Transcript Document

Students with Deafblindness:
Developmental Impact
PowerPoint Slides
to be used in conjunction
with the
Facilitator’s Guide
Copyright © 2012, East Carolina University.
Recommended citation:
Shanks, P., & Henderson, K. (2012). Students with
deafblindness: Developmental impact – A PowerPoint
presentation for professional development. Modules
Addressing Special Education and Teacher Education
(MAST). Greenville, NC: East Carolina University.
This resource includes contributions from the module
developer and MAST Module Project colleagues (in
alphabetical order) Kelly Henderson (Facilitator Guide
Editor), Tanner Jones (Web Designer), Diane Kester
(Editor), Sue Byrd Steinweg (Project Director), Bradley
Baggett (Graduate Assistant), and Sandra Hopfengardner
Warren (Principal Investigator).
Session Agenda
• Introduction
• Session Goals and Objectives
• History of Education for Persons with
Deafblindness
• Diversity
• Overview of Skill Areas
• Cognitive Skills
Session Agenda, continued
•
•
•
•
•
Social Skills
Motor Skills
Language and Communication Skills
Summary
Evaluation
Terminology
• Throughout this session, we will use the
term “deafblindness” as a single word.
• In 1991, the International Association
for the Education of the Deafblind (now
known as Deafblind International)
resolved to adopt this spelling.
• It demonstrates that this is a unique
disability and not the sum total of a
vision and a hearing loss (Miles & Riggio, 1999).
You open your inbox…
Introduction
• Are you feeling panicky yet? If so, you
would be not alone.
• Deafblindness is a low incidence
population in the United States, meaning
many general education and special
education teachers have little to no prior
experience with a learner who experiences
deafblindness.
Introduction, continued
• More children are being identified as
deafblind, increasing the need for
educators who understand the
developmental impact of this disability.
• An estimated 90% of children identified
as deafblind also experience one or
more additional disabilities and/or health
challenges.
Introduction, continued
• These compound the effects of
deafblindness and further complicate
developmental delays experienced by
these learners and educational planning
of their instructors.
Introduction, continued
• Some questions you might have about this
new student:
1. Are all students who experience
deafblindness the same? They cannot hear
or see anything, right?
2. How will deafblindness impact this child’s
skills? Will it impact all skill areas?
3. What are the common characteristics of
the largest population of learners with
deafblindness?
Session Goal
• Goal: This session is desgined to
explore the developmental implications
of deafblindness and the impact these
implications hold for the educational
experience. Information about this
impact and the application of this
information to the day-to-day educational
experience for learners who experience
deafblindness will be covered.
Session Objectives
Upon completion of the module, participants
will be able to identify:
1.the wide individual difference in skill level
for learners identified as deafblind;
2.how deafblindness causes delay;
3.the impact of deafblindness on skills
across developmental domains; and
4.basic terms and skills associated with the
education of learners with deafblindness.
History of Education for Persons
with Deafblindness
• March 1887, Helen Keller and Anne
Sullivan became student and teacher.
• Helen Keller’s subsequent success in life
brought attention to both the dignity and
rights of people with deafblindness and
other disabilities.
• Until 1965, however, programs for the
education of learners with deafblindness
were few and scattered widely across the
country. Entrance was limited to learners
who appeared to have the cognitive
potential for academic achievement.
History, continued
• The rubella epidemic of 1964-65 was a
pivotal point.
• Prior to this, there were few educators of
the deafblind because there were so few
persons who experienced deafblindness.
• After the epidemic, numbers of people
with deafblindness grew dramatically as
did governmental interest in services for
persons with deafblindness.
History, continued
• Since the mid-1960’s the number of
learners with deafblindness has continued
to grow
• This partially resulted from advances in
medical technology that have led to a lower
death rate among very premature infants.
• Advances in genetic testing have allowed
easier identification of syndromes that
cause deafblindness.
History, continued
• As a result, more children with
deafblindness are being identified and
their unique learning needs are being
addressed earlier in life.
• Learners who experience deafblindness
and require services increased from 4,000
in the mid-80’s to 7000+ in the mid-90’s.
• More than 10,000 children in 2010 were
identified as deafblind and requiring
services.
Diversity
• Learners with deafblindness are not all the
same.
– They represent a very diverse population with a
wide range of needs and strengths.
– Children identified as deafblind may have some
residual, or usable, hearing and/or vision.
Complete blindness and complete deafness
are rare.
– Most experience other disabilities and/or health
concerns that complicate their ability to learn.
Activity- Diversity
• All these children have a wide array of
vision, hearing, and developmental skills,
but all are considered “deafblind.”
• “Deafblindness” is not a defining term. It
only indicates that the child experiences
some form of vision loss AND hearing
loss significant enough to impact
learning. The child may or may not
experience other disabling conditions.
Activity- Diversity, continued
• Our educational approach must be
individualized and centered upon each
learner’s unique strengths, needs and
learning style.
• In groups, consider how each of the
bulleted characteristics might impact the
cognitive, social, and motor
development in each case.
Activity- Diversity, continued
1. A three-year-old who is completely blind
and hears no speech sounds but might
hear a bus horn while on a walk:
– Seems to have average motor and
intellectual abilities,
– Is just beginning to walk on her own,
– Has not yet learned to talk with others.
Activity- Diversity, continued
2. A six-year-old with congenital rubella
syndrome who hears nothing and sees
things only in the very middle of where
he looks (his visual field):
– Has behavior problems caused by attention
deficit hyperactivity disorder.
