Winter 2008 Table of Contents
Versión Español de este artículo (Spanish Version)

Enriching Interactions With Children Who Have Multiple Impairments Including Visual Impairment

By Sara Kitchen, Texas School for the Blind and Visually Impaired Outreach educational consultant for students with visual impairment

Abstract: This article describes structuring positive interactions around children and young people’s preferences and responses. A description of the structure of an interactive routine to foster communication is included.

Keywords: blind, visually impaired, multiple disabilities, deafblind, communication, routines.

Interaction is often difficult and scary for youngsters with multiple impairments including visual impairment. It is often unpredictable, in that others enter and leave without warning. Positive interactions help create a bond, establish trust, and foster communication. An adult who is trusted will more likely be successful in drawing out participation in a child. When interacting with a child who has visual and multiple impairments, especially when establishing a bond, it is important to pay attention to the subtleties of the child’s personality. Knowledge of this can help develop interaction that the child will enjoy and endeavor to maintain.

Tips to help foster interaction

Be quiet (initially). Listen and observe what kind of verbal interaction the child enjoys, for example:
- Silly voices
- Singing/Rhyming
- Quiet soothing babble
- Slapstick/Homer Simpson sounds
- Being imitated
Observe behavior. Observe the type of sensory experience the child engages in, for example:
- Rocking
- Jumping
- Flapping Hands
- Head banging
- Little movements
- Big movements
Create games that are fun for the child and not offensive to their sensory system. Pair auditory and motor behavior to create a simple interactive game that can be played, for example:
- A child likes singing and rocking: row the boat is a great game which involves singing and rocking. It can be played at various intensities according to the child’s needs.
- A child likes silly voices and jumping: the child holds the adult’s hands while jumping on a trampoline (or the floor if there is no trampoline). The adult says, “jump,” in a high voice when the child jumps high. The adult says ,”jump,” in a low voice when the child jumps low.
- A child likes head banging and being imitated: often children who engage in head-banging are craving more deep pressure. This can come in the form of hugs. When the child makes a noise, the adult can make that noise and squeeze the child simultaneously.

Wait for the child to signal that he/she wants more. This gives him/her a role; otherwise, it isn’t really an interaction! The child may signal for continuation in a variety of ways, for example;
- They may look at the adult when the adult has paused.
- They may move their body after the adult has paused.
- They may make a sound when the adult has paused.
Once you have established a fun, positive interaction, make it a routine. Do it often, and do it in the same way. Introduce the game in the same way:
- Signal to the child that the game will begin by touching them in a particular way.
- Introduce the interaction by saying their name the way you call them when you’re getting ready for a fun interaction.
- Bring an object if there is one in the game and let the child explore it before beginning.
Perform the steps of the game in the same order. Use the same materials (if there are objects included). End it in the same way, for example:
- Do the same number of turns and then tell them (say or sign) that you are finished.
- Say “bye bye” at the end.
- Put the object that is used away in a container.

Routines provide predictability which decreases stress. Positive interactions establish a bond. When a child feels safe, stress is decreased and learning opportunities are increased. Positive results will follow, and everyone will have fun along the way!

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Last Revision: June 9, 2008