Infant Behavior & Development 37 (2014) 416–427

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Infant Behavior and Development

First symbols in a girl with Down syndrome: A longitudinal study from 12 to 18 months Karina Cárdenas a,∗ , Cintia Rodríguez b , Pedro Palacios c a

Pontificia Universidad Católica de Chile, Chile Universidad Autónoma de Madrid. Facultad de Formación de Profesorado y Educación, Departamento de Psicología Evolutiva y Educación, Campus de Cantoblanco, 28049 Madrid, Spain c Departamento de Psicología, Centro de Ciencias Sociales y Humanidades, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico b

a r t i c l e

i n f o

Article history: Received 7 February 2013 Received in revised form 15 March 2014 Accepted 2 June 2014 Keywords: Down syndrome Early communication Symbolic uses Adult–child interaction

a b s t r a c t Symbolic uses of objects originate in communicative and triadic contexts (adult–childobject). In this longitudinal study we explore the emergence and development of the first symbolic uses in triadic interaction contexts in a girl with Down syndrome between 12 and 18-months of age. We conducted five sessions of video recording, at 12, 13½, 15, 16½, and 18 months chronological age. At each session we videotaped the girl and her mother interacting with different objects. Data were coded in semiotic categories used in previous studies (Rodríguez & Moro, 1999) and a microgenetic analysis was conducted for each session. The first symbolic uses by the girl appeared at 13½ months. Symbols were of different types and levels of complexity, and the adult had an important role in facilitating the production of these symbols. © 2014 Elsevier Inc. All rights reserved.

1. Introduction To operate with symbols is essential for children’s psychological development (Piaget, 1946/2000). To cross the border which separates non-symbolic from symbolic meaning implies progress in the development of the child’s cognitive capacities. Entry into the symbolic mode allows children to refer to absent referents and to break away from meanings related only to the here and now, to immediate and material reality. The use of symbols by children opens up new and powerful ways of knowing, interaction and communication, both with themselves (Rodríguez, 2009) and with others (Barthélémy-Musso, Tartas, & Guidetti, 2013; Martí, 2012; Rivière, 1990). Knowing how children operate with absent meanings is essential in order to act effectively to promote their development. This is especially important when they present a disability, as in the case of children with Down syndrome. 1.1. Origin of symbolic uses of objects from the Object Pragmatics perspective In this paper we use the term ‘symbolic uses of objects’ to distinguish them from conventional uses and to highlight that symbolic uses have their roots in social rules of object uses. We use the term symbol when referring to what other authors say.

∗ Corresponding author at: Pontificia Universidad Católica de Chile, Campus Villarrica. Bernardo O’Higgins 501, Villarrica, Chile. Tel.: +56 223547365. E-mail address: [email protected] (K. Cárdenas). http://dx.doi.org/10.1016/j.infbeh.2014.06.003 0163-6383/© 2014 Elsevier Inc. All rights reserved.

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There is significant uncertainty regarding the origin of symbols in general, and the symbolic uses of objects in particular and its close relationship with the notion of the object, dominant in Psychology, as an evident “physical reality” that shows directly what it is. Implicitly or explicitly symbols are often seen in early development studies as emerging from a literal, evident, “physical reality”. Objects, considered that way have, what we call, a natural status. This quotation, by Bjorklund and Gardiner, is an excellent illustration of this naturalization of objects: “When given objects or an apparatus, [children] do not need to be told to interact with them to see what they might do [. . .]. They do this spontaneously. In the process, they discover important properties about objects and how something works” (2011, p. 167, stressed by us). However, a central idea of the Object Pragmatics perspective (Moro & Rodríguez, 2005; Rodríguez & Moro, 1999) from which we approach this study, is that objects are not so obvious. Objects do not say by themselves how they should be used. They have public norms of use shared by the community (see also, Costall & Dreier, 2006; Sinha & Rodríguez, 2008). People in everyday life use them with conventional functional purposes. Previous studies have demonstrated that children need semiotic adult mediation to get to use the object according to its function (Basilio & Rodríguez, 2011; Brand, Baldwin, & Ashburn, 2002; Dimitrova & Moro, 2013). When, by the end of the first year of life, the child starts using objects according to their social functions, it is because the objects have become the sign of their use. The object has not only a “physical” permanence as Piaget and other authors have stressed, (see also Spelke (1998) for a nativist approach on object permanence)1 but also a conventional functional permanence (see discussion in Rodríguez, 2012). When this permanence appears, at the end of the first year, the object starts to be used as a member of a class, which allows the child to categorize the material world according to the possibilities of public uses shared with others. Without this functional permanence, without the stability provided by the conventional uses of objects, and the common ground (Dimitrova, 2013; Dimitrova & Moro, 2013) that it offers in communicative contexts, there would not be “stabilized forms” capable of being separated from the material object to be applied to any material object, or in its absence, as occurs with symbolic uses (Rodríguez et al., in press). Findings from the study of functional and symbolic object use in children with autism are relevant to this distinction (Sterner & Rodríguez, 2012; Williams & Kendell-Scott, 2006; Williams, Kendell-Scott, & Costall, 2005). Children with autism are delayed in achieving conventional uses of objects and their uses are often qualitatively different from typically developing children and children with Down syndrome. The functional permanence of the object, in one way or another, is the basis for the first symbolic uses of objects toward the end of the first year of life. To summarize, from the Object Pragmatics perspective, symbolic uses: (1) do not have their roots in a “literal physical reality”. Rather, symbolic uses are built on rules based on the conventional uses of objects which are shared by the user community to which the child belongs. (2) Symbolic uses are forms of conventional uses that are detached from their original context and are applied to other objects or situations. What remains in the symbolic uses is the rule of the conventional use of the object that it evoked and thanks to which we recognize the symbolic use themselves and their meanings. As Sinclair (1970), from the Geneva School, stressed, following Furth’s (1969) work: “objects have to be defined in a certain way before they can represent something else or be represented by something else. [. . .] [W]hen a child uses a box as a bed in his play, ‘he knows what a bed is and what a box is; precisely because of this double knowledge he can use one as a symbol for the other”’ (p. 124). (3) Children’s first symbolic uses are not produced from a symbolic vacuum. Adults play an important role in guiding the child to begin to use objects according to their conventional function, but they are also fundamental in the entry of the child into symbolic uses. Long before the child can understand the symbolic uses performed by adults or can use symbols themselves, adults use objects in symbolic ways when they interact with children (Noll & Harding, 2003; Perinat & Sadurní, 1993; Rivière, 1990; Rodríguez & Moro, 2008). In their communication with children – through different sign systems – adults enable children to first understand symbols performed by others and then appropriate and use them themselves (Rodríguez, 2007; Palacios, 2009). (4) Objects are central for communication: it is with them or about them that children first communicate intentionally with others. As is noted in the literature, particular attention must be paid to how the nature of an object influences communication with others in general and symbolic productions in particular (Rakoczy, Tomasello, & Striano, 2005; Striano, Tomasello, & Rochat, 2001). (5) Children develop symbolic uses of objects in a gradual way. The first symbols are not produced with absent referents or by object substitution. Rather, they are performed with suitable objects (replica or not) but in uncompleted scenarios, that is, out of the real and efficient context of use. For example, “when a child of 12 months pretends she is eating using a real wooden spoon, we consider that this indicates a symbolic activity because, the spoon is representing in place of, acting as a sign for the absent scenario” (Rodríguez, 2012, p. 132). With an empty spoon, even if it is the artifact with which one eats, the conventional use is impossible. 1.2. Symbolic development in typically developing children and in those with Down syndrome According to Piaget (1946/2000) children start representing reality by using different signifiers to represent other things – what is signified. That is, they perform their first symbols from the sixth sensori-motor substage (around 18–24 months),

