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Chris Tabb, Statewide Orientation and Mobility Consultant


 (Note: This document was intended for all members of a student’s IEP Team. The pronouns are intentionally varied; “student” will be used at times and “child” will be used at others. Though it may appear that one section is intended for a parent and another for an education professional, all strategies can be implemented both in the home and the educational setting.)

Encourage Purposeful Movement:

Having times in the day that allow the student to practice moving independently will help them to develop skills that can be generalized to new areas and longer duration travel. Purposeful movement can be as simple as bringing a hand to a preferred toy that is next to or even on the body. When there are structures in place to support and encourage this movement at home and at school, the motivation to travel and begin moving with purpose will increase. Examples of establishing a supportive environment for purposeful movement include having a location for preferred toys that the student can access at any time and reliably find favored objects there. This strategy can be enhanced or extended by using tactile markers that show certain areas are “their” areas, such as marking a cubby and coat hook with a texture or small object that will help them to know where their own things are at school. The marker can also include a braille label so they begin develop the concept that braille is associated with names of things. Other places where it would be helpful to include “their” symbol or tactile marker are their chair, desk, door to their room at home, etc. With an expectation of predictability and control in the environment, the student is more likely to initiate travel on their own and also begin developing a sense of self-mastery and confidence for travel as they receive their own, earned reward when they reach their favored objects or destination of choice. This natural reinforcement perpetuates the motivation to move.

Another helpful strategy is to plan some “free exploration” time into the student’s day, just a brief period (e.g. 10 to 20 minutes) where they can practice navigating in the school and or home environment (even outdoors when the terrain and other conditions are safe for doing so). This gives an appropriate and educationally beneficial opportunity to satisfy and encourage curiosities they may have about their environments. If they become disoriented or find something unexpectedly, it becomes an excellent opportunity to develop problem solving skills. An example might be finding a hallway in the school that allows them to take a new route to class, or finding a library cart in the hallway and learning how to navigate around it safely. During this time, an adult is nearby to assist as necessary, but the student is deciding what to do and where to go, rather than the adult providing the agenda and directing their actions.

Developing Sensory Efficiency:

Encouraging the student to become aware of all of the sensory inputs they have the physical ability to attend to in the environment will help them begin nurturing the skills related to sensory efficiency. Remember to include tactile, auditory, kinesthetic, proprioceptive, olfactory, and if there is the ability to receive visual information, then vision as well.

One way to think of the difference between kinesthetic and proprioceptive is how you feel on a hill. When walking up or down a hill, you feel different muscles being used; and, if you are walking up the hill you certainly feel the additional strain and effort needed to ascend the hill. This muscle sensation is kinesthetic. This is a way to tell whether there is an elevation change on a path regardless of vision. Proprioceptive would be the sensation that you feel in your joints, such as in your ankle as you flex forward or backward to be upright while standing on a hill. The same sensation can be recognized while standing on a foam roll, or while leaning on the edge of a step or curb. These are not typically “taught” to children as most children have already recognized they are on a hill with their vision, it is considered incidental learning. When we take the time to deliberately draw attention to these other sensory inputs available to our children, we help them learn tools that they can use to access information about their environment at any time.

When teaching, we will often say “look at this” or “do you see how…”; these visual representations are often the way that adults learned and they convey the information they are teaching to students in the same manner. By thinking about the other senses available to our students we can help them to “visualize” their environments through these other, or additional sensory channels. It might be clapping hands in the gymnasium to hear the echo and then comparing the same clapping sound in the smaller and often more auditorily reflective bathroom; or, listening for the sound change while passing interconnecting hallways in a quiet main hallway. As adults likely learned about the world in a wholly different manner, it may take some additional thought and creativity to introduce sensory exercises, but the dividends returned in independence in the children is tremendous. Once they begin recognizing all the sources of information available to them and continue attending to the sensory information, their ability to visualize (visualized through a variety of sensory channels, such as sound waves that make a picture for sonar) their world continues to develop.

Here are some activity examples to practice:

  1. Localizing sounds, such as identifying the location of dropped object or pointing at a person who is walking and following the sound of their steps.
  2. Aligning with sounds
  3. Walking toward, away from sounds
  4. Walking around sounds to circumnavigate something
  5. Identifying patterns in sounds
  6. Using echoes and reflected sound (passive and active echolocation)
  7. Distinguishing sources of sounds, such as car, lawnmower, airplane
  8. Estimating distance of sound
  9. Estimating direction of sound; is it coming toward or going away from
  10. Understanding when one’s own ability to use sound is impacted by changes within the environment, or within one’s self
  11. Finding other sensory means to verify or confirm what is being received or interpreted through the auditory channel

Tactile could be touching different textures or temperatures. It might be a lesson in feeling the sun on the skin for maintaining alignment along a route and determining direction of travel by knowing the location of the sun.

Olfactory sense can aid orientation and connection with the environment to provide clues for what might be happening in the environment, such as smelling the aroma of a bakery, or recognizing a strong smelling dumpster that you have to walk past every day in the parking lot as you approach the school.

Advancing Concepts:

Rough and smooth, inside and outside, more and less, fast and slow, these are all concepts that can be developed across educational settings and in the home. It is best to present these in natural settings wherever possible such as finding the rough brick next to the smooth glass in the hallway while transitioning to an activity. The more concepts that are developed and used in varied places and settings, the greater the power and connection of the concepts. Those that are originally introduced at a desk activity might later be used when matching textures of clothing, discerning landmarks, etc.

Often concepts that would be learned through exploration by children who are visual learners must be taught more deliberately to students who are blind and visually impaired as they may not otherwise recognize learning opportunities that are in the environment. This might include feeling the glass windows and discussing the qualities of glass; it holds temperature and is hot in the summer and cold in the winter, it is very often smooth and hard yet is makes a different sound than either wood, metal, or plastic. Each of these materials can be explored, and new concepts related to their qualities introduced, compared, and contrasted.

Consistency in Learning Environments:

Regular repetition and having all Team members working on the same concepts and skills, with the same language for these, will facilitate the acquisition of the concepts and skills. Keeping the number of new concepts and skills to a minimum level that is represented and reinforced in multiple areas across settings (i.e. in the classroom, with each related service, and at home) keeps the new information at the center of attention and learning and allows for a maximal number of occurrences to connect the concepts with different situations and environments. The more the concepts are experienced the quicker the acquisition, and the more they are encouraged the stronger their resiliency and meaning.

