Perspectives - Vol. 2, No. 1 - New Methodologies In Assessment And Treatment

The Internet remains an untamed frontier. Its rules and etiquette have evolved, and continue to evolve, from its participants. You can find unparalleled richness in human expression; the principles of mass publication are no longer the property of the elite. You can also find unconscionable mean-spiritedness, the darker side of faceless, facile communications. As a member in the electronic community, you might ask yourself how you'd like to contribute."

People are transmitting signals via e-mail, IRC (chat rooms), virtual reality (via video and software hookups such as CU SeeMe, IPhone, and WebPhone) and accessing and downloading information from the super highway known as WWW (World Wide Web). The manner in which society now processes information is immediate, comprehensive, and available to anyone with transport to a computer. While the FAQ's (frequently asked questions) are in, the facts aren't even out: electronic communication is here to stay. The unknown is its long-term impact on the user.

The possibilities and advantages of computers, coupled with hypermedia and computer animation will be explored as a specific educational tool in which these resources are applied to the teaching-learning process when working with emotionally disturbed deaf/hearing-impaired students. Moreover, a methodology which incorporates these features, will proffer improvement in both spoken and written communication skills of the hearing-impaired. The methodology will encompass all the aspects of language systems (speech, linguistic structure, writing, etc.) and the different communication codes employed. Research will incorporate a sign language employed for the creation of communicative and linguistic context that in turn will assist the deaf / hearing-impaired person to generate an interior language. This interior language will seed the development of linguistic and reading abilities aimed at improving both oral and written communication. Moreover, coupling this approach with art therapy based techniques utilizing hypermedia applications in order to foster educational and therapeutic learning will also be examined. The results of that study will look at increased attention span, the development of visual expression, increased self confidence, creativity and enhanced communicative skills.

Analyzing an individual's mode of communication is critical when working with the deaf /hearing-impaired population. For example, modes of communication employed by family members may vary and the range of language systems may be expansive, circumscribed, bimodal, or absent. For the deaf person, visual information constitutes inner language. Without expression or a way to communicate this language, the individual can become isolated within his environment, community, and his world. (Horovitz-Darby, 1991)

Human communication codes, complex and mysterious, are normally based on a combination of signals that can be picked up be several senses. (Chomsky, 1965) Nevertheless, the deaf/hearing-impaired person does not have access to the communication code used by aural /oral persons: that is those who can hear the spoken language. Deprived access to this operational code leads to difficulty in interaction and understanding of one's environment as well as affliction with appropriate thought structures for each stage of development (Carretero & Garcia, 1984; Fourcin, 1982; Meadow, 1980; Rodriquez, 1990; Siefelbuch, 1980; Vygotsky, 1962).

Meadow (1980) reviewed language acquisition for three categories of deaf children whose linguistic environments and socialization inputs differed according to the communication modes of their parents: (a) deaf children of deaf parents who use only Ameslan (American Sign Language), (b) deaf children whose hearing or deaf parents use a simultaneous communication of spoken and /or signed English, and (c) deaf children whose hearing parents speak only English. Harvey (1982) found most deaf children and their hearing parents unable to communicate in the primary language system of Ameslan. This language is linguistically distinct from signed English even though both are considered manual communication. Ameslan has its own syntax and is therefore not derived from English grammatical structure, whereas signed English follows the same syntax as spoken English.

Whereas deaf children whose parents expose them to a simultaneous combination of signed and spoken English develop bimodal expressive language, the children whose parents use the strict oral English approach acquire language at a "painfully slower" rate. Moreover, Moores' (1982) research indicated that children of deaf parents are superior to deaf children of hearing parents in academic achievement and English language abilities. Since 90% of hearing parents do not speak sign language (Schein and Delk, 1974), two distinct languages can be represented in families with both deaf and hearing members and as a result, educators and therapists alike are commonly faced with members who do not speak the same language. This finding can not be underestimated in treatment and education. Two distinct cultures and languages are represented. Thus, therapists and educators alike confront a cross-cultural and bilingual phenomenon (Horovitz-Darby, 1991).