– Has intelligence scores that are equal to that
of a 6 month old infant.
Activity- Diversity, continued
3. A sixteen-year-old girl who hears
nothing, has a visual impairment and
severe cerebral palsy; it is difficult to
move and control her arms and legs:
– Has no apparent ability to talk or
understand the words of others.
– Has no estimate on intellectual abilities due
to her lack of motor function and her
inability to answer questions.
Activity- Diversity, continued
4. A two-year-old girl who was born
prematurely, requires constant medical
care and has no hearing and is totally
blind:
– Is severely developmentally delayed across the
whole range of development.
– Has brain damage due to hemorrhages before
she was born likely causing the apparent total
lack of vision and hearing since her eyes and
ears appear to be normal.
Activity- Diversity, continued
5. A 17-year-old young man who was born
deaf and lost vision after birth:
– Has above average intelligence.
– Is educated half-day in a special school for
the deaf and half-day at his local high school.
– Takes college prep coursework with the help
of a sign language interpreter.
– Plans to attend college.
Overview of Skill Areas
• Young children who are deafblind, especially
those who have been deafblind from birth,
experience a unique set of limitations.
• This affects their internal understanding of
the world around them. Essentially their
world is a tiny microcosm of ours, existing
only as far as they can see, hear, or touch.
• There is great variation in the amount of
hearing and vision a child diagnosed as
“deafblind” experiences.
Overview of Skill Areas, continued
• The greater the loss, the more dependent
learners will be upon the people in their
world to bring their environment to them.
• For many, if it is not within reach, it does
not exist for them.
• This limited access to the world greatly
reduces their experience base and they
have far fewer interactions with people
and objects
Overview of Skill Areas, continued
Deafblindness dramatically and negatively
affects all domains of development, or
areas of development, including:
• Cognitive Skills: Thinking skills like memory and
concept development.
• Social Skills: The interactive skills of one’s
culture (e.g., smiling, eye contact, and being
polite). Social skills lead to creating and
sustaining relationships.
• Gross Motor Skills: Movements of the large
muscles of the body like trunk control, head
control, walking and running.
Overview of Skill Areas, continued
• Fine Motor Skills: Movements that use the
fingers and hands, often done in conjunction
with the eyes, and movements of the toes,
feet, lips, and tongue.
• Language Skills: Skills that enable listening,
speaking, reading, and writing with
understanding.
• Communication Skills: Interactive skills that
allow meaningful communication with others,
including things like facial expression and
gestures.
Overview of Skill Areas, continued
Consider these scenarios:
Life for a Typically Developing Child
Will is a typically developing 6-month-old and is
sitting in his family room. He sees his mother walk
across the room carrying a bottle, makes a
cooing noise, and listens to his mother ask,
“What, baby, are you hungry?” The baby begins
to salivate and smile as mother and the bottle
come closer. His mother shakes the bottle and
Overview of Skill Areas, continued
Will hears the milk sloshing. He begins to
wiggle and bounce in anticipation, causing him
to shift weight and maintain balance. He
reaches out as his mother approaches. Mother
picks him up, making eye contact and smiling
the whole time. Smiling back, Will makes eye
contact, too. He reaches out and grabs the
bottle while adjusting his head position to
quickly latch on to the nipple.
Overview of Skill Areas, continued
Life for a Child who Experiences
Deafblindness
Jamal, a 6-month-old baby with deafblindness,
is lying on a blanket in his family room. He only
sees shades of gray and black and hears
muffled sounds from somewhere. He suddenly
becomes aware of pressure under his arms. His
startle reflex takes over.
Overview of Skill Areas, continued
Jamal goes rigid and begins to cry just as he
begins to fly through the air. His visual field
becomes very dark and he feels air on his face.
The muffled sounds increase. Suddenly a
nipple is on his lips. Finally, a feeling he
understands! He begins to relax and suck on
the bottle.
Overview of Skill Areas, continued
• These scenarios may help you begin to
understand the isolating effects of
deafblindness.
• The world is unpredictable and full of
sudden changes that are stressful.
• Consider the moments of learning for
each child. A “thumbs up” indicates a
positive experience; “thumbs down”, a
negative experience.
Will’s Experience
Developmental
Domains
Cognitive
Social Skills
Fine Motor
Gross Motor
Language
Communication
Experiences
Bottle
mother
nipple=food
Eye contact
Smiling
Touch=comfort
Reach for bottle
Grab bottle
Suck/swallow
Reach for mother
Adjust head
Balance Shift
Listening to
mother’s words
Cooing
Reaching
Smiling
Mother’s tone =
comfort
Jamal’s Experience
# of Learning
Moments
Experiences
# of Learning
Moments
Nipple=food
3
1
Touch=startle
3
1
Suck/swallow
3
1
4
0
1
0
4
Crying to
communicate
fear/confusion
1
Overview of Skill Areas, continued
• Will has 18 highly varied positive
interactions ripe with teachable moments.
They happen naturally between Will & his
mother without prior thought or planning.
• Jamal has 2 negative and 2 positive
interactions in the same routine. He
learned to fear touch unless it is a nipple
to the lips and that crying is his most
effective means of communication.
