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Is awesome really awesome?
Research in Developmental Disabilities 27 (2006) 56–69
Is awesome really awesome? How the inclusion of informal terms on an AAC device influences children’s attitudes toward peers who use AAC§ Ann R. Beck *, Stacey Bock, James R. Thompson, Linda Bowman, Stacey Robbins 4720 Speech Pathology and Audiology, Illinois State University, Normal, IL 61790-4720, USA Received 20 February 2004; received in revised form 15 July 2004; accepted 15 November 2004
Abstract Two videotapes were created of a child communicating with a voice output augmentative and alternative communication (AAC) device. In one the child communicated using formal English only and in the other the child communicated using formal English and age appropriate informal terms. Children in grades 4 and 5 viewed either the formal English only or the formal and informal English videotape. After viewing the videotape, children completed a measure of self-reported attitudes toward children who use AAC. Results indicated effects for gender and for the gender by grade interaction. These results are discussed along with clinical implications. # 2005 Elsevier Ltd. All rights reserved. Keywords: Attitudes; AAC device; Children
Since passage of the Education for All Handicapped Children Act (PL 94-142) in 1975, children with disabilities have had the right to obtain a free and appropriate public education. According to Guralnick (2001) ‘‘one of the most far-reaching and perhaps § Portions of this paper were the basis for a poster presentation at the 2003 American Speech-Language-Hearing Association Convention in Chicago, Illinois. * Corresponding author. Tel.: +1 309 438 2654; fax: +1 309 438 5221. E-mail address: [email protected] (A.R. Beck).
0891-4222/$ – see front matter # 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.ridd.2004.11.013
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radical components of this legislation is related to the prospect of providing services and supports to young children with disabilities together with typically developing children in what is now referred to as inclusive environments’’ (p. 3). Guralnick states further that there are many practiced forms of inclusion throughout schools and that the degree to which children with and without disabilities are included together varies significantly from school to school. Regardless of the form inclusion takes, however, the feature that defines inclusion is the ‘‘existence of planned participation between children with and without disabilities in the context of children’s educational/developmental programs’’ (Guralnick, p. 3). Planned participation between children with and without disabilities can result in various positive outcomes. Diamond and Innes (2001) reported that interactions with peers without disabilities can increase peer-related social skills of children with disabilities. For children without disabilities, interacting with peers with disabilities can enhance an understanding and appreciation of individual differences and promote more accepting attitudes towards peers with disabilities. In order for these positive outcomes of inclusion to be optimally realized, planned participation must target academic and social integration of children with disabilities into the classroom (Beukelman & Mirenda, 1998). The extent to which social integration of peers with disabilities occurs will be influenced significantly by attitudes other children hold toward their peers with disabilities (Diamond & Innes, 2001). As Diamond and Innes point out ‘‘For people with disabilities, negative attitudes may be just as effective as physical, architectural barriers in limiting opportunities to participate fully in schools and communities’’ (p. 160). Research has documented that one type of disability toward which people hold negative attitudes is a communication disability (e.g., Burke, 1994; Lallh & Rochet, 2000; Rice, Sell, & Hadley, 1991). Ability to communicate is an essential element of successful interactions between individuals and, even as early as preschool age, children perceive peers who differ from themselves on the basis of communication (Gertner, Rice, & Hadley, 1994). Diamond (1993) found that impaired language skills were among the types of disabilities of which young children were most aware. Not only are children aware of communication differences among their peers, but they have been found to discriminate against their peers who have such differences (Gertner et al., 1994). Approximately 0.3–1% of school-aged children have such complex communication needs that they are unable to communicate functionally through spoken language and are candidates for augmentative and alternative communication (AAC) systems (Glennen & DeCoste, 1997). One of the main concerns of interventionists who work with children who use AAC is to ensure that those children are able to participate in activities of daily life and are included and accepted by their peers (Beukelman & Mirenda, 1998; Downing, 1999). Knowledge of the determinants of children’s attitudes toward peers who use AAC is important in aiding school professionals in creating optimal planned participations between children who do and who do not use AAC. Prior research shows that one determinant of children’s attitudes toward peers who use AAC is gender. In general, boys report less positive attitudes toward peers who use AAC than do girls (Beck & Dennis, 1996; Beck, Fritz, Keller, & Dennis, 2000; Blockberger, Armstrong, O’Connor, & Freeman, 1993). Beck et al. (2000) reported that the attitudes of boys became less positive as they increased in age from first through fifth grade.
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Another area that might influence children’s attitudes toward their peers who use AAC is the vocabulary programmed into an AAC device. Children who are nonspeaking and who cannot yet spell, are frequently unable to create their own lexicons and are therefore often dependent upon another person to choose their words for them. Typically the people who select vocabulary to be programmed into a child’s AAC device are adults. Carlson (1981) indicated ‘‘In spite of the best intentions of teachers, parents, speech-language pathologists, and others, the lexicon is often inappropriate to the child’s personality, situation, and developmental stages’’ (p. 240). In order to ensure a more appropriate child lexicon, Downing (1999) emphasizes the importance of utilizing a language sample of typical same-age peers. Use of such a language sample can aid the people programming an AAC device in providing a child who is nonspeaking with a vocabulary that allows that child to sound like his or her peers rather than like the adults in his or her environment. Beukelman and Mirenda (1998) recount a story communicated to them by P. Daharsh that supports the importance of programming a communication device to include vocabulary and informal terms used by peers: Greg’s friends came to me one day and said, ‘‘You need to put some cool stuff in Greg’s machine (an electronic communication device). He sounds weird now.’’ ‘‘What do you mean?’’ I asked, ‘‘What’s wrong with what’s in there?’’ ‘‘Well, you know how he says ‘Hello, how are you?’ when he comes into the class in the morning?’’ his friends replied. ‘‘No one talks like that. We say ‘How you doin’ dudes?’ or ‘Hey, guys, what’s happening?’ or something.’’ (p. 27) Evidence such as the above anecdote supports the social validity of including vocabulary in an AAC device that allows children to sound like their speaking peers. This action appears then to be a clinically sensible one to take to increase speaking peers’ positive attitudes toward children who use AAC. A computerized search of the literature (ERIC) as well as a manual search of the last 10 years of Augmentative and Alternative Communication, and Language, Speech, and Hearing Services in Schools, and of the last nine years of The American Journal of Speech-Language Pathology, however, resulted in finding no published empirical data supporting this action. As Hegde (1993) stated, the procedures used by clinicians must have demonstrated empirical validity. When a strategy or technique is being used that is not based on demonstrated empirical validity, clinicians cannot be certain that what they are doing is having the desired effect. Although it seems probable that including informal terms on an AAC device will increase peers’ acceptance of the child who uses the device, without empirical support the possibility exists that doing so might actually have a negative influence on children’s attitudes toward their peers who use AAC. Cook and Semmel (1999) discussed competing theories of peer acceptance. One theory suggests that peer acceptance is based on the recognition of similarity between individuals. According to this theory, the greater the similarity between individuals, the more likely they will be to accept one another. Social groups will pressure individuals through threat of rejection to conform to the groups’ norms. If this theory is correct, then providing a child who uses AAC with vocabulary
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similar to that of his or her speaking peers should result in an increase in peers’ positive attitudes toward the child who uses AAC. The contrasting theory, however, posits that individuals who are severely atypical might be valued by a group because these individuals explore, test, and demonstrate ‘‘the limits of acceptable behavior’’ (Cook & Semmel, 1999, p. 51). Within this theoretical orientation, the group will actively resist the rejection of someone who is different and will protect those who appear helpless and significantly outside the group norms. If this is the case, then speaking peers’ attitudes toward a child who used AAC might be negatively influenced by a vocabulary that sounded like the norm. The purpose of this study was to investigate how programming vocabulary on an AAC device that contained current, age-appropriate informal terms would influence attitudes of grade-school age children toward a peer who used AAC, and whether gender and grade also would influence attitudes towards peers who use AAC.
