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Self-Determination Units and Lessons

Use with How Does My Vision Affect My Access to Information? Self-Determination Lessons 9, 10, & 11

  1. List 3 personal goals you have.
    • 1.
    • 2.
    • 3.
  2. Will your vision make it difficult for you to accomplish any of these goals independently?
    • Yes
    • No
  3. What steps would you have to start taking now to achieve these goals?
    • Step 1:
    • Step 2:
    • Step 3:
  4. Who could you use as a support or resource to complete the steps you listed in #3?

Self-Determination Units and Lessons

Use with How Does My Vision Affect My Access to Information, Lesson 6

Eye with image of the world in place of the iris.

Activities and Things I Do on My Own or with TechnologyActivities and Things I Ask Others to Help Me WithActivities and Things I Cannot Do at All

Self-Determination Units and Lessons

Use with Strategies for Communicating with Others about Access Lesson 12:  Personal Preferences for Access to Visual Media

Directions:  Indicate which method of access you use most often for each of media.

  • RP-; I use regular print (no optical devices)
  • LP- I use large print
  • B/T- I use braille/tactile materials
  • OD- I use an optical device (telescope, magnifier, cell phone, tablet)
  • WH- I can do this if someone helps me
  • X- I can’t do this yet

diagrams and charts in science / social studies books            
small visual screens (cell phone, microwave key pad)            
store receipts            
food boxes and cans            
my handwritten notes            
board games            
library books            
Interactive board or classroom board            
projector screen            
computer monitor            
information on classroom walls            
sporting events & performances            
school assemblies            

Here are some resources to help you learn more about driving with low vision using bioptics.  This resource list was developed for a collaborative workshop from Short-term and Outreach Programs for parent and students with low vision called, In the Driver's Seat, which is offered annually at Texas School for the Blind & Visually Impaired.


Peli, E. & Peli, D. (2002). Driving with Confidence: A Practical Guide to Driving with Low Vision.  Singapore: World Scientific Publishing Co.

Region 4 Education Service Center. (2013). 2nd ed. Program in Low Vision Therapy. Houston, TX: Region 4 Education Solutions (Chapter 10, Driving)

Corn, A.L. & Rosenblum, P. (2000). Finding Wheels: A Curriculum for Nondrivers With Visual Impairments for Gaining Control of Transportation Needs. Austin, TX: Pro-Ed Publishers. (Unit 7, Bioptic Wheels: Low Vision Driving)


Bioptic Driving Network (BD) with the American Optometric Association

Bioptic Driving USA (Drs. Richard and Laura Windsor)

The Low Vision Gateway


Steps to Becoming a Bioptic Driver presented by Chuck Huss, April 4, 2011.


Strowmatt Driver Rehabilitation Services (Texas Education Agency licensed driving school member)              

The Association for Driver Rehabilitation Specialists (ADED)

NOAH (National Organization for Albinism and Hypopigmentation


Huss, Chuck, 2014. Step-by-Step Guide to Reinforcing Pre-Driver Readiness Skills with Novice Bioptic Driving Candidates. Handout from TSBVI Outreach Programs workshop, In the Driver's Seat.  Download this document in regular print (Word or PDF) or in large print (Word or PDF).

Busy medium business setting or small metropolitan areas

The first time you complete this exercise use your monocular.  If you have a bioptic, try this exercise a second time to compare the difference.

Exercise2Unlike most residential areas, where there are few traffic lights and generally light vehicle and pedestrian traffic, medium business settings and small metropolitan areas make greater demands on all drivers.  After you feel confident in distance scanning in residential areas, take a drive in a busier setting where there may be multiple lanes of traffic, a variety of traffic lights, one-way streets, and many cars and pedestrians moving into traffic.  Once again as you ride along, let the driver know what you spot and when using the distance scanning technique. As you are traveling, look ahead as far as possible and comment on these things:

  • Stops signs, traffic signs, traffic lights and other warning lights
  • Pedestrians approaching the street to cross
  • Vehicles approaching from the opposite direction
  • Vehicles traveling beside and in front of you on a multi-lane road
  • Vehicles turning into the street from other streets or driveways
  • Things that must be maneuvered around like delivery trucks and vans parked on the street
  • Hazards, animals or objects in the street

Considering your observations, answer these questions:

  • How was this experience different from driving in a quiet residential area for you?
  • What things that were difficult for you to spot?
  • What did you find confusing or surprising about the roadways, pedestrian traffic, or vehicle traffic?
  • Did you see any potential collision “traps”?  If so, what would have been your “out”?
  • What things did you specifically need to use your monocular or bioptic to see?
  • Did the weather, light or other uncontrollable conditions impact your performance?
  • What skills do you most need to work on related to driving with low vision?

Developed by TSBVI Outreach Programs based on materials provided by Chuck Huss, COMS, Driver Rehabilitation Specialist with the West Virginia Bioptic Driving Program

Return to:

Bioptic Driving: Passenger-in-car Skills

Exercise 1

Exercise 3

by Jim Durkel

What is a portfolio?

A portfolio is a collection of work. It is easiest to imagine the portfolio for an artist or a writer; these portfolios would contain photographs of the artist's works or samples of the writer's writing. It may be a little harder to imagine how a portfolio for an intervener would look.

Before discussing how a portfolio for an intervener would look, lets look at why an intervener might want to create a portfolio.

Why create a portfolio?

A portfolio is evidence of your skills and talents as well as a record of training you have done. The portfolio can be used as a "scrapbook" to help you remember and reflect your successes, it offers you an opportunity to think about ways to improve your skills, and it can be used as proof of your abilities and accomplishments during annual performance reviews or when interviewing for a new position. Many colleges are using portfolios to document life accomplishments and are offering their students course credit for these accomplishments.

In your role as an intervener, you are working as a paraprofessional in the public schools. With the enactment of the Federal "No Child Left Behind" legislation concerning quality public education there are new guidelines concerning the qualifications of paraprofessionals. A portfolio is one way to document that you have these qualifications.

What can be in a portfolio?

Portfolios can be as simple or as elaborate as you wish. It is important that materials be organized in some way so that proof of an accomplishment is easy to find and is clearly labeled. A portfolio is not merely a collection of materials that have been stored willy nilly in a cardboard box. Nor does a portfolio need to contain an example of everything you have ever done. A portfolio is an organized collection of samples of your accomplishments designed to show case your skills.

These samples can take many forms. For example, a portfolio may contain a copy of a post-secondary degree or copies of certificate of attendance from workshops or conferences. The portfolio might contain video tape segments of you engaged in an activity with a student. It might contain a copy of materials you adapted for your students. Just keep in mind that the portfolio is a record of your work, not of the student's work. (Though you can create a separate student portfolio to document your student's accomplishments and progress.)

