Students with Deafblindness: Developmental Impact. PowerPoint Slides to be used in conjunction with the Facilitator s Guide

Transcription

1 Students with Deafblindness: Developmental Impact PowerPoint Slides to be used in conjunction with the Facilitator s Guide

2 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).

3 Introduction Session Agenda Session Goals and Objectives History of Education for Persons with Deafblindness Diversity Overview of Skill Areas Cognitive Skills

4 Session Agenda, continued Social Skills Motor Skills Language and Communication Skills Summary Evaluation

5 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).

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7 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.

8 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.

9 Introduction, continued These compound the effects of deafblindness and further complicate developmental delays experienced by these learners and educational planning of their instructors.

10 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?

11 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.

12 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.

13 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.

14 History, continued The rubella epidemic of 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.

15 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.

16 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 in the mid-90 s. More than 10,000 children in 2010 were identified as deafblind and requiring services.

17 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.

18 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.

19 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.

20 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.

21 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.

22 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.

23 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.

24 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.

25 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.

26 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

27 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.

28 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.

29 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

30 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.

31 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.

32 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.

33 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.

34 Will s Experience Jamal s Experience Developmental Domains Experiences # of Learning Moments Experiences # of Learning Moments Cognitive Social Skills Fine Motor Gross Motor Language Communication 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 Nipple=food Touch=startle Suck/swallow Crying to communicate fear/confusion

35 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.

36 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).

37 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.

38 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!

39 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.

40 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.

41 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.

42 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.

43 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.

44 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.

45 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.

46 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.

47 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.

48 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.

49 Cognitive Skills Cognitive skills include thinking skills like memory & concept development. Photo Courtesy Photos8.com

50 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.

51 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

52 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.

53 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.

54 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.

55 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.

56 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.

57 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.

58 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.

59 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.

60 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.

61 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.

62 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.

63 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.

64 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.

65 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.

66 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;

67 Cognitive Skills, continued Presenting information slowly; Waiting for reactions that indicate perception or understanding; Looking for anticipation in the learner that might signal understanding;

68 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.

69 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.

70 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

71 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.

72 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.

73 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.

74 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.

75 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.

76 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;

77 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.

78 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.

79 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.

80 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.

81 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.

82 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.

83 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;

84 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;

85 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.

86 Activity- Social Skills Watch the video Materials for Active Learning available at Look for age appropriate items for early elementary age (Kindergarten to 3 rd grade) and late elementary age (4 th 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.

87 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.

88 Motor Skills, continued Children who experience deafblindness often have fine and gross motor skill delays. Photo courtesy Photos8.com

89 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.

90 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.

91 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.

92 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.

93 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.

94 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.

95 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.

96 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).

97 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.

98 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.

99 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.

100 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.

101 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.

102 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.

103 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.

104 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.

105 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.

106 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;

107 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

108 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.

109 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

110 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.

111 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.

112 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.

113 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.

114 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.

115 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.

116 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.

117 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:

118 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.

119 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.

120 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.

121 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.

122 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.

123 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

124 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.).

125 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.

126 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.

127 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.

128 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.

129 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

130 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.

131 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.

132 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;

133 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;

134 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.

135 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.

136 Activity- Language and Communication Skills Watch the video Actions Speak Louder than Words, available at The video provides further instruction on creating communication opportunities for young children with deafblindness.

137 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.

138 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.

139 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:

140 Summary, Continued Students with Deafblindness: Literacy Development for Learners Students with Deafblindness: Interaction with Objects Students with Deafblindness: Educational Implications:

141 Session Evaluation A form for participants to evaluate the session is available in the Facilitator s Guide.

142 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?

143 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?

144 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.

145 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.

146 Application & Extension activities, continued 2. Developmental checklists: Select several skills from each age section from a developmental checklist such as the one at gnosisinfantmilestonesbcw.htm Detail how deafblindness could delay development of skill and plan an activity that might help develop the skill.

147 Application & Extension activities, continued 3. Watch the short video clip at 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