1. Methodology 1.1. Participants Participants were 84 children whose parents had signed and returned written consent forms. These children were selected from two public grade schools in the same Midwestern community with a population of approximately 110,000. Because children who are familiar with peers who have disabilities probably have had to determine their own standards for whether or not they will accept a child with disabilities, one of the selection criteria for inclusion as a participant in the study was that each child who served as a participant would be familiar with peers who have disabilities. Familiarity with children with disabilities was based on the fact that both schools from which participants were drawn included children with disabilities in the school population and all children who participated answered yes to at least one of two questions regarding familiarity with other children who had disabilities (i.e., Do you have a friend who has a disability? In the past week have you played with or talked to a child who has a disability?). A disability was defined for the children as something that keeps a person from doing things that other people can do, like walking or talking or seeing or hearing, and that does not heal and go away, but that lasts for a long time. Of the 84 children who participated, 46 were in grade 4 (21 girls, 25 boys) and 38 were in grade 5 (21 girls, 17 boys). The majority of these children were from middle to higher-middle income families. While a few of the participants were of African–American, Hispanic, or Asian descent, the majority were of white, nonHispanic descent. 1.2. Materials 1.2.1. Videotapes Two videotapes were created. Both tapes showed a child communicating with the same speaking adult female using a voice output communication device. In order to ensure that the child who was videotaped could learn and follow a scripted conversation and could
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access the AAC device in a manner and timeframe that was consistent across both videos, the same child, who was not disabled in any way, was selected to role play the child who used AAC in both of the videotapes. Only the forearm and hand of the child accessing the device was visible in the videotapes. This eliminated any biases that might have arisen in children who viewed the videotapes due to the specific age, gender, or physical status of the child in the videotape, and allowed for the impression that the child needed an AAC device due to the presence of a disability. The child communicated with a Prentke Romich Co. AlphaTalker with a 32 location overlay in both of the videotapes. The same overlay, produced with Windows Boardmaker (1994), was used on the AlphaTalker in both of the videos. The overlay contained 32 colored pictures without any printed words. The AlphaTalker is a digitized voice output device. The recorded voice in both videos was that of the same collegeaged, Midwestern adult female who was chosen specifically for this task due to the youthful sound of her voice and to her natural intonation patterns when using both formal English and informal terms. The only difference between the two videotapes was the vocabulary used by the child to convey messages. In one videotape the child communicated using only formal English and in the other the child communicated using formal English and current, age-appropriate informal terms. The formal English only video was 2 min, 24 s in length, and the formal English plus informal terms video was 2 min, 4 s in length. 1.2.2. Script Two scripts were created. In both scripts the adult had 18 conversational turns and the child had 19 conversational turns that included initiations, responses, and comments. In the informal terms script, 13 of the child’s responses contained an informal term or phrase. In both scripts the child’s responses ranged from one word responses to seven word sentences. In both scripts, the child accessed nine messages by activating one icon, four messages by activating two icons, five messages by activating three icons, and one message by activating four icons. In the formal English only script the child’s average number of words per response was 3.7, which was quite consistent with the formal English plus informal terms script where the child’s average number of words per response was 3.8. The adult’s responses were identical in both scripts. Both scripts are presented in Table 1. The topic of the scripts was a popular children’s movie—Harry Potter and the Sorcerer’s Stone. The content of the script was written to be age-appropriate for children in grades 4 and 5 and to avoid gender bias. Additionally, the script was written so that it was not necessary for one to have seen the movie, or be familiar with the story, in order to understand the conversation. One of the co-authors spent a month working in a public grade school before writing the script. During this time she listened to and made notes of the types of phrases and words that were used frequently by the children in grades 4 and 5. Additionally, three mothers of children in grade school were asked to list informal terms that their children used frequently. The most commonly used terms from these sources were then included in the informal script. When both scripts had been completed, two mothers of grade school aged children reviewed the scripts to ensure that the script containing informal terms sounded natural and appropriate for children in grades 4 and 5.
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Table 1 Formal and informal scripts Formal
Informal
C: Hi, How are you? A: Fine. How are you? C: Fine. A: What did you do last night? C: I saw a good movie! A: What was it? C. Harry Potter and the Sorcerer’s Stone. A: I saw it, too. I thought it was pretty good. C: It was great! A: What was your favorite part? C: When Harry went to Hogwarts. A: That was a happy time for Harry. C: Yes, no more aunt and uncle. A: They were pretty mean to Harry, but they sure thought Dudley was. . . C: Nice! A: What did you think of Dudley? C: He’s mean. What was your favorite part? A: When Harry met He-Who-Shall-Not-BeNamed the last time. C: That scared me! A: It was rather scary. So, what else did you like in the movie? C: The sorting hat. A. I liked that, too, especially when it didn’t put Harry in the wrong house. C: That would have been bad! A: I agree. Why do you think so? C: He wouldn’t have been a seeker. A: Yes, he seemed like a natural at that game. C: That’s right! A: Did you like Professor Snape? C: Not at all—he was too mean. A: But he did turn out to be a good guy at the end. C: He’s still a scary person! A: Do you think you’ll go the second movie? C: I can’t wait! A: I imagine it will be as good as the first one. C: Me, too. A: Well, it’s getting late, I better go. C: Good-bye.
C: Hey, What’s up? A: Not much, how are you? C: Fine. A: What did you do last night? C: I saw the coolest movie! A: What was it? C. Harry Potter and the Sorcerer’s Stone. A: I saw it, too. I thought it was pretty good. C: It was sweet! A: What was your favorite part? C: When Harry went to Hogwarts. A: That was a happy time for Harry. C: Yeah, no more aunt and uncle. A: They were pretty mean to Harry, but they sure thought Dudley was. . . C: Awesome! A: What did you think of Dudley? C: Loser! What was your favorite part? A: When Harry met He-Who-Shall-Not-BeNamed the last time. C: That freaked me out! A: It was rather scary. So, what else did you like in the movie? C: The sorting hat. A. I liked that, too, especially when it didn’t put Harry in the wrong house. C: That would have stunk! A: I agree. Why do you think so? C: He wouldn’t have been a seeker. A: Yes, he seemed like a natural at that game. C: Big time! A: Did you like Professor Snape? C: Gimme a break—he gave me the creeps. A: But he did turn out to be a good guy at the end. C: He’s still a scary dude! A: Do you think you’ll go the second movie? C: I can’t wait! A: I imagine it will be as good as the first one. C: Totally. A: Well, it’s getting late, I better go. C: Later.
Additionally, two grade school aged children, who were not participants in the study, were asked to review the scripts and to give their opinions. In all cases, the mothers and children agreed that the script containing informal terms was something that might naturally be produced by a child in grade 4 or 5.