1

See the discussion about this issue in Moore and Meltzoff (1999) and the criticism of the nativist approach in Karmiloff-Smith (2012).

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although Piaget also gives some examples of symbolic play from 15 months of age. Piaget relates the capacity to symbolize with symbolic play. In play the child creates situations similar to those experienced. The child transforms reality according to its desires, interests and needs of the self, by deforming assimilation (more or less pure assimilation). The symbols, for Piaget, have a status which is individual and non communicative. But other researchers claim that symbols arise in contexts of communication with others, precisely in order to communi˜ 2001, 2004; Martí, 2012; Palacios, 2009; Perinat & Sadurní, 1993; Rivière, 1990). Furthermore, cate (Cárdenas, 2012; Espanol, symbols not only serve to communicate with others and share internal worlds (Rivière, 1984) but can also be used to communicate with oneself (Rodríguez, 2009). Some authors suggest that symbols in action, that is, symbolic uses, begin before speech and in some cases long before, both in children with typical development and in those with Down syndrome (Cárdenas, 2012; Lalueza, 1991; Lalueza and Perinat, 1994). Children use objects in a symbolic way, at first without accompanying language, to get into a “dialogue” with the other. In typically developing children in triadic interaction contexts, the first symbolic uses of objects, around 12 months of age, are not accompanied by words or onomatopoeias (Palacios, 2009). In a longitudinal study of children with Down syndrome between 12 and 21 months chronological age (CA) in interaction with adults, Cárdenas (2012) found that children not only performed symbolic uses with a playful function, to laugh and have fun, but also to share meanings in relation to objects. Language started to appear little by little. Progressively, children accompanied their symbolic uses with other signs such as vocalizations, onomatopoeias, unintelligible language and finally words. Barthélémy-Musso et al. (2013) state that in peer interaction, children three years of age with typical development do not use language to organize their symbolic scenarios and that it is actions – not language – that give order or meaning to the symbolic scene. Empirical studies show that typically developing children show an invariant pattern or sequence of symbolic play (e.g. Nicolich, 1977; Piaget, 1946/2000). The pretense for self occurs before pretense directed to others, and sequences of pretend acts appear only after single symbolic acts have been performed (Belsky & Most, 1981; Lézine et al., 1982/1983; McCune, 2010; Sinclair, 1970). In the case of children with Down syndrome, the course and content of symbolic play is very similar to that which is observed in children with typical development, matched according not to their CA, but to their mental age (MA) (Beeghly & Cicchetti, 1987; Beeghly, Weiss-Perry, & Cicchetti, 1990; Cielinski, Vaughn, Seifer, & Contreras, 1995; Cunningham, Glenn, Wilkinson, & Sloper, 1985; Hill & McCune-Nicolich, 1981; Motti, Cicchetti, & Sroufe, 1983; Venuti, De Falco, Esposito, & Bornstein, 2009). Some authors report that in typically developing children (in solitary play or with others) some children perform symbols directed to themselves at 11–13 months (Belsky & Most, 1981; McCune, 2010; Palacios & Rodríguez, 2014). In the previously mentioned longitudinal study by Cárdenas (2012) of Down syndrome children, she found symbols in one child at 12-months CA and another at 15 months. The symbols were mainly performed with the same object used in its functional everyday use, “eating” with an empty spoon or putting the mobile phone to his/her ear, for example. However at 15 months a child performed a symbolic use by object substitution, using the doll’s cap to “feed” the doll. In Palacios and Rodríguez’ study (submitted) of typically developing children, as in the study by Cárdenas (2012) of children with Down syndrome, children and adults performed most symbolic uses with the same object used by children to perform conventional uses. These first symbols are very close to the conventional use of objects and can be considered to be the first “symbolic step”, as part of the referent is present. The rules of conventional use are detached from their usual object and then applied to other objects outside of their usual practical context of use. Lalueza (1991), in a longitudinal study, analyzed symbolic development in children with and without Down syndrome in a play setting shared with adults. He found that in both groups, while simple manipulation of objects such as hitting or sucking them, [what we consider non conventional uses (Rodríguez & Moro, 1999)] tended to decrease as children were growing up, uses of objects “as if” tended to increase, in accordance with other authors’ findings (Beeghly & Cicchetti, 1987; Beeghly et al., 1990; Belsky & Most, 1981; Hill & McCune-Nicolich, 1981; McCune, 2010; Nicolich, 1977; Piaget, 1946/2000). Different authors note that adult involvement influences the quality of children’s play (p.e. Bornstein, Haynes, Legler, O’Reilly, & Painter, 1997; Cielinski et al., 1995; Fiese, 1990; Noll & Harding, 2003; O’Connell & Bretherton, 1984; Venuti et al., 2009). Higher levels of play are associated with supportive behaviors with the object afforded by mothers (Roach, Stevenson Barratt, Miller, & Leavitt, 1998). When adults perform symbolic acts or show how the game can be played, children with typical development and Down syndrome both develop the topics in ‘as if’ play and become more involved in the symbolic play itself (Lalueza, 1991; Noll & Harding, 2003). A number of authors remark on the communicative role of the adult. Adults may adopt a model or “teacher” role through the use of different types of signs in what can be considered a form of narrative (Lyra & Valsiner, 2011; Perinat & Sadurní, 1993, 1995). Lalueza and Perinat (1994) and Lalueza (1991) point out that mothers of Down syndrome children insist more than the mothers of typically developing children on a correct functional or conventional use of objects, and that they care less about the development of ‘as if’ play. Moreover, in most cases, adults who interact with Down syndrome children do not give them the time to end a sequence. They tend to interrupt their activity, end it, or change to another one. On the few occasions when adults allow more time for the child to play, children can be observed performing a complex ‘as if’ plan.

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Fig. 1. Objects used in study.

Some studies have focused on comparing different aspects of symbolic play in children with and without Down syndrome according to their MA (e.g. Beeghly & Cicchetti, 1987; Beeghly et al., 1990) rather than looking at what CA these children perform their first symbolic acts and at their characteristics. We decided to work with CA because (1) we are interested in exploring the moment in development when the child produces her first symbolic uses and how they change with age. Using CA allows us to obtain results that could have implications for early intervention with children with Down syndrome; (2) Lalueza (1991) notes that the subscales of the Brunet–Lézine development scale are very biased by the importance they give to motor behavior, resulting in a disadvantage for children with Down syndrome who often have a delay in motor development. Knowing at what CA children with Down syndrome reach certain milestones in their development is a valuable sign of cognitive-communicative potential that must be considered. The aim of this study is to analyze the first symbolic uses of objects in triadic interaction contexts – that is, adult–childobject – of a girl with Down syndrome. Gestures, vocalizations or language are considered only if they appear to accompany these symbolic uses of objects. In this sense, this study is not dedicated either to linguistic or gestural analysis. Many other studies have already addressed these important issues. The following questions have guided this study: (1) what kinds of uses of objects does the girl perform? (2) When are the first symbolic uses performed? (3) What are the characteristics of these symbolic productions? (4) What objects are used in a symbolic way by the girl and by the adult? and finally, (5) what role does the adult play in the first symbolic uses produced by the child? 2. Method 2.1. Participants The subjects of this study were a 12–18 months-old girl (G) with Down syndrome and her mother (M). The father was never actually filmed in the video though he was present in all the sessions. The subjects were contacted through the Children’s School Polichinela in Madrid Community, Spain, which the girl had attended since she was 9 months old. 2.2. Procedure and materials We performed a longitudinal case study. We conducted 5 sessions of video recording, at 12, 13½, 15, 16½ and 18 months CA, at the participant’s home. Participants sat on a carpet spread on the floor. We gave them 10 different objects together and in no particular order: an empty liquid soap bottle/dispenser, a plastic horse, a cardboard box with a string at one side, a toothbrush, a wooden spoon, a lighter, a doll, an oval stone, a toy mobile phone and a cloth (see Fig. 1). The same objects were used in a previous study with typical developing children in a triadic interaction situation (Palacios, 2009; Palacios & Rodríguez, 2014). Every session lasted 10 min. The instruction given to M was always the same: “interact with your daughter as you usually do”. The sessions were fully transcribed in ELAN 3.8.0, according to the procedure used by Rodríguez and Moro (1999). Language, vocalizations, gestures and uses of objects by each participant were transcribed separately.