Overview of Skill Areas, continued
Consider these scenarios with teens:
School for a Typically Developing Teenager
Elaina is a typically developing sophomore. She
spends the vast majority of her energy on
interactions with friends and just enough on
schoolwork to get mostly A’s and B’s. She chose
most of her classes and teachers while planning
her schedule last spring. She is driving her
parents crazy with non-stop, dusk to dawn activity.
Her older brother drops her off at school (riding
the bus would be so embarrassing).
Overview of Skill Areas, continued
Elaina sees a good friend and that immediately
grabs her attention. She calls out and runs to
catch her friend. They walk in together to her best
friend’s locker where her “group” congregates
before class.
She is taking pretty standard coursework
punctuated by a vocal music class, for which she
has talent. She heads that way, thrilled that her
day begins with something she loves. She stops
to talk with friends she notices.
Overview of Skill Areas, continued
Elaina enters the music room, STILL talking (she
is a teenage girl!), she takes a seat, smiling at
the instructor when she catches her eye. She
quiets down as the instructor taps the music
stand. Elaina has memorized the piece and
easily follows the instructor as she plays the
piano. As the music swells and fades, Elaina
adjusts her voice and ends the piece at just the
right moment. How satisfying to create something
so beautiful to start the day!
Overview of Skill Areas, continued
School for a Teenager with Deafblindness
Kayla, also a sophomore, experiences
deafblindness. She has always been known to
experience significant cognitive impairments and
a vision loss due to Retinopathy of Prematurity
(ROP). She was diagnosed with hearing loss in
third grade, and from that point has been labeled
as deafblind. She attends a self-contained
classroom with a kitchenette and laundry
facilities.
Overview of Skill Areas, continued
She is involved in one-on-one activities most of
the day, planned by her teacher and
implemented by a paraeducator. Usually,
materials float in and out of her world, so she just
sits and waits. Some things feel familiar, like her
cup. That means drink. Others just feel funny so
she drops them. She arrives at school on a
special bus. A familiar person meets her at the
bus and grabs Kayla’s hand. Kayla puts her hand
on the lady’s arm but tenses up as they begin to
walk.
Overview of Skill Areas, continued
Kayla knows what is coming. She is scared on
the steps because it feels like stepping into air!
She pulls back and begins to moan. She finally
steps down when she feels an overpowering tug
on her arm. She begins walking - over the rough
pavement, smooth tile and carpet through
crowded halls. Carpet is easier and feels safe.
During the walk, muffled sounds surround her,
and she turns her head this way and that as each
catches her attention, but it is hard to walk and
listen at the same time.
Overview of Skill Areas, continued
They are moving fast enough that she eventually
tunes out the sounds and focuses on walking.
She feels the person turn and Kayla follows into
her room. She knows it is hers because the hand
makes her touch something bumpy by the door
and because it smells like fabric softener. She
stands still and without warning her coat is pulled
off. She waits. Then suddenly, a stick is in her
hands. That means vibration time! Kayla
vocalizes and happily walks with the lady, a
wiggle in her step, to the vibration room.
Overview of Skill Areas, continued
The room feels warm. She feels lots of air moving
around her. The lady who lives in the vibration
room and smells good comes and rubs her arm
and disappears. It is calm and quiet for a little bit.
Then it happens! The magical vibrations with their
accompanying muffled noises begin. They are
rhythmic and Kayla likes the predictable rhythm.
She sways and vocalizes. She suddenly feels a
smooth stick in her hand and feels someone
shake her hand.
Overview of Skill Areas, continued
Kayla begins shaking her hand too and feels the
stick begin to vibrate. She matches the rhythm
instinctively as the vibrations continue. This is
wonderful! Suddenly, she feels the stick being
pulled away and realizes the vibrations have
stopped. Frustrated by the disappearing stick
and no more vibrations, she cries out and hits
her head until the hand makes her stop. She
begins to moan.
Overview of Skill Areas, continued
• While both girls are sophomores and
enjoy music class, these scenarios
demonstrate the extreme differences in
their school experiences.
– Elaina is surrounded by peers and adults,
interacting, hanging out, following interests,
and making significant choices about her
educational experience.
Overview of Skill Areas, continued
− Kayla has learned a bit about the world around
her and is beginning to understand the routine
of her day but the world is still unpredictable.
Her coat comes off and disappears, her
activities appear and disappear. There is no
hanging out in the hall, no social interactions
with peers or adults short of a few greetings,
and the abrupt end to an activity she was
enjoying. Much of her day is filled with waiting
and things happening to her without warning.
Overview of Skill Areas, continued
• The isolation that accompanies
deafblindness varies highly according to
each child’s ability to see and hear.
• Teach learners to use the senses they do
have to gather information in the most
efficient means possible
• Talking with and learning from teachers of
the visually impaired and/or hearing
impaired will be critical.
Activity- Overview of Skill Areas
In small groups, use the scenario for Kayla and
discuss modifications that would have helped her
to understand and anticipate her experiences in
the music room.
– What do we know about Kayla’s level of
development from the scenario?
• Break out into developmental domains and
make lists in small groups and report back.
– What are the problems for Kayla in the music
room?
• Brainstorm solutions and report back.
Cognitive Skills
• Cognitive skills include thinking skills like
memory & concept development.
Photo Courtesy Photos8.com
Cognitive Skills, continued
• In the Will/Jamal and the Elaina/Kayla
scenarios, the typically developing child
is developing cognitive skills very
naturally during day-to-day experiences
through the distance senses.
• Vision, hearing, and smell are the
distance senses, while taste and touch
are near senses.