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1.2.3. Measurement scale The assessment of attitudes toward augmentative and alternative communication (AATAAC; Beck et al., 2000), a 26 item, five-point Likert rating scale designed to assess attitudes of elementary-aged school children toward peers who use AAC, was the measurement tool used in this study. The AATAAC consists of 26 rating items. Seven of these are intended to measure cognitive aspects of attitude, five to measure affective aspects, and 14 to measure behavioral intents. Of the cognitive items, three are positively worded and four are negatively worded. Four of the affective items are positively worded and one negatively worded. These 12 cognitive and affective items are randomly ordered with positive and negative items alternating. The behavioral intent items are the last 14 items on the AATAAC. All are positively worded. (Scale items are listed in Appendix A). Beck et al. have established acceptable levels of internal consistency, test-retest reliability, content validity, concurrent validity, and construct validity for this scale. Additionally, Likert rating scales have been shown to be appropriate for measuring attitudes toward individuals who use AAC or who have disabilities (Gorenflo & Gorenflo, 1991; Rosenbaum, Armstrong, & King, 1986). 1.3. Procedure A 2 2 2 independent groups design was used. Participants from both schools were selected from two grade 4 classrooms and two grade 5 classrooms within the participants’ respective schools. Due to teacher request, the participants from one of the schools remained in the groups formed by their classrooms. One fourth grade classroom and one fifth grade classroom were randomly assigned to watch the video containing informal terms and the remaining fourth grade and fifth grade classrooms watched the video containing formal English only. In the second school, participants from each classroom were randomly divided into two groups with the stipulation that boys and girls were as evenly divided between groups as possible. One subgroup from each classroom was randomly assigned to watch the video containing informal terms while the remaining subgroup watched the video containing formal English only. In all cases children from the same classroom were tested in back to back sessions so that they could not talk to each other before all children had completed the experimental task. Of the total of 84 participants, 24 children in grade 4 watched the video with informal terms and 22 watched the video with formal English only; 19 children in grade 5 watched the video with informal terms and 19 watched the video with formal English only; and 19 boys and 24 girls watched the video with informal terms and 23 boys and 18 girls watched the video with formal English only. All sessions were conducted in the late spring of the same academic year. All testing within a school was done either in the same empty classroom or multipurpose room. The experimenters went to the children’s classrooms to pick them up for the study. When all children had gathered in the hall outside their classroom, the experimenters requested and, in all cases, obtained their verbal assent to participate in the study. Children were then led to the room where the study was conducted. This room contained a chair and desk space for each child. AATAACs were placed face down on the desks in front of each child’s chair. A pencil was on top of each AATAAC. Children were asked to leave the
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papers alone until they were told what to do. Scripted instructions were used in each session to ensure that all children received the same information. (Appendix B). As shown in the Appendix B, AAC was briefly described to children in the first portion of the instructions. The children were then told they would see a video of a child their age who used AAC, and were asked to watch the video carefully. The selected video was then played twice for the children. After children had watched the video, they were instructed to turn their papers over and answer the questions regarding their school, grade, date, and gender. Following these questions were the two questions concerning their familiarity with children with disabilities. They were instructed to answer these questions after the term disability was defined for them. The final items on this page were two examples of how the children were to answer the scale items. Appendix B contains the scripted instructions that were read to the children for completing these items. When both example items had been completed by all children and no child had a question about how to complete the remainder of the scale, children were instructed to turn to the next page and complete the remaining items, keeping the child they had just seen on the video in mind as they did so. If they had any questions about an item or a word in an item, children were told they could raise their hand and one of the experimenters would assist them in reading the item. After children completed the entire scale, they were instructed to go back through their scales to make sure they had answered each item and had only given one answer to each item. They were further instructed to not change any of their answers at this time. Any questions children had about AAC or children who used AAC were answered after their experimental session was concluded. 1.4. Data analysis The AATAAC is scored for positive items by giving each answer of strongly agree 5 points, agree 4 points, can not decide 3 points, disagree 2 points, and strongly disagree 1 point. Scoring is reversed for negatively worded items. The number of points for each item is summed and divided by the total number of items answered. The maximum mean score possible is 5. Higher scores represent more positive attitudes than lower scores. Mean AATAAC scores were the dependent measure. A 2 (informal versus formal English only) 2 (gender) 2 (grade 4 versus grade 5) analysis of variance (ANOVA) was calculated. Significance level was set at a = .05. Alpha was calculated to obtain a measure of reliability for the AATAAC. A coefficient of .92 indicated high internal consistency for this study. To determine if the sample size in this study was large enough to show an effect of the independent variables (i.e., informal versus formal language, gender, and grade), a power analysis was calculated. Based on Cohen’s (1977) guidelines for effect size, the results of this power analysis indicated that the average sample size in this study of 10 per cell was adequate to show an effect of large (delta = 0.999) and medium size (delta = 0.911), but was less adequate to show an effect of small size (delta = .196). Given the fact, however, that an effect of small size might not be of clinical or practical significance, it is more important to have power sufficient for showing an effect of medium or large size than an effect of small size.
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2. Results Results of the 2 (informal versus formal English only) 2 (gender) 2 (grade 4 versus grade 5) ANOVA indicated a main effect of gender [F(1, 76) = 12.42, p = .001] with girls’ mean AATAAC scores (3.88, S.D. = .48) being higher than boys’ (3.53, S.D. = .54). There were no differences for grade or vocabulary. The only interaction effect was gender by grade (F(1, 76) = 3.958, p = .05). While girls’ self-reported attitudes became more positive from grade 4 to grade 5, boys’ became less positive. To determine effect size of gender within each grade, eta squared was calculated. Eta squared for gender in grade 4 was .03 and for gender in grade 5 was .33 (Table 2). That is, within grade 4, 3% of the total variation in AATAAC scores was explained by gender. For children in grade 5, 33% of the total variation in AATAAC scores was explained by gender.
3. Discussion 3.1. Gender and grade differences Results indicated that, in general, self-reported attitudes of girls were more positive toward a peer who uses AAC than were those of boys. In their review of determinants of children’s attitudes toward peers with disabilities, Rosenbaum, Armstrong, and King (1988) indicated that gender was ‘‘the single most potent and consistent determinant of attitudes about disabilities’’ (p. 33). To account for this gender difference, Rosenbaum et al. cited Gillian’s 1982 work indicating that while preadolescent boys are more concerned with rights and justice, preadolescent girls tend to be more concerned with caring about others and relationships. Additionally, Rosenbaum et al. indicated that boys are more physical and interested in active play than are girls. If these suggestions are true, then girls may be more predisposed than boys to building relationships with and to holding more positive attitudes toward children with disabilities. Additionally, the gender differential found for participants in the current study was more pronounced for children in grade 5 than for children in grade 4. That is, self reported attitudes of boys in grade 5 toward a peer who uses AAC were less positive than were those of boys in grade 4 and the self reported attitudes of girls in grade 5 were more positive than
Table 2 Means, formal deviations, and eta squared for the significant interaction of gender grade Group
N
Mean
S.D.
Grade 4 Boys Girls
25 21
3.60 3.79
.52 .53
Grade 5 Boys Girls
17 21
3.42 3.98
.56 .42
Eta squared .03
.33
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those of girls in grade 4. These findings are consistent with those of Beck et al. (2000) who reported that attitudes of boys in their sample toward a peer who used AAC became progressively less positive for boys in grade 1 versus grade 3 versus grade 5. Consistent findings indicating that attitudes of boys who are familiar with peers with disabilities become less positive as the boys increase in age throughout elementary school have important implications for school professionals who work in inclusionary settings. Activities need to be planned and implemented that promote more positive attitudes among boys and address the tendency of boys’ attitudes to decline with age. The fact that in the current study the mean attitude scores of girls in grade 5 were more positive than those for the girls in grade 4 suggests that, in contrast to boys, some elements of the interactions between these girls and their peers with disabilities resulted in an increase in the positive nature of the older girls’ attitudes. This could be due to the increased length of time older girls had been included with their peers with disabilities. Additionally, as would be consistent with Ryan’s (1981) indication that children develop more positive attitudes toward peers with disabilities as they age from preschool through their early teen years, the difference in attitudes scores between girls in grade 4 and girls in grade 5 could be due to differences in the developmental stages of these girls. 3.1.1. Informal versus formal English Effect of type of vocabulary used in the conversational scripts in this study was not statistically significant. This lack of significance was in contrast to the clinical expectation that vocabulary on a child’s voice output AAC device that is like that of his or her speaking peers will increase peers’ acceptance of the child who uses AAC. A possible explanation could be the specific informal terms that were chosen to be included in this study. Choice of these terms, however, was carefully made so that the terms were ones that local children in grades 4 and 5 used frequently. Indeed, the scripts were reviewed by mothers, professional SLPs, and grade school aged children before being used and were considered to be typical sounding by all reviewers. The researchers used the same process for selecting vocabulary as would be used by clinicians programming AAC devices for individual students who use AAC. If, therefore, children did not react more positively to the informal script than to the formal English only script because of the specific informal terms contained in this script, then this suggests that, even with the best planning, the selection and use of informal terms on children’s AAC devices might not serve to increase the acceptance of a child who uses AAC by his or her peers. The fact that the voice recorded on the AlphaTalker was that of a young adult female in her 20s could also have influenced the results. Even though the speaker’s voice was youthful and her intonation patterns were natural and similar across conversational scripts, children might have noticed that the informal terms were being spoken by an adult who was not part of their social group, which could have altered their reaction to the informal video. Because interventionists might have to record their own voices on children’s AAC devices when messages have to be programmed and an acceptable peer is not readily available, knowledge of children’s attitudes toward informal and formal messages recorded with an adult voice is important. An area of future research, however, should be the influence on
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children’s attitudes of the type voice (e.g., adult versus gender-neutral child versus synthesized) used to record informal terms. An additional explanation for the lack of a positive influence of informal terms can be gleaned from theories of peer acceptance. As discussed earlier in this paper, competing theories of peer acceptance exist (Cook & Semmel, 1999). One theory indicates that peer acceptance is based on the similarities between children. Another theory indicates that children with significantly atypical behavior are accepted by their peers on the basis of differences that allow their peers to test the limits of acceptable behavior (Cook & Semmel). Cook and Semmel investigated these theories in the context of children’s acceptance of their peers with various types of disabilities (e.g., emotional disorders, physical disabilities, mental retardation). Cook and Semmel’s results indicated that children in nonheterogenous classrooms accepted peers with severe disabilities better than children with mild disabilities. A nonheterogenous classroom was defined as one in which fewer than 50% of the students were from ethnic minorities or were below gradelevel readers and fewer than 20% of the students had a disability. Cook and Semmel explained their results by indicating that when students in a classroom form a relatively homogenous group, ‘‘individuals with severe disabilities readily stand out as markedly different, prompting differentiated expectations among peers and fulfillment of a functional and protected role. Atypical behavior is thus expected and a critical element of their group role, resulting in a level of acceptance’’ (p. 57). Additionally, Cook and Semmel reported that the more severe a child’s disability was, the more accepted that child was by his or her peers. As an example they cited a boy who was nonambulatory and who used AAC to communicate and who was also the second most socially desired student in his class. According to Cook and Semmel’s (1999) definition, the participants of the current study all belonged to nonheterogenous classrooms. These children would likely have viewed a child who could not talk and who used an AAC device to communicate as one who had a relatively significant and salient disability. If this was the case, then, according to the theory of peer acceptance supported by Cook and Semmel’s findings, behaviors such as using informal terms that made the child with a disability appear more typical might actually have served to lessen students’ willingness to assign the child a special role and thereby might not have increased students’ acceptance of this peer.
