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Activity E: Case Story: Johanna

Participant Guidelines

The purpose of this activity is to compare and contrast communication development in a child without disabilities and a child with a visual impairment and additional disabilities.

Materials. “Case Story: Johanna” (attached)


  1. Read the case story about Johanna.
  2. Answer the questions listed below and turn them in to the instructor.
  3. Discuss the answers in class or via an online discussion.


  1. List the methods Michelle used to communicate and put a star next to her most-common communication method.
  2. List the methods Johanna used to communicate and put a star next to her most-common communication method.
  3. How did Phyllis and Lynn communicate with their daughters?
  4. What strategies did Phyllis use to encourage Johanna to communicate?
  5. What communications of Johanna did Phyllis miss?
  6. How do you think Johanna’s visual impairment influenced her communication?
  7. How do you think Johanna’s additional disabilities influenced her communication?
  8. Do you think the trip to the park was a good opportunity for Johanna to develop communication skills? Why or why not?

Case Story: Johanna

Michelle and Johanna sat in the sandbox at the park. Michelle poured sand out of her bucket and watched it slide into a low pile. Johanna was propped in the corner of the sandbox for support. She wore a sunbonnet and prescription sunglasses, but still kept her head down to block the light. She wiggled her fingers in the sand.

The girls’ mothers, Phyllis and Lynn, sat on a bench a few feet away from the sandbox. They had been friends for several years, ever since Lynn moved into the apartment next door. They were excited when they found that they were both expecting their first babies just a few weeks apart. Phyllis was terrified when Johanna was born and the doctors told her something was wrong. They even said that her precious little girl might die. She was afraid for her tiny baby daughter and unsure of how she and Mark would take care of her. There were so many medications and so much medical equipment in the hospital, and much of it came home with them. Along with all her fears, Phyllis still felt a pang of jealousy knowing Lynn had an easy delivery, and Michelle was healthy. Michelle was such a beautiful, perfect baby—able to go home the day after she was born. Phyllis and Mark spent every minute they could at the hospital for months until they were able to bring Johanna home.

Once Johanna was home, Lynn made a habit of coming over a couple of days a week. The first time, she left Michelle with her boyfriend, Scott. She worried Phyllis might think she was flaunting her healthy daughter, and she didn’t want to hurt her friend. Phyllis, however, insisted that she bring Michelle, and on the next visit, she did. Phyllis cried after they left, grieving for the healthy child she had always imagined, but she never told Lynn her feelings. Phyllis and Lynn started spending time together several days each week, and their girls grew up sharing playpens, toys, and clothes. Johanna was so much smaller than Michelle that she could always wear Michelle’s hand-me-downs. This helped Phyllis and Mark, who were feeling the financial strain of raising a child with so many special needs.

This trip to the playground was a regular event for the girls when the weather was nice. The girls and their mothers enjoyed the trips though Phyllis and Lynn worried about the girls getting hurt. Phyllis was afraid that another child would run over Johanna and injure her. Lynn worried about Michelle starting to run and climb herself. Despite their motherly concerns, Phyllis and Lynn knew it was important for their girls to get out and to explore their world.

Back in the sandbox, Johanna was beginning to squirm. The plastic braces on her legs were getting hot in the sun. Michelle had stopped pouring the sand and was peering intently at a dark object in the sandbox. She picked up the piece of gravel and held it out to Johanna.

“Ook,” Michelle said.

Johanna stopped squirming and leaned forward to see the object her friend was holding. She started to reach for the rock, but she was off balance and had to put her hand back down to keep from falling.

“Here,” said Michelle, placing the rock on Johanna’s lap and searching for more rocks buried in the sand.

Johanna picked up the rock and looked at it. She held it up and looked around for her mother. Even though her mother’s shape was blurry, Johanna could hear her talking and knew where to look. Johanna then started to put the rock in her mouth.

“No, honey,” said Phyllis. “Don’t put that in your mouth.”

Phyllis got up and quickly walked the few steps to the sand box. Johanna had stopped with her hand a few inches from her mouth. When Phyllis reached the sandbox, she crouched down and put out her hand.

“Give it to me,” she said.

Johanna squinted at her mother’s face, then looked back at her rock. She started to move her hand toward her mouth again.

“No,” Phyllis said firmly. “Give it to me.”

After a few seconds, Johanna stretched out her arm and dropped the rock a few inches from her mother’s fingers.

“Thank you,” said Phyllis with a big smile and lots of enthusiasm. “You are such a good girl.”

Johanna smiled back at her mother and made a few sounds.

By this time, Michelle had lost interest in the sandbox and had climbed out. She headed toward the small climbing area for toddlers. Phyllis patted Johanna, handed her Michelle’s bucket, and then went back to talk with Lynn. Lynn was watching her daughter intently as she and Phyllis resumed their earlier conversation. Michelle stopped climbing and looked around for her mother. Michelle waved at her mother then happily went back to climbing. Johanna, still sitting in the sandbox, dropped the bucket. She didn’t know what to do with it. She was still hot and the sand was starting to itch on the backs of her legs. Michelle had left, and Johanna was bored. She started squirming again and then began to whine. After a few minutes, Phyllis came over again and smiled at Johanna.

“Are you tired of that sandbox?” she asked. “Let’s go see what Michelle is up to.”

She reached down and scooped up Johanna. She carried her over to the baby slide. Lynn was already at the slide standing behind Michelle as she climbed the four steps to the top of the slide. Michelle hesitated at the top of the slide then slid down. At the bottom, she rolled off and clapped her hands.

“Yeah!” said Phyllis clapping her hands as best she could while holding her daughter. “Did you see Michelle slide?”

Johanna looked at her mother then slowly brought her hands together and clapped twice, though she had trouble bringing her hands together smoothly. Johanna shifted in her mother’s arms and tried to twist away from her.

“Do you want to slide?” Phyllis asked.

Johanna continued to try to twist away.

“Here let’s get on the slide.” Phyllis said.

She placed Johanna on the top of the slide and kept both hands on her to help her balance.