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Versión Español de este artículo (Spanish Version)

By Gigi Newton, Teacher Trainer, TSBVI Texas Deafblind Outreach

Editor's Note: Gigi Newton is no longer with TSBVI. To reach a member of the Deafblind Team contact David Wiley at (5/2015)

As I travel around the state, visiting children with deafblindness in their homes and classrooms, I always check the child's hearing aids. Since these children need to make use of all of the sensory information available to them, having hearing aids that fit and work properly is very important. Unfortunately, many times I have found hearing aids that weren't working properly. In one instance I checked the hearing aids on a child when I arrived at a school mid-day, and I discovered that for two hours he had been listening to a "hiss" because the aids were set on "T" for use with a telephone. His hearing aids had effectively blocked any possibility of him hearing any sound other than that hiss. The reason this had happened was because the teacher and the paraprofessional did not know how to check the hearing aid. This should not ever happen to any child with a hearing impairment, but especially not to a child with deafblindness!

The classroom that has a child with a hearing impairment should have a hearing aid stethoscope and battery tester to check the hearing aid every day. Classrooms should also have a supply of extra batteries. In addition, IEP modifications and strategies should include the assignment of a staff person who will be responsible for checking the hearing aid on a daily basis. Regional Day School Programs for the Deaf (RDSPD) staff can demonstrate how to check hearing aids.

A videotape, Hearing Aid Management Skills for Families of Young Children Who Are Deaf or Hard of Hearing (Item #206), that can help is available through Hope, Inc. for $42.00. Parent advisors are shown explaining and demonstrating basic concepts and skills related to the management of the child's hearing aids such as understanding the anatomy of the ear, hearing tests, the audiogram, identifying parts and function of the hearing aid, putting the aids on the child, giving the hearing aid a daily listening check, establishing full-time hearing aid use, and troubleshooting for the source of feedback. Additionally, the INSITE curriculum, Volume I (pages 300-397) also addresses hearing aid management. It includes the same topics as the tape in print format. The two-volume set is available from Hope, Inc. for $90.00. Order the video or reading information from:

HOPE Inc. (Home and Family Oriented Program Essentials)
1856 North 1200 East
North Logan, UT 84341
Tele/fax: (435) 245-2888
Web site:

You can also purchase a Hearing Aid Care Kit from HARC Mercantile, Ltd. for $40.00 ( This particular kit includes: a dehumidifier and storage case, stethoscope, forced air blower to keep earmolds dry, a mini-brush for cleaning the outside of the hearing aid, a wax remover tool, and a battery tester and holder. Similar kits may be available from other sources; check with your local audiologist or hearing aid distributor. Their contact information is:

HARC Mercantile, Ltd.
Phone - Voice/TTY: (800) 445-9968
Phone - Voice/TTY: (269) 324-1615

Step One: Examine the aid for damage

Hearing aids take a beating, especially from children. Make sure the case is not cracked or broken, that there is no visible sign that the aid has recently visited the toilet, or that the earmold is not plugged with earwax. If you notice major problems, make sure that the parents know about it right away. Classroom staff can sometimes handle problems, such as wax in the earmold. Other times the aid will need to be returned to the dealer. Sometimes a good audiologist, speech pathologist, or teacher of the deaf and hearing impaired can address the problem, especially if it is just a broken cord or moisture in the aid or earmold. Staff members should be clear about who can address which types of problems and be instructed on regular maintenance.

Step Two: Check the battery

Battery testers can be purchased from any number of variety or hardware stores such as Walmart, Home Depot, or Radio Shack. Some will check any size or type of battery, and some are designed to check only the small, flat type of battery used in hearing aids and watches. They are fairly inexpensive; one that will do the job of checking a hearing aid battery can be found for as little as $7- $10.00. Different hearing aids use different size batteries, so it is important to make sure the tester is set to the correct setting for the size of battery your child's hearing aid uses. The size of the battery is written on the battery. Generally all you need to do is touch the + (positive) end of the battery to the + (positive) wire or point on the tester and then touch the - (negative) end of the battery to the - (negative) wire or point of the tester. An indicator of some type will register whether the battery is "good" or needs replacing. Batteries should be check every day, even if you put a new battery in just the day before.

Step Three: Use a stethoscope to listening to the hearing aids

Once you have examined the aid and checked the battery, you need to listen to sound quality of the hearing aid. It is not enough to hear a whistle (feedback) from the hearing aid and assume it is working correctly. You need to listen using a device called a hearing aid stethoscope. A hearing aid stethoscope looks similar to a doctor's stethoscope except that it has a coupler that fits onto the earmold. When the hearing aid is turned on, you can listen to the sound quality.

It is a good idea to listen to the hearing aid every day to detect sound problems that can occur as a result of a short in a cord, moisture or dirt in the aid, or other problems that impact the aid. You can also detect sounds that would indicate that the hearing aid is set on the telephone setting.

Be sure the aid is set on "M" for microphone, that the volume is at the lowest setting, and that the aid is turned on. Slowly adjust the volume. Listen to the environmental sounds; then listen to your own voice. Say the vowel sounds such as ah, ee, oo, i and also consonant sounds such as b, t, s, sh. The sounds should be clear. This is a nice place to start teaching the child to check his own hearing aid. You can have him vocalize for you, while you listen; then you can vocalize for him after the aid goes in his ear and have him listen. This is also a nice turn-taking activity and a way to work on vocalizing.

Step Four: Check for feedback

Place the earmold in the child's ear after the aid is set on the volume recommended by the audiologist. The earmold should fit securely in his ear and should not whistle (this is feedback). If you do hear feedback, remove the aid and cover the opening of the of the canal in the earmold with your thumb. Turn up the volume. Do you hear feedback? If you do there is a problem with the aid itself. If not, you know the problem is the earmold is no longer fitting the child. New earmolds need to be made frequently (every 4-6 months) for a young child who is growing rapidly.


Just like glasses, hearing aids will not help a child if they are not worn. They also will not help him if they are not working properly. No child should ever have to suffer an additional hearing impairment because the professionals are not making sure the hearing aids are turned on, set properly, and working. If you are not sure how to check your child's (or student's) hearing aid, contact a teacher of the deaf or hearing impaired or the hearing aid dealer or audiologist who prescribed the aid. You wouldn't let a child use a wheelchair that was broken. Why should you let him use a hearing aid that wasn't working?

Versión Español de este artículo

(Originally published in Summer 2001 SEE/HEAR Newsletter)

By Cyral Miller, TSBVI, Director of Outreach and Ann Rash, Teacher Trainer, TSBVI, VI Outreach

Instruction in the use of alphabetic braille has become a hot topic across the state and nation. Also known as uncontracted or Grade 1 Braille, the term refers to a braille code made up of the letters of the alphabet, punctuation symbols and the number sign. It has 180 rules. In contrast, contracted or Grade 2 Braille consists of the alphabet plus 189 one cell and two cell contractions representing various combinations of letters. Contracted braille, with 450 rules, is a more complex system of letters plus whole word and part word contractions. Grade 2 Braille is regarded as the standard form of literacy for blind individuals. It is endorsed for its space-saving properties and for increased reading speeds achieved by accomplished readers. Since the 1950s most published materials from the American Printing House for the Blind and other braille producing organizations have been produced in Grade 2 Braille, and most instruction provided to braille reading students in both local and specialized schools has been in the contracted form.

The VI Outreach Team at the TSBVI became interested in alphabetic braille as a way to increase literacy options for students with visual impairments. There is a national search for strategies to help more blind and visually impaired students develop competence in reading and a sense that many students who could and should be readers are not mastering braille. During on-site visits to schools and in conversations with teachers of students with visual impairments (TVI's), we have encountered students who struggle for reading competency despite adequate levels of specialized services. Other students are not offered braille instruction because additional disabilities are thought to limit their ability to read braille contractions. We became familiar with One is Fun: Guidelines for Better Braille Literacy, by Marjorie Troughton, written in 1992. In that Canadian publication, Ms. Troughton reviewed research on approaches to teaching braille literacy, comparing instruction in contracted and uncontracted braille. She put forth compelling arguments to reconsider the current practice of introducing braille with Grade 2 contractions. We invited Dr. Linda Mamer from British Columbia, Canada to present One is Fun materials at the Texas Focus conference in El Paso. She reinforced the idea that introducing braille with uncontracted systems may offer greater literacy opportunities for many of our students.

To further explore this issue, we surveyed selected professionals with expertise in braille literacy and looked for written documents. There were four questions on our survey:

  1. Have you had experience teaching or observing the instruction of uncontracted braille?
  2. What students, in your opinion, might be good candidates for short-term instruction in uncontracted braille (to be followed by instruction in contracted braille)? Why? Let us know how you define short-term.
  3. What students, in your opinion, would be good candidates for long-term instruction in uncontracted braille (and won't switch over)? Why?
  4. Please share with us your knowledge of research relevant to practitioners making decisions on which type of braille instruction is appropriate for specific students.

We received responses from 16 individuals, including Tanni Anthony, Dr. Anne Corn, Francis Mary D'Andrea, Dr. Cay Holbrook, Dr. Alan Koenig, Dr. Linda Mamer, Dr. Sally Mangold, Dr. Dixie Mercer, Debra Sewell, Anna Swenson, Nancy Toelle, and 5 TVIs from California and Colorado. All 16 respondents had experience teaching or observing instruction in uncontracted braille, thus confirming widespread use of this technique. We have included many of their survey comments below along with what we have learned from reading and discussions. In a presentation on this issue at the 2001 Texas AER conference, many participants acknowledged using this method with students. We were interested to find that several admitted to feeling guilty at trying alphabetic braille, because they had been taught that real braille is Grade 2 (contracted) Braille.

There are a variety of students for whom the short-term teaching of alphabetic braille should be considered. Most survey respondents suggested that beginning readers and adventitiously blinded students in particular would benefit from learning braille introduced in uncontracted form.

Beginning readers in early elementary classrooms typically are taught with phonics-based instruction. In Texas, the Texas Reading Initiative, a research-based program developed in 1997 and implemented statewide, relies heavily on phonics for early instruction. Jennifer Dorwin, a home counselor with The Blind Babies Foundation in California noted, "Many young sighted readers use the method of phonics to decipher words and learn how to read. I think it is only fair that we do not deprive our braille readers of the same processes." Other survey responses also highlighted the correspondence between alphabetic braille and regular print. For example, Debra Sewell said, "Students in a general education classroom using a skills-based phonetic approach to reading" would be good candidates for beginning with alphabetic braille. Alphabetic braille is a direct parallel to print, with letter-by-letter reading and writing, so phonetic rules are the same for both. In Grade 2 Braille, contractions frequently combine syllables and groups of letters into one sign.

Nancy Toelle shared an experience of teaching Grade 1 Braille to a kindergarten student, who learned to read and write at the same rate and using the same methods as her peers. In addition to direct instruction by her TVI, all other classroom activities throughout the day incorporating the language arts were performed alongside her classmates using the same materials in Grade 1Braille.

