Influences of Sign and Oral Language Interventions on the Speech and Oral Language Production of...

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2011 Volume 4 Number 4

reviewsCenter for Early Literacy Learning

Carl J Dunst

Diana Meter

Deborah W Hamby

Influences of Sign and Oral Language Interventions on the Speechand Oral Language Production of Young Children with Disabilities

Te influences of sign and oral language interventions on the speech and oral language production of preschool-agedchildren with different types of disabilities were examined in 33 studies including 216 children Te childrenrsquos dis-abilities included autism Down syndrome intellectual and developmental disabilities social-emotional disorders and

physical disabilities All of the studies used some type of simultaneous communication (oral language together withsome type of sign language) to promote the childrenrsquos increased use of vocal or verbal behavior Results showed regard-less of type of sign language that simultaneous communication facilitated the childrenrsquos production of speech and orallanguage Te interventions also had positive effects on child speech and oral language production regardless of other

variables including type of child disability and the different conditions of the interventions Implications for practiceare described

CELLreviews are a publication of the Center for EarlyLiteracy Learning (CELL) funded by the US Depart-ment of Education Office of Special Education Pro-grams (Grant H326B060010) CELL is a collabora-tion among the Orelena Hawks Puckett Institute theAmerican Institutes for Research and the PACERCenter Appreciation is extended to Marcil Boucherfor her comments and feedback on an earlier versionof this CELLreview Copyright copy 2011 Orelena HawksPuckett Institute All rights reserved

Te extent to which adult use of sign and oral language with young children with developmental disabilities fa-cilitates or promotes the speech and oral language produc-tion of the children is the focus of this research synthesisReviews of research investigating the use of sign language

with older children and adults with Down syndrome (Clib-bens 2001 Remington amp Clarke 1996) autism (Goldstein2002 Mirenda 2002 Wendt 2006) physical disabilities(Pennington Goldbart amp Marshall 2005) and other typesof developmental disabilities (Bonvillian amp Nelson 1982Millar Light amp Schlosser 2006) found that simultaneouscommunication has positive effects on speech and oral lan-guage acquisition Te focus of this research synthesis wasthe effects of different types of sign language training on thespeech and oral language production of young children withDown syndrome autism language impairments intellectualand developmental disabilities and other kinds of disabili-

ties who had little or no oral language abilities Te research synthesis differs from other research re- views and meta-analyses by examining the use of SignedEnglish American Sign Language Japanese Sign LanguageOntario Sign Language and other types of sign language(eg Makaton) on child speech and oral language produc-tion and investigating the manner in which signing facili-tated speech and oral language production Te studies inthe research synthesis were coded and analyzed in order tobe able to unbundle (Lipsey 1993) and unpack (Dunst amp

rivette 2009) the interventions to (a) isolate which charac-teristics of the interventions accounted for variations in thestudy outcomes and (b) identify the conditions under whichsimultaneous communication was most effective in terms offacilitating speech and oral language production of youngchildren with disabilities Te main focus of the research synthesis was the rela-tionship between adultsrsquo use of signing and oral languageand childrenrsquos speech and oral language production Tistype of intervention uses sign language and speech simul-taneously where signing is hypothesized to promote or fa-cilitate the production of oral language among children whohave little or no speech (Schlosser amp Wendt 2008) We were

particularly interested in empirically evaluating the extentto which sign language interventions facilitated or impededspeech and oral language learning in order to resolve the long



2 CELLReviews Volume 4 Number 4

standing debate and controversy whether or not signing isan effective speech and oral language-learning interventionstrategy for young children with disabilities (see eg Carr1979 Zangari Lloyd amp Vicker 1994)

SEARCH STRATEGY

Studies were located using ldquo sign languagerdquo OR ldquo signing rdquoOR ldquo signed rdquo OR ldquo finger spell rdquo OR ldquomanual communicat rdquoOR ldquomanual englishrdquo AND ldquoinfanrdquo OR ldquotoddler rdquo OR ldquo pre-

school rdquo OR ldquo kindergartenrdquo OR ldquoearly childhood rdquo NO ldquodeaf rdquoNO ldquohard of hearing rdquo NO ldquohearimpair rdquo as search termsBoth controlled vocabulary and natural language searches

were conducted (Lucas amp Cutspec 2007) PsychologicalAbstracts (PsychInfo) Educational Resource InformationCenter (ERIC) MEDLINE Academic Search PremierEducation Research Complete FirstSearch CumulativeIndex to Nursing and Allied Health Literature WorldCatand Dissertation Abstracts were searched Tese were sup-

plemented by Cochran Database Google Scholar and In-genta searches and a search of an extensive EndNote Librarymaintained by our Institute Hand searches of the referencesections of all identified journal articles book chapters andbooks were also examined to locate additional studies Stud-ies were included if the majority of participants were eight

years of age or younger some type of sign language and orallanguage was used simultaneously to promote the childrenrsquosspeech and oral language production and a child vocal or

verbal outcome measure was used to evaluate the effects ofthe sign language interventions Studies that investigated thefacilitation of the use of some type of sign language as the

primary means of communication were excluded

SEARCH RESULTS

Tirty-three studies were located that included 36 sam- ples of children Appendix A shows selected characteristicsof the children who were taught using simultaneous com-munication to facilitate speech and oral language productionTe studies included 216 children Te mean chronologicalages of the children ranged from 7 to 102 months (Median= 60 months) In those studies including the childrenrsquos de-

velopmental levels of functioning the mean mental ages ofthe children ranged between 11 and 65 months (Median =24 months) Te childrenrsquos disabilities included Down syn-drome autism intellectual disabilities language disorders orimpairments cerebral palsy emotional or behavior disordersintellectual disabilities and other types of disabilities Basedon information included in the research reports 51 of thechildren had severe or profound developmental delays 43of the children had mild or moderate developmental delaysand 6 of the children had less serious developmental delays

Te types of sign language used to promote speech andoral language production and selected characteristics of the

interventions are shown in Appendix B American Sign Lan-guage (N = 14 studies) Ontario Sign Language (N = 1)

Japanese Sign Language (N = 1) Signed English (N = 11)Makaton (N = 1) or other unspecified types of sign language(N = 13) were used in the studies Te different types of signlanguage were all used with adult oral language to facilitate

the childrenrsquos signing andor speech and oral language pro-ductionTe interventions varied considerably in terms of the

length of time the interventions lasted and the numberfrequency and length of sessions Te interventions rangedfrom one to 16 months in length (Mean = 493 months SD= 377) Te average number of sessions ranged from one tomore than 100 (Mean = 5739 SD = 9372) Te individualsessions lasted between 15 minutes and 4 hours (Mean = 53minutes SD = 6278) Te frequency of the sessions rangedfrom two times a day five days a week to just one session ev-ery 2 to 4 weeks Most of the studies included other intervention char-

acteristics or conditions together with signing Most of thestudies also included a number of different naturalistic orextrinsic reinforcements that were provided in response to achildrsquos use of signs and vocalizations or verbalizations Tir-teen studies used some type of extrinsic reinforcement sixstudies used some type of intrinsic reinforcement and fivestudies included both types of reinforcement Tree studiesused unspecified types of reinforcement Te outcome measures in the studies included eitherchild vocalizations or verbalizations Vocalizations includedsome type of vocal sounds other than words Verbalizationsincluded only oral language production Te largest majorityof outcome measures were the number or percentage of child

vocalizations or verbalizations prompted or spontaneouslyused by the children although a few studies included stan-dardized measures of expressive language abilities (Bzoch ampLeague 1971 Clark Moores amp Woodcock 1975 HedrickPrather amp obin 1975) One focus of analyses was the spon-taneous nonprompted use of vocalizations or verbalizationsto communicate as a result of the simultaneous communica-tion interventions wenty-one of the studies used some type of single par-ticipant design and 12 studies used some type of group de-sign Te single participant studies included ABA multiplebaseline alternating treatment or pretest-post test designsTe group studies used pretest-post test comparative condi-tions or experimental vs control group designs wo typesof comparisons were made in both the single participant andgroup design studies One included comparisons of eitherbaseline or nonintervention conditions with intervention or

post test outcomes Te other included comparisons of ei-ther sign or oral language interventions with sign and orallanguage interventions Cohenrsquos d effect sizes for the baseline vs intervention

phases in the single participant design studies and Cohenrsquos



CELLReviews Volume 4 Number 4 3

d effect sizes for the between group or comparative condi-tions in the group studies were used to evaluate the effects ofsign language intervention Te effect sizes were calculatedas the mean difference between the intervention conditionsand the pretest or baseline conditions divided by the pooledstandard deviations for the two conditions (Dunst Hamby

amp rivette 2007) In cases where the baseline indices in thesingle participant design studies were all zero the effect sizes were estimated using the standard deviations for the both thebaseline and intervention phases combined as the denomina-tor (Rosenthal 1994) Te average effect sizes and their 95confidence intervals were used for substantive interpretationof the finding A confidence interval not including zero indi-cates that the average effect size differs from zero at the 005level (Shadish amp Haddock 2009)

SYNTHESIS FINDINGS

Appendix C includes the intervention conditions in

each of the studies the child outcomes that were the focusof investigation the particular contrasts or comparisons that

were the focus of this research synthesis and the effect sizesfor these comparisons or contrasts Preliminary analysesfound that the average effect sizes for the single participantdesign studies (Mean = 141 95 CI = 117 ndash 165) weremore than twice as large as those for the group design studies(Mean = 063 95 CI = 043 ndash 083) Te findings there-fore are presented separately for the two types of studiesTe extent to which the pattern of results of the two typesof studies were similar or different was used for substantiveinterpretation