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Table 1 Categories uses of objects by G and communicative mediators and gestures by M. Child

Adult

Uses of objects

Communicative mediators and gestures

Non conventional uses: uses of the object according to what the object permits physically. For example: bite, pull, shake, and suck. Conventional uses: using the objects according to their customary function. For example: putting an object in a box.

Conventional Demonstration: the adult communicates the conventional use of an object to the girl.

Symbolic uses: performing an action and/or using an object to represent something absent. For example: “eat” from an empty spoon.

Types of demonstrations:

Distant: presenting herself as a model. For example, pressing a mobile phone’s key. Immediate: making the girl use the object. For example, taking the girl’s hand and making her press the mobile key. Symbolic Demonstration: the adult communicates a symbolic use of the object to the girl. Two types: Distant: acting as a model. For example, “brushing” her teeth with a toothbrush. Immediate: making the girl perform the symbolic use. For example: taking the girl’ hand with the toothbrush and “brushing” her teeth. Ostensive gestures: showing or giving an object. Indexical gestures: indicating something located at a distance or nearby. For example: pointing at an object. Redundancies: When a gesture becomes more evident. Immediate: the pointed object is touched. Multiple: a gesture is repeated. Language: Onomatopoeias and speech.

Table 2 Complexity levels (1–6) of the symbolic uses by G and M. 1. Symbolic use of her own body as signifier. Such as swinging her body to represent a horse. 2. Symbolic use with the same object of conventional everyday use. Such as “to eat” with a spoon. 2.1. Directed to herself 2.2. Directed to the adult 2.3. Directed to another character, the doll or horse 3. Symbolic use with the same object of conventional everyday use and linguistic productions 3.1. Vocalizations 3.2. Onomatopoeias 3.3. Language 4. Substitution of objects: using an object as if it were another. Such as “eat” with a toothbrush. 4.1. Directed to herself 4.2. Directed to the adult 4.3. Directed to another character, the doll or horse 5. Double substitution. Two or more objects used as if they were other objects. Use the box as a “plate” and a toothbrush as a spoon “to eat”. 5.1. Directed to herself 5.2. Directed to the adult 5.3. Directed to another character, the doll or horse 6. Pretending without the material medium of the object. Such as putting a hand on the ear to represent a receiver. 6.1. Directed to herself 6.2. Directed to the adult 6.3. Directed to another character, the doll or horse

Data were coded with the semiotic categories used in previous studies (Palacios, 2009; Palacios & Rodríguez, 2014), adapted for the purposes of this research. Coding was done in two consecutive phases. Firstly, the uses of objects by G and the communicative mediators and gestures used by M were coded (see Table 1). Secondly, the symbolic uses by the participants were coded according to complexity level (see Table 2). We conducted a microgenetic analysis to observe precisely the moment of appearance, features and frequencies of and the changes in the symbolic uses performed by the child and the adult. One session was selected randomly and coded by two independent coders. The categories “uses of objects” and “communicative mediators and gestures” each got a Cohen’s Kappa coefficient of 0.91. The category “complexity of symbolic level” got a Krippendorff’s alpha to ordinal data of 0.97 (Freelon, 2010). The coefficient values are considered as “almost perfect agreement” by Viera and Garret (2005).

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40 30 Non convenonal uses 20

Convenonal uses Symbolic uses

10 0 12

13 ½

15

16 ½

18

Fig. 2. Frequency of object uses performed by G in each session.

40 Ostensive Gestures

Frecuency

30 20

Indexical Gestures

10

Convenonal Demonstraon

0 12

13 ½

15

16 ½

18

Symbolic Demonstraon

Months CA

Fig. 3. Frequencies of the communicative mediators performed by M in each session.

3. Results 3.1. Types of uses of objects performed by G In the first session, at 12-months, G performs mostly non-conventional, undifferentiated uses of the objects (see Fig. 2); she shakes, sucks and hits them. Conventional uses are also observed, putting an object in a box for example (see Table 1), but infrequently. At 12 months G does not perform symbolic uses with the objects. As G grows up, the performance of non-conventional uses tends to decline, reaching the lowest level at 18 months. With regard to symbolic and conventional uses, there is variability among the sessions. At 13½, 15 and 16½ months the symbolic uses exceed conventional ones, in contrast to the results at 18 months. 3.2. M’s communicative mediators usage in triadic interaction M’s role is fundamental in the interactions. M uses verbal and non-verbal communicative mediators,2 with different semiotic complexity, to communicate to G the different uses of objects. M performs two types of demonstrations with the objects: Conventional and Symbolic (see Fig. 3). In the conventional demonstrations, M performs conventional uses of objects, for example, pressing the mobile’s keys or lighting the lighter. In the symbolic demonstrations, M uses an object in a symbolic way: she represents in different degrees something absent. For example, she uses the soap container to “put soap” on her hands or “eat” from an empty spoon. Both types of demonstration can also be of two types: Immediate or Distant. Immediate, is when M includes G in her demonstration, directing her hand to a particular use or demonstrating an object’s use on some part of G’s body, and distant when M presents herself as a model or demonstrates an object’s uses. Most of the demonstrations performed by M were distant, and the symbolic demonstrations were less frequent than conventional ones. M also performs ostensive and indexical gestures (see Fig. 3). The ostensive gestures made by M have two main functions: (a) showing, and (b) giving the objects to G. When M shows or gives an object to G, the child looks at M’s face or at her gesture with the object. Sometimes, when G does not answer these ostensive gestures, M turns to other “easier” strategies: she adds communicative redundancies in her gestures. For example, she exaggerates her ostensive gesture by moving the object many times in front of G or by making sounds (see Observation 1). Sometimes M touches G’s body, once or many times, performing, in this way, a multiple and immediate ostensive gesture, getting the child’s attention and establishing a common referent about which to communicate with each other. M, in all sessions, uses more ostensive gestures than indexical gestures to establish a common ground with G. This confirms the importance of this type of communicative gesture in triadic interaction with proximal objects. Some of the indexical gestures performed by M were also immediate and/or multiple. The indexical gesture most used by M was pointing, whether at an object or at G’s body. Despite the fact that different demonstrations of uses of objects and gestures were performed by M in the interactions, they were not always understood by G. In observation 1, we give an example of how G and M interact with a box and a stone in the first session (12 months-old) without reaching a common ground, an agreement about what to do with the objects and where to put them. Observation 1 0; 11 (30)3 . Duration: 28 s Non-conventional uses of the stone and the box by G