Students who lost their vision in later years and needed to switch from print to braille were also seen as good candidates for learning alphabetic braille, at least initially. "Most adults who have read print need to experience successful reading in braille as quickly as possible in order to maintain the motivation to learn. Uncontracted braille allows them to read adult literature soon after learning the alphabet," wrote Sally Mangold in her response to our survey. As Harley noted, "A most important factor in the braille reading program for the late newly blinded is the provision for success in reading since newly blinded persons are generally insecure and are very sensitive to failure." (Harley et al, 1987)

Many survey responses also indicated that alphabetic braille is a good choice for a population of students who were described variously as having additional disabilities, learning disabilities, lower cognitive abilities, or as learning at a functional academic level. Carson Nolan concluded in 1974 that comprehension and reading speeds with contracted words were more difficult for students noted as "slow learners." (Lowenfeld, 1969) Based on studies conducted with contracted braille, "the evidence of the study strongly suggests that for students whose IQ is below 85, braille is an extremely inefficient medium of communication and the necessity of mastering it may constitute an additional education handicap." (Nolan & Kederis, 1969) The assumption seems to have been that because the complexity of contractions makes Grade 2 Braille hard to read, instruction in braille for students with additional disabilities should be limited. In One is Fun, Ms. Troughton stated that by removing most contractions and simplifying the necessary rules, these populations became more adept at reading and more successful in braille literacy.

Frances Mary D'Andrea described a student who had a brain tumor removed. "Prior to my trying uncontracted braille with her, she had been unsuccessful in learning to read, although she had memorized the alphabet. She had very good auditory and phonological skills. By the end of the school year, she was reading a number of little books that I had made up for her. She moved away at the end of that year, and called me the next year to tell me that she was now reading Grade 2 Braille books."

In Instructional Strategies for Braille Literacy we found an example of a young student, Tony, who was having difficulties learning to read braille. His TVI had taught him the alphabet using the Mangold program . She used the Patterns series, but he had problems remembering the vocabulary words from one day to the next and even from one hour to the next. The teacher tried numerous other strategies and then decided to consult with the teacher of students with learning disabilities (LD) in Tony's school.

The recommendation from the LD teacher was to use a linguistic approach. He guided the TVI teacher in using word families, such as the 'at' family (e.g. fat, cat, sat, and mat), to create stories that Tony could read. The TVI also created games and used other strategies that had been tried before, but this time with Grade 1 and the new reading strategies. Tony's self esteem improved and his reading level increased. He later became a Grade 2 reader and was on level with his peers by fourth grade. (Wormsley, 1997)

The Outreach survey asked for other categories of students who may initially need to use uncontracted braille. Students who are learning English as a second language were mentioned. These students rely on their knowledge of a written language they have already learned, and may become confused by needing to master new symbols and writing rules in addition to the new vocabulary. For some of these students, alphabetic braille was described as a gateway to literacy; a successful entry point from which they could move on to fully contracted Grade 2 Braille.

Some students may learn alphabetic braille and not switch to Grade 2. Debbie McCune from Colorado noted that this category includes students with "cognitive limitations and students who do not have a need for heavy reading." Tanni Anthony added, "There may be students with memory challenges who would need to stay on this type of system, or kids who need continual reinforcement of the braille code in their environment and as such, need to have everyday people around them understand the braille code." Dixie Mercer also identified students who are unmotivated to use braille and whose primary literacy need is for a functional labeling system. A simple alphabetic code might be the most successful system for this type of student. Frances Mary D'Andrea stated, "To me, the test would be: Is it functional? Is it practical? And does it contribute to the student's sense of accomplishment as a reader?"

Linda Mamer and others mentioned that students who are deafblind and learning many language codes, including finger spelling, might stay with alphabetic braille. All respondents stress ongoing assessment, keeping the possibility of Grade 2 Braille always in mind. Sally Mangold stated, "There may be students who learn slowly and have certain learning disabilities who may function best in uncontracted braille for years. The determination as to whether to keep them in uncontracted braille should be made on an evaluation of their level of success where they are."

Many educational practitioners rely more on folk art and instinct than formal studies. Alan Koenig and Cay Holbrook both noted that there is very limited research on the use of uncontracted braille other than One Is Fun. In many cases, instructional strategies may be based on what materials are available. Marjorie Troughton wrote, "When these decisions were made (to have all books published in Grade 2 Braille) it was not possible physically or financially to publish books in two different codes. However, with today's technology, computers, scanners and printers, it is no longer impractical. The reasons for only one code are no longer valid. The reasons for two codes are very evident. It is time that a larger percentage of possible braille users be given the opportunity to have a code that is useful to them." (Troughton, 1992).

Anna Swenson summed up our exploration of this topic well by stating, "I continue to feel that there is no `right' way to teach braille, given the many variables involved. Teachers should select the approach that best meets the needs of an individual child in a specific educational setting. There are certainly anecdotal success stories on both sides of this debate. While further research may clarify best practice in certain situations, expanding, rather than narrowing, the range of options will enable teachers to make the best instructional decisions for their students."

Overall when we looked at texts commonly used by vision professionals, the international work on developing a Unified English Braille Code, the Texas Reading Initiative, survey responses and dialogue with teachers of students with visual impairments, several questions kept surfacing:

    1. What are the most important skills young braille readers need to acquire reading in the braille medium?

The Texas Reading Initiative has shown that young readers must make a connection between sounds and individual letters. They need to associate and manipulate sounds to form words. They need to write about their experiences and be able to read back that information. Reading consists of many skills, including letter discrimination and use of meaningful vocabulary. For many reasons, young braille readers often do not have adequate reading readiness skills in the early elementary years. Research has shown that the tactual discrimination skills of first grade blind children, and their recognition of common household objects by touch, may vary widely. (Nolan and Kederis, 1969) Early instruction must maximize successful movement from oral to written language experiences, focusing on connections between sounds, letters and real life experiences.

    1. Should we completely switch from contracted to uncontracted braille?

All research we reviewed, ongoing discussions with practitioners, and our survey results point to adding alphabetic braille as an instructional strategy, rather than advocating taking away Grade 2 Braille. As in all decisions, careful consideration and assessment should determine the child's learning media. If a child is successfully progressing using contractions, clearly he/she is learning in the most appropriate medium. For most braille readers wishing to access published literature at the highest speed, the goal will be to master all of Grade 2 Braille. Currently, standardized tests such as the Texas Assessment of Academic Skills are produced in Grade 2 Braille, as are most other normed test materials. The alphabetic braille code can be an entry for many who, once hooked on the excitement of fluent reading, transition into more advanced literacy instruction. In some areas of Canada and a few American districts, braille readers move to contracted reading in upper elementary grades. Others will transition earlier or later, as appropriate to their learning styles. Uncontracted braille offers early successes with the mechanical challenges of braille reading.

    1. Could we increase the literacy options for our students with learning disabilities?

All students are different, and no one method of teaching reading will work for all students. It is essential to have a variety of approaches to match individual student needs, especially for students with specialized learning challenges. Several reading strategies commonly used for students with learning disabilities are not recommended for braille readers because "of the contractions in the braille code that do not always provide for single letters." (Sacks & Silberman, 1998) Phonics-based reading, code-emphasis instruction, and the Orton-Gillingham methods all fall into this category. Rather than limiting the potential methodologies used to teach reading, alphabetic braille instruction for students with visual impairments and learning disabilities may expand the teacher's ability to individualize reading instruction.

    1. Could we increase the literacy options for our students with multiple disabilities?

Sighted students who have cognitive disabilities read and write using print to their maximum abilities. The teachers working with these students are motivated to continue providing reading instruction because they see the importance of their students being able to read and write their names, write lists for shopping, read a menu, or write a short note to a friend. Our students with visual impairments and cognitive impairments should have the same opportunity and means to complete these functional tasks. If braille is their medium, they need sufficient practice in reading and writing. Uncontracted braille may be the strategy that allows them to acquire functional literacy. Using uncontracted braille, they could braille a list for the grocery story, read a braille menu at McDonald's, braille phone numbers of their friends and family, and read the signage in many public buildings. Uncontracted braille would also be easier for the teachers and staff working with the student to learn, and would allow them to give immediate feedback to the student.

Sighted students are able to use materials that pair words with pictures and symbols that help decode the print. Students with visual impairments and additional disabilities may also benefit from tactual symbols that are paired with uncontracted braille to support communication and literacy activities.

    1. How would using uncontracted braille impact the braille reader in the mainstream?

Alphabetic braille in its simplicity allows everyone in the reader's life to become a participant in the reader's literacy. General education staff, peers, and family can quickly learn the letter symbols and punctuation signs. Use of alphabetic braille in early learning allows the braille student to listen to and learn the same reading lessons as their peers in the classroom. The rules governing spelling of words is the same for all students, and the materials can be more easily checked by the general education teacher without waiting for a skilled braille reading TVI to arrive.

The certified TVI may need to explore available published resources to find alphabetic braille materials. Agencies such as APH are beginning to research the use of alphabetic braille and plan to produce some titles in this format in the future. The first sixteen clusters of BRAILLE FUNdamentals, a new TSBVI braille curriculum, teach the alphabetic code. The textbook division of the Texas Education Agency will consider requests for Grade 1 Braille texts and currently produces some titles that have been requested in that format. At this time, most existing publications are available in Grade 2 Braille; however, with electronic files, all formats can be produced. It is exciting that advances in technology for braille production have given our students more options for literacy.

After compiling the survey responses, examining some of the available resources and speaking with TVIs from around Texas, we are convinced that the use of alphabetic braille has potential to increase literacy options for many students with visual impairments in Texas. Have you had experiences teaching uncontracted braille? We would love to hear about them. Does this article spark your interest? Do you want to try this strategy with your students? We are very interested in teaming with districts or TVIs who want to explore instruction in alphabetic braille. To be hooked up with a member of our VI Outreach team, you can contact Ann Rash at (512) 206-9269 or or Cyral Miller at (512) 206-9224 or .

References and Readings

Beginning Reading Instruction: Components and Features of a Research-Based Reading Program (1997). Publication Number CU7 105 01. Texas Education Agency, Austin, Texas.

Harley, R. K., Truan, M. B., and Sanford, L. D., (1987). Communication Skills for Visually Impaired Learners. Charles C. Thomas, Publishers, Springfield, Ill. p. 233.

Lowenfeld, B., Abel, G.L. & Hatlen, P.H. (1969). Blind Children Learn to Read. Charles C. Thomas, Publishers, Springfield, Illinois, p.27.

Nolan, C.Y. & Kederis, C.J. (1969). Perceptual Factors in Braille Word Recognition. Research Series No. 20. American Foundation for the Blind, New York, NY, p.43.

Sacks, S.Z. & Silberman, R.K. (1998). Educating Students who have Visual Impairments with Other Disabilities. Paul Brookes Publishing Co., Baltimore, MD, p.171.

Troughton, M. (1992). One is Fun: Guidelines for Better Braille Literacy. Brantford, Ontario.