Difficulties in gaining access to this aural/oral code used by hearing people require the deaf / hearing-impaired person to be provided with an alternative code to develop communication and thought structures normally, thus facilitating spoken and written language learning. Experience has demonstrated that the most appropriate code for this task is sign language, whether bilingual or bimodal. Bilingual sign language implies acquiring competency in the mother tongue's sign language and then employing that as a basis for acquiring oral language as a skill as a "second" language. Bi-modal sign language, is based in the structures of the primary language: grammatical context of sentences and morphosyntactic elements of the spoken language are maintained. The advantage of employing computers (and in particular hypermedia) to effectively counteract the problematic features of accessing communication codes used by hearing people will be presented as well as the possible specific educational learning objectives applied to enhancing learning processes and treatment.

As stated earlier, hearing impairment affects the transmission of humans' most commonly used operational code: spoken language (Crystal at al; 1976). This impairs the deaf/hearing-impaired person's ability to receive and transmit messages and therefore hampers interaction in their environment. For a deaf person, learning spoken language is an arduous and laborious process. Voice control and articulation training sessions are integral parts of speech comprehension that can aid the deaf person to acquire adequate speech registration for enabling communication with hearing people. Two channels currently exist to aid the deaf person in accessing spoken language: (a) the hearing channel: whether functional or not, due to decibel loss its use depends on the auditive remains (b) and lip reading. Either conduit is limited and communication exclusively directed through one or the other compromises comprehension. This is due to two factors: (a) grammatical elements are lost without contextual references to increase the semantic contents of the message and (b) solid thought structures normally reinforced through spoken language are shunted and don't simultaneously develop with the cognitive processes. These limitations do not necessitate abandoning training but rather augmenting it with existing improvements in technology (such as hypermedia assistance).

Additionally, previous research has indicated that art therapy techniques concurrently lead to unlocking cognitive delays with emotionally disturbed populations when development has been arrested due to emotional maladjustment and trauma. (Horovitz, 1981, 1983; Rawley, 1970, 1976, 1978, 1996). Moreover, it has been concluded that art therapy techniques coupled with exploration of emotionally laden experiences leads to improved self esteem, social adjustment, and cognitive gains.

While the deaf /hearing-impaired person acquires the skill to read in the same way as hearing people do, difficulties related to the process (particularly graph-phonene transformation and acquisition of correct pace, intonation and speed) create difficulties which last longer among the deaf. The problems of voice, articulation, phono-respiratory coordination and the like are severely compromised by deafness due to the lack of a model and auditory feedback. Thus reading by the deaf /hearing-impaired person is generally arrythmic, monotonous and often unintelligible for the listener. Yet transmission of the messages received are undoubtedly even more significant. These problems can take form in two ways: those that arise from lack of auditory feedback and those that arise from linguistic deficiencies. Since reading analysis is made in reference to the interlocutor, analysis of reading articulation and association to its meaning in context as well as enunciation is severely compromised. The linguistic deficiencies result in lack of vocabulary and jeopardized syntactic structures, semantic values (derived from morphological aspects of language), and linguistic contextual understanding.

Computers are a widely used tool to improve education by facilitating learning. Various programs (such as PLATO, HYPERCOURSEWARE, WIGGLEWORKS, etc.), publications (such as Journal of Education Multimedia and Hypermedia, Education & Training Technology International, Computer and Education, etc.) and research conducted by varying institutions are currently available.