Here is a partial list of what might be in the portfolio. This list is not necessarily complete!

  • A summary of your credentials/qualifications/etc. which might include:
    • Your resume (you might want to include job descriptions from relevant experiences)
    • Results from any written exams you have taken relevant to being a paraprofessional in the public schools
    • Copies of post-secondary degrees
    • Copies of school transcripts (possibly including high school), especially showing relevant classes, like sign language or child development (you may want to include course syllabi to highlight the content of the classes)
    • Certificates of attendance for workshops and/or conferences (you may want to include the agendas for these trainings to highlight the content of the training)
    • Professional certificates, like those for sign language interpreters, Braille transcribers, or day care providers
    • Descriptions of relevant personal experiences, such as having a child of your own with disabilities
    • Copies of previous work performance evaluations
    • Letters of recommendations from employers (especially supervisors or professionals who directed your work)
    • Copies of any relevant honors or awards
  • Written samples of your work, which might include:
    • Data collection sheets that highlight how you collected and organized data
    • Samples from a school-home communication book (make sure you have permission from the child's parents and other relevant school personnel, if necessary)
    • Communication other team members
    • Articles you might have written for a newsletter
    • Handouts you might have developed for an in service training or workshop
  • Examples (either the material itself or photographs) of materials you have created or material adaptations you have made
    • Samples of materials in Braille
    • Samples of communication boards
    • Samples of adapted games
    • Samples of experience books
    • Samples of calendar systems
    • Adapted recipes
    • Bulletin boards you created
    • Adapted worksheets
  • Samples of the student's work that reflects your role as an intervener:
    • A hard copy of TTY conversations with the student that highlight your support of the student's performance
    • An experience story written by the student that includes references to you and your role during the experience
    • A video tape or photographs of you supporting student success in some activity, for example:
      • An independent living activity, such as grocery shopping or cooking
      • The student ordering an item at a fast food restaurant
      • The student interacting with peers
      • The student engaged in a recreation/leisure activity
      • The student engaged in an academic (reading, math, science, etc.) activity
      • The student in PE
      • The student using some piece of adapted equipment, including low vision aids, mobility devices, note takers, assistve listening devices, communication devices, etc.
      • The student engaged in a recreation/leisure activity
  • Samples that demonstrate your competency in some procedure or instructional technique, for example:
    • Video tape of you interpreting for the student
    • Video tape of a conversation with the student that highlights your skills at facilitating the interaction
    • Video tape of you checking hearing aids or assistive listening devices
    • Video tape of you acting as a sighted guide for your student
    • Video tape of you providing various levels of prompts and reinforcements
    • Video tape of any medical procedures you have been trained and authorized to conduct (such as tube feeding) (you might want to include written evidence of the training)
    • Video tape of you implementing positioning and handling techniques you have been trained and authorized to do (you may want to include written evidence of the training)
    • Video tape of any sensory integration activities (such as brushing) that you have been trained and authorized to do (you may want to include written evidence of the training)
  • Evidence of your thinking about your role as an intervener, for example:
    • Excerpts from a journal where you reflect on the student's progress and what you might do keep doing or change
    • Excerpts from team meetings (with permission from other team members) that highlight your suggestions/thoughts
    • Reflections from some article you read/workshop you attended/video tape you viewed that gave your some ideas about something to try with your student
    • A professional development plan for yourself

Some hints for organizing the portfolio

  • Consider making an index for the portfolio. The index might follow the recommended competencies for an intervener.
  • Consider using a 3 ring binder for as much of the material as possible. Where video tape is used, make sure the video tape is clearly marked with a reference to the competency or skill demonstrated on the tape.
  • If you are including materials that don't fit in a 3 ring binder, consider storing all the materials together in a storage box
  • The portfolio is not static. You can add new material and take out old material that is no longer representative of your work.

(Originally published in Spring 2006 SEE/HEAR Newsletter. Web Resources have been updated 4/2017)

By Holly L. Cooper, Ph.D., Outreach Assistive Technology Consultant, TSBVI

Abstract: This article describes and illustrates a variety of tactile writing systems used with individuals with blindness. Tactile codes included are New York Point, Boston Line Type, American Modified Braille, Moon type, Fishburne and standard Braille. Alternative media including Tack-tiles and tactile symbols are also discussed.

Key words: Programming, Braille, tactile symbols, tactile writing, reading.

This year, 2006, is the Sesquicentennial anniversary of the founding of Texas School for the Blind and Visually Impaired. In 1856, when TSBVI was founded, not only was Texas on the frontier of the American west, but education for people with blindness and visual impairments was also at the frontier of education. At the time there was no standard tactile reading code for people with blindness. In recognition of the advances and changes in blindness education in the last 150 years, we present an overview of tactile reading and writing codes for people with blindness.


Braille, the reading and writing code currently used in the U.S. and other English speaking countries by readers with blindness and visual impairments, was invented by Louis Braille. Braille was a Frenchman who lost his sight from an eye infection caused by an accident with his father’s leather working tools in childhood. Louis Braille developed his ideas for a tactile code system adapted from French soldiers who wanted to be able to read notes in the dark. Louis Braille modified this 12-dot system into 6 dots and had written in Braille and taught others by 1832. Braille was introduced in the U.S. about 1860 and was taught at the St. Louis School for the Blind and other schools.

The Braille Alphabet A through J

There have been many other tactile reading media for people with blindness in the past 200 years. Originally, most reading instruction was done with books made with raised or embossed letters created by wetting paper and printing with an ink printing letterpress. People also learned letters and reading by using carved wooden letters arranged into words, and letters made with bent and twisted wire. It was long thought by educators of blind people that having a tactile code different from letters that sighted people read would separate blind people from the mainstream of society and limit the amount of reading material to which they had access. Special reading codes would also mean teacher training was more demanding, and finding teachers able to work with students with blindness more difficult. Around the same time Louis Braille was developing his code, other codes were also being developed. Many blind students secretly learned Braille and other dot-based tactile writing codes when their schools officially taught embossed letters. Ultimately the dot-based letters of Braille became the most widely accepted tactile reading code in English speaking countries, and most of the world.

Boston Line Type

Boston line type was developed by Samuel Gridley Howe, the founder of the New England School for the Blind (later Perkins School for the Blind) in Massachusetts. Since at the time there was no reading medium for people with blindness, Howe developed an embossed simplified angular roman alphabet without capitals which he called Boston line type. He published the first book in Boston line type in 1834, and this type continued to be the primary tactile reading code used in the United States for the next 50 years. The American Printing House for the Blind first published books in Boston line type, and it was the official code used by students at Perkins until 1908.