2 M’s language, although it is also a communicative mediator of object use, was not taken into account in Figs. 3 and 5 because it was used most of the time and it is not central to this research. However, we considered it important and consequently we mentioned it here. 3 Chronological age: years, months, days.

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Frecuency

40 30 20 Mother

10

Girl

0

Objects Fig. 4. Total frequencies of the use of objects in a symbolic way by M and G.

Table 3 Frequencies of the use of objects in a symbolic way by M and G in different sessions and correlation coefficient. Age

12 m

Objects

M

G

M

G

M

G

M

G

M

G

Mobile Spoon Doll Toothbrush Horse S. Bottle Box Cloth Lighter Stone Total

3 1 – 4 1 – – – – – 9

– – – – – – – – – – 0

– 11 9 7 2 3 – – – – 32

8 4 3 1 – – – – – – 16

2 – 3 2 3 – – – – – 10

8 1 2 – 2 – – – – – 13

1 1 1 3 3 1 – 1 1 – 12

8 7 4 1 – – – – – – 20

4 2 2 – 1 3 1 – – – 13

1 1 – 1 – 2 2 – – – 7

V de Cramer

a

a

13½ m

15 m

.72

.54

16½ m

.75

18 m

.51

Not calculated because G’s data are a constant. M: mother G: girl.

M gets the stone from the box, she moves it around her palm showing it to G five times, saying “look, a little stone, look”. G looks at M’s action. M puts the stone in her palm giving it to G and says “take it”. G takes the stone and looks at it. M points and touches the stone 4 times and says “put it in the box”. G looks at the stone and sucks it. M says “no, not in the mouth” and wags her finger. M says “[name]”, while she touches G’s leg many times to call her attention. G continues with the stone in her mouth. M insists, “[name], not in the mouth, ttttt, nooooooo” while she takes it away from G’s mouth. G drops the stone which falls in the box. G hits the box with one hand. M says “look, this way”, while she takes the stone and adds “look, you’ll see” while she holds the stone near her own body. M shows the stone on the palm of her hand and says “look at the stone”. G looks at the stone. Then M holds the stone slightly closer to G, giving it to her and saying “take it”. G looks at the stone and puts her hand on it. M says “take it”. G takes the stone and looks at it. M says “this way, put it in the box” while she points inside the box. M takes the box; she moves it making a sound what it is inside and puts it on the floor. G puts the stone to her mouth. M takes G’s hand with the stone saying “no, not to the mouth, [name]”. G looks at M. M looks at G and says “not to the mouth”, while she moves G’s hand with the stone away from G’s mouth and then M shakes her head (i.e. indicates ‘no’). Finally M says “not to the mouth” while she wags her index finger (i.e. indicates ‘no’). G looks at M. This long observation illustrates how M and G communicate when interacting with two objects. M makes an effort to get G to perform a conventional use of the object, that is, put the stone in the box. In this case the convention is related to the use of the box, which is an object-artifact in which things are kept, and not in relation to the stone, which as a natural object has no particular conventional use. It is clear that stones are not customarily sucked; this is why we speak of a non-conventional use. M uses ostensive and pointing gestures with an educative function. M also uses mediators with immediate communicative redundancies, when she touches the box which has been pointed at, and multiple ones when she does so repeatedly. However, in spite of the redundancies used by M when pointing at the box to get G to put the stone inside the box, G does not do it. She performs two non-conventional uses instead, sucking the stone and hitting the box. G does not seem to understand M’s pointing gestures – her communicative intention – probably because G does not share the same meanings as M in relation to the box’s use. For G, the box is not yet a “box” where things are put or kept in. In other words, it is not yet a sign of its use for her. However, she does understand M’s ostensive gestures: when M gives and/or shows the stone, she looks at the object and takes it.