4. Conclusion The lack of effect found for type of vocabulary used in the current study should not be taken as an absolute indication that the inclusion of informal terms will never influence peers’ attitudes. The possibility exists that future studies using different experimental stimuli (e.g., actual interactions with children who use AAC devices, the use of a child’s voice or of a synthesized voice) might have findings indicating a positive influence of informal terms on children’s attitudes. Nonetheless, the results of the current study suggest that, contrary to expectations generated from clinical anecdotes, the introduction of informal terms into a child’s AAC device might not influence that child’s acceptance by his or her peers. The decision of what vocabulary should be included on a child’s AAC device
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needs to be made carefully. Both the input of the child who uses AAC and that of the child’s peers should be considered. Furthermore, it is important that interventionists conduct careful follow-up evaluations of peers’ reactions to informal terms communicated by a child who uses AAC to ensure that the child’s AAC system is not creating additional barriers for that child but is instead helping to improve the quality and quantity of the child’s social interactions.
Appendix A. AATAAC training and scale items Scale items numbered according to their order of appearance on the AATAAC A.1. Cognitive items 12. Children who use AAC try to understand what others are saying to them. 7. Children who use AAC try to talk about what other children want to talk about. 11. Children who use AAC take as many turns as other children do when they are talking. 2. Children who use AAC don’t take many turns when they try to talk. 6. Children who use AAC really don’t want to talk with other children. 8. Children who use AAC can’t change their words if they are not understood. 10. People have trouble knowing what children who use AAC are trying to say to them.
A.2. Affective items 3. 5. 9. 1. 4.
I like children who use AAC. I would feel comfortable around a child who uses AAC. I think children who use AAC are fun to be with. I would feel good about myself if I was with a child who used AAC. Children who use AAC scare me.
A.3. Behavioral items 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.
I I I I I I I I I I I
would would would would would would would would would would would
work at school with a child who uses AAC. eat lunch with a child who uses AAC. go to the park with a child who uses AAC. introduce a child who uses AAC to my friends. invite a child who uses AAC to my house. play with a child who uses AAC. sit next to a child who uses AAC in class. talk to a child who uses AAC. invite a child who uses AAC to a party I had. walk in the school halls with a child who uses AAC. choose a child who uses AAC to be on my team in P.E.
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24. I would go to the library with a child who uses AAC. 25. I would ask a child who uses AAC to sleep over at my house. 26. I would go to a movie with a child who uses AAC.
Appendix B. Instructions B.1. Portion of script of instructions describing AAC Augmentative/alternative communication—or AAC (write AAC on blackboard) is used by students who can not speak like you and I can. There are many reasons some children can not speak. Some may have physical disabilities that do not allow them to talk like most of us can. Some may have difficulty thinking as easily as others so that speaking is hard for them. Many students who cannot speak were born that way, others have had accidents which have caused them to have difficulties speaking. One way of helping students who can not talk is to provide them with what is called augmentative/alternative communication systems—or AAC. Students who use AAC may use a number of different ways of communicating—some may sign or gesture, some may point to pictures, letters, or words, some may use machines or computers that talk for them. B.2. Portion of script containing instructions for the completion of the AATAAC Now turn to the first page. Here you see spaces for your school, grade, and date. Please fill these in now. On the bottom of this page you see two more questions. These are examples of how you will answer the rest of the questions. I will explain how to answer these items. First of all, there are no right or wrong answers. I want you to answer each item just the way you really feel. Please answer as honestly as you can—and remember, there are no right or wrong answers. Now, look at the first item (point to each item as it is referred to and the response boxes as they are referred to). It says ‘‘Little babies are lots of fun for their parents’’. Underneath that item there are five boxes. You will put an X through one of these boxes. In the first box you will see the words ‘‘strongly disagree’’ and under it a frowning face. If you really don’t think babies are fun for their parents, put an X through this box. In the next box you see the word ‘‘disagree’’. If you just sort of think babies aren’t fun for their parents, put an X in this box. The next box says ‘‘can’t decide’’. This is the box you would put an X through if you don’t know if babies are fun for their parents or not. The next box says ‘‘agree’’. Put an X through this box if you kind of think babies are fun for their parents. The last box has the words ‘‘strongly agree’’ and has the happy face under it. If you really think babies are fun for their parents, put an X through this box. Let’s try another one. This item says ‘‘Little babies are messy and they cry too much.’’ If you think this is really true, put an X through the box that says ‘‘strongly agree’’ and has the happy face under it. If you think it’s just kind of true, put an X through the box that says ‘‘agree’’. If you aren’t sure if babies are messy and cry too much, put an X through the box in the middle that says ‘‘can’t decide’’. If you kind of think that babies aren’t that messy and don’t cry too much, put an X through the box that says ‘‘disagree’’. If you really don’t think that babies are messy and cry too much, put an X through the box that says ‘‘strongly disagree’’
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and has the frowning face under it. Do you have any questions? Remember to mark only one box per answer and to answer the items as honestly as you can—there are no right or wrong answer.