Wormsley, D.P. (2000). Braille Literacy Curriculum. Towers Press, Overbrook School for the Blind, Philadelphia, PA.

Wormsley, D.P. & D'Andrea, F.M., eds. (1997). Instructional Strategies for Braille Literacy. American Foundation for the Blind, New York, pp. 161-162.

Spring 2000 Table of Contents
Versión Español de este artículo (Spanish Version)


By Dr. Wendy Drezek, Infant Teacher, San Antonio, Texas

Children normally learn language through their interactions with people and things in the world. They learn the give and take of communication. They learn that language gets them what they want. They learn what words mean by watching what is happening while adults talk. They get feedback from others through their facial expression, posture and proximity, as these make communication more or less effective. All this learning depends on vision.

When vision is poor, children get less information about the world. They get less feedback about the effect of their communication on others. They may be more passive and interact less with people and things on their own. Children with poor vision are less aware of distant objects, and request and refer to them less often. Adults try to help by doing more for the children so the children have less need to initiate communication. Meaning is less clear when the 80-90% of information that is visual is absent or unclear. So, children with visual impairment frequently have weak language.


In traditional ways of assessing early language, children are asked questions or required to identify objects or pictures. They don't have opportunities to generate their own responses. Their responses are prestructured by adults. These approaches may assess a child's ability to imitate responses or follow directions, but they don't access what the child can initiate to change the environment.

On the other hand, totally unstructured collections of language have a different limitation. For example, you can keep a running log of the child's utterances, and analyze it only for length, syntax and meaning. If you don't consider the appropriateness of the language to the situation, however, the child's ability may be overrated. Children with visual impairment frequently use long correct sentences without appropriate content. Repeated questions and echoed speech are examples of correct structure with inappropriate content. The problem of prestructuring can again occur if adults cue all the language.

Traditional assessment can be supplemented to address the children's ability to use their language systems without adult structure. To assess a child's ability to create language in a situation, a language log using specific guidelines is necessary. The observer and child must have shared the activity, for example frosting a cupcake, so the observer knows what the content should be. In this situation, two kinds of assessment are useful. First, the observer can booby trap some aspects of the activity so the child has to generate new language to get what is desired. (The observer might provide a frosting can which is sealed so the child has to request help to get to the frosting.) Then, after the activity, the observer and child talk about it, with the observer using "Tell me about the cupcake" as the only cue to assess what information the child can produce.


The problems with improving language are similar to those of assessment. Much of standard language programming relies on prestructured responses answering questions, labeling, imitating, pointing to selected pictures or symbols, or highly cued responses. While these can be useful parts of a program, the goal of any language program has to be a child who can initiate and create communication without adult structure.

The first step in any language program is to make sure there are things the child wants, so communication has a purpose. For many children, such desires are evident. For some children, wants may need to be fostered through appealing activities or especially interesting objects. Doing less for a child, and "not understanding" what the child wants unless the child communicates, encourage more requesting. To build meaning, children will need systematic exploration and activity which pairs language with hands on experience of the available world. Signs, pictures and objects can be invested with meaning by being paired repeatedly with action and many sensory experiences.

Natural consequences are used at the earliest stage of language acquisition to get more output and more specific language. A child can choose between a snack or a favorite toy or nothing. Gradually the child will learn to choose the symbol or use the word or sign for the desired end. Using "ba" which is used for ball, to try to get a cookie, results in a physical therapy activity on the ball. "Kuh" gets the cookie.

Booby-trapping, or building in problems that require language to solve them, is one way to encourage the child to produce language without cues. Responding to a repeated question by ignoring it, or to an echoed statement by responding to its meaning rather than its intention, are natural consequences which make that kind of communication less rewarding. If Bob, who wants a cookie, says, "What do you want Bob?" to get the cookie, and no one gives him a cookie since the question is addressed to himself, he will learn eventually that an echoed question is not a request. If the adult thinks, "I know he wants the cookie." and gives it to him, Bob is learning that an echoed question is an appropriate request. In general, any adult interpretation of inappropriate statements as appropriate will weaken the child's language.

It will strengthen language independence more to ask, "What do you want?" at free play, so the child has to use the internal system to form a response; than to play 20 Questions and give multiple choices. At the very early stages of language, however, choices are essential, and even inappropriate responses may need to be encouraged. For some children, consistent responses will need to be identified, developed and refined.

The language logs can also be analyzed for kinds of language use, weakness in the appropriateness of the language, and to assess the depth and overall strength of the child's language. Specific patterns can then be identified and addressed. For instance, if Suzy calls a broom a "sweep-it-up" and a watering can a "pour-it-out," it is clear that she has trouble relating the function of an object to its label. This can then be addressed in activities in which functions and labels are stressed.


Traditional language assessment and programming may produce an inflated evaluation of the child's ability to use language independently. It may be useful to include measures and activities to assess and encourage spontaneous appropriate language.

Editor's note: If you have questions, or would like more in-depth information about this unique approach to language development, Wendy can be reached by e-mail at .

Jean Robinson, TSBVI VI Outreach Family Support Specialist

Author’s Note: This article is a combination of an article reprinted with permission from “Businessman receives award for motivating others” by David Ball, Reporter with The Orange Leader and from an interview with JoAnn Priddy, mother of Brett Simpson

Abstract:  A young man with deafblindness wins The Christian Knapp Great Motivator award for his success owning and operating his own business. His involvement in his local community began as a high school student and has won him recognition. His mother shares her thoughts about their journey.

Keywords: Family Wisdom, deafblind, disability, employment

Brett Simpson is one impressive individual. What’s so impressive about Mr. Simpson is that he is blind and deaf, yet he goes to work every weekday. He owns and operates Brett’s Place, a snack bar at the main entrance of the Orange County Courthouse in Orange, Texas. In October 2011, during the annual conference for the Deaf-Blind Multihandicapped Association of Texas (DBMAT), he received the "Christian Knapp Great Motivator" award for his work accomplishments. The award is named after a young man whose life was short but very motivating to others.

Brett and his family feel Orange County should share in his joy. The county employees played a big part in Brett achieving this award. He succeeds Burt Hardwick, a blind man who ran the snack stand for 30 years. The business was already set up for a blind person and it was a perfect place for him. He has an amplification device (FM system) that enables him to hear over environmental noise. He also has a wireless receiver in his pocket that vibrates if a customer has trouble getting his attention. The Orange County Commissioners’ Court voted to give the contract to Mr. Simpson and he has been in operation for two years.

JoAnn Priddy, Simpson's mother, said that her son could stay home but he wouldn’t like it. “His favorite part of the job is talking to people. He likes visiting and is very social. No matter what he’s doing, he will always want to help other people. He’s made a lot of friends. It’s like a family here,” she added. “He’s always been independent. He was taught that at an early age,” his mother said. He was involved in several activities growing up including his church youth group, a summer job with Camp Fire Boys and Girls and received the Best Camper award at the Lions’ Camp in Kerrville. And if that wasn’t enough, Simpson also was given the prestigious Courageous Heart honor from the Diocese of Beaumont.  After he graduated from high school in 2006, he attended the Texas School for the Blind and Visually Impaired (TSBVI) in Austin for two years. There, they taught him important skills such as using a tactile grocery list for supplies and reading simple Braille. The school made a video of him working at their snack bar. He also worked in the TSBVI library and at a food bank in Austin.

Mr. Simpson gets up on his own at 5:30 every morning and gets to work by 7:20. His morning routine includes a 30 minute walk on his treadmill. His co-worker, Amanda Dille, gives him a ride to work and he sings in the car the entire time. “I love him,” Dille said. “He’s a nice boss. He lines me out. He’s structured and organized.” You also can find him singing every other Thursday at The Barking Dog Lounge on open mike night. Last week, he sang, “It’s Five O’clock Somewhere.” He sang the same song at the 2011

Lions’ Club convention in Beaumont. Simpson is a member of the Texas Federation of the Blind and attends their monthly chapter meeting in Orange. Priddy said the organization is seeking other blind people to join. He has become active in the Community Christian Church attending activities and services twice a week.

Upon reflecting on the last 25 years, Priddy noted that her biggest frustration was training and re-training vision teachers in her local district. Her son had 3 different vision teachers that were new to the field of blindness. Coordinating teacher training fell on Priddy and she felt that she was starting over each time a new teacher came on board. It took time for a new teacher to understand Brett’s communication and learning style and for them to form a meaningful relationship. One of Priddy’s best experiences was participating in Futures Planning several years ago with Deafblind Outreach Transition Specialist, David Wiley. “It opened my mind up and gave me the chance to dream about all the possibilities. I realized that Brett could do something he loves and have a happy life.”

 Brett Simpson with Melanie and Gary Knapp of DBMAT

Brett Simpson with Melanie and Gary Knapp of DBMAT

By Robbie Blaha, Education Specialist, TSBVI Deafblind Outreach

with help from Stacy Shafer, Millie Smith and Kate Moss, TSBVI Outreach

SEE/HEAR Editor’s Note: This article first appeared in the Fall 1996 edition of SEE/HEAR newsletter published by Texas School for the Blind and Visually Impaired and Texas Commission for the Blind. It was developed in response to requests we have had from teachers who are working with children who have the most profound disabilities. Typical assessment information provided little for the teachers to use in developing programming for this type of child.

Since it’s inception of laws providing for the free and appropriate education for all students in this country our schools have seen a steady increase in the population of students who are considered to have the most profound disabilities. Although our willingness to serve these children is evident, our understanding of these students’ educational needs, assessment and programming is still very much in its infancy. It is easy to feel we do not know what to do with these students. Developmental checklists and assessment tools used with other populations are not often sensitive enough to provide usable information to those charged with the instruction of this type of student.

The purpose of this article is to: (1) present basic user friendly assessment questions and background information which relates to this particular population, (2) acknowledge the individuality of each of these children by building a personal picture of how they learn, and (3) provide useful information with which to develop programming. This is not intended to be a comprehensive assessment process but rather some questions and background information to consider when planning for this particular population.

What Can Be Done To Gain And Hold This Child’s Attention?

Attending And Biobehavioral States

A typical nervous system exhibits a range of levels of arousal. In all of us there is a structure in the brain stem that controls levels of arousal (biobehavioral states). Some examples of these levels of arousal states are deep sleep, drowsiness, alertness, anxiousness, and agitation. (Guess, 1988). If our nervous systems are n the normal range, we spend our day shifting across the states in a typical manner. We sleep at night, are alert and absorbed in a good book and drowsy after a big noon meal We may become very agitated when paying our bills or it a stray dog digs up the garden.