Te extent to which different types of signing were as-

sociated with increases or differences in the child speech andoral language production outcomes is shown in able 1 Te

able 1 Average Effect Sizes and 95 Confidence Intervals for the Sign Language Interventions on Child Vocal and Verbal Behavior

ype of Sign Language

Number AverageEffect Size

95 ConfidenceIntervalEffect Sizes Sample Sizes

Group Design Studies

American Sign Languagea 11 20 57 21-93

Signed English 9 44 79 57-101

Unspecified 13 77 80 34-125

Single Participant Studies

American Sign Languageb 22 10 123 101-146


Unspecified 29 18 104 66-143

a Includes one study that used Ontario sign language and one study that used Makatonb Includes one study that used Japanese sign language

interventions regardless of type of sign language were re-lated to increased child speech and oral language productionIn the group design studies the average effect size ranged be-tween 057 (95 CI = 021 ndash 093) and 080 (95 CI = 034- 125) In the single participant design studies the averageeffect sizes ranged between 104 (95 CI = 066 ndash 143) and

168 (95 CI = 124 ndash 213) Te pattern of results for thetwo types of studies showed that the sign language interven-tions positively influenced child speech and oral language

production able 2 shows the results for the differences betweenthe contrasting or comparative conditions and the studyoutcomes In the group design studies comparing either pre-intervention vs post intervention outcomes or oral or signlanguage intervention vs sign and oral language interventionthe average effect sizes were 081 (95 CI = 055 ndash 108) and050 (95 CI = 020 ndash 070) respectively In the single par-ticipant design studies comparing baseline or noninterven-tion pretest vs intervention or post intervention differences

the average effect size was 140 (95 CI = 115 ndash 166) Teaverage effect size in single participant design studies wherethe baseline included either oral or sign language interven-tions and the intervention phases included both oral and sign language interventions the average effect size was 106(95 CI = 052 ndash 160) aken together the results showedthat regardless of research design or comparativecontrast-ing conditions the interventions were effective in terms of

promoting child speech and oral language production Te effectiveness of the sign language intervention onchildren with different disabilities and severity of delays isshown in ables 3 and 4 respectively Te findings showedregardless of type of disability or severity of delay that the

sign language interventions positively influenced the speechand oral language production of the study participants In




able 2 Average Effect Sizes and 95 Confidence Intervals for the Different Contrasting and Comparative Study Conditions and theStudy Outcomes

Comparative Conditions




Pretest vs Sign + Oral Post est 23 109 81 55-108

Oral or Sign vs Sign + Oral 10 59 50 20-80

Single Participant Design Studies

Baseline vs Sign + Oral 68 41 140 115-166

Oral or Sign Baseline vs Sign + Oral 15 14 106 52-160

able 3 Average Effect Sizes and 95 Confidence Intervals for Different Child Disabilities and the Study Outcomes

Child Disability




Autism 16 58 69 47-91

Down syndrome 11 50 75 17-133

Developmentalintellectual delaysa 6 33 73 35-111


Autism 46 25 104 86-123


Social-emotional disorders 11 5 186 103-270

Intellectualdevelopmental delaysa 4 3 151 113-188

a Includes children with different types of delays or disabilities other than Autism or Down syndrome (see Appendix A)

able 4 Average Effect Sizes and 95 Confidence Intervals for Severity of Child Disability and Delay and the Study Outcomes

Severity of Child Delay




MildModerate 9 45 85 18-152

SevereProfound 15 38 67 40-94

Mixed 9 58 66 40-91







the analyses of the relationship between type of child disabil-ity and speech and oral language production in the groupdesign studies the average effect sizes ranged from 069(95 CI = 047 ndash 091) to 075 (95 CI = 017 ndash 133) Inthe single participant design studies the average effect sizesranged from 104 (95 CI = 086 ndash 123) to 186 (95 CI

= 103 ndash 270) In the severity of delay analyses the averageeffect sizes ranged from 066 (95 CI = 040 ndash 091) to 085(95 CI = 018 ndash 152) in the group design studies In thesingle participant design studies the average effect sizes were144 (95 CI = 106 ndash 181) for the children with mild ormoderate delays and 125 (95 CI = 098 ndash 153) for thechildren with severe or profound delays Te extent to which the sign language interventions

positively affected either or both vocal or verbal child be-havior is shown in able 5 Tere were only verbalizationoutcomes in the group design studies but both vocalizationand verbalization outcomes in the single participant designstudies Te sign language interventions had positive effects

on child speech and oral language production in both typesof studies In the group design studies the average effect sizefor child verbalizations was 072 (95 CI = 51-92) In the

single participant design studies the average effect size forchild vocalizations was 097 (95 CI = 57-137) and forchild verbalizations the average effect size was 148 (95 CI= 121-175) Whether or not the sign language interventions influ-enced spontaneous use of child speech or oral language was

determined by coding the vocal and verbal outcomes ac-cording to spontaneous language production prompted re-sponses or some combination of both Te results are shownin able 6 For both types of studies the sign language inter-

ventions were associated with increased spontaneous childspeech and oral language production In addition the signlanguage interventions were associated increased promptedspeech and oral language production in both types of stud-ies

All but a few studies used either or both naturalisticand extrinsic reinforcers for child speech and oral language

production Te naturalistic reinforcers included access to preferred objects activities or edibles (food or drink) Te

extrinsic reinforcers included verbal or physical praise edi-bles or some type of tokens able 7 shows the relationshipsbetween type of reinforcement and child speech and oral

able 5 Average Effect Sizes and 95 Confidence Intervals for ype of Child Outcome

Child Outcome




Verbalizations 33 141 72 51-92


Vocalizations 23 9 97 57-137


able 6 Average Effect Sizes and 95 Confidence Intervals for Spontaneous and Prompted Child Speech and oral language Production

ype of Child Speech




Spontaneous Speech 9 48 83 61-105Prompted Speech 18 87 68 33-103

Combination 4 23 54 -21-128


Spontaneous Speech 11 7 167 79-254

Prompted Speech 51 33 144 115-173

Combination 5 4 114 32-197




language production In the group studies both types of re-inforcement were associated with average effect sizes of 078

(95 CI = 037 ndash 119) and 067 (95 CI = 032 ndash 101) fornaturalistic and extrinsic reinforcers respectively In the sin-gle participant design studies the average effect sizes rangedfrom 082 (95 CI = 046 ndash 118) for naturalistic reinforcersto 169 (95 CI = 135 ndash 203) for extrinsic reinforcers

Te final set of analyses examined the relationshipsbetween the length of the interventions in months and thenumber of intervention sessions and child speech and orallanguage production Te results are shown in Figure 1 Inthe group design studies more months of intervention andmore intervention sessions were associated with larger effectsizes In the single participant design studies fewer monthsof intervention and fewer intervention sessions were associ-ated with larger effect sizes Te pattern of finding appear tobe the result of the fact that the children in the single par-ticipant studies tended to receive more frequent and intenseinterventions compared to the children in the group designstudies

CONCLUSION

Findings showed that regardless of type of sign lan-guage simultaneous communication had positive effects onthe speech and oral language production of young children

with different kinds of disabilities Te findings also showed

that the interventions had positive effects in terms of facili-tating the childrenrsquos spontaneous speech and oral language production Te results taken together demonstrate the factthat different types of simultaneous communication facili-tated speech and oral language production when used withchildren with little or no language behavior Te findings in-dicate contrary to arguments made by some (see Carr 1979Zangari et al 1994 for a description of the debate) that theinterventions did not impede speech or oral language pro-duction

able 7 Average Effect Sizes and 95 Confidence Intervals Associated With the Use of Different ypes of Reinforcement and the StudyOutcomes

ype of Reinforcement




Naturalistic 8 8 78 37-119

Extrinsic 16 70 67 32-101



Extrinsic 34 16 169 135-203

Combination 26 16 120 84-155

M E A N E F F E C T S I Z E

Figure 1 Average effect sizes and 95 confidence in-tervals for the relationships between number of months ofintervention number of intervention sessions and childspeech and oral language production

TYPE OF STUDY

It has been well established that infantsrsquo and toddlersrsquouse of nonverbal gestures is associated with language learning

and production (eg Bates amp Dick 2002 Camaioni AureliBellagamba amp Fogel 2003 Capirci Montanari amp Volterra1998 Iverson amp Goldin-Meadow 2005 Kita 2003 oma-sello Carpenter amp Liszkowski 2007) Sign language appearsto have the same effect as was found in this CELLreviewBates and Dick (2002) noted for example that gestures

0

025

05

075

1

125

15

175

2

Gr oup Designs Sing le Par ticipant Designs

1 to 6 Months

7 to 16 Months

Number of Months of Intervention

0

025

05

075

1

125

15

175

2

225

25

Group Designs Single Participant Designs

1 to 20 Sessions

21 + Sessions

Number of Intervention Sessions




pave the way for young children to crack the language codeat which time gestures play a less important role in languagedevelopment and for some children drop out altogether Te fact that natural gestures play less and less of a rolein typical oral language learning once the language code iscracked suggests a need to investigate whether the same is the

case when formal types of sign language are used to facilitatespeech and oral language production Tis unfortunately was not directly evaluated in the studies included in this re-search synthesis Tat type of study is indicated and couldcontribute to a better understanding of the conditions under

which simultaneous communication interventions need toldquogive wayrdquo to language-only interventions

Implications for Practice Te use of signing together with oral language to facili-tate a young childrsquos speech and oral language development isindicated in cases where a child has little or no communica-tion skills and other teaching methods have not been found

to be successful Simultaneous communication is likely to af-fect the childrsquos use of signs where the signs function as a foun-dation for attempts to produce speech and oral language Te

particular words that are selected as behavior targets shouldbe onersquos associated with highly desired and preferred objectsactions and people to ensure child interest and engagementto speech and oral language production Te words shouldalso be onersquos that are easy for the child to produce As thechild becomes proficient in using the targeted words signingshould be faded out (if learning sign language is not the goal)to permit speech and oral language to become the primaryform of communication CELLpractices for use by both parents and practitio-

ners include activities for incorporating sign language intoadult-child activities and interactions to encourage earlycommunication language and literacy development (wwwearlyliteracylearningorg) Te practice guides for infants arespecifically designed to engage children in activities to pro-mote acquisition of speech and oral language skills Te In-

fant Signing Dictionary practice guide includes descriptionsof 15 signs for actions that most children enjoy and engage inon a day-to-day basis Te interested reader can find descrip-tions of additional signs by searching the Internet for InfantSigning Dictionary Te websites that will be located include

video examples of many different signs Te signs can eas-ily be used together with oral language to promote a childrsquosspeech and oral language development