A finger gliding across embossed type, probably Boston Line Type

New York Point

William Bell Wait, working in New York in the middle 1800’s, developed a point code for readers who were blind that used characters which were two dots high and one, two, three and four dots wide. Working at New York Institute for the Blind, Wait began teaching this system to students and invented a point writing machine called the Kleidograph which allowed for easy production of text without the use of slate and stylus. New York Point was widely used by schools for the blind in the United States in the late 1800’s. Mary Ingalls, the sister of Laura Ingalls Wilder author of the Little House books, learned New York Point and embossed letters at Iowa Braille and Sight Saving School in the late 1870’s and 80’s.

new york point alphabet

American Modified Braille

Joel Smith, a piano-tuning teacher at Perkins School for the Blind in Massachusetts, developed the American Modified Braille Code in the 1870’s. When developing his system, Smith designed characters he believed would be fast to read and an efficient use of paper. This code was used in 19 schools for the blind in the United States, including Perkins. American Modified Braille assigned the fewest dots to the characters that occur most often in the English language. If you look at American Modified Braille, you will see the familiar three dot high and two dot wide characters, but dot configurations correspond to different print letters and letter combinations than standard Braille today.

American Modified Braille alphabet letters A through J


Before the development of Braille writing machines, people writing Braille used a slate and stylus. The slate held the Braille paper and provided a template for the dot locations, and the stylus was used to punch holes into the paper. Since the dots are raised, the person had to learn to write in reverse from the back of the paper. Frank Hall, superintendent of the Illinois School for the Blind, developed a personal Braille writing machine in the late 1880’s. In the next decades, other inventors developed writers for Braille and New York Point. Since most machines were not mass produced, their reliability and consistency of writing varied widely. In the 1930’s, the American Foundation for the Blind commissioned a Braille writer from a typewriter manufacturer. It was heavy and not durable enough for practical use. Later, David Abraham of the industrial arts department of the Perkins School For the Blind worked to develop a Braille writer at the urging of Gabriel Farrell, director of Perkins. He had a model working by the early 1940’s but the war years limited manufacturing. After World War II, Abraham’s Braille writer went into production and was on the market in 1951 as the Perkins Brailler.

Since the Perkins Brailler is available to students who read Braille in the United States at no cost through a quota funds system with American Printing House for the Blind, it is the most widely used method of writing Braille in the U.S. However, many other Braille writers are available, particularly in Europe. Now the Tatrapoint is available in the U.S. from Maxiaids. It is lightweight and easily portable with some components made of high-impact plastic. The adaptive model allows adjustment to accommodate different hand and finger sizes. Quantum Technology in Australia recently released a small manual brailler called the Jot-A-Dot. It uses letter weight paper of a small size and is intended for taking short notes. The same company also makes the Mountbatten Brailler, an electronic Braille writing device which talks. Some models interface with computers and ink printers. The Mountbatten provides good support for people helping students who read Braille, but who don’t read Braille themselves.

Braille Writing Devices

slate stylusperkins braillewriterjot a dotmountbatten brailler

Braille Writing Devices Pictured from Left to Right: Slate and Stylus, Perkins Braillewriter, Jot-a-dot, Mountbatten Brailler


William Moon of Great Britain lost much of his sight in childhood from scarlet fever. After finishing school in the mid 1800’s Dr. William Moon experimented with a variety of raised alphabets for teaching reading and writing to blind students. He eventually settled on Moon type, a raised line code based on print letters. Still used in Britain for people with learning or fine motor difficulties, and those who have lost their sight later in life, Moon type is believed by its supporters to be easier to learn and more tactually simple to discriminate than Braille. Although almost unknown in the U.S., books in Moon are available from the Royal National Institute for the Blind and are available in Canada and Australia as well as Great Britain.

Moon can be generated with computer software today. Duxbury, readily available in the U.S. has an English Moon translator available in their “translation tables” menu. Files can be embossed in a “dotty Moon” style with an Enabling Technologies embosser with a Moon setting. Some Moon fonts can be found on the Internet for use with a computer.

Moon books are still produced through a modified typesetting process. Reading materials are now also generated with Moon Writers, thermoform machines, computer Moon fonts printed on swell paper, and Moon translation software and embossers. Moon can also be handwritten with a stylus on plastic sheets with a frame guide in a manner similar to using a slate and stylus to produce Braille. A Moon teaching curriculum is available from Royal National Institute for the Blind in Great Britain.

Moon letters A through J

Moon Type embossed on paper


The Fishburne system of tactile writing was developed in 1972 by S. B. Fishburne. Mr. Fishburne became acquainted with some blind adults and found that many of them were not able to read Braille. He developed a tactile alphabet, which is larger than Braille, to be used primarily for labeling items used by people in daily activities. Fishburne is typically used for labeling objects, containers and appliance controls, not for literary purposes.

The complete Fishburne alphabet

A Fishburne labeler and magnetic labels


Since standard Braille is always the same size, each character 1/8 inch wide by 1/4 inch high, it can be difficult for people with motor impairments or problems with tactile sensitivity to read. Even Jumbo Braille is very small. To address the issue of literacy for individuals with significant disabilities, Kevin Murphy developed Tack-tiles. Tack-tiles are small Lego-sized blocks with Braille dots on each. They are used primarily in educational settings to teach Braille to very young children and those with additional disabilities. Tack-tiles can be used to create a computer keyboard labeled with Braille using the Intellikeys keyboard. Tack-tiles are available with all Braille symbols, including punctuation marks and contractions. Specials sets are available for math and Braille music. For many students with visual impairments and additional disabilities, Tack-tiles and a computer are the best or only means to literacy.

Tack-tiles displaying, "Braille is fun!" in uncontracted Braille.

Tactile Symbols

While not traditionally considered a literacy medium, the use of tactile or tangible symbols has become widely used with students with deafblindness or visual impairments with additional disabilities. Educators seeking to expand the opportunities for such students to communicate and participate in supported literacy experiences in the classroom are using tactile symbols in a variety of learning activities. These symbols are used in communication boards, labels in the classroom, and children’s literature books and language experience stories. While there is no standard vocabulary of tactile symbols as there is the widely used Meyer-Johnson picture symbol system, some recommended standards do exist. The Texas School for the Blind and Visually Impaired maintains an illustrated dictionary of picture symbols on our website. American Printing House for the Blind now has a kit called Tactile Connections with instructions for making and using tactile symbols.

A teacher-made page from a book using a combination of tactile symbols and Braille states, "'A' does the can crushing job. She collects the cans and crushes them in the can."