We are able to consciously control some of these arousal states. For example, if we find we are getting sleepy behind the wheel of a car, we stop to get a cup of coffee. We are calmer in a stressful situation if we bring along a friend or wear a favorite outfit. If something agitates or makes us anxious, we may engage in “self talk” as a form of state management. For example, to calm down we might think to ourselves, “I’m not going to worry about it. It’s not that big of a deal. If worse comes to worse I’ll just…”

For all of us, the only time we can learn new information is when we are able to achieve and maintain an alert state. This is why, after something traumatic throws you into an extremely agitated state, it is sometimes impossible to remember things that were said or to reconstruct a particular sequence of events. You may also find that, after a big lunch in a warm room, you become incredibly sleepy and have trouble reading a long memo from your boss. The ability to attain and maintain an alert state is essential for understanding and learning.

Children with profound disabilities may not exhibit the typical range of states. This is a characteristic of a number of students with profound disabilities. One student may always seem to be sleeping or drowsy. Another is chronically irritable or anxious, leaving adults fearful of interacting with her lest they “set the child off.” Many of these children may have brief cyclical periods of alertness, but seem unable to maintain this state long enough for typical instructional activities. Slightly over-stimulating this child can cause him / her to “shut down” to a sleep state.

Often these children have difficulty achieving and / or maintaining alert states. They may experience health setbacks that bring incredible drains on their energies and effectively prevent them from being able to respond to any environmental demands outside their bodies. In some students with deafblindness the lack of normal stimulation due to an extensive sensory loss causes them to spend much of their time in other than alert states. The key to instructing these children is to understand the internal influences on the child’s ability to attend to instruction.

There is a growing interest in the possibility that external factors can have impact on biobehavioral states in these children. During the assessments, we want to learn things about children that might help them develop better control of their states and maintain alert states for longer periods of time. The more adept they become to attending, the more opportunity they have for learning. Therefore assessment should help determine the child’s current profile of states and what adaptations to the environment may assist the child in achieving and maintaining an alert state.

The questions related to biobehavioral states that should be answered during assessments are:

  • What are the range of states the child exhibits across the day or week?
  • What are the child’s most common states?
  • Is this child able to reach the quiet alert or active alert state?
  • Can he maintain it?
  • What problems does the child have in shifting and maintaining states?
  • What variables appear to effect state in the child (especially attending)?

There are a number of tools that can help in obtaining this information. These include:

  • Assessment of Biobehavioral States and Analysis of Related Influences
  • Appetite / Aversion Form (see page 38)
  • Assessment of Voluntary Movement Component
  • Carolina Record of Individual Behavior (CRIB)
  • Analyzing Behavior State and Learning Environments Profile (ABLE).
  • The Key to Attending: The Orienting Reflex

People have a subconscious monitoring system that is working at all times. If this system detects something that needs our immediate attention, it pulls us to attention with the powerful orienting reflex. The orienting reflex is just that: a reflexive alerting to: significant things. It tells us when to pay strict attention so that we may make a decision whether or not to defend ourselves or to get more information. It alerts the senses to the fact that they need to pay attention, so that survival matters and novel things can be handled. (Silverrain, 1991)

All of us have orienting reflexes throughout the day. As an example, say that you are driving along listening to the afternoon news. The words roll by you until suddenly you hear your street address being said over the air. You snap to attention, lean forward, and turn up the dial to take in every word. You reflexively oriented to something that is important to you. The orienting reflex is powerful because it is the prerequisite to the alert state in the array of biobehavioral states. (Rainforth, 1982) It pulls you to an alert state from another state. Parents use this reflex all the time. If you have a fussy (agitated state) child in the grocery store, you try to distract her so she will calm down. (“Do you see that man with the funny hat? What do you think his name is?”). What you are actually doing is trying to trigger the orienting reflex in the child so she will shift from an agitated state to a calm state.

In the area of attending, a critical component in both assessment and instruction is the orienting reflex. (van Dijk, 1985) It is important to consider because the orienting reflex can potentially be used to help the child who is usually in “other than alert states” shift into attending. The hope is that you can capture their attention on a reflexive level; then provide instruction. (See “associative learning” discussion.)

If the child shows an orienting reflex in response to a change in position, a particular scent, or colored lights, these materials or strategies can be embedded in the lessons to try to gain the child’s attention and help him shift to an alert state. Once he makes that shift, you have a brief window of opportunity to provide further information and to attempt to extend the amount of time that he attends.

An important thing to note: There is a difference between the orienting reflex and a defensive startle. Overhearing your name in a conversation produces an orienting reflex. “The orienting reflex readies the nervous system for further learning.” (Silverrain, 1991) The blare of a fire alarm typically produces a defensive startle. A startle indicates an overload of the nervous system, which is aversive rather than appealing. The result is not “attending,” but rather physical agitation and / or disorientation and / or withdrawal. The child who experiences a defensive startle during an interaction with his instructors or his environment feels under assault rather than invited to participate.

If the stimulus is perceived as aversive, you are less likely to attend and more likely to spend your energies trying to get away from the stimulus. Children who cannot physically get away from an aversive stimulus may literally shut down into sleep to escape. That is why it is critical to determine what the child tolerates or is attracted to (appetite) versus what repels the child (aversion). (van Dijk, 1985)

Families as well as other members of the child’s team often have valuable pieces of information related to the things that seem to catch his attention or deeply bothers him. In the assessment process you need to identify things that elicit an orienting reflex so that you can embed those in your lesson to help the child maintain attending. You also need to assess what things are aversive to the child so you do NOT inadvertently include these things in lessons or social interactions with him and take away his ability to attend.

The questions related to orienting reflex that must be answered during assessment are:

  • What does the orienting reflex look like in this child?
  • What elicits an orienting reflex in this child?
  • What does the defensive startle look like in this child?
  • What elicits a defensive startle in this child?

There are a number of tools that can help in obtaining this information. These include:

  • Assessment of Biobehavioral States and Analysis of Related Influences,
  • Appetite / Aversion Form,
  • Assessment of Voluntary Movement Component

How Does The Child Take In Information?

Preferred Sensory Modalities

We all use our senses to gather information from our environment. These senses include: visual, auditory, vestibular (related to movement and spatial orientation sensed through muscles, tendons, joints, and the inner ear) kinesthetic (related to bodily position, weight, or movement sensed through the muscles, tendons, and joints, olfactory (smell), and gustatory (taste).

We also have preferred senses for taking in information which impacts how we best learn. Some of us learn new material best by listening, others prefer to read the information, and others may need to write new information down. It is important to determine which sensory channel (s) the child with profound disabilities prefers to use and then provide instructional activities and information through those preferred channels. For example, a child may alert to a change in lighting. She may attend longer if there is some music involved in the lesson. She will accept certain types of tactual input in the palm of the hands but never on her mouth. Looking at the self-stimulatory behaviors (i.e. rocking, flicking, etc.) can also give you some information about which sensory systems have value to the child. (Moss & Blaha, 1993)

It is helpful to systematically test across all sensory channels with tools like Every Move Counts and to compile and analyze anecdotal information from families and staff who have daily interactions with the child. These observations contain clues about sensory things involving water. You observe that the one sound that seems to “tune him up” (bring him to attending) is the sound of water running from a faucet. That piece of information tells you that the child recognizes a consistent and a distinct auditory cue and associates it with something that he really enjoys.

The strategy of “multi-sensory approach” is sometimes recommended for this population. There seem to be different working definitions for this term. This approach is sometimes perceived as stimulating all the child’s senses at the same time with the same level of intensity. This version of multi-sensory approach assumes a couple of things:

  1. All senses are triggered in pleasant ways. This may not be true for these children. A child may orient to music through the auditory channel but find tactile information through his hands frightening. Combining these with equal intensity in a lesson may throw the child for a loop.

  2. The child can combine completely different sensory input into a meaningful whole. This may not be possible for all children. For example, some students may need to focus on one channel at a time to understand what is happening. It may be better to pace the lesson so the child can have a longer time to look at or touch something before you start talking about it. You can relate to this need if you think of the times you have turned off your radio when you were looking for a freeway exit in a large unfamiliar city.

The questions that should be considered in assessment related to sensory channelsare:

  • What sensory channels are most effective for gaining the child’s attention?
  • What sensory channels are important for conveying reliable information to the child?
  • What degree of sensory information or pacing of presentation of information helps the child shift his state to attending?
  • What channels are associated with orienting reflexes?

Assessment tools that help to provide this information include:

  • Learning Media Assessment (LMA),
  • Every Move Counts,
  • Appetite / Aversion Form,
  • Inventory of Self-Stimulatory Behaviors.

Does The Child Remember And Learn?

Any type of learning has to do with memory. The following are indicators that a child is remembering specific sensory information.

Habituation As An Indicator Of Memory

When I first moved to Austin I rented a home near the airport. It was a great house but unfortunately stood under the flight path. Incoming flights woke me up at night and interrupted phone conversations for the first few days. After a time, however, I tuned it out and stopped noticing the noise. When my sister came for a visit she asked me, “How can you stand it?” I honestly had no idea what she was talking about. I had gotten used to the sounds and had stopped hearing them. This is an example of habituation. Our minds unconsciously sort through incoming information. Habituation is an indication of memory because you only get used to things that your system is able to remember. Habituation decides what we should ignore or notice and is characterized by a lack of response. This is very important as it allows the nervous system to focus on relevant events and not be overwhelmed by all the trivial types of stimulation occurring around us all the time.

Watching for signs of habituation in a child is important because it tells you he is remembering. Many times you hear comments like, “He used to really jump when the intercom came on, but now he doesn’t seem to notice it. I don’t know if he can still hear it.” Or “This used to be her favorite tape, but now she doesn’t seem to respond to it.” These could be indicators of habituation which signifies that the child views the information as “old news.”

Building Associations As An Indicator Of Memory

Building associations between two events is a type of learning and remembering. Linking a new fact with a familiar one (associative learning) is one way we grow to understand the things around us. Before we talk about ourselves, however, let’s talk about less complex life forms and what they have shown us about associative learning.

“Snails, believe it or not, demonstrate simple associative learning. Recent studies show the effects of learning on the nervous systems of snails. Large groups of sea snails are given a fast spin (simulating the roll of a wave) which makes them contract. Each spin is preceded by a burst of bright light. Bursts of bright light alone have no effect on snails. After a while, the snails will contract when the light is shone on them, as if a spin were imminent. Researchers have shown that during this learning, new nerve connections have grown that did not exist before. The snails began to react or anticipate the spin simply by association with the burst of light.”

“You might find it interesting to know that new born human infants have also shown the ability to associate a preceding event with one that follows. A hungry, crying baby will become quiet when she hears her parent’s footsteps approaching in the night because she anticipates the bottle. We know that the human nervous system is capable of making associations between two events when the final event in the chain relates to basic survival or pleasure needs.” (Silverrain, 1991)

A child who dearly loves the taste of pudding initially shows no recognition of a spoon. However, over time, you may see him develop the same level of enthusiasm for a spoon as the pudding because you the repeatedly paired the spoon with the pleasure of eating pudding. The ability to make an association between the spoon and the pudding is an example of associative learning. (Note: We have learned from early studies that present the spoon immediately before he tastes the pudding is the way to help the child make the connection.) By building these meaningful pairs in a child’s life you are expanding his understanding of the world. Noting any associations that child may have already is important assessment information.

