I am reacting pre-intentionally to the Triple C, a new assessment tool
being used with people with severe communication impairments in my
Triple C is a communication assessment designed for use
with adolescents and adults who have severe or multiple disabilities."
(Bloomberg & West, 1999, 1) . It is "divided into 6
communicative/cognitive stages -
3 preintentional stages -
intentional stages -
"pre-intentional reactive" because I assessed myself and that's where I
got most ticks.
Triple C is published by the Spastic Society of Victoria. It
recommended for use by untrained staff at day and residential centres
for people with developmental disabilities. Its purpose is
it is not associated with any intervention programs- all that staff end
up with is a list of some things their clients do. As the Triple
stops at about a three-year-old level, it does not include
It does not lead on to any other assessment, so no matter how you score
you cannot move beyond being an "intentional referential
communicator". In fact, people with severe disabilities are
to make it that far, as I will show.
have had athetoid cerebral palsy since birth and was once diagnosed
as having a profound intellectual impairment. I cannot talk, walk
feed myself. At the age of three I was admitted to St. Nicholas
Hospital, Melbourne, a government institution for people with severe
and profound mental retardation, and stayed there for fifteen
I'm the person the Triple C was designed for. It could easily
been administered to me when I was lying on the floor at the age of
sixteen with no wheelchair or communication aid.
did really well on Stage 2, the Preintentional Reactive Stage. I
scored 15 out of 15 items. With my comments in brackets, they
did really badly on Stage 6, the Intentional Referential Stage.
of 12 items I only scored 4. Here's the list, with
my comments in
to repeat new or interesting events/movements
[in my case usually unsuccessfully]
the same action on all objects e.g. mouthing,
holding, inspecting [I'm a good looker]
to show anticipation e.g. opens mouth on
to known noises e.g. microwave bell
[especially the microwave bell- I have a startle reflex]
for sound sources - particularly voices
when sees or hears caregiver(s)
respond to interactions by looking at the
person and vocalising
an awareness of strange situations or people
[I usually introduce myself, actually]
studies or inspects objects/people
follows slowly moving objects/people
glance between two objects
uses his or her eyes and hands together
e.g. looking and reaching for objects [mostly when using communication
an object in his or her hand for 10 - 15
seconds [OK, I might have been boasting a bit here]
momentarily at the place an object
(Bloomberg & West, 1999, Checklist)
persistent search for lost objects [I'm
quadriplegic - I don't lose
internal representation e.g. puts shapes
directly into form board [huh?]
cause/effect relationships e.g.
understands that electrical appliances need a switch to turn them on
past experience to solve new problems e.g.
finds a stick to hook an object and drag it within reach [huh?]
on the basis of colour [yes]
objects symbolically e.g. pretends to use a
brush as a microphone, pretends to use a tennis racquet as a guitar [I'm
thirty-something, dammit - a bit old for air guitar!]
at, points to or shows pictures of familiar
objects on request [yes]
to simple two steps (sic) instructions
[how? I'm a
absence of familiar people [yes
spell it out]
photographs or pictures (e.g. line drawings)
for choice-making/communication [no -
approximately 50 single words or signs [in
to produce two word/two sign combinations [ditto]
the purpose of this assessment, the individual's level of
functioning is indicated by the highest stage at which the majority of
skills or behaviours are observed. ... The aim of the assessment is to
determine the communicative/cognitive level which best represents the
individual's level of functioning." (Bloomberg & West, 1999,
Stage 2 was the only stage apart from Stage 1 in
scored a majority of items I'm at the Preintentional Reactive Stage.
Triple C has several fundamental problems.
cognition and function.
early development it is difficult to
separate cognitive and communication skills. ..." (Bloomberg &
West, 1999, 4)
it is based on scales designed for infants. In developing the
Triple C, the authors say they investigated five developmental
checklists, including the Uzgiris and Hunt Scales of Infant
Psychological Development (1980), and Duncan's 1983 guide to
"Communication Levels in Prelinguistic Handicapped Children".
it doesn't take account of age, functional impairments such as
blindness, deafness or quadriplegia, or the effects of medication or
depression. The authors have tried to avoid some of these
with severe or multiple disabilities often 'fail'
standardised assessments due to their degree of disability.