Access to Literacy

Early in the twentieth century the widespread use of many different tactile reading codes and systems made learning to read a challenge for learners with blindness. Disagreement about which code was easiest to read and the most efficient use of paper led to the “War of the Dots” between educators in English speaking countries. A uniform English Braille system was agreed upon in 1932 which included the alphabet and grade 2 contractions. Since that time discussion about other tactile modes of literacy has been limited. In the last five years, concern about access to literacy for individuals with visual impairments and additional disabilities has given rise to discussions about the use of uncontracted Braille, Tack-tiles and other large format Braille, Moon type or other embossed letters, and tactile symbols. While the adoption of standard Braille has given tactile readers access to a large amount of material and more consistent quality of educational experiences, consideration of access to literacy for all learners should prompt educators and parents to broaden their definitions of tactile reading and consider the use of alternative tactile media.

Note: Embossed materials including Boston line type, Moon, New York Point, Fishburne and Tack-tiles photographed courtesy of Texas School for the Blind and Visually Impaired Learning Resources Center teaching materials and archives.

Web Resources

  1. Joel Smith and American Modified Braille
  2. American Printing House for the Blind (APH)
  3. David Abraham, Developer of the Perkins Braillewriter
  4. Moon and Duxbury
  5. The Getting in Touch with Literacy Conference
  6. Paths to Literacy
  7. History of Tactile Reading Codes
  8. Mary Ingalls and the Iowa Braille and Sight Saving School
  9. MaxiAIDS: Products for Independent Living
  10. All About Moon
  11. Deirdre Walsh's article Story Boxes and Story Boards for Students with Multiple Disabilities
  12. Quantum: Maker of the Mountbatten Brailler and the Jot-a-Dot
  13. Samuel Gridley Howe and Boston Line Type
  14. Tack-Tiles Braille Systems
  15. TSBVI's Tactile Symbol Directory (with DIY directions and photos)
  16. Visual Impairment Centre for Teaching And Research (VICTAR)
  17. Robert Irwin's article As I Saw It (War of the Dots)
  18. William Bell Wait and the New York Point System of Reading for the Blind

Terese Pawletko, Ph.D. & Lorraine Rocissano, Ph.D.
Psychology Department
Maryland School for the Blind

AER/DENVER, July 18, 2000

Explanations for "Autistic-like" Behaviors in Blind Children

Their behaviors (e.g., stereotypes, rituals; restrictions in play) seen as:

  • indicative of emotional disturbance
  • associated with sensory deprivation (e.g., turn inward for stimulation)
  • related to mother-child attachment (e.g., in incubators longer; lack of eye contact so hard to read cues; maternal depression further limiting her involvement with child)

Non-Autistic and Autistic Rubella - 
Distinctions noted by Chess et al.

Non-autistic rubella children with sensory defects:

  1. Are very alert to their surroundings through their other senses
  2. Exhibit appropriate responsiveness - "Some are shy, some slow to warm up, some perhaps wary; but one is impressed by their readiness to respond to appropriately selected and carefully timed overtures."

Rubella children with autism and sensory defects

  1. Do not explore with alternative senses
  2. Maintain distance from people that is not explained by the sensory deficits nor by degree of retardation
  3. Their affective behaviors do not resemble those of the same mental age.

Caveats in Diagnosing

  1. Autism is a developmental disability, not parent induced, not induced by blindness
  2. It is a syndrome; no one symptom yields a diagnosis.
  3. Autism is a spectrum disorder, with a wide range of functional levels, and behavioral presentations.
  4. While symptoms show improvement over time, the individual remains autistic. Autism is a lifelong disorder and for most individuals some level of support may be required.

Note: the following sections were depicted as "icebergs." They detail the key diagnostic features of autism using an iceberg approach - the behaviors one might observe on the surface, and the processing difficulties that might account for them.

Problems with Socialization


  • Fails to or has difficulty engaging in reciprocal interactions
  • Treats others as though they were objects
  • Seems uninterested in peers

What you do not see: 

  • Problems shifting attention
  • Unable to process social information effectively
  • Difficulty processing complex stimuli due to difficulties telling figure from ground, and problems making very rapid shifts of attention
  • Cannot process multiple sensory stimuli simultaneously

Implications for Parents and Educators

  1. Recognize that the social world is more complex and less predictable for an individual with autism, and therefore more stress producing.
  2. Do not assume that simple exposure to peers will result in the acquisition of social skills.
  3. A child cannot be pushed to acquire social skills. Begin with something short, structured, teacher directed, and success oriented.

Problems in Language


  • Seems very verbal but can't follow instructions
  • Poor receptive language
  • Echolalia (Echolalia is a positive sign in that it shows that the child is at least discriminating among phonemes, sequencing sounds, using working memory)
  • Pronoun reversal
  • Non-verbal

What you do not see: 

  • May use words expressively which they don't really understand (receptive language lower than expressive)
  • Difficulties discriminating language sounds - poor central auditory processing
  • Difficulties with sequencing phonemes and words
  • Can't break the linguistic code


  1. Check out whether child understands what he/she is saying (e.g., "what does that mean?")
  2. Use controlled language (e.g., short, concrete phrases with time between statements to allow for processing)
  3. If student has vision, try to provide some information visually; if not, provide information tactually.

Problems in Communication


  • Perseverates on one topic
  • Shows no interest in other people's topics
  • Too close or too far when talking
  • Says something unrelated to the conversation
  • May become angry when he hears certain words

What you do not see: 

  • Can't apply rules in context
  • Problems with impulse control
  • Inability to take the perspective of another, as well as problems shifting attention


  1. Direct instruction in the actual setting is key.
  2. Identify clear, concrete rules that the child needs to follow in specific situations.
  3. Social stories can be helpful in providing a child with a script to follow.

Perseverative or Narrowly Focused Interests


  • Need for sameness, predictability
  • Motor stereotypies
  • Focuses on parts of objects in play (e.g., wheels, spins everything, flips handle of basket repeatedly)
  • Age appropriate pretend play not observed
  • Restricted and perseverative interest (e.g., elevators, Xerox machines, CD titles)

What you do not see: 

  • Difficulty getting meaning from environment due to all cognitive processing deficits
  • Repetitive events are easier to understand and make sense of than multifaceted input
  • Repetitive behavior may be experienced as soothing


  1. Recognize that the routines and self-stimulatory behavior are the things that the child understands best and may serve as a "life-preserver" for the child. It is the child's retreat to his comfort zone.
  2. The child's reliance on such behaviors will tend to increase in times of stress and anxiety (e.g., transition, lack of clear expectation, challenges). Ask yourself "why is the child engaging in this now?"
  3. Identify a time when the child can engage in his self- stimulatory behavior; tighten up the structure, schedule, routine to decrease anxiety and increase non-verbal information.