To generate learning processes in assisting the development of cognitive processes, a computer system incorporating a hyper / multimedia environment would have to be composed of various hardware and software resources: (a) a voice card centered on correction of different speech parameters within a meaningful context; (b) iconographic and sound-animated supports to enable the introduction of situations animated through sign language, a sign language dictionary, and dactylogical and visual-phonetic supports for creating emission; (c) computer video for incorporating training exercises to correct lip configuration for improved lip-reading; (d) vibratile-tactile output offering the possibility of incorporating the rhythmic aspect of musical structures and adapting them to speech emission programs, (e) and digital imaging capabilities with various software programs (detailed in the Art Therapy / Hypermedia section) in order to animate drawings and dovetail with existing software programs such as : ALLALO (exercises and evaluation tests that deal with visual perception, lip movement, and vocabulary access), VISHA (voice board based system that trains students in sound presence/absence, tone, intensity, while simultaneously analyzing pupil's sound emissions), HANDS ON (laser disc technology to present a real person on the screen communicating in ASL (Ameslan) - texts stored in the computer combine on the screen with ASL videos), and LAO (Lenguaje Asistido por Ordenador/ Computer Assisted Language) (incorporating a multimedia dictionary which presents not only a written definition or description of a word, but also images of its corresponding sign language equivalent as well as usage examples).

Art Therapy and Hypermedia/Computer Animation: Applications for the Emotionally Disturbed

The effects of art therapy techniques on all aged people with behavioral and emotional problems have long been documented (Kramer, 1975; Naumburg, 1980; Silver, 1989; Moon, 1990; Horovitz-Darby, 1994) and specifically with the deaf/hearing-impaired populations ( Henley, 1992; Horovitz, 1988; Horovitz-Darby, 1988, 1991, 1994; and Silver, 1970, 1976). Coupling CAL (Computer Assisted Learning) with art therapy, however, is a relatively undeveloped potential.

As early as 1987, Canter experimented with creativity and software in art therapy sessions. Canter concluded that people who exhibited difficulty with fine motor coordination and/or impulsive or destructive personalities found computers to be constructive and beneficial tools due to calming effects in the stimulation of creative and intellectual challenges. Moreover, the results concluded after a three month study that: (a) attention span was increased from 10 minutes to over an hour; (b) visual expression was enhanced via drawing and animation programs; (c) computerized musical expression was possible even if the client was unfamiliar with music or musical composition; (d) self-confidence, creativity, and problem solving was developed due to the experience provided by the positive reward from others; and (e) clients cultivated communicative skills in an atmosphere without conflict due to a "user friendly environment". However, what was not researched was the power of the PC coupled with creative software as therapeutic tools and how this might impact more specific populations such as the emotionally disturbed deaf / hearing-impaired.

Turkle (1984) concluded that computers change the way people think about themselves via computational metaphors. Hopkins (1991) researched implications of utilizing computer technology with emotionally and behaviorally disturbed children. Computers were found to increase motivation, control pace of learning, improve self-image and self-esteem, minimize differences between able and less able subjects and improve overall concentration and attention span. Rutter (1972) concluded that language skills, perceptual and perceptual-motor skills were often adversely affected in children with emotional behavioral difficulties. Yet, computers have been linked to productivity because the monitor is like a TV screen and children who are accustomed to watching for long periods of time can focus attention longer because of its small, brightly lit areas. Informational technology is also user friendly in that it is a non-judgmental teaching system and therefore emotionally disturbed students with behavioral difficulties tend to persevere in this environment. Being able to project problems onto characters on the screen enables them to work in a more detached, dispassionate and productive way than would otherwise be possible.

Bailey and Weippert (1992) described a qualitative case-based study that assessed the effectiveness of computer-based learning in improving the linguistic and behavioral responses of two young aboriginal girls who had profound hearing impairment. Moreover syntax errors were reduced from 45% to 25%. Worth noting is that despite the cultural differences, the aboriginal girls in the study were neither daunted nor confused by the technology, nor language used by the computer. It would seem that computer-based learning can thus improve the language competence, attending and concentrating behaviors of young deaf, aboriginal children.