Anticipation As An Indicator Of Memory

Anticipation should be considered an indication of learning and memory. When a child feels his bib go about his neck and begins to open and close his mouth, he is anticipating the next step. He is showing us that he remembers. Unlike habituation that is characterized by a lack of response, anticipation is characterized by a “tuning up” of the system and some action on the part of the child that says “Oh yeah, I remember this!” Anticipation tells you that you have been successful in developing associative learning. You have built an association between bib and eating.

Anticipation of an upcoming event can “rev you up” to maintain an attending state. For example, a person is on a road trip and knows that the exit he must take will be a few miles past a factory on the left. This guy may drive along lost in his own thoughts for thirty minutes or so until suddenly, the factory appears on the left and triggers an orienting reflex. He shifs into the alert state and begins to anticipated the exit. Because he anticipates the exit, he stays alert for a short period of time and looks closely for the sign. Using cues with children helps them anticipate and pull to attending so they can learn.

Surprise As An Indicator Of Memory

Building in a surprise or what has been called a mismatch of expectations (van Dijk, 1985) is a test for memory and learning. A mismatch occurs for the child when he anticipates his mother picking him up and playing a particular swinging game, but is treated to this same game by this father. The child registers his surprise by fluttering his eye lids and breathing more rapidly. The surprise elicits an intense alert state in which associations previously learned are reviewed and compared with the new experience important learning has taken place for him. A child responds to a mismatch of expectations only because he remembers what should have happened.

Questions to ask related to assessing cognition (habituation, anticipation) include:

  • Are there things the child used to orient and respond to that he now seems to notice?
  • Does he stop responding after 2-3 times?
  • Does he seem to pair things, events, and/or people together?
  • Does the child show anticipation of what is about to happen?
  • Does the child register surprise when there is a change in a familiar routine?
  • Does the child seem to know familiar versus unfamiliar people?

As assessment tool that helps to provide this information is Every Move Counts.

What Can This Child Do To Impact His Environment?

Since learning is something the child does with you and not something you do to him, it is critical to determine the easiest way for the child to respond so that he is able to successfully participate. Possible responses that these children might make are changes in affect, vocalizations, gaze shift, and body movements. (Korsten, 1993) Even if these responses are not intentional, you should identify a particular response he gives and try to shape it into a purposeful response. Systematically testing for these responses is an important part of assessment.

Systematic Inventory Of Voluntary Movements

It is important to systematically observe the child in all the positions typically used with him and inventory the voluntary movements he can make. Some of these children are said to have no voluntary movements to use for instructional purposes. Typically this is not the case. When a child is observed in a variety of positions he may show a surprising number of movements. From this inventory of voluntary movements, the team can target a particular response(s) which will allow the child to participate in an activity.

Many children can make a particular movement easily in one position but not in another. Some positions are more stimulating or relaxing for a child and this effects their ability to attend. (“As soon as we put him in side-lying, he stops fussing.”).

Additionally, some children, when moved from one position to another, experience a significant change in their biobehavioral state. They may find the experience frightening and need a period of time to recover before they can attend. These children could benefit from strategies to make the transition less aversive (e.g., touch cues which signal that they are about to be taken from their travel chair or slowing down the pace of the transition). Other children may be at their most alert following a change in position. It is an individual things.

Questions related to voluntary movement that can be addressed in assessment include

  • What specific voluntary movements does the child exhibit across positions?
  • How do different positions affect the child’s level of arousal or biohehavorial states?
  • Does transition from on position to another cause a significant change in the child’s biobehavioral state?.

Assessment tools that help to provide this information include:

  • Every Move Counts
  • Assessment of Voluntary Movement Component
  • Physical Therapy Assessment
  • Occupational Therapy Assessment

Using The Assessment Information In Developing Programming

Programming Strategies

Once this assessment information has been compiled the educational team should be able to draw on it in developing their program. Ann Silerrain suggested some strategies to follow in her 1991 article. These include:

  1. Use assessment data to determine learning media that provides the appropriate level of stimulation---enough to be alert and not enough to cause withdrawal. We must forget about stimulation for the sake of stimulation. “Tolerating stimulation: is not an appropriate goal. Damaged nervous systems need the appropriate type and amount of stimulation; they do not need to be bombarded.

  2. Develop activity routines which have a predictable sequence of steps, objects, or actions that evoke the orienting reflex to reengage the child throughout the activity and provide opportunities for the child to respond or take a turn. Remember pacing is critical in getting child response.

  3. Use familiar objects and people in daily routines as a basis for instruction. Evaluate anticipatory responses to sensory cues to determine the appropriateness of the materials or actions used for cuing. As you cue the child, look for orienting reflexes to occur. Remember that you want to get an orienting reflex, follow with an activity of high interest or one that comforts or meets a basic need as a way of rewarding the child’s response. Over time we should begin to see the child show signs of anticipation. All things we want the child to respond to should be real things or actions that are used by or with the child in everyday routines.

  4. Design a daily schedule of predictable and pleasurable events or routines. With any activity, if we want to see an anticipatory response (evidence that the child remembers) the activity must have a strong emotional appeal for the child.

  5. When we see the child anticipate events and show some awareness of the functional use of objects, then primitive communication choice systems can be used. When a child does such things as gaze at a preferred item then at you; tactually explores two objects and picks the relevant one in context; pushes an object toward you; pulls or pushes your body in a way that says “I want you to do this with me,: then you are beginning to move into the realm of intentional conversation.

  6. When the child is consistently anticipating a particular object or action in a routine, toss in a mismatch to test awareness and communication. This check can only occur within the context of a stable routine. For example, the child is routinely expecting to have you present her red bib before meal time, but instead you put a hairbrush in front of her and her bib off to one side. Will she realize there is a problem and try to communicate that to you? Will she try to get your assistance in resolving the problem? These are indicators of a readiness for more complex learning.


As the family and the other members of the educational team work together they become more able to recognize and respect the skills and strong personal preferences that children with the most profound disabilities show us. All the children have ways of showing us what they want more of and what they would like to avoid. It is our responsibility to develop the assessment expertise needed to be aware of those messages and to use them to build better learning environments for the child.

References And Resources

Guess, D., Mulligan-Ault, M., Roberts, S., Struth, J., Siegal-Causey, E., Thompson, B., Bronicki, G.J., & Guy, G. (1988). Implications of biobehavioral states for the education and treatment of students with the most handicapping conditions. JASH, 13 (3), 163 - 174.

Korsten, J.E., Dunn, D.K., Foss, T.V., and Francke, M.K., (1993), Every move counts. Tucson, AZ: Therapy Skill Builders

Moss, K. and Blaha, R. (1993), Looking at self-stimulation in pursuit of leisure or I’m okay, you have a mannerism. P.S. NEWS!!!, July 1993, pp 10-14.

Rainforth, B. (1982). Biobehavioral State and Orienting: Implications for Educating Profoundly Retarded Students. TASH Journal, Vol. 6, Winter, 1982 (33-37).

Silverrain, A. (1991). An informal paper: teaching the profoundly handicapped child. San Antonio: ESC Region 20.

Simeonsson, R. J., Huntington, G.S., Short, R.J., & Ware, W. B. (1988). The Carolina record of individual behavior (CRIB): Characteristics of handicapped infants and children. Chapel Hill: Frank Porter Graham Child Development Center, University of North Carolina at Chapel Hill.

Smith, M., Levack, N., & MaGee, B. (1996). Teaching Students with visual and multiple impairments: a resource guide. Austin: Texas School for the Blind and Visually Impaired.

Van Dijk, J. (1985). Personal notes from a seminar.

Versión Español de este artículo (Spanish Version)

By Maria L. Muñoz, M.A., CCC-SLP


Babies are born with the ability to distinguish speech from other sounds they hear, even though they do not understand what it means. By the time children reach school age, they are speaking in complex sentences, having conversations, and understanding most of what they hear. How does the development of language occur?

Children's brains are designed to help them learn language. From the time they are born, their brains register and process the sounds they hear. As a child's brain, thinking skills, and motor systems develop, so does his/her understanding and use of language to communicate. Underlying language development is the ability to think about the world, and explore it with vision, hearing, smell, touch, etc. As a child begins to make sense of the world through exploration, language is attached to those experiences. Language develops gradually, from single words at about twelve months to complex sentences at five years, and from simple concepts (juice, shoes) to those that are more abstract (frustrated, addition). School-age children continue to learn and use increasingly complex and abstract language.

Because early language develops through sensory exploration and understanding of the world, language development for a child with a visual impairment or deafblindness will be effected by the nature and severity of the sensory impairments, and by other factors such as motor and cognitive skills. Some children with mild to moderate vision and hearing losses can be taught to compensate for limited visual and auditory information. They do this by using their other senses, thinking skills, and hands-on experiences to learn the meanings associated with words and sentences.


The development of a second language can occur in different ways. For example, a child may be exposed, from birth, to two languages at the same time; or a high school student might take a foreign language elective. I want to talk specifically about children who learn a language other than English at home, then begin to learn English when they enter school. Depending on the parents' requests and services offered by the local district, these children may be placed in an English speaking classroom, an English as a Second Language (ESL) classroom, or a Bilingual Education classroom. It is important to note that a child's classroom placement will have an impact on the development of both first and second languages. Bilingual education classes foster development of skills in English and the child's first language. ESL classes only support skill development in English, a strategy that may be associated with slower acquisition of abstract language.

In general, these children enter school with proficiency in their native languages, which they then use as natural foundations for learning English. The process of acquiring English is gradual and follows a pattern of development similar to first language acquisition. For example, simple sentences are produced before complex ones. Children make errors in English that reflect the linguistic rules of their first language. For example, a Spanish speaking child may say, "I want the ball green," because in Spanish speech, adjectives are spoken after nouns. Conversational skills are acquired (in about 2 years) before the abstract language required in a classroom is fully developed (in 5 to 7 years). These children still learn language best through exposure and experiences.

Second language acquisition, however, often occurs during classroom activities where specific, targeted English skills are being taught, rather than through the hands-on experiences typical of first language acquisition. Children are challenged to learn English quickly, while keeping up with the new concepts introduced in their classes every day. They have little time to learn basic English before it must be understood and used in highly abstract and decontextualized academic activities.


Generally, it has been assumed that if a child's first language develops normally, the second language will also develop normally. Why might this assumption NOT be true for children with visual impairments or deafblindness?

Many professionals, including myself, have observed that verbal children with visual impairments or deafblindness sometimes have great difficulty acquiring a second language. They also may have difficulty transitioning from bilingual education to English-only instruction. I think the differences between learning a first and second language come from the ways those two languages are acquired. As with all children, verbal children with visual impairments or deafblindness also learn their first language gradually, over many years. While the information they are getting from the environment is reduced, within the context of multiple, highly meaningful, multisensory experiences, other senses are used to support and compensate for limited visual and auditory information. A foundation of relatively normal language is built, upon which is added the complex language required in school.