3.3. Symbolic uses performed by G and symbolic demonstration by M M performed symbolic demonstrations with 9 out of the 10 objects presented (see Fig. 4). The three most used objects by M were, in the following order: doll, toothbrush and spoon. On the other hand, G only used 7 of the objects in a symbolic way (see Fig. 4), and only from 13½ – months-old. The three objects most used by G were, in order, the mobile phone, the spoon and the doll. The stone was the only object – not an artifact – which was not used by the participants in a symbolic way. Table 3 shows that at 15 and 18 months the association between subject (G and M) and object variables is average and at 13½ and 16½ months is high. This means that the objects symbolically used by the mother are different or do not relate to those used by the child. Next, in observations 2–6, we show a selection of interactions between M and G with different objects, following the development sequence from 13½ to 18 months. These observations show, on the one hand, G’s improvements when participating in M’s proposals and when performing different types of symbolic uses, and, on the other hand, M’s educative role when using different semiotic mediators to communicate with G – mostly symbolic demonstrations at different complexity levels.

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Observation 2 1; 1 (26). Duration: 18 s Spoon used by M and G in a symbolic way to “eat” G shakes the spoon many times. M says “this is for eating with” while she takes the spoon. M says “look this way, look”. M takes the spoon away from G. M “fills” the spoon with “food”. G looks at M’s action. M says “eat with the spoon” while she says “tttttt” (onomatopoeia). G looks at M’s face. M “fills” the spoon with food again, she says “mm mmm” as she gets the spoon closer to M’s mouth and “eats”. M makes eating sounds, “mmmmttt” and says “how delicious”. M “fills” the spoon again with “food” and “eats” while she says “mmm ttt” (onomatopoeias). M says “how delicious”, G looks at M’s action. M “fills” the spoon again with “food” and offers “food” to G, and G looks at M’s action. M gets the spoon closer to G, giving it to her and says “let’s see, how do you do it? Let’s see”. G takes the spoon, opens and closes her mouth and “eats” with it. At the beginning of observation 2 (13½ months), G performs a non-conventional use, shaking the spoon. Then M adopts an educative role, when she begins telling G what the spoon’s function is: “it is used to eat”. That is, she anticipates her own action with language. Then she performs distant symbolic demonstrations with the spoon, she uses it to “eat”, performing as a model. Finally, M performs immediate symbolic demonstrations; she offers “food” to G. She uses onomatopoeias together with the action, adding to her demonstrations a greater semiotic complexity. G is focused on M’s demonstrations and at the end of the observation, after M has performed symbolic demonstrations, G takes part in the symbolic scenario proposed by M, performing a symbolic use with the empty spoon, achieving complexity level 2.1, without M’s intervention. This shows that she is beginning to comprehend the meaning of the semiotic mediators used by M with this object, and she knows the conventional function of the object spoon. In observation 3 below (15 months), G shows progress from the previous session. She performs a symbolic use with the mobile phone, but now accompanied with vocalizations, achieving complexity level 3.1 (see Table 2). Furthermore, M and the father guide G to a more complex use; they “invite her to talk on the phone” with her father, which seems to be understood by G, because she vocalizes appropriately. Observation 3 1; 3 (2). Duration: 10 s Mobile phone used symbolically by G “to talk on the phone” M has the mobile in her hand. Her father says “come on, call Dad”. M puts the mobile on the floor. G takes the mobile and M says “take it, call Dad”. G puts the mobile to her ear. M says “tell him”. The father says “daaadd”, M adds “come on, say it, dad, where are you?” G holds the mobile on her ear and says “Dad”, puts the mobile away from her ear, repeats “dad” and finally throws it to the floor. In observation 4, (16½ months) we see different symbolic uses by G with the doll, which reveal a more complex level (2.3) than in observation 2 and 3 (level 2.1), because symbols are not directed to herself, but to the object, which is used as a “character”. Observation 4 1; 4 (17). Duration: 13 s Doll used symbolically by G as a character G is “eating” with the spoon [M and G have “given food” to the doll before]. M has the doll in her hand and says “now, get him off to sleep, we have finished eating, sleep him darling”, while she puts the doll under G’s arm. G looks at M’s action, takes the spoon away from her mouth but continues to hold it. G takes the doll. M tries to take the spoon away from G, but she does not release it. G takes the doll to her breast and rocks him, while M and the father say “ea-ea-ea-ea-ea-ea-ea-ea” (onomatopoeias). Then, G takes the doll away from her breast; she looks at it and releases it. M says “give him a kiss” while she takes it and puts it close to G, G blows a kiss to the doll. M keeps the doll in her hand and says “say good night to him”. G looks at the doll. M puts the doll closer to G giving him to her and says “give him a kiss”. G moves the doll close to her chin, kisses him twice and finally throws him to the floor. In observation 4, M organizes a symbolic setting for G, making reference to daily situations and including the doll, creating a complex scenario around it, and G participates in this symbolic scenario performing various symbolic uses, from level 2.3, with the doll. In observation 5, G is 18 months-old. We show a symbolic demonstration performed by M. M uses the box as if it were a plate. That is, she performs a symbol by double substitution (Level 5, see Table 2) in which she mixes “food” with the spoon and accompanies her symbols with onomatopoeias. M invites G to do the same. G puts the spoon close to her mouth; however, she does not perform a clear symbolic action. Observation 5 1; 5 (28). Duration: 17 s Empty box used by M as a plate G takes the spoon the wrong way round, gets the handle to her mouth and licks it. M says “to eat, but upside down. Look, like this”. M takes the spoon held by G, she puts it correctly in her hand and says “look, this way”, M takes G’s hand holding the spoon, and with the other takes the box and raises it. M says “come on, look, let’s imagine this is a plate, ok?” while she introduces the spoon held by G into the box and mixes it as if it were a plate with food. M says “look, tttttt” (onomatopoeias). G drops the spoon. M says: “let’s see, how do you take it? Let’s see” giving the spoon to G. G takes the spoon and puts it in the box. M says “take the plate, let’s see”. G takes the spoon which is in the box, she gets it closer to her mouth and does what might be considered “eating”. Finally, she hits the box with the spoon and throws it to the floor. In observation 6, we see that M performs an immediate symbolic demonstration involving G in the symbolic scenario. She repeatedly invites her to enter the complex symbolic setting. Even though M initiates the symbolic action, G accepts the action performed by M on her body. However, she does not accept “drying” her face when M gives her a cloth. Observation 6 1; 5 (28). Duration: 11 s M uses an empty liquid soap bottle/dispenser to “take out soap” M holds the soap bottle and says “look, I am going to wash your little face, look, look”. Then, M presses the dispenser twice “pouring soap” in one of her hands. G looks at M’s action. M puts the bottle on the floor, and she scrubs her hands many times, moving them closer to G’s face and “washing” G’s face while she says “tgtgtgtg” (onomatopoeia). G moves her head back, allowing M to “put soap” on her face. Finally, M moves her hands away from G’s face. M says “come on, now it is your turn, dry yourself” while G takes the cloth and she crawls away from M.