REFERENCES

Acosta L K (1981) Instructor use of total communicationEffects on preschool Downs syndrome childrens vo-cabulary acquisition and attempted verbalizations Dis-

sertation Abstracts International 42(07) 3099A (UMINo 8128369)

Alarcon M M (1978) Te effects of signed speech on thedevelopment of oral language in noncommunicativeautistic children (Doctoral dissertation University ofNew Orleans 1977) Dissertation Abstracts Interna-tional 38 4086

Barrera R D amp Suzer-Azaroff B (1983) An alternating

treatment comparison of oral and total communicationtraining programs with echolalic autistic children Jour-nal of Applied Behavior Analysis 16 379-394

Barrett R P amp Sisson L A (1987) Use of the alternat-ing treatments design as a strategy for empirically deter-mining language training approaches with mentally re-tarded children Research in Developmental Disabilities8 401-412

Bates E amp Dick F (2002) Language gesture and the devel-oping brain Developmental Psychobiology 40 293-310

Benaroya S Wesley S Ogilvie H Klein L S amp Clarke E(1979) Sign language and multisensory input trainingof children with communication and related develop-

mental disorders Phase II Journal of Autism and Devel-opmental Disorders 9 219-220

Bird E K-R Gaskell A Barbineau M D amp Macdon-ald S (2000) Novel word acquisition in children withDown syndrome Does modality make a difference

Journal of Communication Disorders 33 241-266Bonvillian J D amp Nelson K E (1982) Exceptional cases

of language acquisition In K E Nelson (Ed) Chil-drens language (pp 322-391) London Erlbaum

Bzoch K R amp League R (1971) Assessing language skillsin infancy Gainesville FL ree of Life Press

Camaioni L Aureli Bellagamba F amp Fogel A (2003)A longitudinal examination of the transition to sym-

bolic communication in the second year of life Infant and Child Development 12 1-26

Capirci O Montanari S amp Volterra V (1998) Gesturessigns and words in early language development In J MIverson amp S Goldin-Meadow (Eds) Te nature and

functions of gesture in childrens communication (pp 45-60) San Francisco Jossey-Bass

Carbone V J Lewis L Sweeney-Kerwin E J Dixon JLouden R amp 983121uinn S (2006) A comparison of twoapproaches for teaching VB functions otal communi-cation vs vocal-alone Journal of Speech-Language Pa-thology and Applied Behavior Analysis 1 181-191

Carr E G (1979) eaching autistic children to use signlanguage Some research issues Journal of Autism and

Developmental Disorders 9 345-359Casey L (1977) Development of communicative behav-

ior in autistic children A parent program using signedspeech Forum 12(1) 1-15

Casey L O (1978) Development of communicative behav-ior in autistic children A parent program using manualsigns Journal of Autism and Childhood Schizophrenia8 45-59




Clark C R Moores D F amp Woodcock R W (1975) Te Minnesota Early Language Development Sequence de-velopment kits 1 and 2 Minneapolis MN Universityof Minnesota Research Development and Demonstra-tion Center

Clibbens J (2001) Signing and lexical development in chil-

dren with Down syndrome Downs Syndrome Research and Practice 7 101-105Cohen M (1979 April) Te development of language be-

havior in an autistic child using a total communication approach Paper presented at the annual internationalconvention of the Council for Exceptional ChildrenDallas X (ERIC Document Reproduction ServiceNo ED170996)

Dunst C J Hamby D W amp rivette C M (2007) Guide-lines for calculating effect sizes for practice-based research

syntheses (Winterberry Research Perspectives Vol 1No 3) Asheville NC Winterberry Press

Dunst C J amp rivette C M (2009) Using research evi-

dence to inform and evaluate early childhood interven-tion practices opics in Early Childhood Special Educa-tion 29 40-52

Fulwiler R L amp Fouts R S (1976) Acquisition of Ameri-can Sign Language by a noncommunicating autisticchild Journal of Autism and Childhood Schizophrenia6 43-51

Gaines R Leaper C Monahan C amp Weickgenant A(1988) Language learning and retention in younglanguage-disordered children Journal of Autism and

Developmental Disorders 18 281-296Gibbs E D amp Carswell L E (1988 March-April) Early

use of total communication with a young Down syndrome

child A procedure for evaluating effectiveness Paper presented at the annual convention of the Council forExceptional Children Washington DC (ERIC Docu-ment Reproduction Service No ED296542)

Gibbs E D amp Carswell L E (1991) Using total commu-nication with young children with Down syndrome Aliterature review and case study Early Education and

Development 2 306-320Gibbs E D Springer A S Cooley W C amp Aloisio S

G (1990 November) otal communication for chil-dren with Down Syndrome Patterns across six childrenPoster presented at the annual conference of the Ameri-can Speech-Language-Hearing Association Seattle

WA (ERIC Document Reproduction Service NoED331246)

Goldstein H (2002) Communication intervention forchildren with autism A review of treatment efficacy

Journal of Autism and Developmental Disorders 32373-396

Hedrick D L Prather E M amp obin A R (1975) Se-quenced in983158entory of communication development Se-attle WA University of Washington Press

Hurd A (1995) Te influence of signing on adultchild in-teraction in a teaching context Child Language each-ing and Terapy 11 319-330

Iverson J M amp Goldin-Meadow S (2005) Gesture pavesthe way for language development Psychological Science16 367-371

Jago J L Jago A G amp Hart M (1984) An evaluationof the total communication approach for teaching lan-guage skills to developmentally delayed preschool chil-dren Education and raining of the Mentally Retarded19 175-182

Kahn J (1977) A comparison of manual and oral languagetraining with mute retarded children Mental Retarda-tion 15(3) 21-23

Kita S (2003) Pointing Where language culture and cogni-tion meet Mahwah NJ Erlbaum

Konstantareas M M (1984) Sign language as a communi-cation prosthesis with language-impaired children Jour-nal of Autism and Developmental Disorders 14 9-25

Konstantareas M M Webster C D amp Oxman J (1979)Manual language acquisition and its influence on otherareas of functioning in autistic and autistic-like chil-dren Journal of Child Psychology and Psychiatry 20 337-350

Konstantareas M M Webster C D amp Oxman J (1980)An alternative to speech training Simultaneous com-munication In C D Webster M M Konstantareas JOxman amp E M Mack (Eds) Autism New directions inresearch and education New York Pergamon Press

Kotkin R A Simpson S B amp Desanto D (1978) Te ef-fect of sign language on picture naming in two retardedgirls possessing normal hearing Journal of Mental Defi-

ciency Research 22 19-25Kouri A (1988) Effects of simultaneous communication

in a child-directed treatment approach with preschool-ers with severe disabilities AAC Augmentative and Al-ternative Communication 4 222-232

Kreimeyer K H (1980 April) Sign language for a non983158er-bal child A facilitator or inhibitor of 983158ocal speech Paper

presented at the Rocky Mountain Psychological As-sociation convention uscon AZ (ERIC DocumentReproduction Service No ED206135)

Kreimeyer K H (1984) A comparison of the effects ofspeech training modeled sign language training and

prompted sign language training on the language behav-ior of autistic preschool children Dissertation Abstracts

International 46 (03) 980B (UMI No 8510894)Lipsey M W (1993) Teory as method Small theories of

treatments New Directions for Program Evaluation 57 5-38

Lucas S M amp Cutspec P A (2007) Te role and processof literature searching in the preparation of a research

synthesis (Winterberry Research Perspectives Vol 1No 10) Asheville NC Winterberry Press




Luetke-Stahlman B (1985) Using single-subject design to verify language learning in a hearing aphasic boy Sign Language Studies 46 73-86

Millar D C Light J C amp Schlosser R W (2006) Teimpact of augmentative and alternative communicationintervention on the speech production of individuals

with developmental disabilities A research review Journal of Speech Language and Hearing Research 49 248-264

Mirenda P (2002) oward functional augmentative andalternative communication for students with autismManual signs graphic symbols and voice outputcommunication aids Language Speech and HearingServices in Schools 34 203-216

Oxman J (1976 May) Te possible function of signlanguage in facilitating verbal communication in severelydysfunctional non-verbal children Paper presented at theUniversity of Louisville Interdisciplinary Conferenceon Linguistics Louisville KY (ERIC Document

Reproduction Service No ED130471)Remington B amp Clarke S (1996) Alternative and

augmentative systems of communication for children with Downs syndrome In J A Rondal J PereraL Nadel amp A Comblain (Eds) Down syndrome

Psychological psychobiological and socio-educational perspectives (pp 129-143) San Diego CA Singular

Rosenthal R (1994) Parametric measures of effect sizeIn H Cooper amp L V Hedges (Eds) Te handbook ofresearch synthesis (pp 231-244) New York Russell SageFoundation

Shadish W R amp Haddock C K (2009) Combiningestimates of effect size In H Cooper L V Hedges amp

J C Valentine (Eds) Te handbook of research synthesis and meta-analysis (2nd ed pp 257-277) New YorkNY Russell Sage Foundation

Shimizu N (1988) Sign language training for children withdevelopmental retardation in speech RIEEC Report37 73-78

Sims-ucker B M (1988) A comparison of two nonverballanguage training programs for preschool children withsevere handicaps Dissertation Abstracts International50 (04) 923A (UMI No 8912352)