Cognitive Skills, continued
• It is estimated that for children without
sensory impairments, 99% of all
cognitive learning occurs through the
distances senses of vision and hearing.
• Because they experience vision and
hearing loss, Jamal and Kayla miss the
distance information that Will and Elaina
process and use to make sense of the
world
Cognitive Skills, continued
• Most of the usable information that
Jamal and Kayla received was through
the near sense of touch.
• There were no warnings or cues given to
them to help build context or further
understanding about what was
happening or about to happen.
• Consider how scary and frustrating this
would be.
Cognitive Skills, continued
• Jamal and Kayla missed most of the
information and social interactions from
which their typically developing peers
learned. This happened because:
– They experienced hearing and vision loss.
– Everything happened too fast.
– No one provided them with information that
could substitute for the distance information
vision and hearing loss caused them to
miss.
Cognitive Skills, continued
• Children with deafblindness require extra
time to process information.
– Slowing the pace of routines and interactions
is a critical
– Very young children or those who experience
significant multiple impairments may require
extended time, for example 15 seconds or
more, to process information or to frame a
response.
Cognitive Skills, continued
– Children who are older or less impaired
may need only a few extra seconds.
– Determining processing time should be a
collaborative endeavor with input from all
team members including families. Once
determined, it is important that it is
universally used and respected.
Cognitive Skills, continued
• To help children with deafblindness
develop cognitive skills, we:
– need to know if they have residual vision
and/or hearing and the ranges within which
they can gather information with these
senses.
– must be thoughtful about presenting
information within that range by using touch
and/or object cues.
Cognitive Skills, continued
– Touch cues are prompts made on a
learner’s body, (like a touch on the
shoulder), that are used to convey a well
defined piece of information (like, “This is
mom. I am here.”).
– Touch cues help the learner to anticipate
routines and activities throughout the day
and begin to respond appropriately.
Cognitive Skills, continued
– An object cue uses a familiar object that is
generally part of a routine, presented
visually or by touching the child’s body. It is
a communication prompt that provides
information and builds anticipation leading
to the growth of cognitive skills
– While Jamal easily understood “nipple =
food,” he missed learning what a bottle was
and that it was his mother approaching.
Cognitive Skills, continued
– If his mother had gently placed herself near
Jamal on the floor and just as gently
touched his shoulder (touch cue), while then
waiting for a body movement, a change in
expression or change in alertness that
signaled anticipation, she might have
helped Jamal to understand “mother”.
Cognitive Skills, continued
– If Jamal could see at close distances,
thoughtfully holding the bottle there and
watching for him to focus and react allows
him to use his vision and begin to develop
the concept of “bottle.”
– Placing it on his tummy might have
encouraged him to reach for it, giving him
another option to gather information and to
further develop the concept “bottle” while
developing motor skills.
Cognitive Skills, continued
– Using the bottle in this way consistently
would make the bottle an object cue.
Familiar object cues can be transitioned
later for use as object symbols in
communication systems.
– In this example, Jamal might later learn to
choose a bottle when offered a toy and a
bottle to indicate hunger/thirst.
Cognitive Skills, continued
• Two keys to cognitive growth and
development are consistency and
anticipation.
– Will learned “bottle” and all it means only
after being fed consistently several times a
day from a bottle.
– That consistency helped him to anticipate
food at the sight of a bottle.
Cognitive Skills, continued
– Will demonstrated anticipation through body
movements, verbalizations and attention shift
(cooing, drooling and looking at/attending to
the sight/sounds of the bottle)
– This is a message to those around him that he
has begun to build a cognitive understanding
of “bottle.”
– Had Jamal’s mother consistently used touch
and/or object cues when interacting, Jamal
would learn to anticipate her interaction and
further his understanding of mother and bottle.
Cognitive Skills, continued
– Had Jamal’s mother consistently allowed
him to touch and explore the bottle before
beginning feeding, he would learn to
anticipate food and expand his
understanding of “bottle.”
– Over time he might begin to demonstrate
anticipation and a cognitive understanding
of “bottle” by cooing, drooling, and looking
at/attending to the sight/sounds/touch of the
bottle just like Will did.
Cognitive Skills, continued
• A special education teacher and teachers of
the visually impaired and hearing impaired
should be able to provide information about
what a child can perceive and how best to
provide input.
• Be thoughtful while interacting and to provide
consistent input that will be the basis for
cognitive growth.
Things to Remember:
Cognitive Skills
• Thoughtful adults and friends help
learners with deafblindness to develop
cognitive skills by:
– Presenting information within a range that
allows the learner to perceive it;
– Using touch and object cues to build
anticipation and understanding;
– Presenting information with consistency;
Cognitive Skills, continued
– Presenting information slowly;
– Waiting for reactions that indicate perception
or understanding;
– Looking for anticipation in the learner that
might signal understanding;
Cognitive Skills, continued
– Learning exactly how to interact with each
student by talking with
•
•
•
•
•
A special education teacher,
A teacher of the visually impaired,
A teacher of the hearing impaired,
Family and friends,
Other team members.
Activity - Cognitive Skills
• In small groups, you will be assigned 2 or 3
strategies for supporting development of cognitive
skills. Brainstorm, discuss and present 2
examples of how you could use the strategies in a
classroom or other setting.
• Examples can include specific instructional
techniques, as well as environmental
manipulations that make the strategy more likely
to occur.