Hypo- and Hyper-Sensory Systems


  • Over-reacts to certain noises (e.g., fire-alarms, vacuum cleaner, fan motor)
  • Finds certain tactile experiences aversive (e.g., certain foods, texture of clothing, soft furry objects, being touched)
  • Often finds warm temperatures aversive
  • May not react to bumping head, falling down, etc.
  • Stops listening to instructions when asked to open book

What you do not see: 

  • Has poor regulation of auditory system (e.g., at times may find raindrops sounding like gunshots, other times not a problem; visceral panic regulation to sudden loud sounds like fire alarm - heart and respiration rate do not return to normal for several hours)
  • Can only process one sensory input at a time
  • Brains process temperature, texture, multi-sensory things differently


  1. Be alert to how the sensory environment may be impacting on your student.
  2. Try to keep the environment as low key as possible (e.g., visually clear, sound absorbing materials, no extraneous noise or conversation; balance lighting needs for children's visual impairment with those of arousal).
  3. Be aware of possible multi-sensory input issues and adjust instruction accordingly.


By Kate Moss (Hurst), Education Specialist, Texas Deafblind Outreach

Originally published in the See/Hear Newsletter, Spring 2004 Edition by TSBVI Outreach Programs

Abstract: This article shares information from Dr. Lilli Nielsen’s book, Are You Blind? It focuses on five phases of educational approaches that teachers are to use in working with children if they are using an Active Learning theory approach.

Dr. Lilli Nielsen is the author of many books that look at the way children with visual impairments learn, especially those with other disabilities. Over a period of more than twenty years, she has developed her approach to working with these children that is called Active Learning. This approach is based on the notion that all children learn exclusively by doing until the developmental age of about three. The actions of examining and experimenting with objects using their bodies, is the foundation for the development in cognitive, motor, problem-solving and social skills. She believes that our role in helping children to learn is to create environments that build on skills the child already has, to encourage him to use his body and mind for higher-level tasks. In her book, Are You Blind? She discusses five phases of educational treatment that teachers are to use in working with children. This article will examine these five phases and share some of the highlights of this book.

It is important to note that before beginning to work with any child, a thorough assessment of his/her skills and emotional development is needed, so that you know where to begin. If you start too high you will likely frustrate the child and if you start too low, you run the risk of losing the child’s interest and motivation. Dr. Nielsen has developed a comprehensive assessment tool, the “Functional Scheme” (Nielsen, 2000), and a curriculum to help teachers called the FIELA Curriculum – 730 Environments (Nielsen, 1999).

Phase I: Technique of Offering

Children at this Level

Children at this level of development may seem reluctant to do much. They are often passive or engaged in self-stimulatory behaviors. Their world exists for the most part within the confines of their own bodies. They seldom seek out others for social interactions and may have limited experiences interacting with objects and their environment. This generally occurs because of motor disabilities or health issues that make movement difficult, and/or sensory disabilities that prevent the child from being enticed by the sights and sounds that motivate a typically developing child.

The Role of the Adult

At this stage, Lilli recommends using the technique of offering with the child. First of all the adult will need to set up an environment, such as a Resonance Board with many motivating objects, so that the child can come in contact with them incidentally if he or she makes any movement. The adult will also be with the child, either sitting alongside the child or supporting the child in a sitting position from behind if the child trusts the adult enough for this close contact. If not, the adult needs to respect the child's need for distance and only move in as close as the child seems comfortable with at any time. One of her goals at this level is just to have the child stay in the same room with her.

The adult’s first job is to simply offer the child toys and objects by placing the objects under the child’s hand. The child may touch or grasp the objects when and how he or she pleases. The adult does not talk to the child while the child explores the object in his or her own way. If the child drops or pitches the object, the adult simply offers another object. While offering the objects, the adult also must observe and take note of the objects the child seems to enjoy and those he seems to dislike. What is it about the object that seems to interest the child? What are the actions the child takes on the object? How does the child explore the object and with what physical actions (banging, mouthing, throwing, rolling, etc.)? What distresses the child and how does he show that distress? Does the child show interest in contacting the adult? How does he do that?

Purpose of the Offering Technique:

  • To convince the child that he can trust the adult has no intention of demanding that he does anything at all. Lilli’s only demand is that she wants to play in the same room as the child.
  • To observe the reactions of the child.
  • To learn about the child’s likes and dislikes.
  • To find out what may frighten the child most.
  • To learn about the child’s way of contacting, using this to assess the emotional level of the child.
  • To introduce sound self-activity.
  • To provide the child with the basis for successful introduction to phase II.

Points that Lilli Emphasizes at this Level:

  • Do not move too close to the child too fast — move in a little and watch his reaction.
  • Display an active and positive interest in whatever the child is doing.
  • Some children will not initiate play until they feel certain the adult has left the room. Periodically stop playing for a minute to a minute-and-a-half and just sit silently to see how the child responds. Does his behavior appear to be an invitation for you to continue your activity?
  • Everything the adult does should be done as an “offer.” If the child attempts to initiate an activity, don’t make a big deal about it; act as if he did that every day.

Phase II: Technique of Imitation

Children at this Level

Children at this level are generally somewhat more interested in things outside their own bodies, although they still may exhibit withdrawal, especially with unfamiliar people or people they do not trust. Their interests may also be very limited in scope. They may continue to show a lot of self-stimulatory behaviors, but are more aware of others and can be enticed into interactions with trusted people. They typically don’t initiate many interactions or have limited ways to make contact with others. They are able to play more with objects, but their play with others is more at a level of parallel play rather than interactive play. They also may have only a few actions they perform on objects and have only limited participation in activities. At this point the child may seem unsure of himself in many of his actions.

The Role of the Adult

At this level the adult continues to set up the environment with objects and activities that are highly motivating to the child. For example, if the child likes an object that vibrates, the adult will try to find many different objects that vibrate in differing ways. If the child is particularly fond of a certain color or texture, the adult finds things that seem to expand the child’s experience with other objects that share that quality. One child we know liked banging on and playing with disposable aluminum pie pans. The quality about these objects that seemed to be of most interest to him was the sound they made and that they could be bent to change shapes. He might also have enjoyed that they were lightweight, shiny and cool to the touch. Other things that could be offered to him would include: many sizes and types of metal containers such as individual pot pie pans, turkey roaster, tin cookie canister, metal coffee can; sheets of shiny aluminum foil; wire whisks; metal springs; metal spoons; metal ball bearings or Chinese Mediation balls; and other shiny and/or pliable materials.

