

Mehrabian, A (2009). Non Verbal Communication. 3rd ed. USA:

Transaction Publishers. p1, 182.

58

Miller, C. (2006). Developmental Relationships between Language and

Theory of Mind. American Journal of Speech-Language Pathology. 15,

p146.

Mirenda, P. (2003). Toward Functional Augmentative and Alternative

Communication for Students With Autism: Manual Signs, Graphic

Symbols, and Voice Output Communication Aids. American Speech-

Language-Hearing Association. 34 (1), p204.

Mitchell, M and Jolley, J. (2007). Research Design Explained. 8th ed.

USA: Wadsworth Cengage Learning. p291, 302.

Moore, S (2002). Social Welfare Alive!. 3rd ed. Cheltenham: Nelson

Thornes Ltd. p402.

NAS. (2014). What is Autism?. Available: http://www.autism.org.uk/about-

autism/autism-and-asperger-syndrome-an-introduction/what-is-

autism.aspx. Last accessed 1st Jan 2014.

National Autism Association. (2013). Autism Fact Sheet. Available:

http://nationalautismassociation.org/resources/autism-fact-sheet/. Last

accessed 9th Jan 2014.

NDCCD - National Dissemination Centre for Children with Disabilities.

(1998). Pervasive Developmental Disorders (Fact Sheet 20 - FS20).

Washington, DC: Author.

Newby, P (2010). Research Methods for Education. Essex: Pearson

Education Limited. p115-370.

59

NHS Cambridgeshire. (2013). Total Communication. Available:

http://www.slc.cambridgeshire.nhs.uk/ActivitiesIdeasandInfo/SpecialScho

ol/TotalCommunication/tabid/1626/language/en-GB/Default.aspx. Last

accessed 11th Jan 2014.

NHS. (2012). Autism Spectrum Disorder. Available:

http://www.nhs.uk/conditions/autistic-spectrum-disorder/Pages/Introductio

n.aspx. Last accessed 8th Jan 2014.

Northern, J & Downs, M (2002). Hearing in Children. 5th ed. USA:

Lippincott Williams & Wilkins. p366.

Sanderson, H.. (2011). Total Communication: Person Centred Thinking,

Planning and Practice.. Care Services Improvement Partnership. p6

Steinberg, S (2007). An Introduction to Communication Studies. London:

Juta and Company Ltd. p39.

Stone, W. Ousley, O. Yoder, P. Hogan, K & Hepburn, S. (1997).

Nonverbal Communication in Two- and Three-Year-Old Children with

Autism. Journal of Autism and Developmental Disorders. 27 (6), p677-

696.

Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded

theory procedures and techniques. Newbury Park, CA: Sage Publications,

Inc. p17

Szarkowicz, D (2006). Observations and Reflections in Childhood.

Australia: Cengage Learning Australia. p22.

60

Tassoni, P (2003). Supporting Special Needs: Understanding Inclusion in

the Early Years. Oxford: Heinemann. p103.

Tavalari, D. (2004). Communication in children with Autism Spectrum

Disorders (ASDs): An inquiry, by means of a case study, into how a pre-

school specialist provision for children with ASDs interprets theoretical

models of. MA Education of Children and Young People with Autism.

p13.

TC. (2014). Total Communication Gloucestershire. Available:

http://www.totalcommunication.org.uk/. Last accessed 11th Jan 2014

The Hanen Centre. (2011). How Autism Affects Communication in Young

Children. Available: When does communication start? Communication

begins long before we learn to talk. In the first few months of life, babies

show their interest in communicating by listening intently to the sound of

them. Last accessed 9th Jan 2014.

The Makaton Charity. (2014). About Makaton. Available:

http://www.makaton.org/aboutMakaton/. Last accessed 19th Jan 2014

The Office of National Statistics (2005), The Office of National Statistics

recently reported a rate of autism of 1% in the population of school-age

children. Mental health of children and young people in Great Britain,

London: Palgrave Macmillan.

TheNAS. (2014). Communication and Interaction. Available:

Communication and interaction. Last accessed 9th Jan 2014.

61

Thompson, P. (2010). Validity and Reliability of Qualitative Research.