Second language instruction in a classroom is by nature primarily visual and auditory. One language is used to teach another language, either through use of the first language or by simplified explanations of concepts in the second language. Because children are expected to use and understand abstract academic concepts in English almost immediately, they often don't have time to develop complex language gradually. Children with visual impairments or deafblindness have difficulty compensating for the limited or distorted information received through their visual and auditory systems. They often cannot use touch, smell, taste, or movement to learn abstract concepts that are taught visually and auditorially. Therefore they must rely upon prior knowledge to understand what they are hearing and seeing. They can quickly and easily miss or misunderstand the concepts being taught.

Here is an example of how a student with deafblindness might have difficulty with second language acquisition. Juan, a Spanish-speaking student with a visual and auditory impairment, is in a class that's beginning a study of oceans. The teacher shows a slide of the beach. (Juan sees a light and dark blur, but doesn't recognize the picture.) The teacher says, "We are going to study oceans." (Juan hears "oin." Due to his hearing loss, he can't hear /s/ or /sh/. He's not sure what an "oin" is, and can't see the slide well enough to figure it out.) Next, the teacher shows a slide of a fish and says, "We are going to study saltwater fish." (Juan doesn't know what a "altwatei" is and, again, can't see the picture. With his limited English proficiency and hearing impairment, he doesn't realize that two different words were spoken.) The teacher then asks the class to write a short paragraph about oceans. (Juan looks around and sees the other children writing, but is confused and does not understand the topic.)

In this example, Juan isn't learning the English vocabulary because he cannot hear it clearly. He's unable to fill in the auditory gaps with pictures because he cannot see them. Reduced auditory and visual input prevents Juan from recognizing the topic, and he doesn't realize that the class is discussing familiar things; "mar" (sea) and "pez" (fish). Language learned in this context is very different from learning about oceans by going to the beach, playing in the sand and waves, smelling the salt air, and feeling fish brush against a leg. Juan's ability to learn English is limited by the highly visual and auditory demands that are emphasized in his classroom setting.


1. Consistently implement modifications and devices used to improve hearing and vision, such as hearing aids and glasses.

2. Whenever possible, teach children through hands-on, multisensory activities that will help them learn experientially as well as linguistically.

3. Use a child's native language to support understanding of the second language.

4. Help children understand the relationships between new concepts that are being taught and their familiar experiences.

5. Children may require specific training in their second language, to discriminate between speech sounds and to identify word boundaries. These are critical skills for the development of reading and writing.

6. Periodically check a child's notes and ask questions to verify concept comprehension, making sure that visual and auditory information is interpreted accurately.



Guinan, H. (1997). ESL for students with visual impairments. Journal of Visual Impairment and Blindness, 91(6), 555-563.

Munoz, M. L. (1998). Language Assessment and Intervention with Children who have Visual Impairments: A guide for speech-language pathologists. Austin, TX: Texas School for the Blind and Visually Impaired.

Snyder, T. (1972). Teaching English as a second language to blind people. New Outlook for the Blind, 66(6), 161-166.

Williams, C. B. (1991). Teaching Hispanic deaf students: Lessons from Luis. Perspectives in Education and Deafness, 10(2), 2-5.

(Originally published in Spring 2005 SEE/HEAR Newsletter)

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

Abstract: Suggestions for literacy activities that can be done at home. Included are Braille books, large print books, DAISY format CD’s, audio books, and electronic files. Accelerated Reader booklists are discussed as a source of children’s literature. Discussion of literacy related activities available in the community. Sources for books and other media are included.

Keywords: Programming, Braille, literacy, reading, enrichment

Summer vacation is a time that all students look forward to with great anticipation. Days of fun and leisure can add up to boredom, however. Summers can mean long periods of inactivity and isolation for our students with visual impairments, especially those with additional disabilities. Parents, families, and friends can make summer more fun by finding and planning opportunities for kids to read and enjoy books and other literacy activities during the summer. And literacy is not just for students in a standard academic curriculum. Students who may not become independent readers can still benefit from the exposure to print or braille, the spoken vocabulary and the increased exposure to ideas and people that literacy activities provide. Parents don’t have to be good readers themselves, nor do they even have to be good English speakers to help their children improve their reading skills. They just have to believe reading is an important part of a good education, and help their children find access to the books and literacy experiences that are all around them in the community.

Most classroom teachers will tell you they can see a difference between their students who read at home in their leisure time and those who don’t. Kids who read at home usually are better readers, better writers and have a better vocabulary than their peers who do not enjoy reading as a leisure time activity. Often they also learn more about specific content areas in which they have particular interests, such as science or history. One of the best ways to get your kids interested in reading is to be a good role model: read yourself. Read newspapers and magazines, and read books. Use the local library, buy books at used book stores, look at thrift stores, help start a lending library at your church or place of business, and go to bookstores. When kids see their parents, grandparents, and other adults in their lives reading, they understand that reading is an enjoyable way to spend time. When your children ask questions about your book, talk to them about what you are reading at a level they can understand. Ask them about their books when they read as well.

Braille books and magazines for leisure reading are available from many sources. One of the primary sources for schools is American Printing House for the Blind (APH). APH works with a combination of funding sources that allows them to provide materials free to educational institutions through a quota point system that is tallied for each legally blind student in Texas (and other states). Private individuals can purchase books and materials from APH, but a more practical method is to give a book list to your vision teacher and ask her to request them and loan them to your child for the summer. Materials from APH obtained with quota funds are always considered loans, and books are returned and recycled for other users. Our APH quota funds in Texas are almost never used up at the end of the school year, we are strongly encouraged to use them more! Another source of books is the National Library Service for the Blind and Physically Handicapped (NLS). NLS is a part of the Library of Congress and maintains a loan program of Braille and audio books and magazines. The Texas State Library maintains a Talking Books Program which also includes Braille magazines. Braille books can be purchased from Seedlings, National Braille Press, BookShare, Braille Books Dot Com, and even Amazon. You can find links to all of these sources at the end of this article.

What books should you get? One good place to start choosing books for your child is the Accelerated Reader book list. Accelerated Reader (AR) is a commercially produced product that uses popular children’s books as a source of content, and provides a test for each book on the list. Points are assigned to each book based on level of difficulty, and many schools encourage their students to read books on the list and accumulate points for reading at home. You can search the Accelerated Reader list by author, title, subject, and reading grade level. Many school districts have Accelerated Reader book lists on their websites, you can print the list and take it along when choosing books. Often these lists contain only the books that particular school has in it’s library, so be aware that using the AR website will give you more comprehensive lists. AR does not sell Braille books, so you must make use of other sources to obtain these.

One activity that we often omit from our lives is reading aloud. There are so many choices of ways to spend our leisure time. Often parents do not read aloud to their children. In school, teachers are under so much pressure to improve standardized test scores that enrichment activities such as reading aloud to the class are crowded out of the schedule. Reading aloud is important for many reasons. Children are less skilled readers, and benefit from the role model of an adult reading aloud to them. Instead of listening to other children read, which often happens at school, listening to adults read shows young people how more skilled reading should sound, and smooth fluent reading is easier to listen to and easier to comprehend than the broken up passages read at school by peers. Some research now indicates that children better comprehend the meaning of text they listen to when it is read by a voice familiar to them than when it is read by someone unfamiliar. Another benefit of reading aloud that we often overlook is that reading is a form of story telling and as such is a social activity. Children and many older adolescents and adults enjoy hearing a good story well told, and enjoy hearing it with others. Libraries and bookstores often have read aloud sessions for children, find out what their schedule is and mark them on your calendar. Sign up for their email newsletter to keep track of events. Some communities have story telling societies and guilds. These people meet together to tell stories, have competitions and do story telling at community events. Some storytelling societies celebrate particular ethnic traditions, such as African American or Latino culture or local folklore. Keep in mind the current popularity of book groups. Adult book groups do not typically read their books aloud, but they do read and discuss passages, talk about how the story or characters may be similar to their own lives or lives of people they know, and think about the book in different ways as a result of discussing the book with others. Consider starting a children’s book club at your school or library or with a group of friends that includes your child. Parents can be included in the book group discussion or not according to the wished of the group.

To make the most of read aloud time at home, establish a regular routine with your children, usually reading before bedtime is the easiest routine to stick to. Make it a pleasant activity, sit on the sofa as a group, and tell the older kids that part of why you are doing this is to help you all to become better readers. Establish a deadline for each session, but don’t be afraid to be somewhat flexible. Don’t get hooked into finishing a long book if it’s not realistic to do this. Part of the fun is the anticipation of returning to the book each night. Read and talk about the story. Try not to ask your child too many teacher-type questions, ask open-ended questions such as what their favorite part of the story was, who they liked best, or recall when a similar event happened to them. You can read books that are above the reading level of your children, this will encourage them to learn to follow a more lengthy story by starting chapter books that are not finished in one setting. Ask them before you read each day to recall what has happened so far.

Listening to books on tape or on CD are also literacy activities. While we generally believe that listening to a book or story is not as cognitively demanding as reading itself, students can learn skills about story comprehension, plot, setting, characters and, of course, the subject matter of the book, through listening. Many of our students with visual impairments, whether they are print readers or Braille readers, will use recorded reading materials as they get older and the demands of reading for learning increase. At the college and university level, most books are not available in Braille, so students rely on books recorded for them. Getting the book produced in Braille is usually simply too expensive and too slow to be practical. Children will benefit greatly from learning to be active listeners of recorded content, not just passive listeners of noise. Vision teachers, and sometimes others such as speech pathologists and classroom teachers may work on teaching students to listen for content. This is typically done in a manner similar to teaching reading, the student listens to a passage and answers questions or discusses the content. When more advanced students use recorded material for their school work, they may review the questions that will be asked first before reading the content, they may review an outline provided, or make an outline or summary themselves as they go along. Most parents are familiar with “books on tape.” Our recorded books in school settings are obtained primarily from Recording for the Blind and Dyslexic (RFB&D) which is a resource individuals can access as well, but there are additional sources listed at the end of this article. With the development of technology, many audio books from RFB&D are available on compact disc. Recordings are now made according to specific standards called DAISY format. With a book on CD in DAISY format, you need a special CD player and you can scan for specific words to search for information. A listener can enter the page number and jump directly to a specific page, or paragraph or chapter. The players also allow users to speed up the speech without distorting the pitch, since a skilled listener can comprehend content at a rate much faster than ordinary speech.

Of course, listening to recorded books is becoming more popular among many who love literature but have limited time. Most major publishers now have audio recordings of their most popular books produced simultaneously with or soon after the print version. You can buy books on CD on-line, or at bookstores. You can also find them at used book stores, and at your local library. Several companies now have downloadable books that you can purchase on-line and load into an MP3 player (like an iPod). is one such company, with a monthly cost of $14.95 you get one book a month, plus a subscription to a magazine or newspaper from their list.