Sisson L A amp Barret R P (1984) An alternating treatmentscomparison of oral and total communication training

with minimally verbal retarded children Journal of Applied Behavioral Analysis 17 559-566

incani M (2004) Comparing the Picture ExchangeCommunication System and sign language training forchildren with autism [Electronic version] Focus on Autism

and Other Developmental Disabilities 19 152-163incani M J (2002) Effects of selection-based versus

topography-based communication training on theacquisition of mands by children with autism andmultiple disabilities Dissertation Abstracts International63(07) 2506A (UMI No 3059341)

omasello M Carpenter M amp Liszkowski U (2007) Anew look at infant pointing Child Development 78 705-722

Weber K P (1995) A comparison of vocal training aloneand vocal plus sign language training on the acquisitionof tacts and mands made by preschool aged children

with developmental disabilities Dissertation Abstracts International 56 (09) 3545A (UMI No 9544716)

Weller E L amp Mahoney G J (1983) A comparison of oraland total communication modalities on the languagetraining of young mentally handicapped children

Education and raining of the Mentally Retarded 18 103-110

Wendt O (2006) Te effectiveness of augmentative and alternative communication for individuals with autism spectrum disorders A systematic review and meta- analysis Unpublished doctoral dissertation PurdueUniversity West Lafayette IN

Willems S G Lombardino L J MacDonald J D ampOwens R E (1982) otal communication Clinicalreport on a parent-based language training program


Wolf J M amp McAlonie M L (1977) A multimodalitylanguage program for retarded preschoolers Education

and raining of the Mentally Retarded 12 197-202

Yoder P J amp Layton L (1988) Speech following signlanguage training in autistic children with minimal

verbal language Journal of Autism and Developmental Disorders 18 217-229

Zangari C Lloyd L amp Vicker B (1994) Augmentativeand alternative communication An historic perspective

Augmentative and Alternative Communication 10 27-59

AUTHORS

Carl J Dunst PhD is Co-Director and Research Sci-entist at the Orelena Hawks Puckett Institute in Ashevilleand Morganton North Carolina He is Co-Principal Inves-tigator of the Center for Early Literacy Learning (CELL)Diana Meter BA is a Research Assistant at the Puckett In-stitute Deborah W Hamby MPH is a Research Analyst atthe Puckett Institute




Appendix A

Characteristics of the Study Participants in the Sign Language Studies

Participant Characteristics

Study Number of Children

MeanChronologicalAge (Months)

ChronologicalAge Range(Months)

MeanDevelopmentalAge (Months)

DevelopmentalAge Range(Months) Child Condition

Severityof Delay a

Acosta (1981) 4 48 36-59 23 15-30 Down syndrome MM

Alarcon (1977) 2 78 72-84 NR b NR AutismAutism

SPMM

Barrera amp Sulzer-Azaroff (1983)

2 78 72-84 30 24-36 Autism SP

Barrett amp Sisson(1987)

1 63 983085 NR 983085 Emotional andorbehavioral disorders

SP

Benaroya et al

(1977)

6 NR 60-144 NR NR Autism SP

Bird et al (2000)(Sample 1)

10 42 25-62 22 18-27 Down syndrome SP

Carbone et al(2006)

1 7 983085 NR 983085 Autism MM

Casey (1977)Casey (1978)

4 78 72-84 NR NR Autism SP

Cohen (1979) 1 48 983085 NR 983085 Autism MM

Fulwiler amp Fouts(1976)

1 61 983085 NR 983085 Autism SP

Gaines et al(1988)

21 54 36-86 20 10-33 Autism Intellectualdelay

Intellectual delay AutismAutismAphasia

SP

SPSP

MMSP

Gibbs et al (1990) 6 14 NR NR NR Down syndrome MM

Gibbs amp Carswell(1988) Gibbs ampCarswell (1991)

1 14 983085 NR 983085 Down syndrome MM

Hurd (1995) 8 NR 42-72 NR NR Severe learningdifficulties

SP

Jago et al (1984)(Sample 1)

11 28 18-36 NR NR Down syndromeDevelopmental delay

Not specified

MMDD

MM Jago et al (1984)(Sample 2)

13 28 18-36 NR NR Down syndromeDevelopmental delay Not specified

MMDD

MM

Kahn (1977) 12 72 53-101 NR NR Intellectual delay SP




Appendix A continued


Study Number ofChildren





Severityof Delay a

Konstantareas(1984) 14 95 46-133 65 45-114 AutismAutismDevelopmental

language disorderHead injury Developmental delay Not specifiedNot specifiedNot specified

SPMMMMDDDDDDSP

MMDD

Konstantareas etal (1979) (1980)

2 102 101-103 NR NR Autism Intellectualdelay

SP

Kotkin et al(1978)

2 78 72-84 35 29-41 Down syndrome SPMM

Kouri (1988) 3 33 28-36 22 17-26 Down syndromeAutismNot specified

SPMMDD

Kreimeyer (1980) 1 54 983085 48 983085 Autism MM

Kreimeyer (1984) 4 47 40-64 12 10-14 Autism SP

Luetke-Stahlman(1985)

1 60 983085 25 983085 Intellectual delayAphasia

MM

Oxman et al(1976)

1 94 983085 20 983085 Autism Intellectualdelay

SP

Shimizu (1988) 1 64 983085 24 983085 Autism MM

Sims-ucker(1988)

6 43 38-52 11 8-13 AutismAutism Intellectual

delay Cerebral palsy

SPSP

SP

Sisson amp Barrett(1984)

3 79 56-97 38 27-52 Intellectual delayBehavior disorder

SP

incani (2002)incani (2004)


Pervasivedevelopmentaldisorder

Autism

SP

MM

MM

Weber (1995) 2 38 35-41 NR NR Cerebral palsyLanguage disorder

Down syndrome

MM

MM Weller ampMahoney (1983)

15 NR 18-36 16 NR Down syndrome MM

Willems et al(1982)

1 20 983085 NR NR Not specified MM

Wolf amp McAlonie(1977)

8 35 26-37 21 18-33 Down syndromeDown syndromeDown syndromeNot specified

SPMMDD

MM




a Estimated based on information included in the research reports (DD = Developmentally delayed MM = Mildmoderate delaySP= Severeprofound delay)b Not reported








Severity of Delay a

Yoder amp Layton(1988) (Sample 1) 15 64 NR 28 NR AutismAutism SPMM

Yoder amp Layton(1988) (Sample 2)

15 66 NR 27 NR AutismAutism

SPMM



SPMM




Appendix B

ypes of and Selected Characteristics of the Sign Language Interventions

Study ype of Sign Language

Intervention Characteristics

ApproximateLength of

Intervention(Months)

Average

Number ofSessions

Frequency of Sessions


Sessions(Minutes)

Preferred

Objects Words Reinforcement

Acosta (1981) Signed English with spokenEnglish

NR a 17 1 x day 25 No Verbal and physical praise stickers

Alarcon (1977) Sig ned Exact Eng lish withspoken English

5 80 4 x week 20 No Verbal and physical praise access to desiredobjects opportunity for

play with researcher


American Sign Language with spoken English

2 23 1 x day 38 No Verbal praise edibles


Unspecified sign language with spoken English

NR NR 1 x day x 5 x week

20-40 No Verbal praise edibles

Benaroya et al (1977) Signed English with spoken

English

4 NR NR NR No Access to referent

objectsBird et al (2000)(Sample 1) (reatment1)

American Sign Language 1 3 NR NR No Verbal praise

Bird et al (2000)(Sample 1) (reatment2)


1 3 NR NR No Verbal praise

Carbone et al (2006) American Sign Language with spoken English

NR 28 NR 86 No Verbal praise

Casey (1977) Casey(1978)

Signed English with spokenEnglish

1 NR NR NR NR Verbal praise ediblestokens peer applause

Cohen (1979) American Sign Language with spoken English

11 22 3 x week 20 No Verbal and physical praise edibles


American Sign Language andsigned English with spokenEnglish

5 40 2 x week 30 No Access to desiredobjects

Gaines et al (1988) Unspecified sign language with spoken English

15 80 2 x day x 5 x week

25 Yes Edibles

Gibbs et al (1990) Unspecified sign language with spoken English

16 25 1 every 2-4 weeks

NR Yes NR



14 112 2 x week 30 Yes NR

Hurd (1995) Makaton (sign language) with spoken English

983085 1 983085 NR No NR

Jago et al (1984)

(Sample 1)

Intensive unspecified sign

language with spokenEnglish

7 56 2 x week 210 No Verbal praise


Less intense unspecifiedsign language with spokenEnglish

13 56 1 x week 60-240 No Verbal praise edibles

Kahn (1977) Unspecified sign language with spoken English

9 NR NR NR No Yes NR

Konstantareas (1984) Unspecified sign language with spoken English

1 3 1 x day NR No NR




Appendix B continued





AverageNumber of

SessionsFrequency of Sessions

ApproximateLength ofSessions

(Minutes)

PreferredObjects Words Reinforcement

Konstantareas et al(1979) (1980)

Ontario Sign Language withspoken English

9 180 5 x week 240 No Verbal praise accessto referent objectsactivities and edibles

Kotkin et al (1978) Signed English with spokenEnglish

1 9 3 x day NR No Verbal praise edibles

Kouri (1988) Modified Signed English with spoken English

8 17 2 x week 40 Yes Verbal praise accessto referent objects andactivities

Kreimeyer (1980) Unspecified sign language with spoken English

NR 18 NR NR Yes Access to referentobjects and activities


2 50 1 x day 25 Yes Access to referentobjects activities andedibles



9 NR NR NR No Verbal praise stickers

Oxman et al (1976) Unspecified sign language with spoken English

7 NR NR NR NR NR

Shimizu (1988) Japanese Sign Lang uage withspoken Japanese

6 27 1 x week 30 Yes Verbal praise access todesired objects

Sims-ucker (1988) Unspecified sign language with spoken English


20 No Verbal praise accessto referent objects oredibles

Sisson amp Barrett (1984) Unspecified sign language with spoken English

3 80 5-6 x week 15-30 No Verbal praise edibles



2 32 5 x week 30-40 Yes Verbal praise accessto referent objects and

edibles Weber (1995) Unspecified sign language

with spoken English3 56 1 x day 15-40 No Access to referent

objects and edibles

Weller amp Mahoney(1983)