References Beck, A., & Dennis, M. (1996). Attitudes of children toward a similar-aged child who uses augmentative communication. Augmentative and Alternative Communication, 12, 78–87. Beck, A., Fritz, H., Keller, A., & Dennis, M. (2000). Attitudes of school-aged children toward their peers who use AAC. Augmentative and Alternative Communication, 12, 78–87. Blockberger, S., Armstrong, R., O’Connor, A., & Freeman, R. (1993). Children’s attitudes toward a nonspeaking child using various augmentative and alternative communication techniques. Augmentative and Alternative Communication, 9, 243–250. Burke, V. (1994). Children’s perceptions of peers who demonstrate phonological, voice, or fluency disorders: Implications for caseload inclusion. Unpublished master’s thesis, Illinois State University, Normal. Beukelman, D., & Mirenda, P. (1998). Augmentative and alternative communication: Management of severe communication disorders in children and adults (2nd ed.). Baltimore: Paul H Brookes. Carlson, F. (1981). A format for selecting vocabulary for the nonspeaking child. Language Speech and Hearing Services in School, 12, 240–245. Cohen, J. (1977). Statistical power analysis for the behavioral sciences (rev. ed.). New York: Academic Press. Cook, B., & Semmel, M. (1999). Peer acceptance of included students with disabilities as a function of severity of disability and classroom composition. The Journal of Special Education, 33, 50–61. Diamond, K. (1993). Preschool children’s concepts of disability in their peers. Early Education and Development, 4, 123–129. Diamond, K., & Innes, F. (2001). The origins of young children’s attitudes toward peers with disabilities. Early childhood inclusion: Focus on change, Baltimore: Paul H. Brookes. pp. 159–177. Downing, J. (1999). Teaching communication skills to students with severe disabilities. Baltimore: Paul H Brookes. Education for All Handicapped Children Act, 20 U.S.C. § 1471 et seq. (1975). Gertner, B., Rice, M., & Hadley, R. (1994). Influence of communicative competence on peer preferences in a preschool classroom. Journal of Speech and Hearing Research, 37, 913–923. Glennen, S., & DeCoste, D. (1997). Handbook of augmentative and alternative communication. San Diego, CA: Singular Publishing Group. Gorenflo, C., & Gorenflo, D. (1991). The effects of information and augmentative communication techniques on attitudes toward nonspeaking individuals. Journal of Speech and Hearing Research, 34, 19–26. Guralnick, M. J. (2001). A framework for change in early childhood inclusion. In M. J. Guralnick (Ed.), Early childhood inclusion: Focus on change (pp. 3–35). Baltimore: Paul H. Brookes. Hegde, M. (1993). Treatment procedures in communicative disorders. Austin, TX: Pro-Ed. Lallh, A., & Rochet, A. (2000). The effect of information on listeners’ attitudes toward speakers with voice or resonance disorders. Journal of Speech, Language, and Hearing Research, 43, 782–795. Rice, M., Sell, M., & Hadley, P. (1991). Social interactions of speech- and language- impaired children. Journal of Speech and Hearing Research, 34, 1299–1307. Rosenbaum, P., Armstrong, R., & King, S. (1988). Determinants of children’s attitudes toward disability: A review of evidence. Children’s Health Care, 17, 32–39. Rosenbaum, P., Armstrong, R., & King, S. (1986). Children’s attitudes toward disabled peers: A self-report measure. Journal of Pediatric Psychology, 11, 517–530. Ryan, K. (1981). Developmental differences in reactions to the physically disabled. Human Development, 24, 240–256. Windows Boardmaker Version 1.0.0. [Computer software]. (1994). Solona Beach, CA: Mayer-Johnson Co.
Is awesome really awesome? How the inclusion of informal terms on an AAC device influences children’s attitudes toward peers who use AAC§ Ann R. Beck *, Stacey Bock, James R. Thompson, Linda Bowman, Stacey Robbins 4720 Speech Pathology and Audiology, Illinois State University, Normal, IL 61790-4720, USA Received 20 February 2004; received in revised form 15 July 2004; accepted 15 November 2004
Abstract Two videotapes were created of a child communicating with a voice output augmentative and alternative communication (AAC) device. In one the child communicated using formal English only and in the other the child communicated using formal English and age appropriate informal terms. Children in grades 4 and 5 viewed either the formal English only or the formal and informal English videotape. After viewing the videotape, children completed a measure of self-reported attitudes toward children who use AAC. Results indicated effects for gender and for the gender by grade interaction. These results are discussed along with clinical implications. # 2005 Elsevier Ltd. All rights reserved. Keywords: Attitudes; AAC device; Children
Since passage of the Education for All Handicapped Children Act (PL 94-142) in 1975, children with disabilities have had the right to obtain a free and appropriate public education. According to Guralnick (2001) ‘‘one of the most far-reaching and perhaps § Portions of this paper were the basis for a poster presentation at the 2003 American Speech-Language-Hearing Association Convention in Chicago, Illinois. * Corresponding author. Tel.: +1 309 438 2654; fax: +1 309 438 5221. E-mail address: [email protected] (A.R. Beck).
0891-4222/$ – see front matter # 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.ridd.2004.11.013
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radical components of this legislation is related to the prospect of providing services and supports to young children with disabilities together with typically developing children in what is now referred to as inclusive environments’’ (p. 3). Guralnick states further that there are many practiced forms of inclusion throughout schools and that the degree to which children with and without disabilities are included together varies significantly from school to school. Regardless of the form inclusion takes, however, the feature that defines inclusion is the ‘‘existence of planned participation between children with and without disabilities in the context of children’s educational/developmental programs’’ (Guralnick, p. 3). Planned participation between children with and without disabilities can result in various positive outcomes. Diamond and Innes (2001) reported that interactions with peers without disabilities can increase peer-related social skills of children with disabilities. For children without disabilities, interacting with peers with disabilities can enhance an understanding and appreciation of individual differences and promote more accepting attitudes towards peers with disabilities. In order for these positive outcomes of inclusion to be optimally realized, planned participation must target academic and social integration of children with disabilities into the classroom (Beukelman & Mirenda, 1998). The extent to which social integration of peers with disabilities occurs will be influenced significantly by attitudes other children hold toward their peers with disabilities (Diamond & Innes, 2001). As Diamond and Innes point out ‘‘For people with disabilities, negative attitudes may be just as effective as physical, architectural barriers in limiting opportunities to participate fully in schools and communities’’ (p. 160). Research has documented that one type of disability toward which people hold negative attitudes is a communication disability (e.g., Burke, 1994; Lallh & Rochet, 2000; Rice, Sell, & Hadley, 1991). Ability to communicate is an essential element of successful interactions between individuals and, even as early as preschool age, children perceive peers who differ from themselves on the basis of communication (Gertner, Rice, & Hadley, 1994). Diamond (1993) found that impaired language skills were among the types of disabilities of which young children were most aware. Not only are children aware of communication differences among their peers, but they have been found to discriminate against their peers who have such differences (Gertner et al., 1994). Approximately 0.3–1% of school-aged children have such complex communication needs that they are unable to communicate functionally through spoken language and are candidates for augmentative and alternative communication (AAC) systems (Glennen & DeCoste, 1997). One of the main concerns of interventionists who work with children who use AAC is to ensure that those children are able to participate in activities of daily life and are included and accepted by their peers (Beukelman & Mirenda, 1998; Downing, 1999). Knowledge of the determinants of children’s attitudes toward peers who use AAC is important in aiding school professionals in creating optimal planned participations between children who do and who do not use AAC. Prior research shows that one determinant of children’s attitudes toward peers who use AAC is gender. In general, boys report less positive attitudes toward peers who use AAC than do girls (Beck & Dennis, 1996; Beck, Fritz, Keller, & Dennis, 2000; Blockberger, Armstrong, O’Connor, & Freeman, 1993). Beck et al. (2000) reported that the attitudes of boys became less positive as they increased in age from first through fifth grade.
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Another area that might influence children’s attitudes toward their peers who use AAC is the vocabulary programmed into an AAC device. Children who are nonspeaking and who cannot yet spell, are frequently unable to create their own lexicons and are therefore often dependent upon another person to choose their words for them. Typically the people who select vocabulary to be programmed into a child’s AAC device are adults. Carlson (1981) indicated ‘‘In spite of the best intentions of teachers, parents, speech-language pathologists, and others, the lexicon is often inappropriate to the child’s personality, situation, and developmental stages’’ (p. 240). In order to ensure a more appropriate child lexicon, Downing (1999) emphasizes the importance of utilizing a language sample of typical same-age peers. Use of such a language sample can aid the people programming an AAC device in providing a child who is nonspeaking with a vocabulary that allows that child to sound like his or her peers rather than like the adults in his or her environment. Beukelman and Mirenda (1998) recount a story communicated to them by P. Daharsh that supports the importance of programming a communication device to include vocabulary and informal terms used by peers: Greg’s friends came to me one day and said, ‘‘You need to put some cool stuff in Greg’s machine (an electronic communication device). He sounds weird now.’’ ‘‘What do you mean?’’ I asked, ‘‘What’s wrong with what’s in there?’’ ‘‘Well, you know how he says ‘Hello, how are you?’ when he comes into the class in the morning?’’ his friends replied. ‘‘No one talks like that. We say ‘How you doin’ dudes?’ or ‘Hey, guys, what’s happening?’ or something.’’ (p. 27) Evidence such as the above anecdote supports the social validity of including vocabulary in an AAC device that allows children to sound like their speaking peers. This action appears then to be a clinically sensible one to take to increase speaking peers’ positive attitudes toward children who use AAC. A computerized search of the literature (ERIC) as well as a manual search of the last 10 years of Augmentative and Alternative Communication, and Language, Speech, and Hearing Services in Schools, and of the last nine years of The American Journal of Speech-Language Pathology, however, resulted in finding no published empirical data supporting this action. As Hegde (1993) stated, the procedures used by clinicians must have demonstrated empirical validity. When a strategy or technique is being used that is not based on demonstrated empirical validity, clinicians cannot be certain that what they are doing is having the desired effect. Although it seems probable that including informal terms on an AAC device will increase peers’ acceptance of the child who uses the device, without empirical support the possibility exists that doing so might actually have a negative influence on children’s attitudes toward their peers who use AAC. Cook and Semmel (1999) discussed competing theories of peer acceptance. One theory suggests that peer acceptance is based on the recognition of similarity between individuals. According to this theory, the greater the similarity between individuals, the more likely they will be to accept one another. Social groups will pressure individuals through threat of rejection to conform to the groups’ norms. If this theory is correct, then providing a child who uses AAC with vocabulary
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similar to that of his or her speaking peers should result in an increase in peers’ positive attitudes toward the child who uses AAC. The contrasting theory, however, posits that individuals who are severely atypical might be valued by a group because these individuals explore, test, and demonstrate ‘‘the limits of acceptable behavior’’ (Cook & Semmel, 1999, p. 51). Within this theoretical orientation, the group will actively resist the rejection of someone who is different and will protect those who appear helpless and significantly outside the group norms. If this is the case, then speaking peers’ attitudes toward a child who used AAC might be negatively influenced by a vocabulary that sounded like the norm. The purpose of this study was to investigate how programming vocabulary on an AAC device that contained current, age-appropriate informal terms would influence attitudes of grade-school age children toward a peer who used AAC, and whether gender and grade also would influence attitudes towards peers who use AAC.