The essential handicap of deafness is not a problem of speech, but the frustration of missing concepts. Since art, as well as language, is a means of communicating concepts, and coupling CAL has already been documented to enhance self-esteem, communicative reasoning, and behavioral management, it would stand to reason that increased communication and behavioral management could be augmented with the use of the aforementioned software and hardware applications. There are qualities of experience that cannot be put into words, but can be articulated in art. A captionless cartoon may be eloquent. Even for the hearing in a literate society, verbal language is often not enough. Art requires the exercise of many mental processes. It sharpens awareness and reinforces memory. (Silver, 1970, 1976 )Young, deaf children often cannot verbalize imaginary or vicarious experiences, but they can draft them. Many art therapists have claimed and proven that art develops reasoning power by requiring organization and the constant exercise of judgment. Art does more than reveal emotions. By providing release from emotional tension, art has proven to be both integrating and healing. Moreover, visual expression seems to be intensified for the deaf. Perhaps deaf people seize the opportunity of image-making because their channels for communication are already constricted and concentrated on the visual. Paradoxically, since the deaf may not know the pleasure of aural conversation, perhaps they also have not been distracted by useless chatter.

By offering encouragement and opportunity for creative expression, perhaps the deaf can create a speech to which the rest of us can listen with our eyes.

Language is not the only means of articulating thought. Whenever a symbol operates there is meaning. Depictions, no less than words, are forms of symbolic expression. Since the beginning of time, art has served to communicate experiences and ideas, explicitly or implicitly, in form as well as content. Art meanings are so universal that they transcend languages and cultures. Just as the writer uses words, the artist uses the plastic elements of form, space, line, texture and color. Representation requires the review of experiences and clarification of impressions which call memory into play. Like words, visual symbols preserve ideas that might otherwise vanish. According to Silver (1970, 1976), for the "linguistically challenged", pictures appear to be a way of depicting one's knowledge base while simultaneously sharing this with others. It has been submitted that emotionally disturbed deaf / hearing-impaired people may lack the opportunity for developing the capacity for abstraction; computer assisted learning coupled with hypermedia/computer animation techniques could foster such opportunities by exercising imagination, association, memory, perception, organization, and language acquisition.

The function of this equipment is to provide a computer interface which allows for maximum creativity.

In this research, the investigation purports to foster increased communication, attention span, and positive self worth vis a vis CAL (Computer Assisted Learning) coupled with art therapy techniques. Drawing images will be scanned into the computer and manipulated with existing software (listed in the next section, "Art Therapy and Hypermedia Applications") to offer the deaf patient an opportunity to create visual, animated stories. These art products could foster integration of abstract thinking, spatial reasoning, and augment existing modes of communication. Additionally, the patient's ability to manipulate his / her work via hypermedia applications could be assessed for increased attention span and developmental gains using the Silver Drawing Test (Silver, revised 1996) as a pre-test / post-test measure.

The procedure would need to employ art therapy techniques, coupled with hypermedia and CAL applications on at least a twice weekly basis in an open-studio format. Research indicates that a minimum of twice weekly intervention accelerates the therapeutic process and anything less than that would compromise outcome based assessment. (Harvey, 1982; Henley, 1992). Moreover, the sessions should be no less than an hour in length and if possible should allow for interaction in 3 hour blocks (Kramer, 1975). The reasons are multifold but in this specific instance are quite concrete: initially, deaf patients will need to be taught how to utilize the software applications, engage in digitally scanning existing art work and began to animate their art products. Because using existing programs will require extensive educating and trial and error applications, a certain degree of frustration is to be expected. Past research (previously noted) has indicated the advantage of employing CAL (a "user friendly tool") to verily reinforce the learning process with emotionally disturbed students. Additionally, providing an open-studio format, which would invite the element of play and experimentation, would perforce fortify the learning process. As a result, this research base should have structured open studio times replicating the learning based environments offered at higher education institutions. It is proposed that modeling the computer labs in this manner will instill responsible behavior and social interaction.

