Measuring the communication of those with little or no speech

Within weeks of an article in the American Journal of Speech-Language-Pathology about a new communication scale for people with severe disabilities who use few or no spoken words, requests for the test came pouring in from clinicians across the country. The scale was developed by a team of researchers led by Nancy Brady that included Kandace Fleming, Kathy Thiemann-Bourque and Muriel Saunders at KU and researchers at the University of Washington. Within three months, the requests exceeded 300 including some from Australia, Canada and Turkey.

The Communications Complexity Scale (CCS) is a scale for researchers and clinicians to measure the communication development of children and adults with disabilities as diverse as autism spectrum disorders, deaf-blindness or cerebral palsy. The assessment is aimed at describing where an individual is on a communication continuum, which is helpful for initial assessment and monitoring intervention progress.

“Understanding the communication status of individuals with severe intellectual and developmental disabilities is difficult because they often communicate in ways that may not be readily recognized, even by clinicians,” said Brady.

The CCS is based on the well-established continuum of “presymbolic” stages of communication development in typically developing children from birth: beginning with an infant crying or smiling; followed by eye gaze, gesturing and vocalizing directed at another person; and finally using “symbolic” communication—typically, spoken words.

These developmental indicators have also been documented for individuals with different types of disabilities, according to Brady, and were incorporated into the CCS.

“The CCS helps to quantify how an individual who might otherwise be described as untestable or nonverbal communicates with gestures, vocalizations and eye gaze,” said Brady. “These are important means of communication that need to be recognized and built upon in intervention.”

Brady says that the response by clinicians to the CCS speaks to the urgent need for better measures for the thousands of individuals who communicate nonverbally.

Now the CCS is being validated and tested for its sensitivity in measuring change after behavioral interventions in clinical trials of preschool and early elementary students with collaborators at UCLA.

Brady was recognized in part for her work in developing the CCS as a standardized assessment tool for evaluating expressive communication in children with severe communication problems by one of four 2017 University Scholarly Achievement Awards, which recognize significant scholarly or research achievement for scholars in the middle of their careers.

Funding: National Institutes of Health