Contents

• Introduction
• Total Communication
• Sign Bilingualism
• Auditory Oral
• Choosing Options
• References

Total communication (TC)

The "failure" of oralism

During the 1980's the method known as total communication (TC) was developed in many homes and schools in Britain. It was introduced largely as a reaction against the apparent failure of "oralism" to fulfil its goals.

The oral approach, which prevailed in Britain for most of the 20th century, was based on the idea that deaf children could and should be as "normal" as possible by being taught to speak and understand the speech of others. However, in the latter part of the 20th century oralism came under severe criticism and major Government reports both in the USA and Britain (Note 2) revealed dispiritingly low educational outcomes for the majority of deaf children and young people: deaf young people were leaving school with unintelligible speech, lack of mastery of English language and poor literacy attainments. That pure oralism was failing most children in terms of their academic achievements led to the view that signs as well as speech should be used in communication and language development if deaf children were to stand any chance of achieving according to linguistic and educational potential.

The case for using signs

Total communication sounds a very attractive proposition.

TC, as originally defined (Note 3) involves the use of all methods of communication - hand and body gestures (Note 4), signs (Note 5), finger spelling, speech, hearing, lip movements and facial expression, used flexibly to suit individual children's needs, capacities and circumstances.

It is not intended that signs, finger spelling, etc, will replace speech: the use of hearing and exploiting residual hearing using the best possible amplification is essential in TC.

The idea is that visual communication will support audition and speech. The TC approach is described using a variety of terms - the bimodal approach, Signed English, Signs Supporting English - and day-to-day practices vary, but essentially it involves speech and signs used together.

Those who introduced TC believed that it was unfair to expect deaf children to perceive spoken language through the auditory channel alone. Speech and signs, sight and hearing, it is claimed, work together in a TC approach to enable the deaf child to get "the best of all worlds" from a communication point of view.

The signs used in a TC approach are taken from the sign languages used by members of the Deaf Community in a particular country. So, for example, in the UK, the signs are drawn from British Sign Language (BSL) and in the USA from American Sign Language (ASL). The sign system in a TC approach, however, differs from BSL in significant ways: BSL has evolved over the years within the British Deaf Community and has a very different structure from the structure of English or any verbal language. BSL is not a manual-visual form of English and cannot, therefore, be used simultaneously with speech. The signing of TC, however, is a signed form of English and, in theory, a sign can be produced simultaneously with each word that is spoken. It is a contrived system, therefore, which takes signs from BSL but presents them in English word order.

It is easy to see the appeal of TC: signs are 100% accessible to the deaf child, whereas speech is heard imperfectly. The TC approach appears to offer a deaf child easy communication and access to verbal symbols through sign whilst at the same time making use of whatever residual hearing the deaf child has.

An evaluation of the TC approach

Since there have been many years of experience of TC practice, both in the USA and the UK, it should be possible to judge the effectiveness of this approach.

A problem with evaluating TC, however, is that it is extremely difficult to pinpoint exactly what people are doing in the name of total communication.

In the home, for example, many parents of young deaf children choose to use signs and may be encouraged to use signs by the professionals who support them (Note 6). Yet we do not know how much signing is used in the home - whether formal signs are used extensively or whether "signing" amounts to a few gestures and home-invented signs. We do not know if parents use speech at the same time as the sign(s) or speak after or before the signing.

Even in schools practices vary a great deal: some teachers with a wide sign vocabulary may sign simultaneously with their speech throughout the school day. Other teachers may use signs only in a few specific lessons for the purpose of teaching grammatical points, new vocabulary, difficult concepts. Teachers and support assistants in mainstream classrooms may use an occasional sign to translate a key item spoken by the class teacher to support the deaf pupil's understanding of the lesson. Alternatively, the teacher/support assistant might command the whole attention of the deaf pupil(s) in the class attempting a full translation into signed English of what the class teacher is saying when addressing her class.