In this phase the adult begins by imitating the actions of the child on the objects. For this reason, it is a good idea to have multiple numbers of an object. If the child bangs on the object, so does the adult; simply playing alongside the child at the same level. After a time, the adult can introduce a new action with the object and see if the child will imitate him. If the child does, great! If not, the adult should go back to imitating the action of the child again. This is a conversation of a sort, a turn-taking game. ’“You show me something, and I pay attention and copy you. Now I show you something. Maybe you will pay attention to and copy me. Now it’s your turn again.”

The Purpose of Imitating

  • To increase the child’s interest in activities happening nearby.
  • To increase the child’s ability to take initiatives.
  • To increase the child’s belief in himself.
  • To introduce activities and movements not as yet performed by the child.

Points Lilli Emphasizes at this Level are:

  • Imitation is primarily through auditory and tactile sensory modalities.
  • If the child throws an object, don’t correct him/her! Pick up the object, repeat your play and then place it before the child. It is best to have two of each object — one for child and one for adult.
  • The adult should begin by imitating child, then add some more constructive games (e.g., putting materials together or into one another) briefly before returning to the action the child began.
  • An increase in crying or screaming in a child who was doing that behavior before should be read as a positive “call for attention” from the adult.
  • Your goal is to give the child the opportunity to discover that being with the adult is “pleasant and exciting, and may include new auditory and tactile experiences.”
  • You also want the child to have the opportunity to “discover that he can take initiatives and that doing so leads to the ability to master something in his surroundings.”
  • He learns he has more actions to contribute to the interaction. This provides him with growing self-identity and ability to initiate interactions with other people.

Phase III: Technique of Interaction

Children at this Level

Children at this level are beginning to be interested in more interactive types of games (Lilli calls these “you to me and me to you” games). For example, you might have a bowl with marbles that you both hold on to and take turns pushing and pulling it back and forth between you. You want to see the child attempting to take a turn. The child may not necessarily initiate these games in the beginning at this level, but can be more easily engaged with others. He may, at times, want to take time out for his own exploration of an object, but will come back to the adult to share his interest after a time. This is the child that is interested in his environment and the actions of others and so is ready to begin learning that he can help others. This is a child who may also need support to transition from an enjoyable, interactive activity to a new activity without the adult. Some children at this level may fuss when an interaction comes to an end. It is as if the child were saying, “I want you to stay” and signals an emerging self-identity. The child begins more and more to attempt to make contact with others as he progress at this level.

The Role of the Adult

The adult sets up situations and environments that will foster interactive games. It is important for the adult to be patient and wait for the child to take his turn without trying to persuade him to act. Simply be quiet and still. If the child is trying to complete a motor skill that he has not yet mastered but matches his motor development, the adult can say, “You can help me.” If the child will use his hands, the adult needs to provide every opportunity for the child to familiarize himself with the activity and participate, and to complete the moment when he wants to do it. If the child will not use his hands, the adult can model the activity as close to the child’s hands as the child will allow. This allows the child to have control of his hands, and he can withdraw them when he needs a break. Lilli also cautions us to stop playing the game with the child while the play is still enjoyable. If it goes on longer than the child enjoys, the child may be unwilling to continue to interact with us. Another point Lilli makes is about the adult giving the child “presents.” Say “I put milk in your cup,” instead of “There is milk in your cup.” The whole notion of “yours versus mine” helps promote the child’s self-identity. Use a phrase like, “Your toys are on your shelf and my toys are on my shelf.” The adult also prepares the child when it is almost time for the interaction to come to an end so that the child does not see the adult as rejecting him.


  • To help the child to learn sound dependency on one or several people.
  • To help the child to initiate interactions.
  • To enhance the child’s development of self-identity.
  • To give the child the basis for social development.

Points Lilli Emphasizes at this Level:

  • Focus in on “you to me and me to you” games.
  • If the child becomes interested in something he wants to explore on his own, this should be respected. Wait patiently for a blind child to use his fingers to “look” at the object.
  • It is important always to wait for the child to initiate his part of the game.
  • Complete an action that may be too complex for the child to do, but at the same time tell the child he can “help” with the action.
  • Move at a slow pace. Know when the child “has enough to consider for a while.”
  • Tell the child before you come to the end of the activity that you will be leaving and that you are going on to a new activity. He may continue to play on his own if he chooses to.
  • If the child begins to say “more” or “again,” names the adults, or seeks out adult attention, he is ready for Phase IV while continuing with Phases I-III.

Phase IV: Technique of Sharing the Work

Children at this Level

The purpose of using the techniques of phase I, II, and III focuses on the child’s emotional development. It is done by establishing “an exchange and balance between periods of interaction and sound self-activity, between dependence and independence.” In the next phase, the child is at a place where he is ready to learn that taking action and interacting with others does not mean that he has to do everything or do it perfectly. The child exhibits confidence in performing some actions or activities. He has some beginning understanding of time and a sequence of events. He may appear threatened when familiar activities are changed slightly.

The Role of the Adult

Set up environments and activities that give the child tasks to do that are based on the things the child has experienced success in doing. In the beginning the tasks can be completed in a few seconds up to a few minutes without any consideration for how perfectly the child can complete them. The adult needs to let the child know which part of the tasks he will complete and which part the adult will complete. If the child is reluctant to do the task after being asked several times, the adult can suggest they do it together. The adult must make sure to give the child plenty of time to complete the task, but if he still won't do it, consider if the task is too hard. In complex tasks the adult may need to use various techniques (e.g. offering, imitation, etc.) for different parts. Let the child know how long the task will last and what will follow. This is when you can begin to teach time concepts like yesterday, today, tomorrow, now and next. It is important to have an established schedule.


  • To increase the child's experience of success.
  • To involve the child in new social relationships.
  • To increase the child's interest in acquiring new abilities.

Points Lilli emphasizes at this level:

  • Help the child learn that to be the one who does something does not necessarily mean that one has to do everything or do it perfectly.
  • The abilities the child has been successful with in previous phases form the basis for deciding which activities can be used for the technique of sharing work.
  • Keep tasks short (few seconds or minutes) initially, accept whatever the child does as correct.
  • Explain each time which parts of the activity the adult will perform and what the child will do.
  • Give plenty of time for the child to initiate the task and wait silently and calmly — be neutral.
  • Let the child know how long the activity is supposed to last.
  • Try to keep the environment the same or only make gradual changes.
  • Before going to more complicated and longer lasting activities the choice of technique for every part of the activity should be given careful consideration.