1. Methodology 1.1. Participants Participants were 84 children whose parents had signed and returned written consent forms. These children were selected from two public grade schools in the same Midwestern community with a population of approximately 110,000. Because children who are familiar with peers who have disabilities probably have had to determine their own standards for whether or not they will accept a child with disabilities, one of the selection criteria for inclusion as a participant in the study was that each child who served as a participant would be familiar with peers who have disabilities. Familiarity with children with disabilities was based on the fact that both schools from which participants were drawn included children with disabilities in the school population and all children who participated answered yes to at least one of two questions regarding familiarity with other children who had disabilities (i.e., Do you have a friend who has a disability? In the past week have you played with or talked to a child who has a disability?). A disability was defined for the children as something that keeps a person from doing things that other people can do, like walking or talking or seeing or hearing, and that does not heal and go away, but that lasts for a long time. Of the 84 children who participated, 46 were in grade 4 (21 girls, 25 boys) and 38 were in grade 5 (21 girls, 17 boys). The majority of these children were from middle to higher-middle income families. While a few of the participants were of African–American, Hispanic, or Asian descent, the majority were of white, nonHispanic descent. 1.2. Materials 1.2.1. Videotapes Two videotapes were created. Both tapes showed a child communicating with the same speaking adult female using a voice output communication device. In order to ensure that the child who was videotaped could learn and follow a scripted conversation and could
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access the AAC device in a manner and timeframe that was consistent across both videos, the same child, who was not disabled in any way, was selected to role play the child who used AAC in both of the videotapes. Only the forearm and hand of the child accessing the device was visible in the videotapes. This eliminated any biases that might have arisen in children who viewed the videotapes due to the specific age, gender, or physical status of the child in the videotape, and allowed for the impression that the child needed an AAC device due to the presence of a disability. The child communicated with a Prentke Romich Co. AlphaTalker with a 32 location overlay in both of the videotapes. The same overlay, produced with Windows Boardmaker (1994), was used on the AlphaTalker in both of the videos. The overlay contained 32 colored pictures without any printed words. The AlphaTalker is a digitized voice output device. The recorded voice in both videos was that of the same collegeaged, Midwestern adult female who was chosen specifically for this task due to the youthful sound of her voice and to her natural intonation patterns when using both formal English and informal terms. The only difference between the two videotapes was the vocabulary used by the child to convey messages. In one videotape the child communicated using only formal English and in the other the child communicated using formal English and current, age-appropriate informal terms. The formal English only video was 2 min, 24 s in length, and the formal English plus informal terms video was 2 min, 4 s in length. 1.2.2. Script Two scripts were created. In both scripts the adult had 18 conversational turns and the child had 19 conversational turns that included initiations, responses, and comments. In the informal terms script, 13 of the child’s responses contained an informal term or phrase. In both scripts the child’s responses ranged from one word responses to seven word sentences. In both scripts, the child accessed nine messages by activating one icon, four messages by activating two icons, five messages by activating three icons, and one message by activating four icons. In the formal English only script the child’s average number of words per response was 3.7, which was quite consistent with the formal English plus informal terms script where the child’s average number of words per response was 3.8. The adult’s responses were identical in both scripts. Both scripts are presented in Table 1. The topic of the scripts was a popular children’s movie—Harry Potter and the Sorcerer’s Stone. The content of the script was written to be age-appropriate for children in grades 4 and 5 and to avoid gender bias. Additionally, the script was written so that it was not necessary for one to have seen the movie, or be familiar with the story, in order to understand the conversation. One of the co-authors spent a month working in a public grade school before writing the script. During this time she listened to and made notes of the types of phrases and words that were used frequently by the children in grades 4 and 5. Additionally, three mothers of children in grade school were asked to list informal terms that their children used frequently. The most commonly used terms from these sources were then included in the informal script. When both scripts had been completed, two mothers of grade school aged children reviewed the scripts to ensure that the script containing informal terms sounded natural and appropriate for children in grades 4 and 5.
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Table 1 Formal and informal scripts Formal
Informal
C: Hi, How are you? A: Fine. How are you? C: Fine. A: What did you do last night? C: I saw a good movie! A: What was it? C. Harry Potter and the Sorcerer’s Stone. A: I saw it, too. I thought it was pretty good. C: It was great! A: What was your favorite part? C: When Harry went to Hogwarts. A: That was a happy time for Harry. C: Yes, no more aunt and uncle. A: They were pretty mean to Harry, but they sure thought Dudley was. . . C: Nice! A: What did you think of Dudley? C: He’s mean. What was your favorite part? A: When Harry met He-Who-Shall-Not-BeNamed the last time. C: That scared me! A: It was rather scary. So, what else did you like in the movie? C: The sorting hat. A. I liked that, too, especially when it didn’t put Harry in the wrong house. C: That would have been bad! A: I agree. Why do you think so? C: He wouldn’t have been a seeker. A: Yes, he seemed like a natural at that game. C: That’s right! A: Did you like Professor Snape? C: Not at all—he was too mean. A: But he did turn out to be a good guy at the end. C: He’s still a scary person! A: Do you think you’ll go the second movie? C: I can’t wait! A: I imagine it will be as good as the first one. C: Me, too. A: Well, it’s getting late, I better go. C: Good-bye.
C: Hey, What’s up? A: Not much, how are you? C: Fine. A: What did you do last night? C: I saw the coolest movie! A: What was it? C. Harry Potter and the Sorcerer’s Stone. A: I saw it, too. I thought it was pretty good. C: It was sweet! A: What was your favorite part? C: When Harry went to Hogwarts. A: That was a happy time for Harry. C: Yeah, no more aunt and uncle. A: They were pretty mean to Harry, but they sure thought Dudley was. . . C: Awesome! A: What did you think of Dudley? C: Loser! What was your favorite part? A: When Harry met He-Who-Shall-Not-BeNamed the last time. C: That freaked me out! A: It was rather scary. So, what else did you like in the movie? C: The sorting hat. A. I liked that, too, especially when it didn’t put Harry in the wrong house. C: That would have stunk! A: I agree. Why do you think so? C: He wouldn’t have been a seeker. A: Yes, he seemed like a natural at that game. C: Big time! A: Did you like Professor Snape? C: Gimme a break—he gave me the creeps. A: But he did turn out to be a good guy at the end. C: He’s still a scary dude! A: Do you think you’ll go the second movie? C: I can’t wait! A: I imagine it will be as good as the first one. C: Totally. A: Well, it’s getting late, I better go. C: Later.
Additionally, two grade school aged children, who were not participants in the study, were asked to review the scripts and to give their opinions. In all cases, the mothers and children agreed that the script containing informal terms was something that might naturally be produced by a child in grade 4 or 5.
