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by Robbie Blaha, Education Specialist and Kate Moss, Family Training Specialist - Texas Deaf-Blind Outreach

Students with deaf-blindness frequently require modifications regarding the delivery of instructional services. Without appropriate modifications, the child with deaf-blindness may be unable to access information from the instructional environment. These modifications are generated through the assessment process and are reflected in the reports submitted to the ARD committee. In a number of school districts around the state, the modification sheet is being used to summarize and document some of these specific modifications. We have developed a modification sheet which lists typical modifications for the student with deaf-blindness. We will be sharing this information with school sites around the state during the next year. We hope to get feedback on the effectiveness of its design and its value in facilitating better information about the student's need for the staff working with him/her.

The design of this form is based on the sample modification form developed by Texas Education Agency. Listing information on a single form serves a number of purposes:

  • It compiles and highlights sensory modifications that have been recommended in a variety of reports (e.g. the functional vision evaluation, the audiological, the technology assessment, the communication assessment, and the learning medium assessment). This is especially critical when various recommendations impact each other. For example, the speech pathologist recommends the child see the speaker's face to support speechreading, but the vision report indicates the child can not distinguish facial features at a distance greater than 12 inches.
  • It presents modifications for deaf-blindness which are not typically considered in other reports (e.g. tactile signing).
  • It helps eliminate the recurring problem of "I thought it was somewhere in the ARD notes" or "Since we did that last year, I just assumed they would continue it."

Many of the modifications we have included on the sheet are unique to deaf-blindness. Some of the modifications may be unfamiliar to staff who are not trained in the area of deaf-blindness. Modifications for students with deaf-blindness are not typically covered in preservice programs which train teachers of the visually impaired or teachers of the deaf or hard of hearing. The need for particular modifications is based upon a number of factors which include etiology, age of onset of the disabilities, degree and type of vision and hearing impairments, the presence of other disabling conditions, and most importantly the combined effects of the vision and hearing loss.

The modification sheet proposed by TEA has five sections and list specific modifications. The five sections included are: alter assignments, adapt instruction, adapt materials, manage behavior, and required equipment/assistive technology. Although many of the modifications listed might be needed for a student with deaf-blindness, many typical modifications for this population are not listed. Using these headings, we have included a list of modifications common to deaf-blindness. A sample form will be available soon. The information that follows gives more information about each of these modifications and why they might be needed.


This first section of our form remains the same as the TEA form and does not require explanation. The modifications included under this section include:

  • Reduced assignments
  • Taped assignments
  • Extra time for completing assignments
  • Opportunity to respond orally
  • Emphasis on major points
  • Task analysis of assignments
  • Special projects in lieu of assignments

These modifications may be necessary modifications for some students with deaf-blindness.


Providing a high degree of consistency in presenting new information. A child with deaf-blindness receives fragments of any experience because their eyes and ears omit or distort incoming information. When presenting new information staff must provide information in a consistent way so that the child can more readily grasp the information being taught. For example, when learning new signs tactually or through coactive signing, some children are confused by the variation in the way three different staff members form the same sign. The child may take longer to learn the sign or be unable to learn signs at all because of this variation. The number of people using new vocabulary with the child needs to be limited at first to insure a greater degree of consistency.

Providing experience-based instruction to supplement or introduce group instruction. Children with deaf-blindness have difficulty learning through observation or independent exploration. This results in an experiential and conceptual base that differs significantly from children with any other disability (ies). They must be given the opportunity to recoup information which has been consistently denied to them by their sensory losses. Current thought suggests that this type of educational approach is beneficial to all learners. However, for the child with deaf-blindness this may be the only approach that proves effective.

Providing additional time to locate & attend to referent. Because of their hearing loss a child with deaf-blindness may have difficulty localizing sounds, identifying speakers, etc. The same child's visual impairment creates difficulty when focusing with a change in distance, lighting, or background. If his visual fields are constricted or broken, locating something visually becomes much more complicated. The child with deaf-blindness must have extra time to shift his gaze from the teacher who asks the questions to the student who responds. In other instances, the student may need to have additional time to locate the object or situation under discussion so they can understand the comments.