Available:www.mubs.ac.ug/procdocs/Moral%20Distress/validity_and_relia

bility.ppt. Last accessed 2nd Feb 2014.

Thompson, T (2007). Autism Spectrum Disorders: Definitions and

Implications. Minnesota: The College of Education and Human

Development. p2.

TNAS (The National Autistic Society). (2014). Statistics: how many

people have autism spectrum disorders?. Available:

http://www.autism.org.uk/about-autism/myths-facts-and-statistics/statistics

-how-many-people-have-autism-spectrum-disorders.aspx. Last accessed

1st Jan 2014.

TNAS. (2014). Is There A Cure?. Available:

http://www.autism.org.uk/about-autism/autism-and-asperger-syndrome-

an-introduction/what-are-the-causes-is-there-a-cure/is-there-a-cure.aspx.

Last accessed 7th Jan 2014.

University of Gloucestershire. (2008). Research Ethics: A Handbook of

Principles and Procedures . Available:

http://insight.glos.ac.uk/researchmainpage/researchoffice/Documents/

Research%20Ethics%20Handbook%20final%20Nov%2010.pdf. Last

accessed 25th Jan 2014.

University of Strathclyde. (2014). Advantages and disadvantages of

observation. Available:

http://www.strath.ac.uk/aer/materials/3datacollection/unit5/advantagesand

disadvantagesofobservation/. Last accessed 23rd Apr 2014.

62

Vernon, M. & Andrews, J. (1990). Psychology of deafness. New York, NY:

Longman. p12

Waldock, A. (2014). Total Communication. Available:

http://www.oxtc.co.uk/whatisTC.shtml. Last accessed 11th Jan 2014.

Wallace, M (2006). Action Research for Language Teachers. 10th ed.

Cambridge: Cambridge University Press. p161.

Webster, J. (2010). Neurotypical. Available:

http://specialed.about.com/od/glossary/g/neurotypical.htm. Last accessed

6th Jan 2014.

Whitman, T (2004). The Development of Autism. London: Jessica

Kingsley Publishers. p102.

Wimmer, R & Dominick, J (2013). Mass Media Research. London:

Cengage Learning. p117.

Yin, R. (2009) Case Study Research. 4th Ed. London. Sage. p18

63

Appendices

Contents of appendices:

Appendix One: Tracking sheet

Appendix Two: Participant profiles

Appendix Three: Semi-structured interview questions

Appendix Four: Informed consent; form for parents/guardians

Appendix Five: Informed consent; form for practitioners

Appendix Six: Example of written up observations

64

Appendix One: Research Proposal and tracking sheet

Section 1

Ideas for a title:

An exploration into the Total Communication Aproach when supporting the

communication difficulties in children with an Autism Spectrum Disorder: a

case study.

What do I want to find out?:

1. To explore how the Total Communication approach supports children

with communication difficulties on the Autistic Spectrum.

2. To explore how the Total Communication approach is adapted and

modified to support these children individually

Why am I interested in this?:

I have been working at an SEN Early Years placement since September.

This is a new setting to me, and one that I have found fascinating. I have

been put in a class with children who are Autistic, and have communication

difficulties. The teacher and Learning Support Workers (LSWs) use a variety

of methods of interaction with the children, such as Makaton, visual aids and

oral speech in combination, and these methods are stressed differently for

different children depending on their strengths and weaknesses. This

provoked me to research into this further, and I discovered that this approach

was named the Total Comunication Approach. This is something I wished to

explore in depth.

Key research words:

Total Communication Approach. Autistic Spectrum Disorder. Communication

difficulties. Case study. Interpretive paradigm. Observations. Interviews.

How will I gather data to help me answer my questions?:

65

I intend to use semi-structured interviews and observations as instruments

for my data collection. I will be interviewing practitioners, and observing four

children with autism.

What type of research would it be?:

It would be in the Interpretive paradigm. The reseach will be qualitative,

using empirical primary data.

What books, journals, websites have I found that might be useful?

TEACCH. (2013). Faciliatated Communication. Available:

http://www.autism.org.uk/living-with-autism/strategies-and-approaches/

alternative-and-augmentative-communication/facilitated-communication.aspx.