Signed Exact English withspoken English

5 20 1 x week 20-30 NR Yes not specified

Willems et al (1982) Seeing Essential English(sign language) with spokenEnglish (Anthony 1974)

3 10 1 x week 90 Yes Yes not specified


American Sign Languageand spoken English

5 60 3 x week 15 No NR

Yoder amp Layton (1988)(Sample 1)


3 90 1 x day 40 No Verbal praise access todesired objects

Yoder amp Layton (1988)

(Sample 2)

Signed English 3 90 1 x day 40 No Verbal praise access to

desired objectsYoder amp Layton (1988)(Sample 4)



a Not Reported




Appendix C

Research Designs Outcome Measures Comparative Conditions and Effect Sizes

Study Research Design reatment Conditions

Outcomes ComparativeConditionsContrasts

Cohenrsquos d Effect Sizesype Measure

Acosta (1981) Multiple baselinedesign

Baseline vs Alternating Oral

vs Sign + oral(P1 amp P4)

Baseline vs Alternating Sign + oral

vs Oral(P2 amp P3)

Vocalizations otal number of vocalizations or verbalizations

Baseline vs Sign + oral

Oral vs Sign + oral

P1P2P3P4

P1P2P3P4

43316116113

221-107263

Alarcon(1977)

Single participantdesign

Sign + oral Verbalization Number of correct verbalization probes

Pretest vs Sign + oral P2P3

14200

Barrera amp

Sulzer-Azaroff(1983)

Alternating

treatments design

Alternating Oral

vs Sign + oral

Verbalization otal number of

words verbalized when prompted

Oral vs Sign + oral P1

P2

73

83

Barrett ampSisson (1987)

Multiple baselinedesign


vs Sign + oral(requiring a sign + oral

response) vs

Modified Sign + oral(requiring only oral response)

Verbalization Mean number of verbalized sentence parts learned


Baseline vs Modifiedsign + oral

Oral vs Sign + oral

Oral vs Modified sign+ oral

P1

P1

P1

P1

153

134

146

32

Benaroya et al(1977)

One group pretest post test design

Sign + oral Verbalization otal number ofsingle verbal wordsacquired

otal number ofmultiword verbal phrases acquired

Pretest vs Sign + oral


110

86

Bird et al(2000)(Sample 1)

Comparativeconditions design

Alternating Oral vs Sign vs Sign + oral

Verbalization Mean number of words producedaccurately

Mean number of words producedapproximately

Oral vs Sign + oral

Sign vs Sign + oral

Oral vs Sign + oral

Sign vs Sign + oral

00

44

-13

49

Carbone et al(2006)

Alternatingtreatment design

Alternating Sign + oral vs Oral

Verbalization Number of verbaltacts acquired for

pictured objects

Oral vs Sign + oral 113



Baseline vs Sign + oral Verbalization Mean proportionof elicited verbalizations

Mean proportionof spontaneous verbalizations



P1P2P3P4

P1P2P3P4

200167140164

41200163205




Appendix C continued



Cohenrsquos dEffect Sizesype Measure

Cohen (1979) Multiple baselinedesign

Baseline vs Sign + oral Verbalization Percentage ofunprompted verbal

labeling

Percentage ofunpromptedsimultaneous verbal with signlabeling

Percentageof promptedsimultaneous verbal with signlabeling

Percentage ofunprompted noun- verb combinations

Percentage of prompted noun- verb combinations






132

125

133

147

177

Fulwiler ampFouts (1976)


Baseline vs Sign + oral Verbalization otal number ofacquired verbal words

otal number ofacquired verbal phrases

Baseline vs Sign +oral


114

150

Gaines et al(1988)


Pretest vs post test Verbalization Mean numberof verbalizationslearned

Mean number of verbalizations andsigns learned



47

53

Gibbs et al(1990)


Pretest vs post test Verbalization Expressivelanguage quotient

Pretest vs Sign + oral -51

Gibbs ampCarswell(1988) Gibbsamp Carswell

(1991)


Baseline vs Sign + oral Verbalization Percentage ofcorrect wordsacquired

Percentage ofcorrect words +signs acquired



118

113

Hurd (1995) Comparative groupdesign

Sign + oral vs Oral

Verbalization otal numberof appropriate verbalizations ofthe words ldquobigrdquoand ldquolittlerdquo









Jago et al(1984)

(Sample 1)

Comparativegroup design

Intensive Sign + oral pretest vs post test

Verbalization

Verbalization

Verbalization

Mean number of words acquired

REELa

expressive scores

SICDb

expressive scores

Pretest vs Intensive Sign+ oral



145

260

107

Jago et al(1984)(Sample 2)


Less intense Sign + oral pretest vs post test

Verbalization

Verbalization

Verbalization


REELexpressive scores

SICD expressivescores

Pretest vs Less intenseSign + oral



39

20

77

Kahn (1977) Comparativegroup design

Sign + oral vs Oral vs Control

Verbalization otal number of verbalizations

used without prompting

Oral vs Sign + oral

Control vs Sign + oral

90

111

Konstantareas(1984)


Sign + oral vs Oral Verbalization Mean percentageof independently provided answers

Mean percentageof cued answers provided

Oral vs Sign + oral

Oral vs Sign + oral

24

112

Konstantareaset al (1979)(1980)


Sign + oral Verbalization otal numberof spontaneousor prompted verbalizations

otal number

of spontaneousor prompted verbalizations +signs

otal number ofelicited referent verbalizations

otal number ofelicited referent verbalizations +signs

otal numberof elicited

non-referent verbalizations

otal numberof elicitednon-referent verbalizations +signs







00

114

00

111

100

106





Study ResearchDesign

reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral

Verbalization Number of correct verbal responses


Oral vs Sign + oral

P1P2

P1P2

199402

123362

Kouri (1988) Single participantdesign


Verbalization Number ofspontaneouslyspoken words

Number of verbalresponses toquestions

Number ofspontaneouslyspoken verbal words + signs

Number of verbalizations +signs as responses





P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)


Oral (baseline) vs Sign + oral

Verbalizations Investigator-developedcommunicationscale

Oral vs Sign + oral -10

Kreimeyer(1984)

Alternatingtreatments design

Baseline vs Alternating Prompted sign + oral

vs Modeled sign + oral

Vocalizations Investigator-developedcommunicationscale

Baseline vsPrompted Sign + oral

Baseline vsModeled Sign + oral

P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01




Verbalization Number of verbalizations

Number of verbalizationsaccompanied bysigns



182

139

Oxman et al(1976)

Single participant pretest post testdesign

Sign + oral Verbalization Number of correct verbal responses

Number ofapproximate verbalresponses



44

-08






reatmentConditions



Shimizu(1988)


Baseline vs Sign + oral Vocalization Percentage ofspontaneous

vocalizations alonePercentage ofspontaneous vocalizations withsigns

Percentage ofspontaneous vocalizations with pointing

Percentage ofonly vocalizedresponses tomands

Percentage ofresponses tomands vocalized with signs

Percentage ofresponses tomands vocalized with pointing

Percentageof vocalizedinteractions








119

110

63

106

100

63

166

Sims-ucker(1988)

Simultaneoustreatment single

participant design

Baseline vs Simultaneous

Sign + oral

Verbalization Number of verballabels produced

Baseline vs Sign + oral P1P2

P3P4P5P6

80128

153126126

82

Sisson ampBarrett (1984)

Multiple baselineacross type oftraining design


vs Sign + oral

Verbalization Mean numberof sentence partslearned


Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22




Verbalization Percentageof word verbalizations

Baseline vs Sign + oral P1P2P3

204215

00

Weber (1995) Multiple baselinedesign

Baseline vsSign + oral

Verbalization Number ofcorrect verbalizedor verbalized +signed responses


48

32

Weller ampMahoney(1983)


Sign + oral vs Oral

Verbalization REEL expressivescores

otal number of words spoken

Sign + oralPretest vs Post test


58

113



a Receptive-Expressive Emergent Language est (Bzoch amp League 1971)b Sequenced Inventory of Communicative Development (Hedrick Prather amp obin 1975)c Minnesota Early Language Development Sequence (Clark et al 1975)



reatmentConditions



Willems et al(1982)

Case study Sign + oral Verbalization Number of word verbalizations or

approximations

Pretest vs Sign + oral 530

Wolf ampMcAlonie(1977)


Sign + oral Verbalization MELDSc expressivelanguage scores


Yoder ampLayton(1988)


Sign vs Simultaneous

Sign + oral vs Alternating Sign + oral

vs Oral

Verbalization Number ofspontaneouslyemitted words

Sign vs SimultaneousSign + oral

Sign vs Alternating Sign+ oral

Pretest vs SimultaneousSign + oral

Pretest vs AlternatingSign + oral

59

33

94

55




standing debate and controversy whether or not signing isan effective speech and oral language-learning interventionstrategy for young children with disabilities (see eg Carr1979 Zangari Lloyd amp Vicker 1994)