3.4. Complexity level of symbolic uses and symbolic demonstration of G and M At all ages, except at 12 months for G, M and G performed symbols of different types and complexity levels. Some symbolic uses performed by G were previously demonstrated by M. Most of the symbols performed by M and G were level 2 (see Fig. 5); that is, they used in a symbolic way – out of context – the same object that G knows how to use in its conventional way. Then follows level 4 when M uses an object as if it were another, a box as the doll’s “cradle”, for example. Whereas G performs more level 6 symbols in absentia – without the material medium of the object – fewer level 6 symbolic demonstrations were performed by M. For example, M puts her fist in her ear and talked, representing a mobile and G puts her hand to the ear as if using a mobile. Neither M nor G performed symbols at levels 1 (symbolic use of her own body as signifier) and 5 (double substitution of objects). Symbols performed by G were only directed to herself and to the object, but not to M. At 13½ months-old when G “combs herself” with the toothbrush, both adults correct her, and tell her at the same time “no, it is not for combing the hair”. Moreover, M says “no”, both by shaking her head and saying “no” and states the correct function, “to brush your teeth”. M then corrects G by taking the toothbrush from G and performing an immediate symbolic demonstration, and saying “to brush the teeth”.

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70

Frecuency

60 50 40 30

Mother

20

Girl

10 0 1

2

3

4

5

6

Complexity levels Fig. 5. Complexity level of symbolic productions of G and M. Table 4 Complexity level of the different kinds of symbolic uses performed by G in each session.a Complexity levels/Types of symbolic uses performed by G

Age in months 12

Level 2

Level 3

Level 4 Level 6

a

13½

2. Symbolic use with the same object of conventional everyday use. 2.1. Directed to herself 3 – “Eat” with the spoon “Brush” the teeth with a toothbrush – – Put the mobile to the ear or to the mouth – 6 Blow kisses to the mobile – 1 – 1 Try to place the doll’s cap on herself 2.3. Directed to another character, the doll or horse – – “Give food” to the doll using the spoon – 1 Try to place the cap on the doll’s head Blow kisses to the doll – – Rock the doll – – Rock the horse – – – 1 Kiss the doll 3. Symbolic use with the same object of conventional everyday use and linguistic productions 3.1. Vocalizations Put the mobile to the ear and vocalize – – 3.2. Onomatopoeias “Eat” with the spoon and make onomatopoeic sounds – – 3.3. Language Put the mobile to the ear and speak – – 4. Substitution of objects. 4.1. Directed to herself – 1 “Brush herself” with a toothbrush 6. Without the material medium of the object 6.1. Directed to herself – 1 “Eat” without a spoon “Wash” her hands after the adult has “poured soap” with the dispenser – – – 1 Put a hand to the ear (as if using a mobile) 0 16 Total

15

16½

18

Total

– – 7 – –

3 1 7 1 –

1 1 1 – –

7 2 21 2 1

– 2 – – 2 –

1 – 1 1 – 1

– – – – – –

1 3 1 1 2 2

1

–

–

1

–

1

1

2

–

1

–

1

–

–

–

1

1 – – 13

2 – – 20

1 2 – 7

5 2 1 56

The levels 1, 5 and sublevels with zero frequency were omitted.

In Table 4 we show the different types of symbolic uses performed by G in all sessions. At 13½ months, G mainly performs level 2 symbols, with two at level 6, (without any material support of the object), and one at level 4, substituting one object for another. Level 4 symbols did not occur again. At 15 months, G made a level 3 symbolic use for the first time. G makes other level 3 symbols, at 16½ and 18 months, but only 3 times. At 16½ months some symbolic uses performed before are repeated, but new varieties also appear. Most of them are with objects used symbolically before. Finally at 18 months, only one new symbolic use appears: G “washes” her hands after M has “poured soap” with the soap dispenser (level 6). All others had been used previously. In this session G was more interested in performing conventional uses of objects than symbolic ones.