Providing frequent comprehension checks. You cannot assume the child with deaf-blindness is getting the information at the same rate and in the same manner as the other students. It is critical to check frequently during instruction for comprehension.

Providing one-on-one instructional support. Some children with deaf-blindness have a current need for one-on-one support for all or part of the day in order to benefit from instruction. This may be necessary because the child's vision or hearing limits his ability to access the learning environment independently. This need may exist in one situation, but not in others. For example, some children with deaf-blindness only need one-on-one support in group situations to be able to keep track of the discussion or demonstration, to participate in a hands-on experience, or to interact with their peers. Depending on the child and the activity, a one-to-one ratio can be provided by a variety of people (e.g., peer, teacher of the visually impaired, the third-grade teacher).

Providing intervenor aide. An intervenor is an instructional aide who has specific training in deaf-blindness. Her training would include the information needed to implement the IEP objectives and individual modifications for a child with deaf-blindness. Intervenors are specifically designated to work with a child with deaf-blindness for all or part of the instructional day based on the current need of the child.

Providing an interpreter and/or modifying interpreting services: individual, small group, platform, visual description, and/or oral interpretation. Depending on the degree and type of visual and hearing impairment, the specific situation, and the communication form used by the child, different types of interpreting services may be required. For example, a student with slightly restricted fields and good acuities may be able to use a platform interpreter, or he may require small group interpretation. A child with severely restricted fields and 20/200 vision may need individual interpreting services, visual descriptions, and in some situations sighted guide assistance. A child who relies on speechreading may require the support of an oral interpreter. It is important to consider the type of interpreter support needed to accommodate the child's visual abilities and communication form.

Providing interpreter-tutor aide. An interpreter-tutor differs from an interpreter in that they not only provide direct interpretation, but also provides additional explanation and instruction when it is needed. Some students with needs in developing language, vocabulary and concepts may require this type of support.

Adapting manual communication form by: substituting fingerspelling or alternative signs, tactual signs, (hand) tracking, or coactive signing. There are a variety of manual communication forms used by students with deaf-blindness. Adaptations to these communicative forms are based on the child's cognitive, motoric and visual abilities. Some of these adaptations are specific to deaf-blindness:

  • tactual signs allows the person with deaf-blindness to receive information by placing his/her hands on the signer in order to read signs and fingerspelling by touch.
  • (hand)tracking occurs when the person with deaf-blindness places his/her hand(s) on the wrist area of the signer. This helps him direct his gaze and may provide additional information about a specific sign.
  • coactive signing occurs when the teacher takes the student's hand(s) and helps the student form the sign correctly.

Presenting signs and fingerspelling in appropriate field as noted in functional vision evaluation. Many children have visual impairments which may cause some type of field loss. It is critical to present visual information to them in a location where they can see it most readily. Some signs may need to be adapted to a smaller sign space. This technique could be used in conjunction with the adaptations to manual forms mentioned above. The functional vision evaluation should note any field losses that the child is experiencing.

Altering signing distance as noted in functional vision evaluation. When a child has an acuity problem or a field loss, signing distance is affected. Some children may require signs to be presented within 12 inches of their face to be able to see them. Other children who have restricted field loss with no acuity problems may occasionally need to have the signer at a greater distance from them than may be typical in some situations in order to get the hand and body movements inside of their field of vision.

Varying rate of signing and fingerspelling when presenting complex or novel information. Visual impairments may cause problems in receptive communication, especially if the information is new to the child. The child may not be able to keep up with the rate of signing or fingerspelling used for other students in their class.

Providing specific visual adaptations to instructional environment. The functional vision evaluation, the eye exam, the clinical low vision assessment and the learning media assessment contain pertinent recommendations which should be highlighted on the modification sheet. These might include such things as: allowing child to use eccentric viewing positions, providing additional lighting, etc. (Some recommendations may also be reflected in Section 3 - Adapt Materials and Section 5 - Required Equipment/Assistive Technology.)