Audio books and Braille books are also available in electronic formats. Downloadable books like those from are one type of accessible electronic format. Special exceptions to copyright laws exist in the United States which make it legal for us to put a book in an “alternative format” for people with print reading disabilities. Originally this meant paper Braille, or “talking books”. Now we also use optical scanners to scan pages and convert information to electronic text. This electronic text is simply a computer file of words. With electronic text, and special software we can convert the text to Braille and output it on paper or in refreshable Braille. We can also “read” it with voice output software such as JAWS, or with enlarging software such as ZoomText. Kurzweil reading software allows users to scan text directly into voice files. We can also download electronic files into portable notetaking devices such as BrailleNotes and PAC Mates. In addition, they can be downloaded into the BookPort from American Printing House for the Blind, and users can listen to an electronic-voice output version. Admittedly, you do not have all of this technology available at home, especially in the summer when school is not in session. But you can download a demo version of JAWS which will run for 40 minutes, this will make your computer read aloud. Also, inquire with you vision teacher about what equipment might be available for you to use with your child at home during summer break. Your district may be willing to loan less expensive devices such as the BookPort and the DAISY CD readers.

In addition to simply reading books, there are other literacy activities you can do at home. Many games are good for teaching and reinforcing literacy skills, such as Scrabble, Bingo, and Monopoly. You can purchase Braille versions of these games at the websites listed at the end of this article. Some games can also reinforce math skills, and Braille and large print versions of standard playing cards, Uno, and dominoes are all available. Tactile dice are also made. Consider the arithmetic involved in playing Yahtzee and dominoes according to traditional scoring rules. It’s fun and a challenge. Another way to enjoy reading is sending and receiving letters in the mail. Ask your vision teacher if there are other Braille reading students who will become Braille “pen pals” with your child. If your child has attended a special program at Texas School for the Blind and Visually Impaired, a local Education Service Center, summer camp, or other setting and has met other children who use the same reading medium, try to keep them in touch through the mail. Check with the other child’s parent to see if they are willing to encourage and help with the correspondence process. This summer, don’t let the time become a vast wasteland, plan for opportunities for reading, listening to books, discussing books with friends and playing games that practice reading and number skills.



Magazines and Newspapers, Book Loans

  • The Library of Congress - National Library Service for the Blind and Physically Handicapped (NLS): Through a national network of cooperating libraries, NLS administers a free library program of braille and audio materials circulated to eligible borrowers in the United States by postage-free mail.
  • Texas State Library and Archives Collection - Talking Books Program: Braille magazines and books are available through their loan program


Story Tellers

Renaissance Learning: Accelerated Reader

(Originally published in the Spring 2006 SEE/HEAR Newsletter)

By Robbie Blaha, DeafBlind Specialist, Texas Deafblind Outreach with help from Kate Moss(Hurst), DeafBlind Specialist, Texas DeafBlind Outreach

Abstract: Students with DeafBlindness who participate in the general education curriculum face some unique challenges. This article discusses these issues and proposes some strategies for addressing these concerns.

Key words: Programming, DeafBlind, general education curriculum, intervener, concepts, IEP

Who are we talking about?

Though instruction for many students with DeafBlindness is focused more on life skills or functional skills, some students with deafblindness are in regular education classes or a combination of regular and resource classes. These are the students we are focusing on in this article. They are learning from the general education curriculum, and are presented the same concepts as their peers, even though they may not have the ability to deal with these concepts similarly because of the impact of their DeafBlindness. Even in resource classes, which typically have fewer students and curricular content at least two years below grade level, there are some important considerations for the student with DeafBlindness.

Things to consider:

There are a number of considerations for students with DeafBlindness who are participating in the general education curriculum, even if they are working below grade level.

Access to information

“For a student with deafblindness, the combined effects of the vision and hearing loss create a barrier that significantly impedes the ability to gather information from the environment. This causes chronic difficulties with incidental learning and concept development. Students cannot learn what they do not detect, and they may be unaware of what they are missing. Access to information is a primary issue for all students with DeafBlindness, and should be addressed in each IEP.”

Rate of instruction

In either regular education classes or in resource classes, the typical rate of instruction can occur too rapidly for the student with DeafBlindness to completely process it. Additional processing time is a requirement for this student to be able to gather and interpret information. For students with normal vision and hearing, this process occurs spontaneously.

Unfamiliar concepts

The Texas Essential Knowledge and Skills, or TEKS, comprise the state-mandated curriculum that establishes what every student, from elementary school through high school, should know and be able to do (TEA website, 2006.) When providing instruction related to TEKS, teachers can present information that the student with DeafBlindness may not have the background to understand. For example, a lesson in Texas History can cover a period of time in the 1840’s when cattle drives were common through northern Texas. In order to find meaning in this lesson, the DeafBlind student needs to understand the concepts of an event occurring 160 years ago, that the map of Texas represents a state he lives in, the meaning of the word “drive” as it is used in cattle drive, and what the terms “cattle” and “herd” mean. He would also probably need to know why any one would want to drive cattle from one place to another. This lesson, like most that take place in general education curriculum, would progress at an alarming rate with ever more complex information being shared, and make it very difficult for the deafblind student to keep up.

An additional problem occurs when the teacher clarifies new information being offered in a lesson by using what would be familiar examples for the typical students, but may not be for the student with DeafbBlindness. For instance, the science teacher presents oxidation as a “chemical change brought about by exposure to oxygen” and uses rust on an old car as an example of slow oxidation. While the example helps the class better understand the new information, the student with DeafBlindness is unfamiliar with rusty cars. Rather than clarifying the new information, the example has just increased the amount of unfamiliar information the student has to juggle in the class.

Adaptations, accommodations and/or modifications cannot completely resolve these problems

The student’s IEP adaptations, accommodations and/or modifications may include large print, an FM system, frequent comprehension checks, preferential seating, reduced assignments (meaning 10 vocabulary words rather than 20) and assistance from an intervener. While all of these are critical in assisting the student to gather information, there is still a demonstrated need for the curriculum to be modified. The modification of the curricular content may involve reducing and prioritizing the information that the student is responsible for learning. The goal is for the student to have the information that provides a useful working knowledge of the curricular content.

Concerns about the “other stuff” the student does not know

There is ongoing evidence that the student with DeafBlindness is lacking a body of information that may be considered an extension of the expanded core curriculum that is taught to students with visual impairments.

Basic environmental/cultural facts: Other students possess an incredible amount of knowledge about their immediate environment and teen culture that would be very useful for the student with DeafBlindness. The student may not know, but would benefit from knowing things like: What is a mall? Who is Lance Armstrong? What are some popular bands/songs that teens like? How do you buy a soda at school?

Social skills that encourage good relationships: Many students with DeafBlindness miss out on basic social skills that other nondisabled students get incidentally. Examples of these skills include such things as: How do you greet people (peers, adults, strangers)? Where do you sit in the cafeteria if you want your peers to interact with you? How do you respond if a classmate tells you that she has been sick?

Self advocacy skills: students with DeafBlindness need to know how to get other people’s support in gaining access to the environment and to learning. They need specific instruction in self-advocacy. Examples of these skills include things like: how do I explain to others how to use my FM system, or let the teacher know that he or she needs to turn the microphone on or off? How do I ask a peer to give me sighted-guide so I can get through the crowd at the pep rally? How do I let someone know I don’t understand the instructions on a test?


There are many things that can happen to prevent the student with DeafBlindness from appropriately accessing the general education curriculum in these settings. Here are some problems we often see:

    • The intervener is given sole responsibility for adapting the information that is being presented in the classroom. Often times he/she is left to choose and attempt to explain the information to the child as the rest of the lesson flows past.
    • Sometimes the student ignores the teacher and the teacher ignores the student. This may happen because the teacher thinks the intervener is the only adult who is supposed to be involved with the student. At other times it may be the student who perceives the intervener as the only source of credible information.
    • There is no real expectation that the student will learn anything of substance from the general curriculum. Unfortunately for the student with DeafBlindness, some people think it is enough that the deafblind student is sitting in the classroom with typical peers. They may think it is acceptable that the  student with DeafBlindness only memorizes facts and never really understands the concepts needed to finish homework or to take tests independently. The intervener or others often do most of the assignment and give the student some bits of it that he/she can do with existing skills.
    • The student does not have time in the day to do the critical concept and skill development that truly brings understanding to the student and increases social skills and independence. For most students with DeafBlindness, additional time for this work must be provided by scheduling a study hall period or having regular time provided throughout the day for this work to be done. All too often, this extra time is not provided in the student’s schedule, so he/she is scrambling to participate in the class with the other students.
    • The student is not participating in making sure his/her adaptations are in place. Too often a student with DeafBlindness finds his/herself in a learning situation without the supports he/she needs, and makes no effort to advocate for that support to be provided. The intervener or the teacher takes all the responsibility for making sure the adaptations are in place for the child. When the student becomes dependent on someone else to magically supply the adaptations he/she needs, what happens when that person is out sick? Self-advocacy skills need to be taught. Being able to ask for what you need is just as important as having that support provided to you.

What should happen?

To gain a useful bank of information from the Texas Essential Knowledge and Skills (TEKS), there are a variety of things that should be considered. First of all, the amount of information the child will be taught needs to be reduced by prioritizing critical concepts. Separate lesson plans need to be developed to teach underlying concepts that support learning the general curriculum. In addition, the student must have instruction in critical concepts and skills that build relationships, independence, and an understanding of the world around them.

How do we make that happen?

  1. Modify the general curriculum.
    • Each regular education teacher and resource teacher should select the main points that are critical for the student to learn.
  2. Select the appropriate items from the expanded core curriculum.
    • The TVI, through interviews with each team member as well as discussions with and observations of the student, should guide the team in selecting the environmental information and social skills to be taught.
  3. Resolve logistical considerations.
    • Time is provided in the student’s daily schedule for learning concepts related to the general curriculum and items from the core curriculum.
    • The team decides which person will be responsible for providing the instruction in each setting, and also who will take on the responsibility for materials preparation.
    • A plan is made related to accessing the community as part of instruction as it is needed.
  4. The IEP is written to specify how all of the above areas will be addressed and by whom.
    • For example, the TVI may take on responsibility for Brailling all materials, but the intervener will adapt other materials under the guidance of the TVI. That needs to be spelled out so that every team member is clear about whose responsibility it is to take care of producing the materials. If the student needs additional time to work on concept development, time will need to be carved out of his/her schedule, perhaps as a study hall period. The intervener needs to know what concepts to work on with the student, and how the instructor would like to approach those concepts. If these things are left to chance, it is typically the student who suffers.


A student with DeafBlindness who participates in the general education curriculum, either in general education classes or resources classes, has very complex challenges in accessing the curriculum and benefiting from these programs. For the student to be successful both academically and socially, the supports provided and the content of the program need to be well orchestrated by the student’s educational team. Providing the student with an intervener may be necessary. However, the intervener needs to be part of a coordinated team effort, and not given the total responsibility for figuring out and implementing that support for the student. Providing support to the student in general education settings can be incredibly challenging, but if done well can lead to excellent outcomes for a student with DeafBlindness.