Routines in the student’s day provide natural repetition and opportunities to learn new concepts and practice others that have already been introduced. Ensuring that the child has the same routine presentation will help them achieve increasing levels of independence within the activities of the routine; photographs with descriptions of the steps for the routine and its set up can be laminated and placed near the routine area so that whoever is working with the student will set it up the same way. This allows the student to focus on learning the routine itself and any concepts that are being deliberately included rather than having their attention distracted by differences in setup or preferences of the adult they are working with.

An example for the early stages of purposeful movement is an activity mat or rug, where toys are placed in consistent locations (e.g. the musical toy always goes in one corner, the vibrating toy diagonal to the first, a plush toy in the third, and a squeeze toy in the final corner). With the toys being placed in consistent locations, regardless of the adult the student is working with, they will be more inclined to explore, as they will be able to predict where their favorites will be, and then successfully achieve getting what they want independently. These skills can then be generalized to larger areas, such as travel within the classroom, the school building, and ultimately the school area, including the outdoor recess area.

Value Sharing:

Interactive games and value-sharing-time, where the student is met at their own place and level of interest, is the best place to begin developing rapport. This rapport development is a foundation for later expansion of skills when students are presented with possible fear at learning new skills (e.g. entering loud environments, crossing streets, etc.) and can rely on the trust they have developed with the adult they are working with.

As adults we often forget to be truly listening to the student, especially when the child is nonverbal. We need to remember to join them in their moment whenever possible rather than starting by trying to coax them into the moment we would like them to be having. We are much more apt to get their “buy in” to the activity we are proposing for them to do if we have first met them where they are and shared what they are involved in. In this way, we are already connected and communicating before offering what we would like them to consider doing.

Motivators and Communication:

Keep track of what is motivating and aversive to your child. These items or sensory experiences can then be used as “carrots” or motivators for other activities if they are positive motivators for your child; or, if they are aversive stimuli they can be helpful for demonstrating choice and conceptual understanding with preferences. This can be during a choice sequence with a calendar system, etc. to verify that an item that is expected to be viewed as aversive by the child will not be chosen, and a preferred item will be selected. Once these items are consistently communicated using the actual object, they can then be transitioned to a symbol or piece of the item, such as the chain from the swing to represent the activity of swinging. Eventually the symbol will become even more abstract, such as one link of the chain or even a raised line drawing, just as print and braille words are an abstraction of the physical and concrete things they represent.

Once the child is demonstrating the ability to use symbols they can be used to communicate planned activities, make choices, and express preferences. They can also be used to create functional routines and reasons for practicing routes, such as going from the classroom to the playground to reach the swing, or visiting the office to deliver a daily attendance record as part of a job routine. These activities can then be reviewed with the symbols to “talk” and communicate about the experiences of the activity; this further develops concepts, literacy, and a sense of understanding and control within the environment as well as the social benefit of sharing about an event.

Experience is the Best Teacher:

Let safe accidents happen. We learn from mistakes and if we prevent a child from having accidents occur, we are depriving them of the opportunity to learn from the mistake or accident. If a child is walking on the playground and tumbles on the ground due to a change in elevation, they learn what it is to fall, they learn how to get up, and with enough occurrences they learn to shift their balance and prevent themselves from falling. It has to be lived, to be learned. Certainly there are some accidents that are beyond the scope of safety, such as the fall from the top of the swing set or stepping into a street with moving vehicles. These are indeed areas the adult should intervene. But, if an accident will not result in bodily harm it can be an opportunity for learning to occur. Sometimes we pre-teach a skill to a child, such as a protective technique that includes bringing the hand up and in front of the head to prevent bumping into a table when bending down; generally the skill is only truly acquired when the child bumps the table with their head and is able to make the connection within themselves that bringing the hand up before bending down could prevent the bump in the future. If as adults we always provide the prompt or cue to implement the protective technique for them to avoid bumping their head, we are interfering with the natural learning process. There are certainly times we have to help the child to process the event and connect the technique with the desired outcome, but eventually they must learn to self-initiate the technique for it to be effective and having the “safe” accident happen is truly the best teacher.

Celebrate the Successes:

There are many “milestones” that are printed in books but it is important to keep track of personal “milestones”. The first time your child rolls over and is able to get to a toy, it is a milestone. Reaching an arm out to touch something that draws their attention is a milestone; it warrants celebration and a note in a family journal. These celebrations of successes in life are at least twofold. They help us track the succession of accomplishments that your child has and they help us to see how far they have come. Sometimes, in the day to day challenges we forget how far we have come, how many challenges we have in fact overcome. The awareness of growth helps us to have confidence that we will continue to move toward greater levels of independence and to remember “the best is yet to come!” 

By Jim Durkel, CCC SPL/A and Statewide Staff Development Coordinator, TSBVI OutreachWith help from Jenny Lace, Gigi Newton, and Kate Moss, TSBVI Texas Deafblind Outreach

Originally published in the Fall 2003 See/Hear Newsletter

Abstract: This article discusses the importance of including auditory training in curriculum for students who are deafblind. It also offers some suggestions for activities and resources related to providing auditory training.

Key Words: deafblind, auditory training, auditory assessment, hearing aid, cochlear implant

Children who are deafblind need to develop skills in using auditory information. Children who are deafblind need to learn to use whatever residual hearing they may have for a variety of reasons including travel safety, identifying people, literacy, communication, and so forth. They also need to learn how to use adaptive devices and equipment such as cochlear implants, hearing aids, and voice output devices. Auditory skills development, just like visual skills development, requires well-thought-out instruction that is provided regularly and consistently throughout the child's school career. Learning to listen, a skill we all need help with, is a skill that is critical for these children.

Steps in Providing Auditory Training

For children with visual impairment or deafblindness the first step in auditory training is to provide access to as much auditory information as possible. If there is a hearing problem, this starts with the use of hearing aids or a cochlear implant. Key to the use of these devices is good behavioral audiological assessment. This is because the best hearing aid or implant fit can't be obtained without behavioral testing.