Additionally, all sessions should be monitored on tape in order to assist in analyzing information that leads to frustration and communication breakdown as well as educational breakthroughs. (With the very disturbed, dual-diagnosed clients, it is expected that frustration may lead to destructive behavior and require removal from the studio.) While rules will be posted and enforced regarding the care of computer equipment, the research has to build in factors to prevent such behavior. It has been proven by aforementioned researchers (Kramer, 1975; Henley, 1992; Allen, 1995; McGraw, 1995; McNiff, 1995) that the open studio space enhances physical relaxation, creativity and supports non linear communication. In the words of McNiff (1995, p.183), " We reframe the practice of art therapy by focusing on what the studio does, what the materials do, and how artworks created by ourselves and others affects us. When we look at art therapy through the eyes of the soul, we see an ecological field of forces, a total presence of creation, that simply does not fit the linear language and concepts of behavioral science. The mainstream of art's medicine will always flow from the studio." Therefore, by offering an open-studio format, subjects will be allowed to enter and exit at free will thus eliminating potentially restrictive environments that often result in exacerbating violent behavior. While it is expected that some frustration will occur, back-up personnel must be available should crisis intervention become necessary.

Outcome based assessment could include the data results from videotape analysis, pre-test/post-test results from the Silver Drawing Test (designed to measure cognitive functioning over time that includes concepts of sequencing, conservation, language acquisition, spatial reasoning, and imaginary skill building), and the actual artistic products created through hypermedia applications and CAL structure.

Because the deaf / hearing-impaired respond extremely well to non-verbal interventions and assessment batteries, a pre-test/post-test of the Silver Drawing Test of Cognition and Emotion (SDT) should be given to each subject (Silver, revised 1996). Drawings have been used to assess intelligence for over 50 years. While several tests including the Bender Visual-Motor Test (1938), the Draw-A-Man Test (Goodenough-Harris, 1963), the Human Figure Drawing Test (Koppitz, 1968) and the Torrance Test of Creative Thinking (1984) measure fluency, flexibility, originality, and elaboration, they are not designed for assessing the ability to solve conceptual problems graphically.

In the SDT, drawing takes the place of language as the primary channel for receiving and expressing ideas. Stimulus drawings prompt response drawings that solve problems and represent concepts. The three subtests, Predictive Drawing, Drawing from Observation, and Drawing from Imagination, require cognitive and emotional replies. Moreover, Silver specifically developed this assessment with the deaf population in mind. As a result, the results of this test correlate well with other more traditional methods of evaluation such as the WISC-R. Developmental techniques of the Silver Drawing Test are listed under the National Institute of Education Project #79-0081, which can be found under Appendix C of the Silver text (1996).

Information gleaned from the pre and post-test components of the Silver Drawing Test will underscore developmental and cognitive delays or achievement as directly related to the function of computer-based learning extracted from experimentation with hypermedia and computer animation. While research has already indicated that CAL combined with hypermedia effectively translates into cognitive and developmental exceleration (when working with the hearing population), the data extracted from the SDT will estimate the findings from a developmental vantage point as well as provide quantitative data that can be analyzed and calibrated.

Moreover, as previously described, all sessions will be videotaped and further analyzed in order to assess behavioral changes over time that will be linked to specific software and programmatic influences that led to increased language acquisition, communication, and developmental and behavioral changes.

It is proposed that art therapy applications coupled with the aforementioned software will in fact induce the learning process, bolster self-esteem and lead to improved communication and social interaction.

While computer technologies applicable for education have been myriad (intelligent tutoring systems, programmed learning systems, etc.), many researchers have concluded that hypermedia/multimedia techniques effectively facilitate learning. Its treatment of information, access, and structure resemble the mental processes and, in fact, corral and stimulate the investigative properties involved in the learning process. (Jonassen, 1992)

The future is about computer understanding and meaning. According to Negroponte (1995), the guru and author of "Being Digital", new ideas come from differences. Creativity, it seems, comes from "unlikely juxtapositions". Maximizing differences engages the imagination, fuels creativity and engages optimism and passion. May we work towards that end.

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