4. Discussion Regarding our first question, about the different kinds of uses of objects performed by the girl, our results are consistent with findings from previous researches in children with Down syndrome and typical development. For example, as the girl grows up, non-conventional uses diminish while symbolic uses tend to increase (Beeghly & Cicchetti, 1987; Belsky & Most, 1981; Hill & McCune-Nicolich, 1981; McCune, 2010). In terms of when the first symbolic uses are performed by the child, we found that the girl performed her first symbols at 13½ months, an early CA, probably because she is interacting with the adult who performs, among other signs, different symbolic demonstrations with different objects, as in the study conducted by Cárdenas (2012). Our findings are in line with

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those of other authors’, who argue that adults have an important role in the quality of the interaction and of the child’s play (e.g. Cielinski et al., 1995; Fiese, 1990; Noll & Harding, 2003; Roach et al., 1998; Venuti et al., 2009). Regarding our third question about the characteristics of symbolic uses of objects, our findings show that symbols performed by the girl present diverse complexity levels, level 2 being the most frequent, as in typically developing children (Palacios & Rodríguez, 2014). We hypothesize that this is because this kind of symbolic use is close to the object’s everyday functional use. The fact that level 1 shows a frequency of zero means that in future research we should consider including this symbolic use, in level 6, where symbols are performed without the support of an object. We note that the girl performed just one symbol by substitution (level 4), at 13½ months. We should question whether this was in fact a symbol by substitution because, in the longitudinal study carried out by Cárdenas (2012), children performed symbols by substitution only from 15 months, and more than once in the same session. Such substitutions confirm that symbolic uses are conventional forms detached from their original context and applied to other objects with absent referents (Rodríguez et al., in press). Another characteristic of the symbolic uses is that they were self directed and directed to an object, but not directed to the adult, unlike those which occur in some children with Down syndrome at 18 months (Cárdenas, 2012). The fact that the girl directed her symbols to the doll in the second session, at 13½ months, may have occurred because of the presence of the mother promoting through language and symbolic demonstrations these types of symbolic uses. Regarding our fourth question, objects used in a symbolic way by child and adult, the mobile phone and the spoon were the most used objects by the girl, as in the study conducted by Cárdenas (2012). This is probably because they are very common objects in daily life. The adult, preferred to act with the doll and the toothbrush. The objects also have an important role in the production of first symbolic uses by the girl. Most of the symbols performed by the girl and the adult were made with the same material object (replica or artifact) used in a conventional way, by their functional permanence (Rodríguez, 2012). It is remarkable that only the stone was not used in a symbolic way by the participants, as it happened with typically developing children from 9 to 15 months (Palacios, 2009). This is perhaps because the stone is a natural object without a conventional use. Even though other uses can be applied to the stone, such a substitution requires a higher level of abstraction and was probably beyond the understanding level of the girl. With respect to level 6 symbols, performed without an object, the question arises as to whether they are symbolic uses or symbolic gestures (Andrén, 2010; Dimitrova & Moro, 2013), especially when the girl moves her mouth as if she was eating. In this case it could be food that is being represented, constituting a symbolic gesture to “eat”. It is possible that when the symbolic use of the tool spoon has been “fixed”, it can be performed in a brief way as a gesture. This is an aspect that will be considered in future research. Both the girl and mother had important roles in the interaction. The interest shown by the girl in relation to the different uses of objects gave information to her mother about her interests and knowledge about the meanings of objects. With this information, the mother organizes symbolic scenarios and conducts the girl in more complex uses (Sastre & Pastor, 1999). Finally, concerning the role that the adult has in the first symbolic uses produced by the child, our findings show that the mother acts as a guide or “teacher”, accompanying the symbolic uses made by the girl (Perinat & Sadurní, 1993, 1995). Some of the symbols performed by the girl were also previously performed by the mother with a communicative function. The interactions between the girl and her mother involving different objects not only have a communicative status, but also can be considered educative. The mother, in a natural context such as the home, provides the girl with the right tools to communicate with others (signs of different levels of complexity). Thanks to this semiotic diversity, the girl is able to understand the symbols performed by the adult, and then perform her own symbolic uses. Knowing how a mother and her daughter communicate with each other, and the different signs that they used in relation to symbolic uses of objects, could give us clues for guidance to parents and professionals working in early intervention. Our results, though limited, could have implications for adult–child interaction in family contexts, in pre-schools and in early intervention, because they make explicit the use of semiotic mediators of different complexity performed by an adult in the presence of referent objects. Signs used by the adult to communicate with the girl were near to her level of comprehension, and the adult constantly considers the girl’s interests. Our study has some methodological limitations. Our statistical analyses do not address the relationship between the mother’s and the girl’s symbolic behaviors. For future research we consider that it would be appropriate to include other kinds of analysis, such as sequential analysis. Thereby we could analyze in depth the relationship between the mother’s tutorial role and the child’s development in symbolic use of objects and the relation between symbolic uses performed by G and the use of different types of signs performed by A. 5. Conclusion In a triadic interaction context a girl with Down syndrome performed her first symbolic uses at 13½ months. Her symbols are products of a multimodal communication semiotically mediated by the adult. The symbolic meanings employed by the girl represent, in different ways and degrees, absent referents (or aspects of them). That is, we observed an evolution in symbolic uses, which were most frequently performed by using a material object. Material objects, with their cultural shared functions, are powerful tools that enable the encounter and communication with the other. When the object’s functions are

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