SEARCH STRATEGY

Studies were located using ldquo sign languagerdquo OR ldquo signing rdquoOR ldquo signed rdquo OR ldquo finger spell rdquo OR ldquomanual communicat rdquoOR ldquomanual englishrdquo AND ldquoinfanrdquo OR ldquotoddler rdquo OR ldquo pre-

school rdquo OR ldquo kindergartenrdquo OR ldquoearly childhood rdquo NO ldquodeaf rdquoNO ldquohard of hearing rdquo NO ldquohearimpair rdquo as search termsBoth controlled vocabulary and natural language searches

were conducted (Lucas amp Cutspec 2007) PsychologicalAbstracts (PsychInfo) Educational Resource InformationCenter (ERIC) MEDLINE Academic Search PremierEducation Research Complete FirstSearch CumulativeIndex to Nursing and Allied Health Literature WorldCatand Dissertation Abstracts were searched Tese were sup-

plemented by Cochran Database Google Scholar and In-genta searches and a search of an extensive EndNote Librarymaintained by our Institute Hand searches of the referencesections of all identified journal articles book chapters andbooks were also examined to locate additional studies Stud-ies were included if the majority of participants were eight

years of age or younger some type of sign language and orallanguage was used simultaneously to promote the childrenrsquosspeech and oral language production and a child vocal or

verbal outcome measure was used to evaluate the effects ofthe sign language interventions Studies that investigated thefacilitation of the use of some type of sign language as the

primary means of communication were excluded

SEARCH RESULTS

Tirty-three studies were located that included 36 sam- ples of children Appendix A shows selected characteristicsof the children who were taught using simultaneous com-munication to facilitate speech and oral language productionTe studies included 216 children Te mean chronologicalages of the children ranged from 7 to 102 months (Median= 60 months) In those studies including the childrenrsquos de-

velopmental levels of functioning the mean mental ages ofthe children ranged between 11 and 65 months (Median =24 months) Te childrenrsquos disabilities included Down syn-drome autism intellectual disabilities language disorders orimpairments cerebral palsy emotional or behavior disordersintellectual disabilities and other types of disabilities Basedon information included in the research reports 51 of thechildren had severe or profound developmental delays 43of the children had mild or moderate developmental delaysand 6 of the children had less serious developmental delays

Te types of sign language used to promote speech andoral language production and selected characteristics of the

interventions are shown in Appendix B American Sign Lan-guage (N = 14 studies) Ontario Sign Language (N = 1)

Japanese Sign Language (N = 1) Signed English (N = 11)Makaton (N = 1) or other unspecified types of sign language(N = 13) were used in the studies Te different types of signlanguage were all used with adult oral language to facilitate

the childrenrsquos signing andor speech and oral language pro-ductionTe interventions varied considerably in terms of the

length of time the interventions lasted and the numberfrequency and length of sessions Te interventions rangedfrom one to 16 months in length (Mean = 493 months SD= 377) Te average number of sessions ranged from one tomore than 100 (Mean = 5739 SD = 9372) Te individualsessions lasted between 15 minutes and 4 hours (Mean = 53minutes SD = 6278) Te frequency of the sessions rangedfrom two times a day five days a week to just one session ev-ery 2 to 4 weeks Most of the studies included other intervention char-

acteristics or conditions together with signing Most of thestudies also included a number of different naturalistic orextrinsic reinforcements that were provided in response to achildrsquos use of signs and vocalizations or verbalizations Tir-teen studies used some type of extrinsic reinforcement sixstudies used some type of intrinsic reinforcement and fivestudies included both types of reinforcement Tree studiesused unspecified types of reinforcement Te outcome measures in the studies included eitherchild vocalizations or verbalizations Vocalizations includedsome type of vocal sounds other than words Verbalizationsincluded only oral language production Te largest majorityof outcome measures were the number or percentage of child

vocalizations or verbalizations prompted or spontaneouslyused by the children although a few studies included stan-dardized measures of expressive language abilities (Bzoch ampLeague 1971 Clark Moores amp Woodcock 1975 HedrickPrather amp obin 1975) One focus of analyses was the spon-taneous nonprompted use of vocalizations or verbalizationsto communicate as a result of the simultaneous communica-tion interventions wenty-one of the studies used some type of single par-ticipant design and 12 studies used some type of group de-sign Te single participant studies included ABA multiplebaseline alternating treatment or pretest-post test designsTe group studies used pretest-post test comparative condi-tions or experimental vs control group designs wo typesof comparisons were made in both the single participant andgroup design studies One included comparisons of eitherbaseline or nonintervention conditions with intervention or

post test outcomes Te other included comparisons of ei-ther sign or oral language interventions with sign and orallanguage interventions Cohenrsquos d effect sizes for the baseline vs intervention

phases in the single participant design studies and Cohenrsquos






SYNTHESIS FINDINGS

















Unspecified 29 18 104 66-143






















Child Disability




Autism 16 58 69 47-91




Autism 46 25 104 86-123












Mixed 9 58 66 40-91


















Child Outcome









ype of Child Speech
















CONCLUSION










Extrinsic 16 70 67 32-101



Extrinsic 34 16 169 135-203

Combination 26 16 120 84-155



TYPE OF STUDY



0

025

05

075

1

125

15

175

2


1 to 6 Months

7 to 16 Months


0

025

05

075

1

125

15

175

2

225

25


1 to 20 Sessions

21 + Sessions














REFERENCES




































































































AUTHORS





Appendix A








Severityof Delay a



SPMM


2 78 72-84 30 24-36 Autism SP



SP

Benaroya et al

(1977)



10 42 25-62 22 18-27 Down syndrome SP

Carbone et al(2006)

1 7 983085 NR 983085 Autism MM





1 61 983085 NR 983085 Autism SP

Gaines et al(1988)



SP

SPSP

MMSP





SP



Not specified

MMDD



MMDD

MM












Severityof Delay a



SPMMMMDDDDDDSP

MMDD



SP

Kotkin et al(1978)



SPMMDD





MM

Oxman et al(1976)


SP


Sims-ucker(1988)



SPSP

SP



SP




Autism

SP

MM

MM


Down syndrome

MM



Willems et al(1982)




SPMMDD

MM












Severity of Delay a




SPMM



SPMM




Appendix B






Average

Number ofSessions



Sessions(Minutes)

Preferred















English



















25 Yes Edibles



NR Yes NR





983085 1 983085 NR No NR

Jago et al (1984)

(Sample 1)



















AverageNumber of



(Minutes)

















7 NR NR NR NR NR













objects and edibles













(Sample 2)





a Not Reported




Appendix C









vs Oral(P2 amp P3)



Oral vs Sign + oral

P1P2P3P4

P1P2P3P4

43316116113

221-107263

Alarcon(1977)




14200

Barrera amp


Alternating

treatments design

Alternating Oral

vs Sign + oral




P2

73

83





response) vs





Oral vs Sign + oral


P1

P1

P1

P1

153

134

146

32







110

86






Oral vs Sign + oral

Sign vs Sign + oral

Oral vs Sign + oral

Sign vs Sign + oral

00

44

-13

49

Carbone et al(2006)




pictured objects








P1P2P3P4

P1P2P3P4

200167140164

41200163205










labeling










132

125

133

147

177







114

150

Gaines et al(1988)






47

53

Gibbs et al(1990)





(1991)






118

113


Sign + oral vs Oral










Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55






SYNTHESIS FINDINGS

















Unspecified 29 18 104 66-143






















Child Disability




Autism 16 58 69 47-91




Autism 46 25 104 86-123












Mixed 9 58 66 40-91


















Child Outcome









ype of Child Speech
















CONCLUSION










Extrinsic 16 70 67 32-101



Extrinsic 34 16 169 135-203

Combination 26 16 120 84-155



TYPE OF STUDY



0

025

05

075

1

125

15

175

2


1 to 6 Months

7 to 16 Months


0

025

05

075

1

125

15

175

2

225

25


1 to 20 Sessions

21 + Sessions














REFERENCES




































































































AUTHORS





Appendix A








Severityof Delay a



SPMM


2 78 72-84 30 24-36 Autism SP



SP

Benaroya et al

(1977)



10 42 25-62 22 18-27 Down syndrome SP

Carbone et al(2006)

1 7 983085 NR 983085 Autism MM





1 61 983085 NR 983085 Autism SP

Gaines et al(1988)



SP

SPSP

MMSP





SP



Not specified

MMDD



MMDD

MM












Severityof Delay a



SPMMMMDDDDDDSP

MMDD



SP

Kotkin et al(1978)



SPMMDD





MM

Oxman et al(1976)


SP


Sims-ucker(1988)



SPSP

SP



SP




Autism

SP

MM

MM


Down syndrome

MM



Willems et al(1982)




SPMMDD

MM












Severity of Delay a




SPMM



SPMM




Appendix B






Average

Number ofSessions



Sessions(Minutes)

Preferred















English



















25 Yes Edibles



NR Yes NR





983085 1 983085 NR No NR

Jago et al (1984)

(Sample 1)



















AverageNumber of



(Minutes)

















7 NR NR NR NR NR













objects and edibles













(Sample 2)





a Not Reported




Appendix C









vs Oral(P2 amp P3)



Oral vs Sign + oral

P1P2P3P4

P1P2P3P4

43316116113

221-107263

Alarcon(1977)




14200

Barrera amp


Alternating

treatments design

Alternating Oral

vs Sign + oral




P2

73

83





response) vs





Oral vs Sign + oral


P1

P1

P1

P1

153

134

146

32







110

86






Oral vs Sign + oral

Sign vs Sign + oral

Oral vs Sign + oral

Sign vs Sign + oral

00

44

-13

49

Carbone et al(2006)




pictured objects








P1P2P3P4

P1P2P3P4

200167140164

41200163205










labeling










132

125

133

147

177







114

150

Gaines et al(1988)






47

53

Gibbs et al(1990)





(1991)






118

113


Sign + oral vs Oral










Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55















Child Disability




Autism 16 58 69 47-91




Autism 46 25 104 86-123












Mixed 9 58 66 40-91


















Child Outcome









ype of Child Speech
















CONCLUSION










Extrinsic 16 70 67 32-101



Extrinsic 34 16 169 135-203

Combination 26 16 120 84-155



TYPE OF STUDY



0

025

05

075

1

125

15

175

2


1 to 6 Months

7 to 16 Months


0

025

05

075

1

125

15

175

2

225

25


1 to 20 Sessions

21 + Sessions














REFERENCES




































































































AUTHORS





Appendix A








Severityof Delay a



SPMM


2 78 72-84 30 24-36 Autism SP



SP

Benaroya et al

(1977)