Any child who is unable to participate in pure tone conventional screening, may need the educational team to compile information about his functional use of hearing before going to the audiologist. Some of the same activities that teach listening can be used to check hearing. By including listening activities at a level appropriate to the child, the child will learn to respond better in more formal hearing assessment situations. The team that knows exactly what behaviors indicate a child with limited communication skills has heard something can be very helpful to the audiologist who may not know what to look for as a response.

The next step is getting consistent use of the device (implant, hearing aid) if the child needs one. A hearing aid or implant is of no help to the child if the child doesn't wear it regularly.

The third step (if the child has some type of device) is to establish a system of daily checks of the hearing aid or implant to make sure it is working properly. Wearing a broken device is an additional impairment to whatever residual hearing the child might otherwise have available to use.

It is important to understand that, even though a child consistently wears an appropriate device in good working condition, he may still not have the same access to auditory information as another child. Each child will have a unique blend of abilities in the areas of hearing, vision, thinking and communication. Some children can become very sophisticated users of a wide range of auditory information while other children may be able to learn to use some, but not as much, auditory information. However, any child will benefit from learning to use any and all auditory information they can.

After the hearing aid or implant, then what?

Auditory training does not end with putting on a hearing aid or implant. The child needs help to learn how to use the device and the information the device allows him to hear. The goal of auditory training is to help a student discriminate sound (in increasingly fine steps from gross sounds to speech) in order to gain meaning from the sounds he hears.

Goals at the highest level of auditory training focus on helping a child use speech. Using speech well requires a person to make very fine discriminations of pitch, loudness, and timing. When we hear a child give an appropriate verbal response to another person's spoken word or phrase (verbal stimulus), we know that he is making those fine discriminations. For most children the social benefits of responding to others' verbal communication is enough reinforcement that they learn quite naturally to make these discriminations and responses. For example, a baby eagerly says "bye-bye" again and again, just to trigger his grandmother's delight and keep her interacting when she announces it's time to go home.

Remember that auditory training is about helping a child make finer and finer discriminations. A gross discrimination is being able to recognize absolute quiet from a very loud sound. The sound is there or not there. A fine discrimination is the difference between the sound "s" like the first sound in "sun" and "f" like the first sound in "fun." Even people who are hearing have trouble hearing the difference between these sounds (especially over telephones!)

Moving from a gross discrimination like the presence or absence of sound, one step towards a finer discrimination would be to hear the difference between a loud sound and a quiet sound. The next step from there is to hear the difference between a loud sound, a medium sound, and a quiet sound.

Now, it is not just enough to be able to hear these differences. We want our to children to recognize why these differences are important. We want our children to respond in a way that demonstrates that sounds have meaning. For example, a car horn honking is important to pay attention to; it signals danger. A loud knock at the door or the sound of a doorbell lets you know that someone is outside and wants to come in for a visit. The telephone ringing, the sound of the alarm clock ring, and many other sounds have meaning in our world. Think of other situations where the presence or absence of a sound means something; all of these sounds can be used in auditory training and can be tied to real-life, functional activities for the child.

Of course, it is not fair to ask a child to make discriminations or responses that are beyond their ability. It would be like asking someone without eyes to read print (braille might be ok!) or asking a 6-year-old to play basketball like Michael Jordan. That's why it is important to start with gross discriminations, utilizing sounds you know that the child really can hear. You want the child to have success at each step in learning to use his hearing. When listening becomes too difficult or aversive, the child is likely to shut down. Listening should be a rewarding experience for the child.

Fitting Auditory Training Into the Child's Day

It is important to do a quick check of a child's auditory skills every day to make sure his or her hearing aid, cochlear implant, or assistive listening device is working. Doing this type of activity when the student arrives at school can catch problems with technology, but it also serves as a good time to tune the child into listening for voice. A quick way to do this is to use the Ling Six Sound Test. The Six Sound Test is used to determine the student's ability to detect and/or discriminate speech sounds. The six sounds are used because they cover the speech range from low frequency to high frequency. The six sounds are "a" as in "baaaa", "u" as in mooo, `e' as in we, "sh" as in shoe, "s" as in sun, and "m" as in mom. This test is given live every day voiced by the adult with the student's own hearing aids, cochlear implant, and/or assistive listening device.

First, check the student's amplification as you normally would. Then, as the student wears the amplification, say the six sounds either from behind or in front with your mouth hidden from view. Ask the student to respond in some way to the sounds such as clapping, raising his/her hand, jumping up and down, etc. This is done to test for detection. If you ask the student to repeat the sound you can test discrimination. It is important to be consistent. Always say the sounds at the same volume and distance from the student. However, vary the order in which you say the sounds every day.

If, all of a sudden, you notice the child not responding as well as they have been, it may be that the child's amplification is not working or the child's hearing has changed. (As might happen if the child has an ear infection.)

It often works best to have a regularly scheduled time to work on auditory training, especially if you are introducing a new activity. Sometimes this can be scheduled as a small group activity or can be done with an individual child. It is easy to turn listening into a fun experience or a game. A child with very little hearing can sit on the floor near the door and listen for you to knock. He can open the door and pretend to be surprised to see you. She can put the baby doll in a bed "to sleep" and make the baby wake up when the alarm goes off. A group of children can dance to the music and freeze when it stops.

Practice, throughout the day, on listening skills learned in more formal lessons helps the child generalize the skills. For example, the student can listen for the teacher to call his or her name to come line up. For the child with very beginning discrimination skills, the student can listen for a drum sound (off/on environmental sounds). Another child might be asked to listen for his name as you target the skill of off/on awareness of voices. For the child a little farther along, you might ask her to discriminate between names that are very different in length and vowel/consonant structure such as "John" and "Latisha." Another student might be asked to discriminate between a normal voice and a whisper or between two very similar names such as "Bill" and "Will." Letting the child play teacher and have the other children listen can also reinforce their interest in tuning into sounds.

Every lesson in school or every activity at home has potential for working on auditory skills. Have the child listen for a timer to go off to let you know that his oatmeal is ready. Ask the bus driver to honk his horn when he stops out front. Listen for the sound of Dad's truck when he comes home in the evening. (With the help of a cell phone you can even keep the wait short if he gives you a call when he is just down the street.)