References (TEA website, 2006. TEKS and TAKS)

(Update 5/7/2015: The original link is no longer valid. Information regarding the Standards-Based Individualized Education Program Guidance can be found at this link:

(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

(de Primavera 2006 Ver/Oír)

English version of this article (Versión Inglesa)

Por Mary Sue Welch, Miembro del Directorio de la TSBVI, Dallas, TX

Resumen: Un Miembro del Directorio de la TSBVI comparte sus recuerdos de esta escuela y reflexiona sobre la forma en que ellos han tenido influencia en la persona que ella es hoy día.

Palabras Clave: familia, ciegos, discapacidades visuales, experiencia personal, Historia de la TSBVI.

Nota del Editor: El siguiente es un extracto de la contribución de Mary Sue a la página dedicada a los Recuerdos del Sesquicentenario en el sitio web de la TSBVI. Lo invitamos a leer por completo su fascinante artículo en ¿Tiene alguna anécdota divertida sobre la escuela? ¿Se encariñó con alguno de los profesores que tuvo aquí? Por favor, contribuya con su propia historia o con una historia sobre sus amigos o familiares que pudieran haber asistido a esta escuela.

Mi vida no siempre ha sido un cuento de hadas como es hoy. Actualmente, vivo en el piso número 23 de un edificio muy alto en el centro de Dallas con una maravillosa vista de la ciudad. Mi esposo (que también es ciego) tiene un buen trabajo y compró un automóvil Mercury Monterrey nuevo, de color negro, que es conducido por un maravilloso joven. Este joven me lleva de compras y facilita nuestras vidas de muchas maneras. No, no siempre he tenido una vida así.

Fui la hija ciega de una familia blanca, vidente, de clase media de Huntsville. Sí, mi madre, mi padre, mi hermano Walter Charles, mi medio hermano Tommy y mi media hermana Marie eran todos videntes. Tenían otros problemas, pero ninguno era ciego. Mi madre dice que mi nacimiento fue tormentoso y que ella experimentó grandes dolores físicos. Muy a mi pesar, ella nunca me describió como un bebé hermoso. En realidad, me dijeron que tenía una tez azulada y que nunca tuve los ojos abiertos cuando me llevaban a mi madre en el hospital.

Mi madre simplemente pensó que estaba dormida todo el tiempo, pero mi padre se preocupó. El día que llegué a casa, mi padre me llevó al dormitorio y me alumbró en los ojos con una linterna. Mi ojo derecho respondió, pero el izquierdo no hizo absolutamente nada. Después de compartir sus preocupaciones con mi madre, ellos se separaron. Cuando tenía seis semanas de edad, comenzamos las visitas a los oftalmólogos que duraron hasta que tenía tres años, cuando un médico de Austin le dijo a mis padres que no se podía hacer nada respecto a mi visión. Les recomendó que planificaran enviarme a la Escuela para los Ciegos de Texas y que me preparara para mi vida como una persona ciega. Realmente, creo que las cosas fueron más fáciles para mis padres en ese momento porque sabían qué esperar.

Me fui de casa para asistir a la Escuela para los Ciegos de Texas el 26 de septiembre de 1954, el día después de cumplir seis años. Temprano ese domingo en la mañana, mi abuela materna tuvo un derrame cerebral. Mi madre estaba desolada, pensando que perdía a su madre y a su niña. A pesar de eso, mis padres me pusieron a mí y a mi equipaje en el automóvil y me llevaron a Austin. Fue un acto muy generoso que les agradezco hasta hoy.

Les dijeron que no podrían visitarme ni llamarme durante tres semanas. Les explicaron que yo necesitaría ese tiempo para aclimatarme a mi nuevo entorno. Me dejaron jugando en los balancines con mi primer amigo en la escuela. Todo estuvo bien hasta la noche, pero entonces comencé a extrañar mi casa. Los padres de turno en la residencia no eran muy cariñosos, así que lloré hasta que pude quedarme dormida sin recibir consuelo de nadie. No se permitía que los niños salieran de la cama, pero ellos habrían ido a consolarme si hubieran podido. Los padres de la residencia pensaron que sería mejor que aprendiera por medio del sufrimiento y así lo hice.

A la mañana siguiente, realmente comencé mi entrenamiento para adquirir independencia ya que aprendí a hacer mi cama. Me imagino que fue un desastre, pero ahora puedo hacerla bastante bien.

Mi profesora de primer grado tenía una voz muy hermosa. Ella era tranquila y amable y la quise mucho. Comenzó a trabajar conmigo en Braille de inmediato. Me encantó y aprendí rápido. Todavía me gusta el Braille y estoy tomando un curso para ser transcriptora de Braille certificada ahora que ya soy vieja.

Recuerdo mi primera visita a la biblioteca de la escuela como un hecho que marcó mi vida. Estaba fascinada con tantos libros en un solo lugar. Con el transcurso de los años, pasé gran parte de mi tiempo estudiando y leyendo en la biblioteca. Los libros han seguido siendo una verdadera fuente de placer para mí durante toda mi vida. Agradezco a nuestra maravillosa bibliotecaria por incentivar mi amor por la lectura y mi deseo por saber más sobre los demás. Probablemente ella estaría un poco desilusionada si supiera que los libros que más me gustan son las novelas de misterio y las con tramas legales. Creo que ella habría querido que me gustaran los clásicos.

Aunque nunca fui buena en música, tomé lecciones de piano durante 7 años. Mi profesora de piano siempre me incentivó. Me decía que aunque nunca pudiera tocar bien, aprendería mucho sobre la confianza en mí misma y la serenidad gracias a mi entrenamiento musical. Pienso que fue a partir de esos días que desarrollé el gusto por hablar en público. Mi música también logró mi aceptación como una adolescente en mi grupo de Rainbow Girls. Yo era músico y eso era mucho para las niñas que no podían tocar ningún instrumento. A propósito, ingresé a las Rainbows con la ayuda de mi profesora de cocina en la escuela. Le mencioné que estaba interesada y ella me presentó a sus amigas que me auspiciaron.

Me gradué de la Escuela para los Ciegos de Texas en 1966. Asistí a la escuela durante unos años muy interesantes. Más que las grandes aceras que dividen el campus en la mitad, separando el lado de las niñas del de los niños. Incluso dentro del edificio principal, había escaleras y fuentes de agua separadas para los niños y las niñas. Y por supuesto, nos sentábamos en lados separados en el auditorio. Hasta que tuve 16 años, tenía miedo de beber de la fuente de agua de los niños por temor a quedar embarazada. Debíamos tener mucho cuidado de tomarnos las manos en el pasillo porque si el director nos veía hacer eso, la pareja daría mucho que hablar. Teníamos una calificación en conducta y una vez tuve una C simplemente porque bebí de la fuente de agua equivocada. ¿O fue porque me sorprendieron besándome en la fuente? Fue una de las dos. De todas maneras, tuve problemas en casa y en la escuela.

Cuando pienso en mis días en la Escuela para los Ciegos de Texas, recuerdo todo tipo de sonidos y aromas. Aún percibo algunos de ellos cuando visito la escuela. El edificio principal aún huele a libros – no sólo a libros – a libros en Braille. El timbre no es exactamente el mismo que cuando yo era estudiante, pero me encanta oírlo sonar. Aunque sé que puedo usar cualquiera de las escaleras, sigo usando la “escalera de las niñas”. ¡Sólo esa es la correcta!

Recuerdo especialmente las mañanas de invierno. Usábamos radiadores de vapor para calefaccionar nuestros dormitorios. Muy temprano en la mañana me despertaba el sonido de esos radiadores mientras se calentaban. Sonaban con un ruido estrepitoso y luego silbaban y me encantaba oír todo ese ruido. Me sentía segura. Me aferraba a uno de mis libros en Braille y leía hasta que sonaba el timbre para despertarnos.

La primavera era casi tan buena. Teníamos reuniones los lunes, miércoles y viernes en el auditorio de la escuela. Los miércoles eran nuestros favoritos. Casi siempre teníamos recitales de estudiantes ese día. Las ventanas del auditorio estaban abiertas. Los pájaros cantaban y nuestros amigos hacían sus presentaciones. Eran momentos maravillosos para todos nosotros.

Como una pequeña niña en la escuela, me encantaban los días de lluvia. A veces los padres de la residencia nos preparaban dulces de chocolate o palomitas de maíz. Escuchábamos historias en la radio o simplemente jugábamos adentro. Teníamos pequeñas sillas en el dormitorio justo de nuestro tamaño. Aún podía ver un poco entonces y recuerdo que estaban pintadas de color rojo, azul, verde y amarillo. Reuníamos todas las sillas en la parte de atrás del dormitorio y construíamos un bote – al menos lo que percibíamos como un bote.

Los sábados asoleados, a menudo íbamos a patinar afuera o jugábamos juegos como Red Rover, Red Rover. Esto sólo podía suceder después de que terminábamos nuestras tareas domésticas. Siempre teníamos que hacer nuestras camas, sacudir los muebles, limpiar el piso y limpiar los radiadores. No nos desagradaban esos trabajos. Nos daba la sensación de estar a cargo de nuestros dormitorios. Al menos eso era lo que yo sentía. Aprendíamos responsabilidad y cómo cuidarnos nosotros mismos y nuestros hogares.

En mi último año en la escuela tuvimos a un nuevo superintendente. Bill Allen había sido el superintendente por 40 años y jubiló el año en que nuestra escuela fue integrada. El nuevo superintendente tenía a sus propios niños y las cosas en el campus cambiaron enormemente. La integración se realizó sin dificultades, al menos yo no supe que hubiera dificultades hasta hace poco, cuando leí la historia publicada aquí por Gene Brooks. Simplemente estábamos felices por conocer a algunos chicos nuevos. Por primera vez tuvimos un Consejo de Estudiantes y votaron por mí como presidente. También tuvimos por primera vez un anuario y yo fui co-editora de The Wildcat. También gané el prestigioso premio Crisco por mis habilidades para cocinar y para coser.

La graduación fue triste y emocionante, como lo es para todos los jóvenes alrededor del mundo. Planeaba ir al college, pero estaba terriblemente asustada de que nunca pudiera aprender a movilizarme por el campus. Aunque había sido miembro de la Sociedad de Honor Nacional, no tenía mucha confianza en mi habilidad de aprender sin el apoyo de la escuela. Además, estaba enamorada, así que cuando tuve la oportunidad, opté por el amor y me casé poco después de cumplir 18 años.

Tengo la fortuna de participar en el Directorio de la TSBVI. Me da un gran placer compensar en algo a la escuela que me enseñó independencia y confianza en mí misma. Aquellos viejos edificios me refugiaron y creo que muchos de nuestros profesores realmente nos amaban. Este lugar, esos tiempos, me ayudaron a ser lo que soy hoy día.

¡Esa es la pregunta! ¿Quién soy? Soy una profesional, una esposa, una madre y una persona ciega. ¡Soy yo! Y eso me hace muy feliz.