Using Cues to Enhance Receptive Communication

By: MaryAnn Demchak, Charmaine Rickard, & Marty Elquist

Purpose of this fact sheet

This fact sheet will provide you information on:

The difference between receptive and expressive communication
The importance of using cues to augment what we say
Who benefits from extra cues
Using cues to convey different types of messages
Important guidelines to remember when using cues

What is Communication?

Communication is made up of two parts: receptive and expressive communication. Receptive communication refers to the way a listener receives and understands a message from a communication partner*. Expressive communication refers to how one conveys a message to a communication partner by gesturing, speaking, writing, or signing. Meaning can be added to expressive communication by using specific body language or vocal inflection. For more information on this topic, please see the project fact sheet Providing Cues to Enhance Expressive Communication.

Importance of Using Cues to Enhance Understanding

Infants and children with multiple disabilities often have difficulty understanding spoken words. Spoken words can be accompanied in many different ways from simple (e.g., gestures, facial expressions) to far more complex methods (e.g., sign language, written words). It is important to provide additional information to these children through the senses available to the child. That is, you must consider the child’s vision and hearing when adding cues.

Benefits of Adding Cues

Children will begin to understand familiar activities and events.
Cues help to develop a sense of security.
Children will begin to anticipate and participate (perhaps partially) in familiar activities and events.
Cues help transitions to progress more smoothly.
(Order project fact sheets Making Changes in Routines & How to Interact with Individuals with Dual Sensory Impairments for more information on the benefits of adding cues).

Who Will Benefit From Extra Cues?

Individuals with severe, multiple disabilities
Individuals with combined vision and hearing impairments

Types of Cues

Touch or tactile cues
Object cues
Olfactory or smell cues
Visual cues
Kinesthetic or movement cues
Auditory or sound cues

Information Cues Can Provide

A command or directive. Example: Tapping on child’s shoulder to say “Sit Down.”
Feedback (positive or negative). Example: Rubbing child’s back to say “Good Job!”
Information. Example: Pressing on child’s hips to say “Time to change.”

Basic Guidelines for Using Cues

Be easy and convenient
Have an obvious relationship to the referent
Be “accessible” to the child
Be pleasant or neutral for the child
Immediately precede an action or activity
Alert the child that something will follow the cue
Focus the child’s attention on the interaction or activity that follows

Touch or Tactile Cues

Touch or tactile cues are used to give the individual with dual sensory impairments a way of understanding about activities, people and places through the use of touch and/or movement. Touch cues are made on a child's body using distinctive motions or touches.

Selecting Touch Cues

A firm or deep pressure touch is more easily tolerated than a light touch.
Children with medical needs often dislike having the bottom of their feet touched.
Cues should be different from one another so that the child can discriminate among them.
Cues should be associated with the upcoming interaction or activity as much as possible.(Order project fact sheet Touch Cues for more information.)

Object Cues

Object cues are everyday objects from daily activities used as cues for those activities. The communicative cues are made with objects that touch the child’s body or are presented visually to the child. An example would be touching a wash-cloth to a child’s hand to cue that it is time to wash the child’s hands and face.

Types of Object Cues

Identical objects: Objects that are exactly like the referent (e.g., a pretzel glued to a communication card).
Partial or associated objects: Using parts of an object (e.g., a bicycle grip to cue bike riding), or objects associated with an activity (e.g., a key ring and key to cue going to one's locker).
One or two shared features: A more abstract symbol that shares only one or two features with the referent (e.g., a piece of the same type of vinyl to represent a therapy ball).

Selecting Object Cues

Consider child’s vision and visual field when selecting and presenting object cues.
Objects should be distinct (e.g., a brightly colored washcloth).
Miniature objects make poor symbols.
- Miniatures require good vision and advanced cognitive skills.
- Sensations received when touching a miniature are very different from those received when touching the actual object represented.

Object Calendars

Object cues are often used in conjunction with calendar boxes.
Object calendars are used to help students to learn to anticipate activities and to form a sequence of the day. (For more information about object calendars, see the object calendar tip sheet.)