Schools have bells and alarms of all kinds; practice listening for the bell to ring before you go to lunch. When the principal makes an announcement over the intercom, encourage the child who hears it first to alert his classmates. As you read "Three Billy Goats Gruff" have one child pretend to be the troll who hides under the bridge and listens for the sound of the goats tramping on the bridge. Have another child listen for the phrase, "Who's that tramping on my bridge?" before responding vocally. Point out sounds as you take a walk and tie them to the objects and events that make that sound such as a loud air conditioner, a noisy cart in the cafeteria, or the sound of a ball bouncing on the floor in the gym.

There is no limit to the number of activities that teach and reinforce listening skills. Every child with a visual impairment, even those without an identified hearing loss, needs to develop good auditory skills. These play a critical role in developing other skills related to literacy, problem solving, following directions, orientation and mobility, and socialization. The auditory channel is a critical sense for learning for a child with deafblindness.

A child may initially only be able to discriminate gross differences between sounds, but with a lot of auditory training he may learn to discriminate very slight sound differences, even with profound hearing losses. Without training, a child with a very mild hearing loss may have difficulty making sense of what he hears.

What Parents Should Discuss With Their Teams About Auditory Training

Both teachers of students with visual impairments and teachers of the deaf and hard of hearing know the importance of listening skills. If your son or daughter is visually impaired or deafblind you should think about how well the child is able to use hearing for learning. Many children should have auditory training goals included in the IEP. As parents, you may need to get some help in determining where to begin with your child.

Ask your team about how your child uses his hearing in the school setting.Observe situations at home or in the community where your child responds well to sounds or seems to have problems and share that information with your team.If he has not had a hearing check recently, you may want to consider having one done as soon as possible.


There are a number of great resources for teaching auditory training, if you and your team are ready to get started. Check with your school's speech therapist or teacher of the deaf and hard of hearing about materials they may have on hand to assess listening skills and ideas for auditory training activities. Here are a few resources that you may want to consider:


ASIPS _ Auditory Skills Instructional Planning SystemForeworksPost Office Box 82289Portland, OR 97282Phone: 503-653-2614

CASLLS - Cottage Acquisition Scales for Listening, Language & SpeechSunshine Cottage103 Tuleta DriveSan Antonio, TX 78212Phone: 210-824-0579 ext. 244 or TTY/ 824-5563

CHATS, the Miami Cochlear Implant, Auditory & Tactile Skills CurriculumIntelligent Hearing Systems7356 S.W. 48th StreetMiami, FL 33155Toll free: 800-447-9783Phone: 305-668-6102

DASL II _ Developmental Approach to Successful Listening IICochlear Corporation400 Inverness Drive South, Suite 400Englewood Colorado 80112Toll free: 800-523-5798Phone: 303-790-9010

SPICE _ Speech Perception Instructional Curriculum and EvaluationCID Publications4560 Clayton AvenueSt. Louis, MO 63110Toll free: 877-444-4574 (ext. 133)

Computer related

Visi-Pitch IIIKay Elemetrics Corp.2 Bridgewater LaneLincoln Park, NJ 07035Phone: 973-628-6200

This device is only good for use with children who have useable vision. This is a device that provides visual feedback to sounds the child produces, but it can aid the child in paying attention to speech sounds.

Earobics Software (Home version and Specialist/Clinician versions)Cognitive Concepts990 Grove StreetEvanston, IL 60201Toll free: 888-328-8199

This device is only good for use with children who have useable vision. This software has games and activities to work on higher level auditory training skills.

Reader RabbitRiverdeep - The Learning Company, Inc.399 Boylston StreetBoston, MA 02116Phone: 617-778-7600

This device is only good for use with children who have useable vision. This software has games and activities to work on higher level auditory training skills.


Last Revision: September 1, 2010

Banner Photo O&M Page

This page is a place to find resources and information related to Orientation and Mobility. The information and resources found here are intended for the whole Team: professionals, families, and students. This page is intended to provide access to a wide variety of information and resources related to students with visual impairments and deafblindness. Please send ideas for additional resources or features you would like included to Outreach Statewide Orientation and Mobility Consultant, Chris Tabb at .

Quick links for sections on this page:


Blogs, Listservs, and LiveBinders

Education Codes And Legal References

IDEA, Related Services (Sec. 300.34)

Texas Education Code (Specific to Children with Visual Impairments, Sec. 30.002)

Q&A: Expanded Core Curriculum Instruction and Orientation and Mobility Evaluations (Word Format)

Region 18 Legal Framework - summarizes federal and state law by topic

TEA Special Education Rules and Regulations - a resource for federal and state laws, rules, and regulations that covern the delivery of special education servcies in public schools. (As of April 4, 2014 has not been updated to reflect changes related to HB 590 or SB 39.)

Pedestrian Laws in Texas (Sec. 552.010 specific to Blind Pedestrians)Sec. 552.010 specific to Blind Pedestrians)

White Cane Definition and Service Animals in Texas (Sec. 121.002, Sec. 121.005, and Sec. 121.006)121.002, Sec. 121.005, and Sec. 121.006)


Teaching Age-Appropriate Purposeful Skills (TAPS) Texas School for the Blind and Visually Impaired (TSBVI) resource that is an Orientation and Mobility Curriculum for Students with Visual Impairments and includes activities and suggestions instruction, assessment, writing evaluations, street crossing details, working with students with ambulatory devices, the list goes on, and on, and on.

Orientation and Mobility Visual Impairment Scale of Service Intensity of Texas (O&M-VISSIT) The O&M VISSIT: Orientation & Mobility Visual Impairment Scale of Service Intensity of Texas is designed to guide orientation and mobility (O&M) specialists in determining the type and amount of itinerant O&M services to recommend for students on their caseload.

New Mexico School for the Blind Orientation and Mobilty Inventory Another option for ongoing evaluation of students' present levels of performance and a terrific tool for planning appropriate goals and objectives.

Guidelines and Standards for Educating Students with Visual Impairments - a "go-to" document for everything about serving students with visual impairments.

Benefits of O&M

General Orientation and Mobility Recommendations for Functional Programs

Michigan O&M Severity Rating Scale 2013 - two downloadable intensity of service scales from the Michigan Department of Education. One for students with visual impairments (OMSRS) and one for students with visual impairments and additional disabilities (OMSRS+).