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1.2.3. Measurement scale The assessment of attitudes toward augmentative and alternative communication (AATAAC; Beck et al., 2000), a 26 item, five-point Likert rating scale designed to assess attitudes of elementary-aged school children toward peers who use AAC, was the measurement tool used in this study. The AATAAC consists of 26 rating items. Seven of these are intended to measure cognitive aspects of attitude, five to measure affective aspects, and 14 to measure behavioral intents. Of the cognitive items, three are positively worded and four are negatively worded. Four of the affective items are positively worded and one negatively worded. These 12 cognitive and affective items are randomly ordered with positive and negative items alternating. The behavioral intent items are the last 14 items on the AATAAC. All are positively worded. (Scale items are listed in Appendix A). Beck et al. have established acceptable levels of internal consistency, test-retest reliability, content validity, concurrent validity, and construct validity for this scale. Additionally, Likert rating scales have been shown to be appropriate for measuring attitudes toward individuals who use AAC or who have disabilities (Gorenflo & Gorenflo, 1991; Rosenbaum, Armstrong, & King, 1986). 1.3. Procedure A 2 2 2 independent groups design was used. Participants from both schools were selected from two grade 4 classrooms and two grade 5 classrooms within the participants’ respective schools. Due to teacher request, the participants from one of the schools remained in the groups formed by their classrooms. One fourth grade classroom and one fifth grade classroom were randomly assigned to watch the video containing informal terms and the remaining fourth grade and fifth grade classrooms watched the video containing formal English only. In the second school, participants from each classroom were randomly divided into two groups with the stipulation that boys and girls were as evenly divided between groups as possible. One subgroup from each classroom was randomly assigned to watch the video containing informal terms while the remaining subgroup watched the video containing formal English only. In all cases children from the same classroom were tested in back to back sessions so that they could not talk to each other before all children had completed the experimental task. Of the total of 84 participants, 24 children in grade 4 watched the video with informal terms and 22 watched the video with formal English only; 19 children in grade 5 watched the video with informal terms and 19 watched the video with formal English only; and 19 boys and 24 girls watched the video with informal terms and 23 boys and 18 girls watched the video with formal English only. All sessions were conducted in the late spring of the same academic year. All testing within a school was done either in the same empty classroom or multipurpose room. The experimenters went to the children’s classrooms to pick them up for the study. When all children had gathered in the hall outside their classroom, the experimenters requested and, in all cases, obtained their verbal assent to participate in the study. Children were then led to the room where the study was conducted. This room contained a chair and desk space for each child. AATAACs were placed face down on the desks in front of each child’s chair. A pencil was on top of each AATAAC. Children were asked to leave the
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papers alone until they were told what to do. Scripted instructions were used in each session to ensure that all children received the same information. (Appendix B). As shown in the Appendix B, AAC was briefly described to children in the first portion of the instructions. The children were then told they would see a video of a child their age who used AAC, and were asked to watch the video carefully. The selected video was then played twice for the children. After children had watched the video, they were instructed to turn their papers over and answer the questions regarding their school, grade, date, and gender. Following these questions were the two questions concerning their familiarity with children with disabilities. They were instructed to answer these questions after the term disability was defined for them. The final items on this page were two examples of how the children were to answer the scale items. Appendix B contains the scripted instructions that were read to the children for completing these items. When both example items had been completed by all children and no child had a question about how to complete the remainder of the scale, children were instructed to turn to the next page and complete the remaining items, keeping the child they had just seen on the video in mind as they did so. If they had any questions about an item or a word in an item, children were told they could raise their hand and one of the experimenters would assist them in reading the item. After children completed the entire scale, they were instructed to go back through their scales to make sure they had answered each item and had only given one answer to each item. They were further instructed to not change any of their answers at this time. Any questions children had about AAC or children who used AAC were answered after their experimental session was concluded. 1.4. Data analysis The AATAAC is scored for positive items by giving each answer of strongly agree 5 points, agree 4 points, can not decide 3 points, disagree 2 points, and strongly disagree 1 point. Scoring is reversed for negatively worded items. The number of points for each item is summed and divided by the total number of items answered. The maximum mean score possible is 5. Higher scores represent more positive attitudes than lower scores. Mean AATAAC scores were the dependent measure. A 2 (informal versus formal English only) 2 (gender) 2 (grade 4 versus grade 5) analysis of variance (ANOVA) was calculated. Significance level was set at a = .05. Alpha was calculated to obtain a measure of reliability for the AATAAC. A coefficient of .92 indicated high internal consistency for this study. To determine if the sample size in this study was large enough to show an effect of the independent variables (i.e., informal versus formal language, gender, and grade), a power analysis was calculated. Based on Cohen’s (1977) guidelines for effect size, the results of this power analysis indicated that the average sample size in this study of 10 per cell was adequate to show an effect of large (delta = 0.999) and medium size (delta = 0.911), but was less adequate to show an effect of small size (delta = .196). Given the fact, however, that an effect of small size might not be of clinical or practical significance, it is more important to have power sufficient for showing an effect of medium or large size than an effect of small size.
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2. Results Results of the 2 (informal versus formal English only) 2 (gender) 2 (grade 4 versus grade 5) ANOVA indicated a main effect of gender [F(1, 76) = 12.42, p = .001] with girls’ mean AATAAC scores (3.88, S.D. = .48) being higher than boys’ (3.53, S.D. = .54). There were no differences for grade or vocabulary. The only interaction effect was gender by grade (F(1, 76) = 3.958, p = .05). While girls’ self-reported attitudes became more positive from grade 4 to grade 5, boys’ became less positive. To determine effect size of gender within each grade, eta squared was calculated. Eta squared for gender in grade 4 was .03 and for gender in grade 5 was .33 (Table 2). That is, within grade 4, 3% of the total variation in AATAAC scores was explained by gender. For children in grade 5, 33% of the total variation in AATAAC scores was explained by gender.
3. Discussion 3.1. Gender and grade differences Results indicated that, in general, self-reported attitudes of girls were more positive toward a peer who uses AAC than were those of boys. In their review of determinants of children’s attitudes toward peers with disabilities, Rosenbaum, Armstrong, and King (1988) indicated that gender was ‘‘the single most potent and consistent determinant of attitudes about disabilities’’ (p. 33). To account for this gender difference, Rosenbaum et al. cited Gillian’s 1982 work indicating that while preadolescent boys are more concerned with rights and justice, preadolescent girls tend to be more concerned with caring about others and relationships. Additionally, Rosenbaum et al. indicated that boys are more physical and interested in active play than are girls. If these suggestions are true, then girls may be more predisposed than boys to building relationships with and to holding more positive attitudes toward children with disabilities. Additionally, the gender differential found for participants in the current study was more pronounced for children in grade 5 than for children in grade 4. That is, self reported attitudes of boys in grade 5 toward a peer who uses AAC were less positive than were those of boys in grade 4 and the self reported attitudes of girls in grade 5 were more positive than
Table 2 Means, formal deviations, and eta squared for the significant interaction of gender grade Group
N
Mean
S.D.