Social Skills
Social skills are the interactive skills of one’s
culture (e.g., eye contact, smiling, being
polite) that lead to creating and sustaining
relationships.
Photo Courtesy Photos8.com
Social Skills, continued
• From our scenarios:
– Will could initiate a social interaction
because he knew that his mother was
nearby. He saw and heard her.
– Elaina could do the same because she
could see her friends and knew where they
would be.
– Will shared eye contact and smiles with his
mother. He can use these same skills
throughout his life to begin and maintain
social interactions.
Social Skills, continued
– Jamal, whose sensory deficits prevent him
from gathering distance information, did not
know his mother was present and did not
attempt to begin a social interaction.
– The bonding that occurred for Will and his
mother in this shared moment is absent for
Jamal and his mother.
– Kayla had a well-meaning paraeducator
leading her through the halls at a brisk pace
to get to class on time.
Social Skills, continued
– That came at the expense of missing the
social opportunities in the hall.
– The paraeducator was unaware that the
speed with which she moved prevented
Kayla from using her residual hearing.
• It is easy to see how the isolating
effects of deafblindness dramatically
reduce the social interactions that these
learners experience and create social
isolation.
Social Skills, continued
• Social interactions create emotional
stability for people of all ages. Without
social interactions, we do not feel safe,
confident or connected.
• Children who do not have positive social
interactions are at a higher risk for
developing emotional disorders and/or
problem behaviors like aggression or
withdrawal.
Social Skills, continued
• Deafblindness negatively impacts the
development of social skills.
• Being unaware of the presence of
others and/or not being able to clearly
see and/or hear makes the
development of social skills particularly
difficult.
Social Skills, continued
• Other reasons that learners with
deafblindness might lack social skills
include that these learners:
1. might not have the ability to communicate
or a “language” to speak;
2. may have delayed communication skills
as compared to peers making meaningful
conversation harder to maintain;
Social Skills, continued
3. might use an entirely different kind of
communication unknown to the general
population. Examples: facial expressions,
body language, gestures, sign language, a
computer aided “talker”, or a communication
system of pictures or objects;
4. might have health problems that interfere with
social development; and
5. are not always included in the life of their
community, including general education
classes and school events.
•
Social Skills, continued
• The solution lies in both teaching and
access.
– Children with deafblindness need to learn
targeted ways of beginning and maintaining
social interactions. Examples include:
• Programming “Hey, want to hear a joke?” and a
“joke of the day” into a communication device of
an elementary aged student;
• Giving Kayla, from the above examples, a card
that reads, “Can you lead me to class?” to begin
an interaction with the girls headed to the same
vocal music class.
Social Skills, continued
• Peers might also need to learn social
skills.
– The set of skills needed to interact with a
child who experiences deafblindness are
different than the ones they use to interact
with typically developing peers.
– Modeling, direct instruction and feedback
are all techniques that can be used to teach
typically developing children skills that foster
relationships.
Social Skills, continued
– Instructors who use a warm, accepting and
child-centered approach help to keep
peers coming back for more.
– As the conduit of information about a
learner with disabilities, your personality
becomes a part of the mix. If you are fun to
be with, the child with disabilities will be
seen as “fun to be with” as well.
Social Skills, continued
• The final piece is access.
– Social skills cannot be taught in a vacuum.
Inclusive opportunities are the right of all
persons who experience disabilities.
– Advocate for learners with disabilities and help
them to make the most of the social
opportunities they do have.
Social Skills, continued
– A teacher of the visually impaired, special
education teacher or speech language
pathologist can help you to learn the best
social strategies to use with a learner who
experiences deafblindness.
– It is your responsibility to advocate for
access, create opportunities and foster and
support warm interactions between all
children.
Things to Remember:
Social Skills
Thoughtful adults and friends help learners
with deafblindness to develop social skills by:
– Teaching children with deafblindness social
skills, including initiating interactions and
maintaining interactions;
– Teaching peers social skills specific to
interacting with friends who experience
deafblindness;
Things to Remember:
Social Skills, continued
– Increasing access by advocating for
inclusion in community and school life;
– Fostering and supporting interactions that
help children sustain connections with each
other;
Things to Remember:
Social Skills, continued
– Learning more by talking with:
•
•
•
•
•
•
A special education teacher,
A speech language pathologist,
A teacher of the visually impaired,
A teacher of the hearing impaired,
Family and friends,
Other team members.
Activity- Social Skills
• Watch the video “Materials for Active
Learning” available at
http://www.nationaldb.org/ISModules.php
– Look for age appropriate items for early
elementary age (Kindergarten to 3rd grade)
and late elementary age (4th to 6th grade).
– Items in this age group are harder to imagine
for students as many infant and early
childhood toys with tactile qualities are
readily available.
Motor Skills
• Gross Motor skills- movements
associated with the large muscles of the
body like trunk control, head control,
walking, running, etc.
• Fine Motor skills- movements using the
fingers and hands, often done in
conjunction with the eyes, and
movements of the toes, feet, lips, and
tongue.
Motor Skills, continued
• Children who
experience
deafblindness often
have fine and gross
motor skill delays.
Photo courtesy Photos8.com
Motor Skills, continued
• Consider the scenarios:
– Jamal was lying on the floor in his family
room because he had not yet learned to sit
while Will was easily sitting up.
– Elaina had no difficulty navigating her
environment while Kayla had difficulty with
stairs, floor texture, and self-help skills.