T-TESS Texas Teacher Evaluation and Support System for COMS as a PDF document

Introduction to T-TESS for COMS document for COMS and Administrators PDF

Professional Development Assessment System (PDAS) Companion for VI Professionals: Certified Orientation and Mobility Specialists (COMS©)

VI and O&M Preparation in Texas

What Should I Charge for Contractual Services? (Word or PDF)

What is the Expanded Core Curriculum (ECC)?

Training Events

Southwest Orientation and Mobility Association (SWOMA) is a Southwest regional conference. SWOMA typically occurs annually in or near the beginning of November. Visit the SWOMA Conference Page for additional information.

For other training opportunities around the state and nation, please see the Statewide Calendar of Training Events.


TSBVI's Online Learning, Orientation and Mobility

International Orientation and Mobility Online Symposium (IOMOS), Recorded Sessions

Washington State School for the Blind, "Video Clips on Blindness Tips"

Guide Technique from Project IDEAL

How a Blind Person Uses a Cane from BreakingBlind

How To Offer Help To A Blind Person

O & M Video for Parents from Arkansas School for the Blind

Wheelchair Orientation and Mobility from Perkins

Lighthouse O&M Folding Cane Construction from East Texas Lighthouse for the Blind in Tyler

Lighthouse O&M Escalator Training from East Texas Lighthouse for the Blind in Tyler


Perkins E-Learning Webinars

Paths To Literacy (Collaborative between Perkins and TSBVI)

Paths to Technology

An Introduction to Orientation and Mobility Skills- Vision Aware

Perkins Scout Orientation and Mobility- Perkins School

Cane and Compass - Blog posts and lesson ideas for Orientation and Mobility



(Originally published in Summer 2005 SeeHear Newsletter)

By Jim Durkel, CCC-SPL/A, Texas School for the Blind and Visually Impaired Outreach (with help from and thanks to Kate Moss (Hurst), TSBVI Outreach)

Abstract: This article defines the difference between formal audiological hearing tests and functional, or informal, hearing tests and describes how information from these assessments can be shared to meet the needs of a child.

Key Words: programming, audiological test, functional hearing, auditory functioning, deaf, deafblind


The term functional hearing is being used more and more often these days. What does it mean? What is functional hearing and how is functional hearing determined?

Formal audiological tests stand in contrast to “functional” tests of hearing. This is a bit misleading and unfair to standard tests since they can give a great deal of information about the functioning of the auditory system. A better distinction might be formal versus informal. This informal process is a way of gathering information about how students use their hearing to gather information and how they make meaning out of this information in different environments across the day.

Formal Audiological Tests

There are 2 major categories of formal audiological testing: physiological tests and behavioral tests.

Physiological Tests

Physiological tests include auditory brainstem response testing (ABR or BSER), oto acoustic emission audiometry (OAE), and tympanometry. These tests are functional in the truest sense of the word: they describe the neurological or mechanical functioning of the auditory system. They do not involve active participation of the person being tested. Audiologists can hypothesize about how results on these tests will affect an individual’s use of auditory information but there is not an exact one-to-one correspondence between neurological or mechanical function and what an individual can and can not do with his or her hearing.

Behavioral Tests

Behavioral tests require the participation of the individual being tested. The most common behavioral tests involve pure tones. Pure tones are sounds generated by a machine. These sounds are very controlled for their pitch and loudness. Pure tones do not exist in nature. Even individual musical notes are not pure tones. All natural sounds, especially speech, contain a combination of different frequencies (pitch) of varying intensity (loudness). During pure tone testing, audiologists are trying to find an individual’s threshold at various frequencies. Threshold is the intensity level where a sound can just be detected. There is not an exact one-to-one correspondence between auditory thresholds and what an individual can do with her or his hearing, but pure tone testing is important to use as a starting point for predictions and to use as the basis for hearing aid fitting. Procedures very similar to pure tone testing are also necessary for the fitting of cochlear implants, during the procedure known as mapping.

Pure tones can be delivered to the ear either through the air, by using headphones or speakers, or through bone conduction, which involves a special vibrator being placed on the head. Differences in air conduction and bone conduction thresholds give information to audiologists and doctors about what part of the auditory system might be having difficulty.

There is another type of behavioral testing that many students with deafblindness never have administered. Instead of using pure tones, speech is used. Using speech, an audiologist can determine:

a speech detection threshold (how loud speech needs to be for a person to just detect it),a speech reception threshold (how loud a special type of 2-syllable word needs to be before an individual can correctly identify a specific proportion of them), andspeech discrimination (what percentage of words at a fixed loudness an individual can correctly identify).

Unfortunately, the measure that is the most like “the real world”, speech discrimination testing (especially when done in the presence of noise), is also the most difficult. This is because the individual who is being tested needs to be able to repeat words, write words, or point to pictures of words. Speech discrimination testing is very important to good hearing aid fitting and in the on-going adjustment of the speech processor component of a cochlear implant. Many children with significant multiple disabilities are not able to participate in speech discrimination testing.

Again, there is not an exact one-to-one correspondence between these formal audiological tests and every day use of hearing. Then why do these tests?

Both physiological and behavioral tests were designed to give specific information about the auditory system. The conditions under which they are given and the type of input used is carefully controlled so that results of one person’s tests can be compared to another person’s tests. And so that performance on a test one day can be compared to performance on the same test on another day. This gives us the opportunity to talk about the integrity of the auditory system with as little regard to other factors, such as cognitive or physical ability, as possible. The advantage of this is that we can identify where in the auditory system a problem might exist. This has very important medical implications and for this reason alone formal audiological testing should never be replaced with informal testing. The two kinds of testing are complementary.

Formal testing allows for the careful evaluation of hearing aids and the adjustment of cochlear implants. Finally, while pure tone testing done in an audiological test booth is a different listening situation than trying to carry on a conversation in a car, pure tone tests can give a ballpark prediction of the success of that conversation. Physiological and behavioral tests give us a very important starting point.

Listening in the Real World

What is it about “real world” listening situations that make predications from formal tests inexact? There are three factors to consider: the source of the sounds, the environment, and the listener.