Grade 4 Boys Girls
25 21
3.60 3.79
.52 .53
Grade 5 Boys Girls
17 21
3.42 3.98
.56 .42
Eta squared .03
.33
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those of girls in grade 4. These findings are consistent with those of Beck et al. (2000) who reported that attitudes of boys in their sample toward a peer who used AAC became progressively less positive for boys in grade 1 versus grade 3 versus grade 5. Consistent findings indicating that attitudes of boys who are familiar with peers with disabilities become less positive as the boys increase in age throughout elementary school have important implications for school professionals who work in inclusionary settings. Activities need to be planned and implemented that promote more positive attitudes among boys and address the tendency of boys’ attitudes to decline with age. The fact that in the current study the mean attitude scores of girls in grade 5 were more positive than those for the girls in grade 4 suggests that, in contrast to boys, some elements of the interactions between these girls and their peers with disabilities resulted in an increase in the positive nature of the older girls’ attitudes. This could be due to the increased length of time older girls had been included with their peers with disabilities. Additionally, as would be consistent with Ryan’s (1981) indication that children develop more positive attitudes toward peers with disabilities as they age from preschool through their early teen years, the difference in attitudes scores between girls in grade 4 and girls in grade 5 could be due to differences in the developmental stages of these girls. 3.1.1. Informal versus formal English Effect of type of vocabulary used in the conversational scripts in this study was not statistically significant. This lack of significance was in contrast to the clinical expectation that vocabulary on a child’s voice output AAC device that is like that of his or her speaking peers will increase peers’ acceptance of the child who uses AAC. A possible explanation could be the specific informal terms that were chosen to be included in this study. Choice of these terms, however, was carefully made so that the terms were ones that local children in grades 4 and 5 used frequently. Indeed, the scripts were reviewed by mothers, professional SLPs, and grade school aged children before being used and were considered to be typical sounding by all reviewers. The researchers used the same process for selecting vocabulary as would be used by clinicians programming AAC devices for individual students who use AAC. If, therefore, children did not react more positively to the informal script than to the formal English only script because of the specific informal terms contained in this script, then this suggests that, even with the best planning, the selection and use of informal terms on children’s AAC devices might not serve to increase the acceptance of a child who uses AAC by his or her peers. The fact that the voice recorded on the AlphaTalker was that of a young adult female in her 20s could also have influenced the results. Even though the speaker’s voice was youthful and her intonation patterns were natural and similar across conversational scripts, children might have noticed that the informal terms were being spoken by an adult who was not part of their social group, which could have altered their reaction to the informal video. Because interventionists might have to record their own voices on children’s AAC devices when messages have to be programmed and an acceptable peer is not readily available, knowledge of children’s attitudes toward informal and formal messages recorded with an adult voice is important. An area of future research, however, should be the influence on
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children’s attitudes of the type voice (e.g., adult versus gender-neutral child versus synthesized) used to record informal terms. An additional explanation for the lack of a positive influence of informal terms can be gleaned from theories of peer acceptance. As discussed earlier in this paper, competing theories of peer acceptance exist (Cook & Semmel, 1999). One theory indicates that peer acceptance is based on the similarities between children. Another theory indicates that children with significantly atypical behavior are accepted by their peers on the basis of differences that allow their peers to test the limits of acceptable behavior (Cook & Semmel). Cook and Semmel investigated these theories in the context of children’s acceptance of their peers with various types of disabilities (e.g., emotional disorders, physical disabilities, mental retardation). Cook and Semmel’s results indicated that children in nonheterogenous classrooms accepted peers with severe disabilities better than children with mild disabilities. A nonheterogenous classroom was defined as one in which fewer than 50% of the students were from ethnic minorities or were below gradelevel readers and fewer than 20% of the students had a disability. Cook and Semmel explained their results by indicating that when students in a classroom form a relatively homogenous group, ‘‘individuals with severe disabilities readily stand out as markedly different, prompting differentiated expectations among peers and fulfillment of a functional and protected role. Atypical behavior is thus expected and a critical element of their group role, resulting in a level of acceptance’’ (p. 57). Additionally, Cook and Semmel reported that the more severe a child’s disability was, the more accepted that child was by his or her peers. As an example they cited a boy who was nonambulatory and who used AAC to communicate and who was also the second most socially desired student in his class. According to Cook and Semmel’s (1999) definition, the participants of the current study all belonged to nonheterogenous classrooms. These children would likely have viewed a child who could not talk and who used an AAC device to communicate as one who had a relatively significant and salient disability. If this was the case, then, according to the theory of peer acceptance supported by Cook and Semmel’s findings, behaviors such as using informal terms that made the child with a disability appear more typical might actually have served to lessen students’ willingness to assign the child a special role and thereby might not have increased students’ acceptance of this peer.
4. Conclusion The lack of effect found for type of vocabulary used in the current study should not be taken as an absolute indication that the inclusion of informal terms will never influence peers’ attitudes. The possibility exists that future studies using different experimental stimuli (e.g., actual interactions with children who use AAC devices, the use of a child’s voice or of a synthesized voice) might have findings indicating a positive influence of informal terms on children’s attitudes. Nonetheless, the results of the current study suggest that, contrary to expectations generated from clinical anecdotes, the introduction of informal terms into a child’s AAC device might not influence that child’s acceptance by his or her peers. The decision of what vocabulary should be included on a child’s AAC device
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needs to be made carefully. Both the input of the child who uses AAC and that of the child’s peers should be considered. Furthermore, it is important that interventionists conduct careful follow-up evaluations of peers’ reactions to informal terms communicated by a child who uses AAC to ensure that the child’s AAC system is not creating additional barriers for that child but is instead helping to improve the quality and quantity of the child’s social interactions.
Appendix A. AATAAC training and scale items Scale items numbered according to their order of appearance on the AATAAC A.1. Cognitive items 12. Children who use AAC try to understand what others are saying to them. 7. Children who use AAC try to talk about what other children want to talk about. 11. Children who use AAC take as many turns as other children do when they are talking. 2. Children who use AAC don’t take many turns when they try to talk. 6. Children who use AAC really don’t want to talk with other children. 8. Children who use AAC can’t change their words if they are not understood. 10. People have trouble knowing what children who use AAC are trying to say to them.
A.2. Affective items 3. 5. 9. 1. 4.
I like children who use AAC. I would feel comfortable around a child who uses AAC. I think children who use AAC are fun to be with. I would feel good about myself if I was with a child who used AAC. Children who use AAC scare me.
A.3. Behavioral items 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.
I I I I I I I I I I I
would would would would would would would would would would would
work at school with a child who uses AAC. eat lunch with a child who uses AAC. go to the park with a child who uses AAC. introduce a child who uses AAC to my friends. invite a child who uses AAC to my house. play with a child who uses AAC. sit next to a child who uses AAC in class. talk to a child who uses AAC. invite a child who uses AAC to a party I had. walk in the school halls with a child who uses AAC. choose a child who uses AAC to be on my team in P.E.
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24. I would go to the library with a child who uses AAC. 25. I would ask a child who uses AAC to sleep over at my house. 26. I would go to a movie with a child who uses AAC.
Appendix B. Instructions B.1. Portion of script of instructions describing AAC Augmentative/alternative communication—or AAC (write AAC on blackboard) is used by students who can not speak like you and I can. There are many reasons some children can not speak. Some may have physical disabilities that do not allow them to talk like most of us can. Some may have difficulty thinking as easily as others so that speaking is hard for them. Many students who cannot speak were born that way, others have had accidents which have caused them to have difficulties speaking. One way of helping students who can not talk is to provide them with what is called augmentative/alternative communication systems—or AAC. Students who use AAC may use a number of different ways of communicating—some may sign or gesture, some may point to pictures, letters, or words, some may use machines or computers that talk for them. B.2. Portion of script containing instructions for the completion of the AATAAC Now turn to the first page. Here you see spaces for your school, grade, and date. Please fill these in now. On the bottom of this page you see two more questions. These are examples of how you will answer the rest of the questions. I will explain how to answer these items. First of all, there are no right or wrong answers. I want you to answer each item just the way you really feel. Please answer as honestly as you can—and remember, there are no right or wrong answers. Now, look at the first item (point to each item as it is referred to and the response boxes as they are referred to). It says ‘‘Little babies are lots of fun for their parents’’. Underneath that item there are five boxes. You will put an X through one of these boxes. In the first box you will see the words ‘‘strongly disagree’’ and under it a frowning face. If you really don’t think babies are fun for their parents, put an X through this box. In the next box you see the word ‘‘disagree’’. If you just sort of think babies aren’t fun for their parents, put an X in this box. The next box says ‘‘can’t decide’’. This is the box you would put an X through if you don’t know if babies are fun for their parents or not. The next box says ‘‘agree’’. Put an X through this box if you kind of think babies are fun for their parents. The last box has the words ‘‘strongly agree’’ and has the happy face under it. If you really think babies are fun for their parents, put an X through this box. Let’s try another one. This item says ‘‘Little babies are messy and they cry too much.’’ If you think this is really true, put an X through the box that says ‘‘strongly agree’’ and has the happy face under it. If you think it’s just kind of true, put an X through the box that says ‘‘agree’’. If you aren’t sure if babies are messy and cry too much, put an X through the box in the middle that says ‘‘can’t decide’’. If you kind of think that babies aren’t that messy and don’t cry too much, put an X through the box that says ‘‘disagree’’. If you really don’t think that babies are messy and cry too much, put an X through the box that says ‘‘strongly disagree’’
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and has the frowning face under it. Do you have any questions? Remember to mark only one box per answer and to answer the items as honestly as you can—there are no right or wrong answer.
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