• Children with vision loss are slow to
learn to bring their hands together at
midline and to learn to reach and grasp.
Motor Skills, continued
• While lying on their backs, they often lay
with their arms bent and their hands at
shoulder height, a typical newborn
position, for much longer than their
peers with vision.
• When a child with deafblindness does
begin to explore with the hands, the first
independent explorations are often the
face or body of a caregiver.
Motor Skills, continued
• The lack of visual and auditory input
experienced by children with deafblindness
contributes to these delays.
– The movement of hands or objects near the
face does not result in interesting visual stimuli,
so such movements are not a reinforcing.
– Without distance senses providing input,
learners may lack curiosity and resulting
motivation to move.
Motor Skills, continued
– For example, seeing a toy or hearing a
door slam attracts attention and motivates
movements like reach and grasp and
scooting or crawling.
– Children with deafblindness miss such
cues and may need toys that provide other
sensory input, like smell or vibration.
– Placing a vibrating toy just out of easy
reach or placing it so it is touching the leg
rather than in the hand, for example, can
encourage movement.
Motor Skills, continued
– Storage of favored toys or materials in the
same place encourages exploration.
– Adapted play spaces, based on the Active
Learning philosophy and materials of Lilli
Nielsen, can easily be built that allow
favored toys to be strategically placed near
the child.
– Such play spaces can be created for use
with older students as well.
Photo by Shirley Wilson, used with permission.
This outdoor sensory panel combines a wide
variety of texture, movement and sound made
to encourage exploration by children both with
and without sensory impairments at an
elementary school in Wichita, KS.
Motor Skills, continued
• Strategies for encouraging children to
explore objects include:
– Observe the child’s play and exploration.
Look for favorite activities and objects to
give clues about motivation and next steps.
– Provide more objects and activities that are
comparable to ones the child enjoys.
– Allow for repetition. Children need to repeat
movements many times to learn.
Motor Skills, continued
− Delay communicating with a child involved
in play or manipulation of an object.
Children distracted by voices, sign
language or other forms of communication
lose interest in activities or may simply be
unable to process the sensory information
from two things at once. Pick a quiet
moment when the child pauses in play to
interact.
(From Lilli Nielsen, a pioneer in the field of active learning, reported by Shafer, 1995).
Motor Skills, continued
• Children who experience deafblindness
often develop tactile defensiveness, an
extreme reaction to or fear of touch,
textures or food.
– This can reduce the amount and quality of
interaction caregivers provide.
– Can also lead to feeding issues and a lack
of oral motor and/or muscle development.
Motor Skills, continued
• Gross motor movement skills like
crawling and walking are especially
affected in children who experience
deafblindness. Recall from scenarios:
– When motivated by the sight of the bottle,
Will began to wiggle and move. The sight of
his mother, the sound of her voice and the
sloshing of the milk made him reach up.
– Jamal did not see the bottle, did not hear his
mother or the milk, and therefore was not
motivated to move.
Motor Skills, continued
• Tummy time, or time on the stomach, is
important for all infants to develop head
and trunk control.
– Muscle control in infants proceeds from head
to toe.
– When head, neck, and shoulder muscles are
developed, back and stomach muscles can
strengthen as well.
Motor Skills, continued
– It is not unusual, however, for infants with
deafblindness to dislike this position
because it further reduces visual input.
– Infants who experience deafblindness may
need encouragement to play on their
tummies.
Motor Skills, continued
• Motor skills are delayed because
learners are often scared by movement
– Like Jamal’s experience, movement is
random and sudden.
– The addition of touch cues can help reduce
this fear and give order and meaning to a
child’s world.
Motor Skills, continued
– For example, a touch cue for being picked
up might be lifting a learner’s arm up and
holding it up for several seconds.
– When used consistently over time, this cue
would come to mean, “I am going up in the
air shortly.” Holding the arm in the air for
several seconds allows the learner time to
process the cue and allows the adult to look
for anticipation.
– This extra processing time should be
determined and used by all team members.
Motor Skills, continued
• Frequent injury can lead to a fear of
movement.
– Help reduce hazards by providing a
predictable and consistent environment.
– In the classroom, peers must be taught to
push in chairs, close cabinet doors and
keep backpacks off the floor.
– Physical support from the adult can also
lead to a more secure movement
experience.
Motor Skills, continued
– Physical support can include such things as:
1. Full body support, for example, holding a
young child at the shoulders and providing
full contact as the child begins to walk.
2. Limited support, for example, holding a child
at the waist.
• Push toys, like strollers, grocery carts, or
wagons, may help a child to move around
by providing some protection from bumping
into furniture or other obstacles.
Motor Skills, continued
• An Orientation and Mobility Specialist may
be added to the child’s team.
– These specialists help children to learn to
orient themselves in space, move safely
through home, school and other environments
and later, through a community.
– They might teach both learners and team
members how to orient within an environment,
the use of an early push toy, adapted precane or a long cane, how to read a tactile map
and other specific travel techniques.
Things to Remember:
Motor Skills
Thoughtful adults and friends help learners
with deafblindness to develop motor skills
by:
– Providing sensory input to motivate
movement;
– Positioning objects consistently in the
environment;
– Adding touch and object cues to increase
anticipation, understanding and reduce fear;
Things to Remember:
Motor Skills, continued
– Providing a supportive, consistent and a
safe environment;
– Learning more by talking with:
•
•
•
•
•
•
An orientation and mobility specialist,
An occupational therapist,
A physical therapist,
A special education teacher,
Family and friends,
Other team members
Activity- Motor Skills
• Focus on one or two play spaces featured
in “Hold Everything! Twenty ‘stay-put’ play
spaces for infants, preschoolers and
developmentally young children with
sensory impairments and other special
needs” (2004) by Kay Clarke.