Sound Sources

Sound is not simple and speech, the sound we often are most interested in, is the most complex. Speech contains a mix of sound energy at different frequencies and this information changes very rapidly. This mix and these changes allow us to hear the difference between the various vowels and consonants. We then have to assign meaning to the speech sounds we hear. This takes cognitive ability. Finally, to create those sounds ourselves takes motor ability and then auditory ability again as we monitor our own speech.

It is important to understand that being able to detect a sound is a different skill than being able to discriminate a sound. I may be able to hear the presence of a sound because it contains energy in a range my auditory system can handle. But if my auditory system can’t give me the whole picture, if I can’t hear all the energy in that sound, I may not be able to hear how it is different from another sound. Talking over the telephone is an example of this. Telephones do not allow the full range of sound energy to go through. Some high frequency information is taken out so that the telephone can work more quickly. This is why the word “fin” can easily be confused with the word “sin”, or “thin”. You can “hear” (detect) the word but have trouble discriminating (understanding exactly what is heard).

A person with enough speech and language experience, often can “fill in” pieces of what was not heard. For example, someone may call to me from another room and all I can hear is, “Do you have the _og?” Now if I know the other person is trying to light a fire in the fireplace, I will fill in the blank and “hear” log. However, if I have just been petting my German Shepherd, I will probably “hear” dog. This effect of experience and context on hearing is just one reason why formal tests don’t predict use 100%. Experience also helps us interpret other sounds we hear. Before cell phones were common, how many of us knew what those sudden noises coming out of nowhere meant? Why would I pay attention to a doorbell if I grew up in a house that only had a doorknocker? I always think Harley Davidson motorcycles sound like they are broken. This is because they normally sound like my car does when its muffler has fallen off. How many of us think rap music is noise but rock and roll is here to stay?

The Environment

The environment in formal audiological testing is very controlled. Typically, there is little competing visual or tactual information and the room is treated to eliminated noise and echo. Now think of a child’s typical listening environment where there are all kinds of competing sights, sounds, smells, and touches. Some children may get so neurologically “distracted” by what they see that they appear “deaf” in typical listening environments but appear to hear just fine in formal testing environments. On the other hand, it is not uncommon for a listener to use other senses to help support and confirm what was heard. For example, people with Usher syndrome often think their hearing is getting worse when really the hearing loss is stable and it is their visual skills that are declining. These individuals have been using visual information to support their hearing for so long they are unaware of doing so.

The Listener

Finally, there is the listener. Part of the “art” of formal behavioral tests is discovering how to motivate a listener to participate in what is a fairly boring, uninteresting task. The formal testing situation may be so unfamiliar to the child being tested that it is scary. Formal testing may be associated with unpleasant experiences in a doctor’s office. The amount of time allotted for the testing may be too short to allow the child to be comfortable or so long that the child’s participation wanes. The time of day of the testing appointment may not be the time that the child is the most alert. Formal testing often treats the child as if he or she were only a pair of ears and ignores the rest of the child.

The Informal Hearing Assessment Process

The goal of informal hearing process is to:

develop an idea of how the child uses his or her hearing in various environments across the course of the day; andtry to discover what variables support the best use of hearing in order to continuously improve the use of hearing.

During the process, observation will be used to determine what, if any, sounds the child seems to react to and what, if any, meaning the child is getting from auditory information. Observation, of course, is also supported with information from formal hearing tests. Observation also includes setting up situations and seeing how the child responds.

Step 1: General Functioning

The first step of informal hearing assessment is getting an idea of the general functioning of the child.

Does the child show any awareness of any sensory information (visual, tactual, etc.)?How does the child show that awareness?What motor behaviors seem to indicate that the child was aware of and responding to sensory information?

Without this information, you can’t tease out hearing from other factors.

Good questions to ask at this point are:

What does the child do with sensory information?Has the child learned (or can she learn) to associate movement cues with a pleasurable activity?Does the child show anticipation of an event from seeing or touching an object?

Step 2: Responses to Auditory Information

Now you can ask:

Does the child show anticipation or recognition through the use of hearing? That is, does the child anticipate an event when they only hear a sound associated with that event (before they see or touch something associated with the event)?What sounds does the child respond to?

Step 3: Looking for Patterns

At this point, we are looking for patterns of responses. We are trying to find out which sounds under what conditions give the best (easiest to see, most consistent, meaningful to the child) responses.

Is there a difference in performance based on the types of sounds?low pitch vs. high pitchonset vs. cessationsimple vs. complex (for example, one instrument vs. orchestra)rhythmsloud vs. softlong vs. short (duration)Are there any clear preferences?people’s voices (male/female, young/old, familiar/unfamiliar)types of musicmusical instrumentsobjectsIs there a difference in performance in different environments?quiet vs. noisyechocompeting (or supporting) information from other sensesIs there a difference in performance depending on where the sound comes from?in frontbehindrightleftabovebelowHow long after the input does it take for a typical response to occur?Do responses varyacross different environments? (indoors, outdoors, hallways, carpeted room, tiled rooms, etc.)at different times of day?before or after meal time?before or after receiving medication?with the physical position of the child?

Natural observation (doing nothing but watching the child) might not give you all the information you need at this point. Using information from formal hearing tests, you might want to set up some situations to help you observe patterns. For example, the results of formal hearing tests may indicate that the child should be able to hear loud low frequency sounds, like a drumbeat. You then might want to set up a simple turn taking game involving the beating of a drum to see if the child will listen while you beat a drum then take a turn and beat a drum after you stop. If the child can do this, then you might want to try similar games with other sounds that vary by pitch and loudness to see what sounds the child can use and which he or she can’t. Of course, it may take several repetitions of the game, across several days or weeks, before the child learns their role.

Step 4: What Does It Mean to the Child?

The next step is to ask, “How does the child use auditory information?”

At a reflexive, awareness level? Does the child startle to sound but otherwise not pay much attention?At a regulating level? Does sound help the child enter and maintain a quiet and alert biobehavioral state? Are there sounds that send the child into a fussy, agitated state?At a motor level? Does the child turn towards or reach for an object or person making a sound, even if the child can’t see or touch the sound source?At a play level? Does the child enjoy making noise, either with his or her mouth, by activating switches, hitting two objects together, playing musical instruments, etc.At an associative level? Does the child associate a particular sound with a particular event?At a communication level? Does the child recognize any common words, especially his or her name? Does the child try to use any sounds consistently to communicate?