Last accessed 8th Nov 2013.

Lubetsky, M. Handen, B & Mcgonigle, J. (2011). Autism Spectrum Disorder.

Oxford: Oxford University Press.

Stewart, D. (1992). Initiating Reform in Total Communication Programs.The

Journal of Special Education. 26 (1), p68-84.

The Milestone School. (2012). SEN policy. Available:

http://www.themilestoneschool.ik.org/attachments/SEN_Policy_Nov_12.pdf.

Last accessed 8th Nov 2013

Gloucestershire County Council. (2013). Total Communication.Available:

http://www.totalcommunication.org.uk/. Last accessed 8th Nov 2013.

Haynes, W. Moran, M & Pindzola, R (2006). Communication Disorders in the

Classroom. 4th ed. London: Jones and Bartlett Publishers.

What ideas, models, approaches, theories, frameworks have I found that might be useful to help me understand my topic, or analyse my data?:

Data analysis - Qualitative Data Analysis (QDA) -

Taylor, C and Gibbs, G (2010) What is Qualitative Data Analysis? (QDA)',

Available: http://www. style="line-height:

66

1.231;">onlineqda.hud.ac.uk/Intro_QDA/what_is_qda.php. Last accessed

11th Nov 2013.

Theory and practice - Total Communication Approach

Communication Model:

Mehrabian, A (2009). Non Verbal Communication. 3rd ed. USA: Transaction

Publishers. p1, 182.

Proposed time scale of targets:

Plan and Literature Review (First draft) - End of January

Data Collection - Collected by February

Data Analysis - End of February

Findings and overview - End of March

Final draft by Easter

Confirmation of having read the University ethics guidelines at:

http://insight.glos.ac.uk/researchmainpage/researchoffice/pages/

researchethics.aspx

I have read the University ethics guidelines and agree to abide by them*

‘Signed’ Michelle Oak: Date:11th Nov 2013

Section 2 (completed by tutors)

Dissertation approval panel feedback (by 15/11/13):

Approval given: Yes - on supervisor's approval of your methodology

Name of supervisor: Richard

Comments: An interesting topic.

Signed: Paul Dated: 13/11/13

67

Appendix Two

Participant One: Child J

Child J is five years old, and is in his first year at the school. He is Polish, so

English is an additional language (EAL) for him. His formal diagnosis is

Autism, and he also has severe communication difficulties. He responds well

to visual structure, Makaton signing, photographs and symbols. His means of

communicating tends to be facial expressions, body movement and

vocalisations, with the knowledge of simple words from separate categories,

such as animals, colours and numbers.

Participant Two: Child J.M

Child J.M is six years old, and is in his first year at the school. He was

referred to the Communication and Interaction team at this school last year,

and subsequently was transferred last September from a mainstream primary

school. His formal diagnosis is Autism with ADHD, and presents problems

with expressive and receptive language delay, speech delay and additionally

social communication difficulties. His communication profile describes that he

uses speech to communicate effectively for most purposes, and that he has

strong likes and dislikes. His receptive abilities are not as strong as his

expressive abilities.

Participant three: Child L

Child L is six years old, and is in his second year at the school. He has the

formal diagnosis of Autism, and he also has severe communication

difficulties. His receptive abilities are stronger than his expressive abilities.

68

He uses language that includes key words and short phrases to convey his

needs, likes and dislikes. Additionally, he responds well to visual structure,

Makaton signing, photographs and symbols.

Participant four: Child N

Child N is six years old, and in his second year at the school. He has the

formal diagnosis of Autism; where he presents many severe communication

difficulties. He has difficulties with his non-verbal communication, as well as

his expressive communication abilities. His means of communicating tend to

be through using symbols, pictures, minimal language and non-verbal cues.

69

Appendix Three

Interview questions

‘I have asked you to participate in my study by being interviewed because

you work closely with the four participants within the study. I am going to ask

you a series of questions surrounding the four participants, and how the Total

Communication approach is used to support each of these participants

individually. All data collected from this interview will be kept confidential and

will only be used for my research study. You have the right to withdraw at any

time’.

These questions will be asked with the focus on a particular child.