Standardised assessments for this group are often unsuitable because
for a child population and are not appropriate for use with
adolescents and adults"
[like Item 6 Stage 6 "Uses
symbolically e.g. pretends to use a brush as a microphone, pretends to
use a tennis racquet as a guitar"]
with the assumption that the individual is an intentional
[unlike the Triple C, which
assumes that no-one in the
target group has skills worth examination beyond the "Intentional
Referential Stage" - roughly those of a three-year-old.]
based on performance skills, requiring some degree of physical
[like Item 6 Stage 4 "Turns
a mirror or photo over to see the
correct side "]
based on verbal skills, requiring speech or some formal means of
[like Item 11, Stage 6
"Produces approximately 50 single
words or signs"] (Bloomberg & West, 1999, 2)
the items I have added in brackets show that they have failed.
Triple C reminds me of other inappropriate assessments I have
suffered in the past. When I was seventeen, for instance, a
pediatrician was asked to assess my intelligence. The doctor
to be told how I signaled "yes" and "no" - he said it might bias his
assessment. He refused to see me in my posture chair, insisting
be lain on my back. I couldn't sit up unsupported, and I couldn't
my hands. He wanted me to reach for a plastic ring, and when I
he concluded that I was functioning at a less than a six months
I was seventeen - what would reaching for a plastic ring have
That I was a good baby? On his tests I could never have shown
was intellectually normal.
Triple C doesn't ask if the subject can indicate "yes" or "no", or
whether s/he uses a communication aid. It may be obvious to the
authors that this is important, but the Checklist is designed for
"caregivers who may have received minimal formal communication
training." (ibid., 2)
importance of the Triple C is its potential to stop people like me
ever finding a means of communication. There is no suggestion
subject should be referred for AAC, not even 'Joe', one of their
examples, who "works part-time in a garden nursery and lives
semi-independently with a work-mate", "enjoys a good chat" and is rated
Stage 6 (ibid, 14). Presumably this is because "research has
that adults, particularly those who present as preintentional or
unintentional communicators are unlikely to progress through a
developmental hierarchy. The goal of intervention is instead to
increase the frequency of use of existing skills and the establishment
of emerging skills." (ibid., 37)
person with severe communication impairments believes in
miracles. I am one of the few who has experienced one. I
was given a
voice through AAC, and came out of a mental retardation institution to
graduate from university. I didn't do this by progressing through
developmental hierarchy; I did it by learning to read and spell at the
age of sixteen. Nothing else about me changed.
assessment which suggests that learning is not possible for a given
group is founded on prejudice and supports prejudice. Before any
checklist or assessment which labels non-speakers is published there
should be a process of peer review; review not by professionals but by
the peers of those who will be assessed.
This presentation will examine procedures for making professionals
accountable. It is no longer acceptable for professionals to
the standards we have to measure up to. Nothing about us without
Bloomberg, K., & West, D., 1999, The Triple C Checklist of
Communication Competencies - Assessment Manual and Checklist,
If you're interested in my
other work, check these out....
If you want to know about my years in hell, try St.
If you want to know what it did to me, read My
If you want to know what I think of euthanasia, read this.
If you want to know more about my story, read the book
Rosemary Crossley - Annie's Coming Out, Penguin Books.
It's out of print, but second-hand copies are available on Amazon
If you want to know how I got out, look up Facilitated
If you want to know why communication is so important, read The
Right to Communicate.
And read about the
people who are trying to stop it.
And there's my work on The
Terrible Triple C, another one of
the ways in which professionals bastardize people with disability.
If you want to know how I enjoy myself, watch this.
Here are a few links
I also work for DEAL and CAUS, and speak on issues of
disability. For my most recent articles on people without
speech being bastardized see No Angel
If you want to contribute something yourself, give some
money to DEAL; they're working to see
that nobody is left without a voice.
Back to the home page and start
Warning: there is quite a bit of overlap between these
articles. When you take as long as I do to spell a sentence you
use it as often as you can, and the hell with repetition.
Or you can email me at firstname.lastname@example.org