• Share some of the features of each space,
emphasizing some of the characteristics of
motor skill development discussed in this
section.
Language and
Communication Skills
• Language skills help you to listen, speak,
read, and write.
• Communication
skills are interactive
skills that help you
to exchange
information with
others.
Photo courtesy Photos8.com
Language and Communication
Skills, continued
• Children who experience deafblindness
often demonstrate delays in both language
and communication skills.
– As in other areas, the isolating effects of the
disorder are a significant cause of the delays.
– The inability to clearly hear vocal speech can
delay both receptive and expressive language.
– The inability to see and hear clearly may limit
the child’s motivation and opportunity to
communicate with others.
Language and Communication
Skills, continued
• Language, both receptive and expressive,
begins with the labeling of objects,
people, and experiences.
– As a child begins to associate the label with
an object, she may begin to respond, such
as looking at a favored toy when it is named.
– The child who is deafblind has reduced
opportunities to interact with objects and
people, significantly and negatively affecting
language development.
Language and Communication
Skills, continued
– The child who is deafblind is dependent upon
people in the environment to not only create
interaction opportunities but also to label
objects, people, and experiences.
Language and Communication
Skills, continued
• From infancy, the isolation of deafblindness
affects communication by negatively
impacting the infant/caregiver relationship.
– Bonding is difficult for the parents and other
primary caregivers of infants who are deafblind
because of their limited responses.
– Caregivers provide language and
communication input to a typically developing
infants without thinking about how, when, or
why.
Language and Communication
Skills, continued
– Children who are deafblind receive
dramatically less input.
– Input must be thoughtful and planned. Think
back to Will and Jamal for an example of the
difference in input without thoughtful
planning.
Language and Communication
Skills, continued
• Primary caregivers establish a
communicative dance of reciprocity, or the
give and take of communicative behavior,
vocalizations, and words.
– Think of a mother with infant. Mother smiles
and says, “You are a pretty baby; aren’t you?”
She moves the baby, looking for a response,
repeating, “Yes you are,” several times in
response to facial expressions, movements
and vocalizations.
Language and Communication
Skills, continued
– That reciprocal dance is much harder to
implement for infants who are deafblind, as
they do not respond as quickly or in ways
that we expect. For example, the smiles of
infants with significant vision loss are
slower to develop and do not appear in
response to the smile of a caregiver.
Language and Communication
Skills, continued
• We can improve the communicative
environment of young children who are
deafblind by considering the
components of a good conversation.
• Miles (1999) recommends developing
and using the following:
Language and Communication
Skills, continued
1. Mutual Respect: Good conversations are
based upon mutual respect.
2. Emotional Comfort: A good conversation
begins with a welcoming invitation that is warm
and emotionally comforting.
3. Physical Comfort: Good conversations take
place when all conversation participants are
comfortable.
Language and Communication
Skills, continued
4. Topic of Mutual Interest: Good
conversations revolve around topics that are
interesting. Equal Participation: Good
conversations occur when all communication
partners get a chance to take a turn.
5. Comfortable Pacing: Remember that as a
general rule, we will have to slow down to
communicate with learners who are deafblind.
Language and Communication
Skills, continued
6. Comments Rather than Directives or
Questions: Good conversations include lots of
comments and few questions or directives.
7. Mutual Interactions: Good conversations
are mutually interactive and nondirective
8. Responsive patterns: Good conversation
partners respond to all forms of communication.
Language and Communication
Skills, continued
9. Choice Making and Needs: Choices and
needs can be powerful motivators of a good
conversation.
10. Opportunities to Generalize: Children
must use their skills both within the classroom
and in daily life.
Language and Communication
Skills, continued
• Consider child attributes including
preferences, interests, dislikes, and
temperament as an important part of the
communication environment.
– Knowing these can help you to encourage
communication.
Language and Communication
Skills, continued
− For example, a child who dislikes changes
in routine but loves music may not want to
communicate “more” to get music on a
rainy day during indoor recess.
− The change in routine prevents the child
from enjoying and communicating about a
generally preferable activity
Language and Communication
Skills, continued
• Communication systems may be
categorized into two distinct types:
symbolic and nonsymbolic.
– Symbolic systems are more conventional
forms that we use to communicate with
others (e.g. speaking, writing, sign language,
braille, finger spelling, etc.).
Language and Communication
Skills, continued
– Nonsymbolic systems are less
conventional (e.g., facial expressions,
movements, postures, vocalizations,
gestures, and eye contact) but used by all
as well.
– Communication systems can be used to
provide both input (receptive language)
and output (expressive language) for
children with deafblindness.
Language and Communication
Skills, continued
Examples of a few communication systems
include:
1. Nonsymbolic Systems: Use
unconventional modes to convey meaning.
2. Touch Cue Systems: Use systematic
touches to convey meaning.
3. Object Systems: Use objects to convey
meaning.
Language and Communication
Skills, continued
4. Tangible Symbol Systems: Use part of an
object to convey meaning.
5. Picture Communication Systems: Use
pictures to convey meaning.