Questions:

1. What is your understanding of the Total Communication approach?

2. Do you feel that the Total Communication approach is an effective

way to communicate [named participant]?

--If so, how? Which methods do you use?

3. Do you feel that using a range of methods communication, within the

Total Communication approach is beneficial when developing [named

participants] communication skills?

4. Has [named participant] always responded to the same methods, or

have some methods been faded/added?

70

Appendix Four: Parent Informed Consent Form

I am an undergraduate student at the University of

Gloucestershire, studying for a BA in Education Studies.

As part of my degree, I have to conduct a research project. I wish

to explore the Total Communication approach and how this helps

to develop the communication skills of children on the Autistic

Spectrum. I wonder whether you would be willing to let your child

participate by being observed. This means I will be taking

observations of your child in their school setting.

The title of my research project is; an exploration into the Total Communication approach when developing communication skills in children on the Autism Spectrum; a case study.

Any information gathered will remain anonymous and would only

be used for my research project. It would not be used for any

other purpose and it would be destroyed immediately afterwards.

You would be free to withdraw your child at any stage should you,

or your child, not wish to continue.

If you are happy for your child to able to assist me in my study I

would be most grateful and would be pleased if you could sign

below to indicate your consent.

With thanks

MICHELLE OAK

I would like my child to take part in this study.

71

Signed ……………………………………

Print ……………………………………

Date. ……………………………………….

72

Appendix Five: Staff Informed Consent Form

I am an undergraduate student at the University of

Gloucestershire, studying for a BA in Education Studies.

As part of my degree, I have to conduct a research project. I wish

to explore the Total Communication Approach and how this helps

to develop the communication skills of children on the Autistic

Spectrum and I wonder whether you would be willing to participate

by being interviewed.

The title of my research project is; an exploration into the Total Communication Approach when developing communication skills in children on the Autism Spectrum; a case study.

Any information gathered will remain anonymous and would only

be used for my research project. It would not be used for any

other purpose and it would be destroyed immediately afterwards.

You would be free to withdraw at any stage should you not wish to

continue.

If you are able to assist me in my study I would be most grateful

and would be pleased if you could sign below to indicate your

consent.

With thanks

MICHELLE OAK

I would like to take part in this study.

73

Signed ……………………………………

Print ……………………………………

Date. ……………………………………….

74

Appendix Six

Examples of some observations that have been written up

These examples have been selected completely at random.

Observation example one

Context: Child J was asked to join the practitioner in a one on one session.

This session involved playing animal bingo, where the child has to match the

number of ladybird spots corresponding to the number on the ‘number card’.

Firstly the practitioner used speech to gain attention from Child J. She asked

him three times to look at the ladybird which she was pointing at on the table.

Child J was not paying attention, so the practitioner lifted the symbol of the

ladybird to Child J’s eye level. Once she had gained his visual attention, the

picture was placed back onto the table, followed by an instruction to count

how many spots the ladybird had. He mildly responded to this vocal

instruction, by repeating the word ‘ladybird’ three times. The practitioner than

placed his fingers on the dots to count them, and cued him to start counting.

He then consecutively counted the spots individually. Child J was then

distracted by another child playing within the class, so the practitioner then

used the Makaton sign ‘listen’, to regain his attention. She used this sign

twice, before Child J responded verbally with ‘ladybird’. The practitioner than

asked Child J to point to which number resembled the amount of spots on the

ladybird, to which he pointed at with the practitioner using verbal expression

to aid him.

75

Observation example two

Context: All of the children are sat down around a long table to have morning

snack. The practitioner is sat facing them all, giving them the choice of

blackcurrant or milk, and apple or pears.

Child J.M was given the choice of apples or pears verbally and visually (the

practitioner pointed to each fruit whilst verbally expressing the name of the

fruit), to which he quietly and unclearly responded with pears. He was asked

to repeat his choice louder for the practitioner to hear to which he did.

Following this, the practitioner asked Child J.M if he would like some more.

He did not respond, so she asked him to look at her, to gain eye contact. He

went to grab more pears from the table, but the practitioner interrupted him

by signing and saying ‘wait’ at his eye level. She then gave him the pears,

after he said ‘please’ nicely.

76