Despite the lack of standardised practice, research evidence relating to TC suggests that TC, like the oralism of the past, does not live up to its claims.

Evidence of TC failure

Several research studies have led to the consistent finding that the use of signs and speech beyond the early stages of communication development undermines the acquisition of verbal language, literacy and intelligible speech (Note 7).

The large-scale surveys of the attainments of deaf children and young people in the USA in the late 80's and 90's offer perhaps the most serious indictment of the use of TC during the school years.

The surveys, which involved thousands of deaf children and young people, indicate that TC­ educated young people were leaving school with standards of literacy and speech achievements that were no higher than those of deaf young people leaving school in the 1950's and 1960's, that is, before the introduction of TC (Note 8).

The majority of profoundly deaf TC educated children in the USA not only lacked intelligible speech on leaving school but also, with an average reading age of around eight years, they lacked even basic literacy (Note 9).

Research work in the late 1970's and 1980's offers reasons why TC fails to achieve its goals.

One reason is that it is difficult to put into practice. A signed form of English takes about twice as long as the spoken form to articulate. Transcripts of speech-and-signs indicate distortions to speech, which is slowed down and over-simplified, also distortions to the signed component where signs are typically omitted. This is especially the case with "difficult" vocabulary and signs conveying grammatical information (Note 10).

TC has been shown, therefore, to be doing the very opposite of what is claimed - ensuring "total" linguistic information.

It has also been demonstrated that very deaf children, if presented with signs and speech together, are likely to orientate to the signs rather then the speech since it is beyond the capacity of the human brain to decode spoken language through hearing, and signs through vision, at one and the same time (Note 11).

Extensive use of TC thus tends to turn deaf children into "visualizers" rather than "listeners".

TC - a route to speech?

Not all advocates of TC or "speech plus signs" are in favour of its use throughout a deaf child's educational and communication development.

Some (Note 12) consider that using simple signs and gestures during the early years can be an important means of establishing communication in deaf infants. Deaf infants, like any other, use their eyes to scan the environment, to notice objects and events.

It is felt that caregivers can offer helpful gestures, such as pointing to objects, miming actions such as washing the face or going to sleep and make use of formal signs such as for "mummy" or "daddy" in response to the infant's visual attention.

In so doing, it is claimed, parents not only develop satisfying interaction and communication, but also provide readily accessible linguistic symbols. Supporters of TC in the early years claim that, far from detracting from the development of spoken language, the early use of signs facilitates speech communication.

The pressure to use and receive speech, and only speech, is removed.

By being able to use gestures and signs in the early years, it is claimed that the deaf child gains confidence in communication and is better able to cope with the more difficult task of receiving and producing speech.

To facilitate this approach parents and members of the family need to learn some signs, but the task of learning some basic signs is not as demanding as that of learning a complete new language such as BSL.

Robinshaw's (1992) work with deaf infants suggests that gesture and sign may have a constructive role to play in the young deaf child's progression to speech. Robinshaw examined the transition from non-communicative behaviour to language production in both deaf and hearing infants:

For all the infants, deaf and hearing, the use of communicative gesture, such as hand movements and facial expression, formed an important step from pre-symbolic to symbolic language.

The deaf infants' use of gesture as a primary means of communication continued over a longer period compared with the hearing infants, but the deaf children's use of gesture did decline towards the end of the period of study, i.e., as the children approached two years of age.

It was then that their auditory perception noticeably improved and their attempts at speech became more intelligible to care-givers.

Robinshaw concluded that the use of gestures and even formal signs with deaf infants may be helpful in promoting mutual communication between deaf child and care-giver at a time when interpreting the vocalisations of the deaf child is difficult.

She warns, however, that once the deaf child begins to perceive and discriminate auditorily the continued use of signs will have a detrimental effect on the development of auditory discrimination and vocal/verbal development. Children need to develop their capacity to listen and the over-use of signs might deny them the opportunity.

Does TC support the communication of children who receive cochlear implants?

