Communication Hierarchies

Deciding how you will communicate with your child

By: Karen Olson, NEC Educational Consultant

For the parents of a child with deafblindness, deciding how you will communicate with your child can be a difficult decision. And there are many considerations when making these decisions: What does my child see? What does my child hear? What does my child understand?  What are my child’s physical abilities?  How is my child receiving information? How can my child communicate his/her needs?

This article takes a look at a communication hierarchy that may be helpful in making decisions about how to promote both receptive and expressive communication in young children with deafblindness. 







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Of course, it is important to mention here that throughout this hierarchy, you would always be using the spoken word, and if appropriate, the sign.


What are they?

Touch cues are physical cues that are used in a consistent manner on the child or adult’s body to give a specific message about what is about to happen to the person.” (Belote, Fact Sheet, CDBS)

Why use them?

An important prerequisite to language development is the ability to ANTICIPATE, to know what is going to happen next. For our children who may have limited vision and hearing, this can be a challenge. The typically developing child may see their parent walk into the room, and reach their arms out to pick them up. They may hear them walking towards the room, and greeting them as they come into the room. But for the children with deafblindness, they may not know their parent has entered the room and are about to pick them up. For some children, this can be a “surprise” and take some moments to calm down. 

How do I start?

There is not a standardized set of touch cues to follow. It is really based on how you interact with the child; what you are, in essence, already doing:

  1. Pay attention to how you interact with your child when doing routine activities: how do you pick them up, how do you change their diaper, put their shirt on, e.g.;
  2. For example, a touch cue for picking up your child could go as follows: Place your hands on the child with a little pressure as if you are going to pick them up, then;
  3. Start to do the motion 2-3 times while saying something like “Up, up, up!”, then;
  4. Go ahead and pick them up!  

In this way, you are giving your child time to process what is about to happen. In time, they may lift their arms to assist in being picked up!  Consistency is KEY!


What are they?

Object cues are objects or parts of objects used in activities or associated with a particular person. They are used to give information, make requests, and provide feedback. Initially object cues should be used during activities and selected so that the child can easily make an association between an object and the activity it represents (Chen, 1995; Rowland, Schweigert & Prickett, 1995).

Why use them?

Use of real objects, i.e. the actual objects that are used in routines, can become cues for upcoming activities which can allow the child to again ANTICIPATE what will happen next. 

How do I start?

Use the real object that the child will use in a particular activity. The goal is for the child to make a connection between the object and the activity. It is essentially a vocabulary word.

For example:

Bottle or cup = Time to eat or snack time

Car keys = “We’re going in the car now!”

Bath toy or warm washcloth = Bath time!

Diaper = Time to change!

Present the object to the child and then immediately go to the activity. Consistent, repeated use of MEANINGFUL OBJECTS will help the child make an association between OBJECT & ACTIVITY. Again, in time, use of objects will help the child know what is going to happen next so they can prepare themselves. For example, when they see the cup, they might start to lick their lips.


What are they?

Partial Objects are based on real objects and used once a child understands the meaning of the REAL Object. So, rather than a cup, it could be a cup that is cut in half and mounted on a “card.”

The washcloth becomes a very small piece of washcloth. The diaper becomes a very small piece of diaper.

Why use them?

Partial Objects can lead the child from the very concrete to more abstract as it becomes a symbol rather than an object to use.

How do I start?

Once the child understands the meaning of the REAL OBJECT, then you can begin to use PARTIAL OBJECTS.


What are they?

You would be using photographs of the same objects or partial objects they have come to know and understand.  In some cases, you may use commercial pictures, such as Mayer-Johnson pics, but only if the child can recognize them as pictures of real objects. Line drawings can be very useful to help make the transition from real or partial object to the 2-dimentional flat image of a picture or photo.

Why use them?

In the journey to communication competence, the goal is always to become more symbolic. Using photographs and pictures can open a whole new world of communication for the deafblind child who is able to use them both visually and cognitively. There are many communication programs that use pictures also.  However, it can be a difficult transition from objects to pictures or photographs. In that case, line drawings can be used to bridge that understanding.  You may want to begin by TRACING an object (e.g. if a cup = meal time, place the cup on paper and trace around it while the child watches. Let him/her compare the drawing with the real object).  Tracings may have to be done repeatedly and over time.

How so I start?

When the decision to move to photographs or pictures is made, you want to still keep using the objects/partial objects. Pair those with the photographs until you are quite sure the child is understanding them. Then you can remove the objects.


As I mentioned at the beginning of this blog, you will always be using the spoken word and, when appropriate, sign language, regardless of what stage of the hierarchy you are using.  

Exposure to the printed and/or braille word can begin at any time you feel the child may be ready.  Print or braille words can be added to line drawings or photographs long before a student understands.  The more exposure, the more likely they will begin to understand the visual or tactile word. Labelling things in the environment can be an important part of beginning literacy.  Once a student understands the word, the picture or photo can be removed.

The process of communication/language development can take time, and certainly needs consistency. In the end, the child shall lead us, letting us know what approaches work for them, be it the spoken word, sign language, pictures, simple objects, or a combination of these.

Photo by Element5 Digital on Unsplash

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