Step 5: Where Do We Go From Here

Gathering this information over time can help guide programming for the child. Information from steps 1-4 should give an emerging picture of what is meaningful to the child. This information should guide our next steps: that is, how do we help the child use a greater and greater variety of auditory information in more and more situations and with better precision and in more and more sophisticated ways. Informal information should be shared with audiologists to help them in the process of deciding how well a hearing aid or cochlear implant is meeting the needs of a particular child and if adjustments need to be made. Information from the informal hearing assessment process can also help guide the formal hearing assessment process by letting the audiologist know typical kinds of responses a particular child might make to various kinds of auditory input.


There is a book, Every Move Counts, by Jane Korsten (Therapy Skill Builders, 1993) that outlines a process that can be useful for gathering information. Every Move Counts deals with all the senses, not just hearing.

Another soon to be released product that helps look at how a child uses sensory information is the “Sensory Learning Kit”, (Millie Smith, primary author) from American Printing House for the Blind. This product should be available sometime in 2006.

Finally, is “A Process for Identifying Students Who May Be At-Risk for Deafblindness”. This is a collection of information and downloadable forms that can be used to support the gathering of information in an informal way.

Teachers for the deaf and hard of hearing typically have training to help look at auditory functioning in this informal way. They may be a valuable resource in this process.

Summer 2001 Table of Contents
Versión Español de este artículo (Spanish Version)

By Craig Axelrod, Teacher Trainer, TSBVI, Texas Deafblind Outreach
A version of this article appeared in the April 1994 edition of P.S. News!!!

Editor's note: This article is based on information presented by Ray Condon at a workshop in July 1993.

"Oh those sleepless nights will break my heart in two." Truer words have ne'er been spoken, particularly by parents of children with disabilities. While anyone might find a night of restful sleep elusive, it can be a unique challenge for children with disabilities, and their families.

When looking for causes and solutions to a problem like this, parents and school staff should work together as a team. A team will be best able to develop an intervention plan that succeeds. The kinds of stimulation provided at school during the day influence a student's ability to sleep at night, and a sleepy student has difficulty learning. A child's sleep problem is everyone's problem.

What Is Sleep?

Identifying some common facts about sleep will help distinguish general characteristics that most people experience from problems unique to children with disabilities.

  1. The function of sleep is controversial. Some people believe sleep is an internally controlled period of non-responding, during a phase of the circadian cycle, that promotes energy conservation. Others think sleep is a restorative or balancing process that occurs after energy consumption. Everyone agrees that sleep is a state of consciousness.
  2. Sleep occurs in repeating 70 to 100 minute cycles of two states, REM and non-REM. In the REM state, when dreaming happens, the brain is active but the body is effectively paralyzed. In the non-REM state, muscles are relaxed but can move. This state (in 4 stages from drowsy to deep sleep) may serve a restorative function, and is most typically identified as sleep.
  3. Circadian cycles are repeating biological cycles approximately 25 hours long, in which sleep, waking, alertness, activity, rest, changes in body temperature, hormone release and many other body functions take place. This cycle is reset daily to the 24 hour clock by internal processes and external cues such as daylight and darkness, mealtimes, social structures, bedtime and especially time of waking. Daily routines are critical for resetting the biological clock, because external cues influence a body's internal processes. Chronically delayed sleep can lead to reversal of a person's daily schedule.
  4. Wakings and arousals, typically 3 to 7 per night, are normal for children and adults. They're most likely to happen at the end of a REM state and, among other things, enable us to change positions in bed. Usually we're unaware of them and resume sleeping within a few seconds. Problems can arise when a person has difficulty going back to sleep after an arousal.
  5. People require varying amounts of sleep and generally need less sleep with age. Fragmented or fitful sleep is more common after age 7, and especially for people over 45.
  6. Most children sleep deeply during the first and last few hours of night, and more lightly between those times.
  7. Sleep/wake cycles can be easily disrupted in people sensitive to change. Irregular sleep/wake patterns lead to significant alterations in a person's mood, energy level, sense of well being and ability to learn new information. A tired child may not act tired, but be irritable, inattentive, impulsive, aggressive, hyperactive or socially withdrawn. Behavioral indicators like these might suggest a sleep problem.
  8. Causes of disrupted sleep differ between people. An individual's sleep history can be looked at to help identify patterns of problems.

Sleep Problems of Children with Disabilities

Though much has been published about the sleep and sleep problems of adults and children, there's little information about sleep-related issues of children who are visually impaired or deafblind. A review of several studies, however, indicates that children with disabilities are more likely than those without disabilities to have sleep problems.

Our environment provides many cues that help us wake up, stay awake during the day and go to sleep at night. The communication difficulties often experienced by a child with multiple disabilities make understanding and appropriately responding to these cues more challenging. Other factors can also effect sleep. For example, the medication a child is taking may cause daytime drowsiness. A child with high or low muscle tone might be unable to independently change positions in bed, which is important for a good night's sleep. Some children with profound disabilities have difficulty intentionally regulating their levels of wakefulness and move through sleep, drowsiness, alertness and agitation, independent of environmental cues. Individuals who are totally blind experience a high incidence of sleep phase disorder (where days and nights are gradually reversed), in part because they don't receive the light cues that influence their circadian rhythms.

Some of the sleep concerns often identified by parents of children with deafblindness include night wakings, reversed schedules (sleeping in the day), whether or not to use medication, irregular and fragmented sleep, difficulty falling asleep, short durations of sleep, night wandering, extensive screaming or crying at night, and sleeping with parents.

Children may never outgrow their sleep problems, but many situations can be improved with intervention. It's important to see a sleep problem as symptomatic of one or more other problems, then identify and address those problems. Often there are no easy answers, but regular contact between the parents and professionals trying to resolve a persistent sleep disturbance helps everyone on the team stay energetic and optimistic. An outside consultant can contribute objectivity and perspective to a team's overall game plan. In some cases, this may be all that's needed to solve a child's sleep problem. When seeking assistance from the medical profession, it's difficult to find a person with both an understanding of sleep disorders and experience helping children who have multiple disabilities. A knowledgeable professional, with the interest and willingness to work as part of a team, can be a valuable resource. The American Academy of Sleep Medicine has information about sleep disorder clinics in Texas, and can be contacted at:

American Academy of Sleep Medicine
2510 North Frontage Road
Darien, IL 60561
Phone: (630) 737-9700

Pencil line drawing of boy in bed."Sleep is Boy"
Wendy Haynes

Exploring Sleep Behaviors

Sleep disorders are behaviors, triggered and maintained for specific reasons. After the possible causes for a behavior have been identified, intervention strategies can be designed.