10 42 25-62 22 18-27 Down syndrome SP

Carbone et al(2006)

1 7 983085 NR 983085 Autism MM





1 61 983085 NR 983085 Autism SP

Gaines et al(1988)



SP

SPSP

MMSP





SP



Not specified

MMDD



MMDD

MM












Severityof Delay a



SPMMMMDDDDDDSP

MMDD



SP

Kotkin et al(1978)



SPMMDD





MM

Oxman et al(1976)


SP


Sims-ucker(1988)



SPSP

SP



SP




Autism

SP

MM

MM


Down syndrome

MM



Willems et al(1982)




SPMMDD

MM












Severity of Delay a




SPMM



SPMM




Appendix B






Average

Number ofSessions



Sessions(Minutes)

Preferred















English



















25 Yes Edibles



NR Yes NR





983085 1 983085 NR No NR

Jago et al (1984)

(Sample 1)



















AverageNumber of



(Minutes)

















7 NR NR NR NR NR













objects and edibles













(Sample 2)





a Not Reported




Appendix C









vs Oral(P2 amp P3)



Oral vs Sign + oral

P1P2P3P4

P1P2P3P4

43316116113

221-107263

Alarcon(1977)




14200

Barrera amp


Alternating

treatments design

Alternating Oral

vs Sign + oral




P2

73

83





response) vs





Oral vs Sign + oral


P1

P1

P1

P1

153

134

146

32







110

86






Oral vs Sign + oral

Sign vs Sign + oral

Oral vs Sign + oral

Sign vs Sign + oral

00

44

-13

49

Carbone et al(2006)




pictured objects








P1P2P3P4

P1P2P3P4

200167140164

41200163205










labeling










132

125

133

147

177







114

150

Gaines et al(1988)






47

53

Gibbs et al(1990)





(1991)






118

113


Sign + oral vs Oral










Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55















Child Outcome









ype of Child Speech
















CONCLUSION










Extrinsic 16 70 67 32-101



Extrinsic 34 16 169 135-203

Combination 26 16 120 84-155



TYPE OF STUDY



0

025

05

075

1

125

15

175

2


1 to 6 Months

7 to 16 Months


0

025

05

075

1

125

15

175

2

225

25


1 to 20 Sessions

21 + Sessions














REFERENCES




































































































AUTHORS





Appendix A








Severityof Delay a



SPMM


2 78 72-84 30 24-36 Autism SP



SP

Benaroya et al

(1977)



10 42 25-62 22 18-27 Down syndrome SP

Carbone et al(2006)

1 7 983085 NR 983085 Autism MM





1 61 983085 NR 983085 Autism SP

Gaines et al(1988)



SP

SPSP

MMSP





SP



Not specified

MMDD



MMDD

MM












Severityof Delay a



SPMMMMDDDDDDSP

MMDD



SP

Kotkin et al(1978)



SPMMDD





MM

Oxman et al(1976)


SP


Sims-ucker(1988)



SPSP

SP



SP




Autism

SP

MM

MM


Down syndrome

MM



Willems et al(1982)




SPMMDD

MM












Severity of Delay a




SPMM



SPMM




Appendix B






Average

Number ofSessions



Sessions(Minutes)

Preferred















English



















25 Yes Edibles



NR Yes NR





983085 1 983085 NR No NR

Jago et al (1984)

(Sample 1)



















AverageNumber of



(Minutes)

















7 NR NR NR NR NR













objects and edibles













(Sample 2)





a Not Reported




Appendix C









vs Oral(P2 amp P3)



Oral vs Sign + oral

P1P2P3P4

P1P2P3P4

43316116113

221-107263

Alarcon(1977)




14200

Barrera amp


Alternating

treatments design

Alternating Oral

vs Sign + oral




P2

73

83





response) vs





Oral vs Sign + oral


P1

P1

P1

P1

153

134

146

32







110

86






Oral vs Sign + oral

Sign vs Sign + oral

Oral vs Sign + oral

Sign vs Sign + oral

00

44

-13

49

Carbone et al(2006)




pictured objects








P1P2P3P4

P1P2P3P4

200167140164

41200163205










labeling










132

125

133

147

177







114

150

Gaines et al(1988)






47

53

Gibbs et al(1990)





(1991)






118

113


Sign + oral vs Oral










Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55







CONCLUSION










Extrinsic 16 70 67 32-101



Extrinsic 34 16 169 135-203

Combination 26 16 120 84-155



TYPE OF STUDY



0

025

05

075

1

125

15

175

2


1 to 6 Months

7 to 16 Months


0

025

05

075

1

125

15

175

2

225

25


1 to 20 Sessions

21 + Sessions














REFERENCES




































































































AUTHORS





Appendix A








Severityof Delay a



SPMM


2 78 72-84 30 24-36 Autism SP



SP

Benaroya et al

(1977)



10 42 25-62 22 18-27 Down syndrome SP

Carbone et al(2006)

1 7 983085 NR 983085 Autism MM





1 61 983085 NR 983085 Autism SP

Gaines et al(1988)



SP

SPSP

MMSP





SP



Not specified

MMDD



MMDD

MM












Severityof Delay a



SPMMMMDDDDDDSP

MMDD



SP

Kotkin et al(1978)



SPMMDD





MM

Oxman et al(1976)


SP


Sims-ucker(1988)



SPSP

SP



SP




Autism

SP

MM

MM


Down syndrome

MM



Willems et al(1982)




SPMMDD

MM












Severity of Delay a




SPMM



SPMM




Appendix B






Average

Number ofSessions



Sessions(Minutes)

Preferred















English



















25 Yes Edibles



NR Yes NR





983085 1 983085 NR No NR

Jago et al (1984)

(Sample 1)



















AverageNumber of



(Minutes)

















7 NR NR NR NR NR













objects and edibles













(Sample 2)





a Not Reported




Appendix C









vs Oral(P2 amp P3)



Oral vs Sign + oral

P1P2P3P4

P1P2P3P4

43316116113

221-107263

Alarcon(1977)




14200

Barrera amp


Alternating

treatments design

Alternating Oral

vs Sign + oral




P2

73

83





response) vs





Oral vs Sign + oral


P1

P1

P1

P1

153

134

146

32







110

86






Oral vs Sign + oral

Sign vs Sign + oral

Oral vs Sign + oral

Sign vs Sign + oral

00

44

-13

49

Carbone et al(2006)




pictured objects








P1P2P3P4

P1P2P3P4

200167140164

41200163205










labeling










132

125

133

147

177







114

150

Gaines et al(1988)






47

53

Gibbs et al(1990)





(1991)






118

113


Sign + oral vs Oral










Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55













REFERENCES




































































































AUTHORS





Appendix A








Severityof Delay a



SPMM


2 78 72-84 30 24-36 Autism SP



SP

Benaroya et al

(1977)



10 42 25-62 22 18-27 Down syndrome SP

Carbone et al(2006)

1 7 983085 NR 983085 Autism MM





1 61 983085 NR 983085 Autism SP

Gaines et al(1988)



SP

SPSP

MMSP





SP



Not specified

MMDD



MMDD

MM












Severityof Delay a



SPMMMMDDDDDDSP

MMDD



SP

Kotkin et al(1978)



SPMMDD





MM

Oxman et al(1976)


SP


Sims-ucker(1988)



SPSP

SP



SP




Autism

SP

MM

MM


Down syndrome

MM



Willems et al(1982)




SPMMDD

MM












Severity of Delay a




SPMM



SPMM




Appendix B






Average

Number ofSessions



Sessions(Minutes)

Preferred















English



















25 Yes Edibles



NR Yes NR





983085 1 983085 NR No NR

Jago et al (1984)

(Sample 1)



















AverageNumber of



(Minutes)

















7 NR NR NR NR NR













objects and edibles













(Sample 2)





a Not Reported




Appendix C









vs Oral(P2 amp P3)



Oral vs Sign + oral

P1P2P3P4

P1P2P3P4

43316116113

221-107263

Alarcon(1977)




14200

Barrera amp


Alternating

treatments design

Alternating Oral

vs Sign + oral




P2

73

83





response) vs





Oral vs Sign + oral


P1

P1

P1

P1

153

134

146

32







110

86






Oral vs Sign + oral

Sign vs Sign + oral

Oral vs Sign + oral

Sign vs Sign + oral

00

44

-13

49

Carbone et al(2006)




pictured objects








P1P2P3P4

P1P2P3P4

200167140164

41200163205










labeling










132

125

133

147

177







114

150

Gaines et al(1988)






47

53

Gibbs et al(1990)





(1991)






118

113


Sign + oral vs Oral










Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55














































































AUTHORS





Appendix A








Severityof Delay a



SPMM


2 78 72-84 30 24-36 Autism SP



SP

Benaroya et al

(1977)



10 42 25-62 22 18-27 Down syndrome SP

Carbone et al(2006)

1 7 983085 NR 983085 Autism MM





1 61 983085 NR 983085 Autism SP

Gaines et al(1988)



SP

SPSP

MMSP





SP



Not specified

MMDD



MMDD

MM












Severityof Delay a



SPMMMMDDDDDDSP

MMDD



SP

Kotkin et al(1978)



SPMMDD





MM

Oxman et al(1976)


SP


Sims-ucker(1988)



SPSP

SP



SP




Autism

SP

MM

MM


Down syndrome

MM



Willems et al(1982)




SPMMDD

MM












Severity of Delay a




SPMM



SPMM




Appendix B






Average

Number ofSessions



Sessions(Minutes)

Preferred















English



















25 Yes Edibles



NR Yes NR





983085 1 983085 NR No NR

Jago et al (1984)

(Sample 1)



















AverageNumber of



(Minutes)

















7 NR NR NR NR NR













objects and edibles













(Sample 2)





a Not Reported




Appendix C









vs Oral(P2 amp P3)



Oral vs Sign + oral

P1P2P3P4

P1P2P3P4

43316116113

221-107263

Alarcon(1977)