Providing specific auditory adaptations to instructional environment. The audiological, the communication assessment, and in some instances the technology evaluations may contain specific recommendations for adaptations and equipment needed by the child. These might include: assistive listening devices, preferential seating placement, reduction of ambient noise, notetaker, etc. (Some recommendations may also be reflected in Section 5 - Required Equipment/Assistive Technology.)

Adapting braille instruction to match child's English language skills. Some children with deaf-blindness are fluent in American Sign Language, which is a different language from English. Since braille instruction is based on materials that are in English, the staff need to be sure that the vocabulary and language which are used in instructing braille are appropriate for the student.


The sensory assessments suggest specific modifications to materials. Some examples are: enhance contrast, provide specific print size, use toys that produce low frequency sound, etc.


Providing supervision regarding the use & maintenance of assistive listening devices and optical aids. A common complaint from parents and teachers alike is that children with deaf-blindness are not using hearing aids and glasses that are recommended for them. Since these devices allow the child to access information, it is critical that someone is responsible for keeping these devices on the child as well as in good working order. It is also necessary that the child be taught to use the additional information they are receiving as a result of the devices.

Preparing the child prior to transition to new activity by: giving a clear ending to the current activity, giving a symbol representing the upcoming event, and/or discussing the upcoming event. Many children become upset when they transition from one activity to another, especially if they are engaged in a preferred activity. Using routines that are structured to give the child a clear signal for the end of one activity and the beginning of the next activity can be very helpful. Calendar systems often help in this effort. Many children only need some discussion of the activity that is coming up to ready them for the transition.

Reducing the effects of anxiety related to deaf-blindness by: limiting the number of people; providing a predictable environment; reducing performance demands; developing instruction around preferred activities; and/or providing choices in activities. Some children with deaf-blindness have difficulty feeling safe in a world that alternately "comes at you" or "disappears in thin air." Their communication skills may also make it difficult for them to express their feelings and desires readily to all the individuals they encounter. The items listed above may offset these problems.

In general, finding ways to make the environment more predictable can help reduce anxiety. It is also important that these children have some control in their lives.


Children with deaf-blindness need to have access to a variety of adaptive/assistive devices. Many of these are listed below:

  • personal hearing aids and glasses
  • low vision devices such as CCTV, monoculars
  • easel, book stands
  • assistive listening device such as FM systems, vibrotactile aids, or auditory loops
  • alerting devices such as vibrating alarms
  • captioning for television and video materials
  • computer aided real time (CART)
  • lamps or spotlights on interpreter to help the child in visually accessing the information that is being signed
  • TDD/telebraille devices for making phone calls
  • calendar system for specific communication needs and structuring of the daily, weekly or monthly activities
  • relay services

You may need to reference other materials to help in determining the most appropriate modifications for the student in your classroom. Some of the materials that we feel would be helpful are listed below. You may also call with questions regarding modifications.


Baker, Charlotte & Cokely, Dennis (1988). American Sign Language: a teacher's resource text on grammar and culture. Silver Springs, MD: T.J. Publishers.

Gustason, Gerilee & Zawolkow, Ester (1993). Signing Exact English. Los Alamitos, CA: Modern Signs Press, Inc.

Humphries, Tom, Padden, Carol, & O'Rourke, Terrence J. (1980). A Basic Course In American Sign Language. Silver springs, MD: T.J. Publishers.

Reed, Charlotte M., Delhome, Lorraine A., & Durlach, Nathaniel I. (1995). A study of tactual reception of sign language. Journal of Speech and Hearing Research, Vol. 38, 477-489, April 1995.

Smith, Theresa (1992). Guidelines for working/playing with deaf-blind people. Monmouth, OR: D-B LINK.

Watkins, Susan & Clark, Thomas P. (1991). A coactive sign system for children who are dual sensory impaired. American Annals of the Deaf, Vol. 136, No. 4, pages 321-324.