There is some evidence that the use of signs might be detrimental to the development of speech communication if used with deaf children who receive cochlear implants.

There have been several recent studies comparing TC use with auditory-oral practice with implanted children (Note 13).

All these research studies compared two groups of implanted children: there were groups who were receiving a TC approach both pre- and post-implant and other groups who were receiving an auditory­ oral approach pre- and post-implant.

The studies indicate that all the children, oral or TC, made impressive language gains. On average, children wearing multi-channel implants made one year of language progress in one year's time. However, the findings relating to speech perception and speech intelligibility reveal that the children who used oral communication consistently, achieved higher speech perception and speech intelligibility than did the children who used total communication. The "oral" group were considerably superior to the "TC" group in negotiating with the hearing world, e.g. in restaurants, shops.

Research by Zimmerman-Phillips et al (2001) provides some support for using signs in the very early stages of communication where implantation itself is early. This research suggests that the use of signs prior to implantation may be helpful, or at least do no harm, to a deaf child's speech and listening capacity.

Zimmerman-Phillips et al found that for children implanted between 24 and 36 months, auditory-oral children showed faster progress with audition and speech than did total communication children. However, for children implanted earlier (between 12 and 24 months) there were no differences between the oral and the TC groups.

This finding seems to confirm the suggestion of Dowell et al 1996, that very early implantation may reduce the impact of factors that traditionally have adversely influenced performance levels in children.

In other words, it would seem that children whose language development is, therefore, at the very early stages naturally show a preference for auditory-oral communication when implanted.

These days, cochlear implantation is becoming the norm for profoundly deaf children in Britain and the age of implantation is coming down (Note 14). So how should parents, whose child is likely to receive a cochlear implant and who want that child to develop spoken language, communicate with their child prior to implantation?

If the child is profoundly deaf, vocal and verbal interaction may not develop as easily in early infancy as it would with a normally hearing infant. Some parents may feel they should use signs and gestures to help two-way communication along prior to the improvement in hearing capacity brought about by the cochlear implant.

The research evidence cited above suggests that using some simple signs in addition to gestures while the baby is under two probably does not inhibit later auditory-oral development provided that signs are not over-used and that there is an emphasis on speech.

There is no evidence, however, that signs improve the later development of speech or language.

So, probably, parents should do whatever they feel is best for themselves and their deaf child.

But they should certainly heed the warning that an implanted child needs a reasonable chance to utilize the auditory information provided by the implant (Note 15).

If a child has become a visual learner then she will remain a visual learner if real-life opportunities for listening and developing listening capacity are not provided.

Robbins (2002) advises that conversational information should be presented first without signing. Only if this is unsuccessful should signs be added. Once information is clarified parents, according to Robbins, should repeat the information through speaking and listening alone, thus creating an "auditory sandwich".

There is a problem with the use of signs in the early years where children are implanted at a later stage. Some parents may not feel in a position to make up their minds about a cochlear implant in the very early stages, especially if they have only just learned that their child is deaf. It is possible also that the precise level of their child's hearing loss has not been firmly ascertained.

Where parents need time before they make a decision about a cochlear implant for their child it is very important that the habits of listening and making good use of conventional hearing aids are well established in the child.

There is a danger that the early use of signs may detract from the development of audition and that the deaf child acquires the habits of a "visualizer", habits which may be difficult to break despite having a cochlear implant.

There is, then, qualified support for the use of TC, that is, gestures, speech and signs in the early days, as an aid to mutual communication between adult and deaf baby in the "here and now".

There is no evidence that the early use of TC actually improves the later acquisition of speech and verbal language.

And, if practised extensively as a means of developing English language, TC seems to lead neither to intelligible speech nor to acceptable standards of literacy.   - Many people who believed during the 1980s that a combination of speech and signs would provide a solution to the problem of giving language to deaf children became fiercely critical of TC during the 1990's (Note 16) and came to favour what in Britain we call a sign bilingual approach.