Phase V: Technique of Consequence

Children at this Level

Before using techniques at this level the child needs to have an emotional age of two years. This is when the child is ready to learn that his own actions have consequences. The child must show some confidence in what he can do and feel secure interacting with others generally. He may still have some difficulty initially in handling changes, but begins to show more coping skills at this level.

The Role of the Adult

The adult needs to model how consequences work for the child through a discussion of the adult’s actions. By this I mean things like saying, “I have to stop playing and cook dinner, or you will not have anything to eat.” Or, “I need to ask you to wait; I need to find a clean shirt for you.” Then after a time the adult begins to set up situations where the child can experience the consequences of his actions. For example, “If you want me to pour more milk, you must put your glass on the table.” The adult may accept a less than perfect response from the child, and may need to offer encouragement either through prompting or modeling. For example, “See you can put your glass here.” The child begins to understand choice-making.


  • To help the child to endure meeting demands.
  • To help the child to endure changes in life.
  • To help the child to feel self-confident, which is fundamental to the ability to make decisions about his own life.
  • To establish the basis for the sense of responsibility.

Points Lilli Emphasizes at this Level:

  • When the child feels secure and confident in performing different activities and has received information about the consequences involved in activities, it should be possible to let the child experience consequences. BUT only through activities the child is able to perform.
  • As the child is able to fulfill more and more requests he may demand more attention — don’t overly praise but rather act as if it is the most natural thing in the world that he can do something.
  • As independence increases the child may be able to tolerate that he sometimes is unable to succeed in what he intends to do. He will become better able emotionally to accept significant changes in his life. As he moves higher, he will be able to make friends with other people, decide when faced with situations that he has a choice.


Are You Blind? is a book that offers a great deal of guidance in working with a child who is at an emotional developmental age under age three for a typical child. By using the five phases of educational treatment Dr. Nielsen outlines in this book, we can help the child grow emotionally. When the child reaches the emotional age of three, then new approaches to learning may be available to him. We can begin to consider incorporating other more traditional ways of teaching into our plans with these children beyond simply learning by doing.

By Kate Moss and Stacy Shafer, Education Specialists, TSBVI Outreach

Abstract: This article focuses on Phase IV and V of Lilli Nielsen's five educational phases of educational treatment outlined in her book, Are You Blind?, and how the Active Learning principles can be incorporated into activity routines.

Key Words: programming, blind, deafblind, visually impaired, Active Learning, Lilli Nielsen, activity routines

In Dr. Lilli Nielsen's book Are You Blind? she outlines the five phases of educational treatment we can use to help the child with blindness or deafblindness grow emotionally and develop cognitively. The purpose of using the techniques of the first three phases is to establish "an exchange and balance between periods of interaction and sound self-activity, between dependence and independence." In Phase IV, which Dr. Nielsen calls "sharing the work", she describes a child who is at a place where he is ready to learn that taking action and interacting with others is within his capabilities.

If we think about the child at each of these educational phases we can see the progression:

Phase I - The child is very inwardly focused, engaging in self-stimulation, with very limited experiences with objects in the environment, and who is very reluctant to engage with others except the most trusted adult (usually a caregiver).

Phase II - The child is somewhat more interested in his environment and others and can be engaged in brief interactions around high-interest objects or actions or "start-stop-start" games such as patting, swinging, bouncing, rocking, etc. He is still somewhat withdrawn, has limited interests, has limited ways to make contact with others, and has limited things he can do with objects. He can "play" along side the adult and show some interest in what the adult is doing, but does not try to imitate the adult.

Phase III - The child is interested in more interactive types of games (sometimes referred to as "you to me and me to you" ) where he can take a turn, although he may not be able to initiate these games. Many of these games have imitative elements. The child may take time out from the game to process the experience or explore independently, but will come back to the adult to continue the game. He is interested in his environment and other adults and may fuss when the activity comes to an end.

Phase IV - The child is ready to learn that taking action and interacting with others does not mean he has to do everything or do it perfectly. He has confidence in some of his actions or activities. He is beginning to understand time and a sequence of events and will often become upset or act threatened when familiar activities are changed.

Phase V - The child is ready to learn that his own actions have consequences. He generally feels secure interacting with others and though he still may have difficulty initially handling change, he is showing more coping skills. He should have an emotional age of two years before attempting to work with him at this phase. (Nielsen, 1990)

Dr. Jan van Dijk, in his approach to working with deafblind multiply disabled children, also emphasizes the importance of establishing a relationship and learning to read the child's subtle communication as a first step. Similarly he uses co-active movement following the child's lead to engage the child in interaction. He develops anticipation through building structured activities and routines; then slightly changes something in the routine to introduce novelty and learning. All along his goal is to build the child's self-esteem and confidence in his abilities to do for himself and to interact with others. Specific communication skills are tied to these experiences as concepts are developed through experiential learning. (van Dijk, 2001)

Best practices teach us that throughout the child's development in these early stages, routines and turn-taking interactions play a critical role. For example, all children participate in basic care-giving activities such as bathing, diapering, and feeding. Through these care-giving activities that occur daily, the child begins to establish a memory and can anticipate events. Later on, through participation in simple turn-taking games that are done in a routine way, the child is able to cause the adult do something pleasurable by taking an action of his own. Still later in his development, the child is able to take part in a simple series of actions that result in some desired outcome through more structured routines. Finally the child develops independence in completing the steps of the routine he has spent time "helping" the adult to complete.

Phase IV - Sharing the Work or Level I Routines

In her book, Communication: A guide for teaching students with visual and multiple disabilities, Linda Hagood describes three levels of routines, and the child at Phase IV is just at Level I. In the Level I routine she describes an activity that:

Uses short, easy, predictable steps.Has a consistent beginning and end.Occurs at a consistent place and time with consistent objects and person.Is based upon the interests of the child.Is done with the adult in close proximity.Focuses on relationship building.Does not have the expectation of the child completing the activity on his or her own.Uses non-language forms such as objects, vocalizations, touch cues, etc.Views non-communicative behaviors as having communicative intent.

When a child is engaged in an Active Learning approach, it is at Phase IV when we begin using activity routines to supplement his independent exploration activities and simple interaction times with an adult.

At this phase the child should exhibit confidence in performing some actions or activities and have some beginning understanding of time and a sequence of events. When the child is demonstrating these traits, you can begin to include some routines where you expect the child to play an active part into a portion of each day. For example, he might show some anticipation of a familiar set of steps used in making his breakfast by trying to help pour the milk in his cup when the milk carton is opened. He may also become upset when he discovers that the carton contains orange juice and not milk.

