Total Communication at Silver Creek Pre-School – Part 2 of 3

by Maryanne Bruni, OT Reg. (ON) & Sarah Strathy, M.H.Sc. SLP (C) Reg. CASLPO

This article is the second of a three part series on total communication. The first article introduced and defined total communication as it is used at Silver Creek Pre-School, and provided rationale and examples. This article will focus on some of the specific modes of communication, describing how and why they are used in the preschool environment. Video examples will be provided.

Communication modes that will be covered in this article include:

  • Signing: uses tactile/kinesthetic and visual sensory systems
  • Real objects, photos, pictures and picture communication systems: use visual and tactile sensory systems


“Signing” at Silver Creek Pre-School refers to Signed Exact English, in which individual English words have specific signs. In contrast, American Sign Language (ASL) is a completely separate language with its own grammatical structure.  All signing is presented simultaneously with spoken words, and in many cases, with other visual communication modes as well. Thus, the children learn that there is more than one way to receive and express a message.

Signs are introduced to all children at Silver Creek, and are incorporated into all routines, play, circles, and group activities, regardless of the child’s verbal ability.  A child is not withdrawn from the classroom to be taught signs; rather, they are introduced at appropriate times in the classroom, repeated in all appropriate situations, and thus will be recognized by peers if a child eventually begins to use these signs to express him or herself.

The signs introduced relate specifically to day-to-day routines, and encourage the children’s participation in the classroom environment by offering them the ability to:

  • Make requests and choices: for example, the signs for cracker and juice are demonstrated at snack time on a daily basis. The child learns to request snack choices using sign in addition to verbal attempts.
  • Recognize and follow routines: many of the routines and are signaled by gestures and signs, in addition to other visual and auditory cues. Children learn to anticipate the routines and can indicate their understanding of what is next by signing. For example, a closing song with signing indicates the end of the day, and a child, recognizing this, may learn to spontaneously sign “home” and “mommy.”
  • Make comments: for example, a child can comment on a book about animals by signing animal names, such as “duck”, or “dog.”

The following two videos demonstrate early sign modeling and imitation for children for whom verbal skills are emerging:

Video 1: Signing – Nicole Requesting a Cookie at Snack Time

Video 2: Signing – Jordyn Making Choices and Comments During Playtime

Many children with communication delays can process and respond to gestural and kinesthetic communication more quickly and easily than to speech only. Signing capitalizes on the natural gestural component of communication. Literature on communication in children with Down syndrome supports the use of signs in conjunction with spoken words in early communicators. The simultaneous presentation of signs and speech leads to a larger vocabulary, and improvements in language and social skills. At Silver Creek we see immediately the positive effect of including signs when giving and receiving messages with the children. They feel empowered in their communication. They are able to get their message across, and this success bodes well for their communication attempts. Most importantly, the use of signs reduces the level of frustration for both the child and his or her communication partners. As parents are typically the primary communication partners for the child, we offer and encourage basic sign language classes for caregivers.

Signs may include features of the meaning or sound of the word, which may help the child remember how to make the sign. For example, with the sign for “eat,” the hand is brought to the mouth, as if bringing food to the mouth. Signing can be spontaneous, in that no other materials are required. Signing also reinforces face-to-face communication and eye contact, which are important components of spoken communication as well.  Research has shown that rather than impede the development of spoken language, as is often a worry for parents, signing actually promotes the acquisition of spoken language.

The challenges of introducing signing in a total communication approach include the fact that not all people in the child’s world will likely use or understand signs. It is also inconvenient in situations where you cannot be face-to-face to communicate, such as in the car, or between rooms.  Because the hands are used to sign, they can’t be otherwise occupied at the time of communication. Due to motor control difficulties, a child’s ability to sign may be compromised. In this case, signs may be adapted to the child’s level of physical ability. Or, it may be that a visual approach to communication may be more successful with this child.

Real Objects, Photos, Pictures and Picture Communication Systems

“Visual modes” encompasses the use of real objects, photos, pictures, and picture communication systems.

For example, a child who is not yet verbal will be given the opportunity to make a choice, during circle, between two songs. The child will be shown two objects that represent the songs, such as a toy duck (“Five little ducks”) and a toy spider (“Eensy weensy spider”).  The teacher will also use the words and sign when presenting the choices, and the child can indicate a choice by reaching or looking at the desired object. After successful repetitions of this approach, photos of these objects are used. If the child understands the use of photos, more abstract pictures, such as the Boardmaker symbols (Mayer-Johnson) are introduced as choices. As the child’s understanding grows, pictures can be introduced into more aspects of the child’s day, giving the child the ability to communicate needs and wants throughout the day. For example, as a child is being toilet trained, a picture of a toilet is kept in an accessible spot in the classroom. Each time the child is taken to the toilet, the child is encouraged to go and get the toilet picture. Eventually the child spontaneously gets the toilet picture and shows it to a teacher to indicate a need to use the toilet. With the expansion of his or her repertoire of understanding of pictures, the child may have a small album to flip through to find the appropriate picture to express any needs.

Here are videos of Nicole and Stephanie using pictures as part of their interaction. Nicole is using pictures to make choices (Video 3; note that she is also using spoken words), and Stephanie is using pictures to understand the expectation of the activity (Video 4).

Video 3: Using Pictures – Nicole Making a Choice during Printing

Video 4: Using Pictures – Stephanie Outlining Expectations for Yoga

In the Silver Creek classrooms, all play materials and play areas are labeled with pictures. All pictures also have the written word underneath. This again reinforces an expanded ability for the child to understand and interact with his or her environment.  Pictures provide a lasting visual image, requiring less demand on working memory than signs or spoken words. Pictures provide a visual structure to the verbal communication. At Silver Creek, pictures and picture schedules are used to help the children understand and follow routines.  The pictures provide an early introduction to sound-symbol correspondence, and support early literacy skills.

The challenges of using a picture communication system include the need to carry and have the materials handy at all times. Some time and expense is involved in printing and laminating, and then organizing the pictures. Pictures are an interface between direct face-to-face communication. At Silver Creek, we usually hold the pictures right up beside our face, to encourage the child to look at the picture and our face as we speak the words. The use of pictures may be less spontaneous, and a more structured way of interacting.  Some children become distracted by the physical and tactile aspect of the pictures (i.e. the laminating material).

In conclusion, both signing and various means of visual communication supports are used at Silver creek Pre-School to support early communicators who have not yet developed the ability to interact verbally. The teachers and therapeutic staff at Silver Creek develop an awareness of all the ways a child may be able to communicate effectively, and thus can tune into and respond to all communication attempts. This builds the foundation for ongoing communication and language development.

In our next article, we will focus on the use of technology as a part of our total communication approach.


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 January 2013