6. Language Based Systems: Use language to
convey meaning (e.g. spoken language,
written language, braille, tactile sign,
fingerspelling, sign language, etc.)
7. Electronic Communication Systems: Use
technological devices to convey meaning.
Language and Communication
Skills, continued
• Communication systems are often
combined into “multi-modal” systems to
provide optimum input and give the
learner a choice of output.
– For example, a communication partner might
always speak when presenting a tactile or
object cue. The learner with deafblindness
might listen to speech and understand the
tactile cues but use gestures, objects, and
nonsymbolic forms to communicate.
Language and Communication
Skills, continued
• Choosing a mode of communication or
a communication system is based on
child specific characteristics.
– Consider hearing, vision, and motor/fine
motor capabilities
– A young child with some residual hearing,
for example, may hear well enough to use
some speech as a receptive mode but not
hear well enough learn spoken language
Language and Communication
Skills, continued
– Another young child may have enough
vision to see sign language, but not
enough motor ability to produce signs.
– A child may have useable vision and
hearing, but significant cognitive delays
that prevent the use of a conventional
language based system like verbal speech
or sign language.
Language and Communication
Skills, continued
• All strengths, needs, and current levels of
performance must be considered to develop
the ideal communication system for each
child.
Things to Remember:
Language and Communication
Thoughtful adults and peers of learners with
deafblindness to develop communication
skills by:
– Considering and implementing the
components of a good conversation;
– Considering hearing, vision, and motor/fine
motor capabilities;
– Considering preferences, interests, dislikes,
and temperament;
Things to Remember:
Language, continued
– Recognizing and responding to
nonsymbolic, symbolic and multimodal
systems of communication;
– Developing and using a communication
system designed to meet the specific
needs of the learner;
– Developing and using a communication
system designed to take advantage of the
strengths and current levels of
performance of the learner;
Things to Remember:
Language, continued
• Learning more by talking with
– a special education teacher,
– a teacher of the visually impaired,
– a teacher of the hearing impaired,
– an occupational therapist,
– family members,
– other team member.
Things to Remember:
Language, continued
– Learning more by talking with:
•
•
•
•
•
•
A speech and language pathologist,
A teacher of the visually impaired,
A teacher of the hearing impaired,
A special education teacher,
Family and friends,
Other team members.
Activity- Language and
Communication Skills
• Watch the video “Actions Speak Louder
than Words”, available at
http://www.nationaldb.org/ISModules.php
• The video provides further instruction on
creating communication opportunities for
young children with deafblindness.
Summary
• Deafblindness is a unique disability.
• The effects of losses in both of the
major information gathering senses are
likely to cause delays across the entire
spectrum of development.
• Deafblindness is likely to occur with
other disabling conditions further
complicating disability level and
educational interventions.
Summary, Continued
• Learners who experience deafblindness
often do have some residual hearing
and vision.
• Instructors must expect delays, be
prepared to teach skills in all areas, and
to teach these learners how to use any
available hearing and vision.
Summary, Continued
• With careful thought and consideration
learners who experience
deafblindnesscan make progress in any
educational setting.
• Further information about learners who
experience severe multiple disabilities
and/or deaf-blindness can be accessed
through the following modules:
Summary, Continued
– Students with Deafblindness: Literacy
Development for Learners
– Students with Deafblindness: Interaction
with Objects
– Students with Deafblindness: Educational
Implications:
Session Evaluation
• A form for participants to evaluate the
session is available in the Facilitator’s
Guide.
Focus and Reflection Questions
1. Ask participants to talk about any
experiences with deafblindness that they
have had. What strategies were applied
in the situation? Which were successful
and which were not?
Focus and Reflection Questions,
continued
2. What difficulties might be encountered
in forming the support team for a
student with deafblindness? How
would you handle a difficult parent?
Application & Extension activities
1. You have been awarded a $500 grant from a
local service organization to purchase
classroom supplies to meet the needs of
children with deafblindness in your classroom.
Develop 2 lists, one for preschool aged
students and one for elementary aged
students. Keep in mind the limiting effects of
deafblindness on skill development, the age
appropriateness of the materials or activities
and their ability to develop independent
exploration and play. Provide a rationale for
purchases.
Application & Extension activities,
continued
Also identify possible solutions to some or all of
the problems. Some examples include:
– Seating a person with deafblindness in a corner
on far side of food court away from cash register,
drink machines, kitchen;
– Teaching a path to that corner that avoids the light
changes; and
– Seating a student with his back to windows, etc.
Application & Extension activities,
continued
2. Developmental checklists: Select
several skills from each age section
from a developmental checklist such as
the one at
http://p2pga.org/roadmap/diagnosis/dia
gnosisinfantmilestonesbcw.htm
Detail how deafblindness could delay
development of skill and plan an activity
that might help develop the skill.
Application & Extension activities,
continued
3. Watch the short video clip at
http://www.wsdsonline.org/deafblind/likes_
dislikes/video.html Select “Christopher”.
Identify the skills the activity develops
such as:
–Motor: walking, reach, hit
–Cognitive: cause and effect
– Vision: locate target, visual motor to reach and
hit
Application & Extension activities,
continued
• Discuss motivation:
– How did therapist create motivation?
– Qualities of the object?
Self-Assessment
• A self-assessment with response
feedback is available at
http://mast.ecu.edu/modules/db_di/quiz.
Participants may take this assessment
online to evaluate their learning about
content presented in this module