Olfactory Cues

Smells associated with activities or people can also be used as cues. Examples:

Smelling shampoo to cue washing hair.
Wearing the same cologne to cue your presence.

Selecting Olfactory Cues

Observe the child’s preferences regarding smells.
Observe the child to determine if some odors provide too much stimulation.
Observe the child for negative reactions.

Visual Cues

Visual cues use color, contrast, lighting, spacing, and arrangement to make an object more visible to the child. The child’s vision must be considered when selecting visual cues.

Kinesthetic/Movement Cues

Handling, positioning, and moving the child in certain ways that are associated with the upcoming activity are kinesthetic or movement cues.

Examples:

Lifting a child’s arms above head to cue removing shirt.
Gently swinging an infant in your arms before placing in an infant swing.

Selecting Kinesthetic or Movement Cues

Consult the child’s therapist regarding specific positioning and handling related to the child’s tone.
Do not use movement cues that will cause reflexive or involuntary responses.

Auditory Cues

Sound cues involve spoken words and environmental sounds and are a natural way to get a child's attention. Examples:

Saying the child’s name when about to interact with the child.
Tapping a bowl with a spoon to cue giving a bite.

Selecting Auditory Cues

Consider the child's hearing abilities when considering auditory cues.
Consider whether the child is overly sensitive to certain sounds or loudness.
Minimize background noise to increase effectiveness of auditory cues.
Keep spoken words simple or use single key words.

Important Guidelines to Remember

Regardless of the type of cues being used, cues should:

Be easy and convenient
Have an obvious relationship to the referent
Be "accessible" to the child (i.e., consider the child's vision & hearing)
Be pleasant or neutral for the child
Immediately precede an action or activity
Alert the child that something will follow the cue
Focus the child's attention on the interaction or activity that follows

Whenever you are interacting with a child who benefits from extra cues, you should remember to:

Interact with each child in a sensitive way.
Let the child know you are there.
Let the child know who you are.
Do not act on the child without letting him or her know what is about to hap-pen.
Allow the child enough time to respond to your message.
When finished with an activity, let the child know that it is finished.
Let the child know you are leaving.

It is also important to consider each child individually when selecting cues, using cues to which the child responds most readily. It is ok to combine two or more methods of conveying information to the child.

Encouraging Consistency

In order to ensure that the child with whom the cues are being used learns the meaning of the cues, it is important that each person who interacts with the child uses the same cues. As a result of consistent use, the cues will have meaning for the child and will enable the child to anticipate and to participate in activities. There are several strategies that can encourage consistency among the child’s communication partners:

Make sure each person who interacts with the child uses the same cues.
BE CONSISTENT!
Use a touch cue map that shows the location of cues and explains how to use specific cues.
Use a chart to indicate cues to be used to signal new activities.
Use a chart to indicate cues to be used within routines.
Model the cues for communication partners who are just beginning to use the cues with the child.

References

Alsop, L. (1993). Communication. In L. Alsop (Ed.), A resource manual for understanding and interaction with infants, toddlers, and preschool age children with deafblindness. Logan, UT: SKI*HI Institute, pp 46-91.
Huebner, K. M, Prickett, J. G, Welch, T. R, & Joffee, E. (Eds.) (1995). Hand in Hand: Essentials of communication and orientation and mobility for your students who are deaf-blind, (Volume I & II). New York, NY: AFB Press.
Klein, D. M., Chen, D., & Haney, M. (2000). Promoting learning through active interaction: A guide to early communication with young children who have multiple disabilities. Baltimore, MD: Paul H. Brookes Publishing.
Rowland, C., & Schweigert, P., (2000). Tangible symbol systems. Making the right to communicate a reality for individuals with severe disabilities. Portland, OR: Oregon Health Sciences University.
Rowland, C., Schweigert, P., & Prickett (1995). Communication systems, devices, and modes. In K. M Huebner, J. G. Prickett, T. R. Welch, & E. Joffee (Eds.) Hand in hand: Essentials of communication and orientation and mobility for your students who are deaf-blind. New York: American Foundation for the Blind, pp 219-259.