Select a Motivating Activity

So how do you begin? As a first step, try to select activities that are motivating to the child. Think about the things (the objects) the child most enjoys playing with in independent exploration or in times when you are interacting with him. Are there activities you can design that will incorporate these materials? For example, if the child is interested in wire whisks, could you use a whisk to make instant pudding? Also consider the kinds of actions the child finds interesting. Can some of these actions be included in the routine you design? If the child likes to bang the whisk on another object can you have him bang the whisk from the finished pudding on the side of the bowl?

Pick an activity that is simple, one without a lot of complicated steps. Some of the payoff for participating in the routine needs to be apparent to the child from the beginning — "I get to play with the object I like." Additional perks for hanging in there until the end of the activity should also be included along the way — "I really like chocolate. I like banging the whisk on the side of a bowl with my teacher. I like to tear open cartons."

Organize the Materials

Participating in a routine with a child requires your undivided attention so you can respond to him emotionally and not miss any of his comments or reactions. Make sure you have all the materials you will need collected before you begin the activity. Think about the space where you will do the routine. Is this a space where the child feels comfortable and is not distracted by events or people? Is the area set up so that you can be at the child's level, even if that means sitting on the floor? If the child can't or won't sit, can he physically access all the materials and complete an action? This might mean covering the floor with a protective cloth if the activity is likely to get messy. Will the child help you collect some of the materials or is that too much to ask of him at this point? Get everything ready before you ask the child to come "play".

Provide Time to Explore

Give the child time to explore the space and the materials you will be using during the routine. Be sure to let him explore it in his own way and not the way you think he should explore it. If possible, let the child experience his own exploration of the objects outside the routine before introducing it into a structured routine.

Share in his exploration by having a duplicate set of materials for you to use or by giving joint attention to the object. For the visually impaired child this is often demonstrated through a shared tactile experience using a hand-under-hand approach (Barbara Miles, 1999). For example, if he bangs the wire whisk on the table, have one you can bang along side him. If he puts his hand in the water, put your hand in there with his so that he knows you are aware of what he is doing. Don't hurry him in his exploration — this means you need to allow plenty of time for the routine.

Set up the Sequence

It is necessary to the child to provide a clear sequence of steps in the activity. Using a slotted box like the ones typically used for a daily object calendar works well. Place an object you will use in each step in sequential slots of the box. Organize them from left to right so the child can find his way to the next step easily as each step is completed. Provide a finish basket or box to discard the object after you have completed the step. After he becomes more familiar with the routine the child may be able to help you load the objects into the slots after he has thoroughly explored each one. If not you may quickly review each one that you have pre-loaded into the slotted box so he knows where each object and action occurs in the sequence.

Complete the Steps

As you introduce each step, give the child a little time to re-explore the object before asking him to "help" complete the step. Then you can give him the word or sign for the object and model what you are going to do such as pour, stir, throw, tear open, etc. In the beginning the tasks you are asking him to complete can be completed in a few seconds up to a few minutes without any consideration for how perfectly the child can complete them. Be sure he understands which parts you are asking him to complete and which parts you will do. Most importantly, give him plenty of time to attempt to do the step before helping him complete it.

Modeling using a hand-under-hand approach during the routine, allows him to access what you are doing without making demands upon his hands to do all the work. If the child wants to explore the object a bit more after you use it, let him, but finish each step by helping to place the object in the finished box. Going back to the left-most slot and feeling for the next object can be beneficial in encouraging the child to look for the next "step" in the routine. (This is the perfect time to begin to introduce the concept and language of "next".) Eventually (after many times helping you do the action) the object should prompt the child to take the action independently. Wait silently and patiently!

Be Mindful of Pacing

Though you don't want to rush the child through the activity, you also don't want to lose him by dragging things out too long. This is where your teaching becomes an art; you have to be a keen observer of the child's emotional state. You know the child and can read his signs of boredom, anxiety, or pleasure. Allow more time for his "fun" parts and move more quickly through steps that are less pleasurable.

Clean Up and Put Away

To whatever degree the child is capable have him help you collect materials and clean up the space. At first this might simply mean helping you get a key item from its place or put the object representing the activity in the finished basket. If he can carry dirty materials to a sink or throw a water toy into the bucket, get him to do that much. Over time, he should be able to take on greater responsibility for collecting and putting away the materials.

After the Activity is Completed

Take a few moments after the activity is done to "talk" about how the child helped. Don't overly praise him, just comment on his successes and what you did together. If the child is using a calendar system at an anticipation level (at least), you may be able to reflect on the activity before you place the representing symbol in the finished box or basket.

Throw a Curve Once the Routine is Well-Established

When the routine has been completed a number of times and the child is definitely familiar with both the materials and the steps, it may be time to throw him a curve. For example, change the container that holds the milk, put bubble bath into the water, get a very large wire whisk or a very small one. Don't change too much too quickly. You will likely see some surprise or even anxiety when he encounters the change. This surprise will provide a great topic for conversation. It also will expand the child's knowledge of objects and /or actions based on a very familiar, understood event. This is the way we all learn the best, not too much new to take in at one time.


Using routines is an invaluable tool when working with children who are developmentally delayed. A well-designed routine provides a great structure for learning. Incorporating Active Learning principles into the routine is also helpful. Just remember some of the points Dr. Nielsen mentions:

Help the child learn that to be the one who does something does not necessarily mean that one has to do everything or do it perfectly.The abilities the child has been successful with in previous educational phases form the basis for deciding which activities can be used for the technique of sharing work.Keep tasks short (few seconds or minutes) initially, accept whatever the child does as correct.Explain each time which parts of the activity the adult will perform and what the child will do.Give plenty of time for the child to initiate the task and wait silently and calmly — be neutral.Let the child know how long the activity is supposed to last.Try to keep the environment the same or only make gradual changes.Before going to more complicated and longer lasting activities the choice of technique for every part of the activity should be given careful consideration.


  • Hagood, Linda. Communication: A Guide for Teaching Students with Visual and Multiple Disabilities. Texas School for the Blind and Visually Impaired, 1997.
  • Miles, Barbara and McLetchie, Barbara. Developing Concepts with Children who are Deaf-Blind. DB-Link, 2004.
  • Miles, Barbara. Talking the Language of Hands to Hands. DB-Link, 2003.
  • Moss, Kate. "Five Phases of Educational Treatment Used in Active Learning Based on Excerpts from Are You Blind? by Dr. Lilli Nielsen." Texas School for the Blind & Visually Impaired, See/Hear, Volume 9, No. 2, Spring, 2004.
  • Nielsen, Lilli. Are You Blind?, SIKON, 1990.
  • Van Dijk, Jan. Development Through Relationships. DB-Link, 2001.
  • Van Dijk, Jan. An Educational Curriculum for Deaf-Blind Multi-Handicapped Persons, DB-Link, 2001.