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Interactions of pre-symbolic children with developmental disabilities and their mothers and siblings

posted on 14.02.2017 by Joginder Singh, Susheel Kaur Dhillon
Depending on the severity of their disability, children with Down syndrome (DS) and with cerebral palsy (CP) may remain pre-symbolic for prolonged periods. For these children, the absence of symbolic abilities may be evident in both their communication and play. To date, most research on these children’s communication and play development has been conducted within the context of mother-child interaction. Seldom have they been observed interacting with other family members, and in interactions other than dyadic, despite these interactions also occurring daily. The aim of this study was to explore and compare the interaction of pre-symbolic children with DS and with CP with their mothers and siblings, in both dyadic and triadic interactions. A pilot was first conducted to trial procedures and coding systems, and determine the reliability of coding. The main study that followed involved 12 pre-symbolic children with DS (aged 1;10 to 5;04 years), 12 pre-symbolic children with CP (aged 1;09 to 5;07 years), and their mothers and siblings. The study was conducted in Malaysia. Children were observed as they engaged in three play interactions: mother-child, sibling-child, and triadic (mother-sibling-child). These interactions were coded for child communicative behaviours, mother and sibling interactive turns, and child and sibling play. Both groups of children were observed to participate in interaction, characterized by their production of communicative behaviours. They demonstrated significantly more communicative behaviours that could not be assigned intentionality (CAs) than intentional communicative acts (ICAs). Children with DS produced significantly more ICAs than children with CP across all three interactions. Although both groups of children were most reliant on vocalizations when communicating, they did differ in the other modalities used, relying on those most accessible to them in light of their respective disability. Children produced little or no symbolic play across interactions, showing a preference for functional play instead, an expected finding given they were pre-symbolic. The children with DS’s symbolic play was negatively associated with their ICAs, suggesting that unlike symbolic play and language that reflect shared underlying symbolic abilities, symbolic play and ICAs reflect different underlying skills. The physical limitations of children with CP limited their production of not only symbolic, but also other forms of play, in the same way it impeded their ability to demonstrate indicators of coordinated attention required for their communicative behaviours to meet the criteria for ICAs. Children produced the most ICAs during mother-child, followed by triadic and lastly sibling-child interaction, suggesting that the mother’s presence (mother-child and triadic interactions) encouraged children to communicate. Mothers created a more facilitative communication environment for the children than did siblings, by directing high rates of initiations towards them and taking turns that paved the way for the child’s next turn. Although siblings’ low rates of interaction did not provide children with as many opportunities to produce communicative behaviours, it encouraged them to produce high proportions of initiations. The response rates of mothers and siblings to children’s ICAs and CAs did not vary. The theoretical, clinical, and research implications of this study are discussed.


Principal supervisor

Teresa Iacono

Additional supervisor 1

Kylie Gray

Year of Award


Department, School or Centre

General Practice

Campus location



Doctor of Philosophy

Degree Type



Faculty of Medicine Nursing and Health Sciences