Alison MacDonald
Dept of Speech & Hearing Sciences, Queen Margaret University College, Clerwood Terrace, Edinburgh EH12 8TS, UK
Email: amacdonald@qmuc.ac.uk

Introduction by Sally Millar, CM Journal Editor

This article was first presented at the International Association of Logopaedics and Phoniatrics Congress in Edinburgh, August 1983 and was first published in Communicating Together Vol 2 No 4, December 1984, and is reprinted here with permission.

A couple of things have stimulated reprinting of this article. Firstly, it is just a really nice little study which exemplifies – very appropriately in today’s ‘evidence based practice’ climate – how simple but effective it can be for AAC practitioners ‘on the ground’ to carry out valuable research. Secondly, in researching the ‘History of Communication Matters’ for the 21 years Anniversary speech (Janet Scott, Chair of CM) at the CM2006 Symposium it was striking how much was going on in the AAC world long before 1985 – and this article is a good example! The Bliss symbol related findings here are likely to be valid for other symbol systems in use today.

Thirdly, for me, this article underlines something that is today still sometimes forgotten – the importance of users having open-ended access to more powerful systems. Makaton users may need access to the full BSL vocabulary, and symbol users may need access to a system that allows for innovative and unique combinations of symbol meanings, and grammatical strategies, as Bliss does, rather than a closed pre-printed picture set. Lastly, as the short column on page 11 informs, Bliss could be set to make a comeback, now that the symbols can be easily displayed and printed out in BoardMaker software that so many of us already own and use. Also, a new Bliss symbol library will soon be available for use with Widgit software.

Younger AAC practitioners may not realise what a powerful system Bliss is. BCI still exists (www.blissymbolics.org), as does Blissymbols UK (www.blissymbols.co.uk) and indeed sister Bliss organisations all over the world. Bliss is particularly strong in Scandinavia, Eastern & Central Europe and in developing countries where resources are limited and an AAC system that can be easily hand-drawn (though that is not Bliss’s only advantage!) is of great value. ISAAC’s website pages are summarised in Bliss: www.isaac-online.org Blissymbols UK will provide information and/or training Bliss, tailored to your particular requirements. For further information contact: Gillian Hazell gillian@gmhazell.fsnet.co.uk or Sally Millar sally.millar@ed.ac.uk

At the time of the original presentation and article, Alison MacDonald was Chief Speech Therapist with the Scottish Council for Spastics (now Capability Scotland) in Edinburgh, Scotland (my boss - and a great boss, too!). She was also a Senior Presenter for Blissymbolics Communication International (BCI). Alison currently works part-time as a lecturer (in CP and AAC) at Queen Margaret University College, Edinburgh.


Throughout the 1970s, there has been increasing awareness of the benefits of the various systems of non-vocal communication. Such systems are now being applied with more confidence and consequently more flexibility, so that the combined use of signs, symbols, words or pictures is becoming more widespread. Many clients now have relatively equal facility in two or more different modes of communication.

We at the Edinburgh-based Speech Therapy Team of the Scottish Council for Spastics (now Capability Scotland) have been running Blissymbol programs for the last nine years. Since all our non-vocal communicators are physically disabled, Bliss seems to be the most useful method of communication for the majority. Where signing has been introduced, it is usually for one of the following reasons:

• It is more immediate for the user with severe learning disability.
• The person with cerebral palsy and additional deafness requires a quick and spontaneous input medium, regardless of his or her own ability to execute signs.
• Most non-speaking people are bound by the professional’s choice of vocabulary and method of communication, regardless of their own preferences. A multi-media approach seems to be one way of offering the disabled person more freedom of choice.

In most cases, manual signing has been taught initially through the Makaton Vocabulary® stages, progressing to a wider selection of vocabulary from British Sign Language where appropriate.

In many cases the system of preference is governed by factors such as hand function, mobility or preference of peers and family. Out of our eight dual system users, only one can truly be described as using both systems with relatively equal fluency and equal preference. He has a sign vocabulary of well over 350 signs and uses a 400 vocabulary Blissymbol board. He is a 12-year old with athetoid cerebral palsy, but mobile and with fairly good manual dexterity. He has severe sensori-neural deafness with possible congenital auditory imperception and still has no understanding of the spoken word. His comprehension of language therefore is purely through signing or Blissymbols, both of which he started learning at the age of seven years. He now uses both systems spontaneously, but with disordered syntax, and will switch from one to the other to accommodate the receiver, frequently backing one system up with the other to ensure that his meaning is conveyed.

In order to analyse samples of conversation a communication profile of this boy was compiled. Conversation samples were recorded under the following headings: Repetition, Social Responses, Answering Questions (same medium/other medium), Naming, Picture Description, Requesting, Disagreement, Questioning (implied/question words), Spontaneous Comments, Joking. The findings are an analysis of 13 of these samples of communicative interaction, spread over a period of 15 months, and in circumstances where the child had equal opportunity to select either system of communication. He knew that the receiver could interpret both his communication modes and had no declared preference. His Blissymbol board was always present if required. The profiles were then analysed to see if the following three questions could be answered.

Is one type of utterance produced more in one system than the other?

The results in Table 1 show a remarkably balanced spread between the two systems. Social Responses are infrequent and entirely restricted to signing (4:0). Requests are usually signed (20:4). Question words are not used in either system, despite considerable teaching input. Spontaneous Comments and Reporting are almost twice as frequent in Bliss (55:30).

Table 1  Number of utterances of each type

One might conjecture that signing is selected for requests so that they can be signalled quickly while the receiver’s attention is held. However, the more complex information conveyed in spontaneous reporting may be easier in Blissymbols where the vocabulary is recognized rather than recalled.

The profile also highlighted the number of times that the user alternated between two mediums within one utterance. These seemed to sub-divide into confirming (repeating an item in the alternative mode) and mixed medium (where units of an utterance alternated between the two systems). Further analysis showed that there was a considerably higher incidence of moving from sign into Bliss than vice versa (16:9).

What parts of speech are used in the two systems, and are the usages parallel?

One problem here is that a sign or symbol may not always be used according to the classification under which it was taught. For example, the symbol ‘snow’ from the noun portion of the Bliss board was used in one instance to mean ‘cold’. As might be expected the largest group in both systems were nouns, followed by adjectives and then verbs (Table 2). The more permanent visual system, Blissymbols, was preferred for the more static visual concepts, nouns (146:58) and adjectives (78:39), while the dynamic system, signing, was preferred for verbs (20:6).

Table 2  Vocabulary categories

This seems to give useful pointers for teaching purposes. Some of the more pictorial Blissymbol nouns facilitate the teaching of manually signed nouns, while signed verbs facilitate the teaching of Bliss action symbols.

How many signs or symbols are being strung together?

Here again there is a clear difference. Manual signing was preferred for short spontaneous remarks and Blissymbols for longer more complex utterances (Figure 1).

Figure 1  Length of utterances

There were 81 single sign utterances and the maximum number of signs strung together was four. In Bliss, there was a much larger number of multiple symbol utterances, the longest utterance containing nine symbols. The nature of the communication mode seems to be important here. The permanently displayed vocabulary on the Blissymbol board made it easier to compose longer word strings. Another factor to be considered is that it is often possible to convey two or more words with one sign.

It is not possible to make direct comparison between aspects of the two systems and it is certainly not wise to draw conclusions from the findings of one particular case. The profiles do however serve to highlight certain points that have been useful in the teaching of a combined sign and symbol program.  §

Alison MacDonald, Speech & Language Therapist