Total Communication at Silver Creek Pre-School – Part 1 of 3

by Maryanne Bruni, O.T. Reg (ON) and Sarah Strathy, M.H.Sc. SLP (C), Reg. CASLPO

Silver Creek Pre-School is an integrated, caring, and creative early education setting, with therapeutic services delivered within the classroom. The teachers and therapists practice a total communication approach in how they deliver programming, set up the environment, and watch and listen to each child to notice, and respond to, his or her communication.

In the literature, “capital T” Total communication often refers to using spoken language and sign together. At Silver Creek, we define “small t” total communication as including all means of giving and receiving a message (expressive and receptive language). This may include eye contact and eye gaze, facial expressions, natural gestures (e.g., pointing/reaching), signing, real objects, photographs, pictures and picture communication symbols, and technology including BigMack switches, iPads and FM soundfield systems.

Our preschool classroom environments are structured, and programming delivered, with total communication in mind. For example, the teacher introduces snack items by slowly and clearly saying the name a food, while holding up the real object (e.g., a banana). With the food item still within the children’s view, she points to a picture symbol on a snack choice board, and then signs “banana”. This means that the children are presented with a variety of modes through which to receive the message “banana”, including auditory (clear, slow, spoken word), visual (sign, picture, real object) and tactile-kinesthetic (touching/holding the banana or the picture, imitating the sign).

For children who have difficulty understanding language, presenting the spoken word alone can be problematic. The word is said, and then it is gone. The child has to attend to it, hear it, process it, and store it in memory within an instant. Additionally, the word “banana” does not give us any information about what banana means. Alternatively, a picture can stay in view and be used to request later, without having to use memory or recall, and it contains features of the real object (e.g., long, yellow). Signs also often represent features of the referent. For example, the sign for banana includes an action for peeling, which tells the child something about the meaning.

Next, the teacher offers each child an opportunity to request a snack item. One child may use eye gaze to choose between two real objects (e.g., banana or apple), looking at the preferred food. Others may sign or point to a picture. Some may try to say the name of the food, which for banana might sound like “a”, “ba”, “na”, or “nana”. Several will use a combination of verbal, picture and sign. Another child may be eating only a soft purée, but has a BigMack switch available with the recorded message “more”, which she can press when she is ready for the next bite. Some children are learning to use Proloquo2go on the iPad. They touch icons to build a sentence, then tap the display to produce the computer voice output “I want a banana please”.

The teacher, having an awareness of all the ways the child may communicate, is highly tuned into the child’s communication attempts, and is able to respond. When the child receives a response then the communication attempt is reinforced, and the child is more likely to try again. This lays the foundation for the back and forth turn-taking required for later conversation. Additionally, when a child’s message is received, and responded to, frustration and related behaviours are lessened. If we focus only on verbal output, we may miss opportunities to reinforce and celebrate early communication.

Most of the children who attend Silver Creek will eventually use spoken language as their primary means of communication, but some will not, and some will continue to augment spoken language with other means. By presenting these early communicators with different ways of understanding and using language we can equip them with a toolset that they may continue to build on, or relinquish if it is no longer useful. We cannot predict the future, but we can prepare for it.

In our next article, we will focus more on specific modes of communication, and explore some of the advantages and challenges in-depth.


Maryanne Bruni, OT Reg(Ont), has worked with children and families as an occupational therapist for over 30 years. Currently working at Silver Creek Pre-School in Toronto, she provides occupational therapy programs to children aged 2-6 years who have a variety of physical, developmental, and sensory needs. Maryanne lives in Toronto with her husband and 3 daughters. Sarah, who is now 22, has Down syndrome. In 2006, the second edition of Maryanne’s book “Fine Motor Skills For Children With Down Syndrome” was published by Woodbine House. Maryanne collaborated on a research project and subsequent article published in the Journal Physical and Occupational Therapy in Pediatrics on sensory processing in children who have Down syndrome.

Sarah Strathy, M.H.Sc. SLP(C), Reg. CASLPO, joined the staff at Silver Creek Pre-school as a speech-language pathologist in September, 2011. Prior to that, Sarah worked at The PREP Program, a resource centre dedicated to the inclusion of individuals with Down syndrome in home, school and community life, in Calgary, Alberta. At PREP Sarah worked with preschool and school aged children with Down syndrome to maximize their communication skills within a family-centered and participation-based model. Sarah also directed PREP clients and their friends and siblings without Down syndrome, in a production of the musical Annie Junior. Sarah is interested in international disability issues and has visited Tanzania and India in a professional capacity.

Published September 2012