14200

Barrera amp


Alternating

treatments design

Alternating Oral

vs Sign + oral




P2

73

83





response) vs





Oral vs Sign + oral


P1

P1

P1

P1

153

134

146

32







110

86






Oral vs Sign + oral

Sign vs Sign + oral

Oral vs Sign + oral

Sign vs Sign + oral

00

44

-13

49

Carbone et al(2006)




pictured objects








P1P2P3P4

P1P2P3P4

200167140164

41200163205










labeling










132

125

133

147

177







114

150

Gaines et al(1988)






47

53

Gibbs et al(1990)





(1991)






118

113


Sign + oral vs Oral










Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55




Appendix A








Severityof Delay a



SPMM


2 78 72-84 30 24-36 Autism SP



SP

Benaroya et al

(1977)



10 42 25-62 22 18-27 Down syndrome SP

Carbone et al(2006)

1 7 983085 NR 983085 Autism MM





1 61 983085 NR 983085 Autism SP

Gaines et al(1988)



SP

SPSP

MMSP





SP



Not specified

MMDD



MMDD

MM












Severityof Delay a



SPMMMMDDDDDDSP

MMDD



SP

Kotkin et al(1978)



SPMMDD





MM

Oxman et al(1976)


SP


Sims-ucker(1988)



SPSP

SP



SP




Autism

SP

MM

MM


Down syndrome

MM



Willems et al(1982)




SPMMDD

MM












Severity of Delay a




SPMM



SPMM




Appendix B






Average

Number ofSessions



Sessions(Minutes)

Preferred















English



















25 Yes Edibles



NR Yes NR





983085 1 983085 NR No NR

Jago et al (1984)

(Sample 1)



















AverageNumber of



(Minutes)

















7 NR NR NR NR NR













objects and edibles













(Sample 2)





a Not Reported




Appendix C









vs Oral(P2 amp P3)



Oral vs Sign + oral

P1P2P3P4

P1P2P3P4

43316116113

221-107263

Alarcon(1977)




14200

Barrera amp


Alternating

treatments design

Alternating Oral

vs Sign + oral




P2

73

83





response) vs





Oral vs Sign + oral


P1

P1

P1

P1

153

134

146

32







110

86






Oral vs Sign + oral

Sign vs Sign + oral

Oral vs Sign + oral

Sign vs Sign + oral

00

44

-13

49

Carbone et al(2006)




pictured objects








P1P2P3P4

P1P2P3P4

200167140164

41200163205










labeling










132

125

133

147

177







114

150

Gaines et al(1988)






47

53

Gibbs et al(1990)





(1991)






118

113


Sign + oral vs Oral










Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55











Severityof Delay a



SPMMMMDDDDDDSP

MMDD



SP

Kotkin et al(1978)



SPMMDD





MM

Oxman et al(1976)


SP


Sims-ucker(1988)



SPSP

SP



SP




Autism

SP

MM

MM


Down syndrome

MM



Willems et al(1982)




SPMMDD

MM












Severity of Delay a




SPMM



SPMM




Appendix B






Average

Number ofSessions



Sessions(Minutes)

Preferred















English



















25 Yes Edibles



NR Yes NR





983085 1 983085 NR No NR

Jago et al (1984)

(Sample 1)



















AverageNumber of



(Minutes)

















7 NR NR NR NR NR













objects and edibles













(Sample 2)





a Not Reported




Appendix C









vs Oral(P2 amp P3)



Oral vs Sign + oral

P1P2P3P4

P1P2P3P4

43316116113

221-107263

Alarcon(1977)




14200

Barrera amp


Alternating

treatments design

Alternating Oral

vs Sign + oral




P2

73

83





response) vs





Oral vs Sign + oral


P1

P1

P1

P1

153

134

146

32







110

86






Oral vs Sign + oral

Sign vs Sign + oral

Oral vs Sign + oral

Sign vs Sign + oral

00

44

-13

49

Carbone et al(2006)




pictured objects








P1P2P3P4

P1P2P3P4

200167140164

41200163205










labeling










132

125

133

147

177







114

150

Gaines et al(1988)






47

53

Gibbs et al(1990)





(1991)






118

113


Sign + oral vs Oral










Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55












Severity of Delay a




SPMM



SPMM




Appendix B






Average

Number ofSessions



Sessions(Minutes)

Preferred















English



















25 Yes Edibles



NR Yes NR





983085 1 983085 NR No NR

Jago et al (1984)

(Sample 1)



















AverageNumber of



(Minutes)

















7 NR NR NR NR NR













objects and edibles













(Sample 2)





a Not Reported




Appendix C









vs Oral(P2 amp P3)



Oral vs Sign + oral

P1P2P3P4

P1P2P3P4

43316116113

221-107263

Alarcon(1977)




14200

Barrera amp


Alternating

treatments design

Alternating Oral

vs Sign + oral




P2

73

83





response) vs





Oral vs Sign + oral


P1

P1

P1

P1

153

134

146

32







110

86






Oral vs Sign + oral

Sign vs Sign + oral

Oral vs Sign + oral

Sign vs Sign + oral

00

44

-13

49

Carbone et al(2006)




pictured objects








P1P2P3P4

P1P2P3P4

200167140164

41200163205










labeling










132

125

133

147

177







114

150

Gaines et al(1988)






47

53

Gibbs et al(1990)





(1991)






118

113


Sign + oral vs Oral










Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55




Appendix B






Average

Number ofSessions



Sessions(Minutes)

Preferred















English



















25 Yes Edibles



NR Yes NR





983085 1 983085 NR No NR

Jago et al (1984)

(Sample 1)



















AverageNumber of



(Minutes)

















7 NR NR NR NR NR













objects and edibles













(Sample 2)





a Not Reported




Appendix C









vs Oral(P2 amp P3)



Oral vs Sign + oral

P1P2P3P4

P1P2P3P4

43316116113

221-107263

Alarcon(1977)




14200

Barrera amp


Alternating

treatments design

Alternating Oral

vs Sign + oral




P2

73

83





response) vs





Oral vs Sign + oral


P1

P1

P1

P1

153

134

146

32







110

86






Oral vs Sign + oral

Sign vs Sign + oral

Oral vs Sign + oral

Sign vs Sign + oral

00

44

-13

49

Carbone et al(2006)




pictured objects








P1P2P3P4

P1P2P3P4

200167140164

41200163205










labeling










132

125

133

147

177







114

150

Gaines et al(1988)






47

53

Gibbs et al(1990)





(1991)






118

113


Sign + oral vs Oral










Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55









AverageNumber of



(Minutes)

















7 NR NR NR NR NR













objects and edibles













(Sample 2)





a Not Reported




Appendix C









vs Oral(P2 amp P3)



Oral vs Sign + oral

P1P2P3P4

P1P2P3P4

43316116113

221-107263

Alarcon(1977)




14200

Barrera amp


Alternating

treatments design

Alternating Oral

vs Sign + oral




P2

73

83





response) vs





Oral vs Sign + oral


P1

P1

P1

P1

153

134

146

32







110

86






Oral vs Sign + oral

Sign vs Sign + oral

Oral vs Sign + oral

Sign vs Sign + oral

00

44

-13

49

Carbone et al(2006)




pictured objects








P1P2P3P4

P1P2P3P4

200167140164

41200163205










labeling










132

125

133

147

177







114

150

Gaines et al(1988)






47

53

Gibbs et al(1990)





(1991)






118

113


Sign + oral vs Oral










Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55




Appendix C









vs Oral(P2 amp P3)



Oral vs Sign + oral

P1P2P3P4

P1P2P3P4

43316116113

221-107263

Alarcon(1977)




14200

Barrera amp


Alternating

treatments design

Alternating Oral

vs Sign + oral




P2

73

83





response) vs





Oral vs Sign + oral


P1

P1

P1

P1

153

134

146

32







110

86






Oral vs Sign + oral

Sign vs Sign + oral

Oral vs Sign + oral

Sign vs Sign + oral

00

44

-13

49

Carbone et al(2006)




pictured objects








P1P2P3P4

P1P2P3P4

200167140164

41200163205










labeling










132

125

133

147

177







114

150

Gaines et al(1988)






47

53

Gibbs et al(1990)





(1991)






118

113


Sign + oral vs Oral










Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55










labeling










132

125

133

147

177







114

150

Gaines et al(1988)






47

53

Gibbs et al(1990)





(1991)






118

113


Sign + oral vs Oral










Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55








Jago et al(1984)

(Sample 1)



Verbalization

Verbalization

Verbalization


REELa

expressive scores

SICDb

expressive scores




145

260

107




Verbalization

Verbalization

Verbalization







39

20

77





Oral vs Sign + oral


90

111

Konstantareas(1984)




Oral vs Sign + oral

Oral vs Sign + oral

24

112




otal number













00

114

00

111

100

106






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55






reatmentConditions



Kotkin et al(1978)


Baseline vs Oral

vs Sign + oral



Oral vs Sign + oral

P1P2

P1P2

199402

123362











P1P4P5

P1P5

P5

P5

19600

219

162186

156

89

Kreimeyer(1980)





Kreimeyer(1984)







P1P2P3P4

P1P2

P3P4

43

94

60

21

32

91

50

01








182

139

Oxman et al(1976)






44

-08






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55






reatmentConditions



Shimizu(1988)
















119

110

63

106

100

63

166

Sims-ucker(1988)


participant design


Sign + oral



P3P4P5P6

80128

153126126

82




vs Sign + oral



Oral vs Sign + oral

P1P2P3

P1P2P3

338429280

191111

22






204215

00





48

32



Sign + oral vs Oral





58

113






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55






reatmentConditions



Willems et al(1982)


approximations










vs Oral






59

33

94

55

Influences of Sign and Oral Language Interventions on the Speech and Oral Language Production of...

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Transcript of Influences of Sign and Oral Language Interventions on the Speech and Oral Language Production of...