Sleep Hygiene

As mentioned earlier, sleep patterns are influenced by external conditions and events. Setting up and maintaining good "sleep hygiene" is the first step in addressing a child's sleep problem. Factors that will improve sleep include good health, exercise, a meaningful and consistent daily schedule, a balanced diet and appropriate amounts of food, a bedtime environment that encourages sleep, and a pleasant, relaxing sequence of activities in the hour before bedtime.

Collecting Information

In addition to establishing conditions that make sleep more likely, it's helpful to systematically collect information about a child's sleep behaviors. Doing this will help indicate tendencies and patterns that might not be seen if memory alone is relied upon. Clearer understanding of a sleep problem's causes will make successful intervention more likely. Since improvement and change can be slow, documentation also charts progress. In addition, this information will highlight the severity of a child's sleep problem. A child who is routinely awake at night, and sleeping during significant portions of most school days, is not learning very much. An intervention strategy coordinated between school and home will improve the quality of this student's education. A "Daily Sleep Diary," completed over a period of time, can help provide a picture of current and changing sleep behaviors.

Daily Sleep Diary

Name:___________________ Date:___________________

Planned Bedtime:__________ Actual Bedtime:__________

 cooperatedresistedresisted strongly
Cooperation going to bed:      
Cooperation staying in bed:      


Night wakings:beginendtotal time
    Total time slept (naps and night sleep):  

End of sleep - Wake-up time: _____________

Total amount of night sleep (minus night wakings): ________________

Child's mood upon final awakening: __________________________________________

Napsbeginendtotal time
    Total time slept (naps and night sleep):  

Comments and observations:_______________________________________________

Children generally sleep less as they become older, but each child's sleep requirements are unique. Knowing the total amount of time that your child sleeps in a day will have implications for intervention. For example, because naps taken during the day count toward the total number of sleep hours, eliminating daytime naps may help some children sleep better at night. Or, moving naps from 4:00 p.m. to 2:00 p.m. might improve sleep onset at bedtime.

The time a child is awakened is one variable that can be externally controlled and followed consistently. A routine weekday wake up time that changes over the weekend may make adjustment to Monday mornings more difficult.

A child's mood upon final awakening in the morning will be one measure of the previous night's quality of sleep.

Interpreting Information

Now that sleep information has been collected, the "ABC Record of Sleep Problems" can help pinpoint possible reasons for the problem behavior or behaviors. In some cases, an event occuring prior to a sleep problem could be causing the problem sleep behavior. Changing one or more preceding events may make the behavior less likely to occur. A child who roughhouses with siblings before going to bed (antecedent), then remains awake for several hours (behavior), might fall asleep more easily if activities before bedtime are less energetic. In other situations, reinforcing consequences may motivate a child to repeat a behavior. A child who is given a snack (consequence) after getting out of bed (behavior) might learn to get out of bed more frequently. Behaviors won't appear as often when their consequences are less rewarding, especially if effective, more appropriate alternative behaviors are taught.

ABC Record of Sleep Problems

Name:_____________________________ Date:___________________

Describe what happened before the behavior occurred (what, who, where and when). Describe the behavior (include how it began, as well as its intensity, how long it lasted and how many times it occurred). Describe what happened after the behavior occurred (any change in the environment or reactions from people). Why did my child behave in this way? What did the behavior accomplish?

Intervention Techniques

Sleep problems have traditionally been addressed differently by the medical and behavioral communities. Recently though, these approaches have become more consolidated.

Behavioral Intervention

Information collected in the "Daily Sleep Diary" and "ABC Record of Sleep Problems," will help the team identify patterns of problems and possible interventions. Any program that's implemented must be individualized for each child's needs and circumstances. Several intervention plans are described below. Each has a different goal and procedure for addressing a particular sleep problem. A mix and match approach might be helpful. When teaching a child new behaviors, the positive attitude of parents, teachers and other team members is crucial for success. An intervention plan should be implemented at a pace that's comfortable for all participants.

1. Positive Bedtime Routine

Problem: Bedtime resistance

Goal: To teach a child bedtime cooperation


  1. Determine child's natural bedtime
  2. Develop a 20 minute fixed sequence of enjoyable, calming prebed activities (warm bath, lotion rub, story time in a rocking chair, etc.)
  3. Begin the sequence 20 minutes before child's natural bedtime
  4. Follow the sequence and praise child for completing each activity, including going to bed

Things to consider: Prebedtime routines will prepare a child physiologically and behaviorally for bed. Calming activities can be identified and learned at school, then practiced at home during the bedtime sequence and at other times.

2. Graduated Extinction

Problem: Bedtime resistance and night wakings

Goal: To gradually withdraw the consequences maintaining a problem behavior and help a child accept change calmly through "progressive learning."


  1. Implement good sleep hygiene practices
  2. Determine when child should go to bed
  3. Put child to bed; if tantrums persist after 1 to 2 minutes, provide neutral reassurance; repeat as often as necessary
  4. Over time, ignore tantrums for increasingly longer intervals, up to a maximum of 20 minutes
  5. Respond consistently within each episode

Things to consider: A calm child will return to sleep more easily than one who becomes upset.

3. Extinction

Problem: Bedtime resistance and night wakings

Goal: To totally withdraw the consequences that maintain a problem behavior through "planned ignoring"


  1. Implement good sleep hygiene practices
  2. Determine when child should go to bed
  3. Put child to bed and ignore tantrums
  4. If child gets out of bed, direct child to return with minimal attention or interaction
  5. Respond consistently in every episode

Things to consider: Extinction may work with some children, especially those who are younger, nonambulatory, and/or not "fighters." Other children might continue struggling, then become physiologically agitated and difficult to calm.

4. Scheduled Awakening

Problem: Night arousals and night wakings

Goal: To retrain a child who regularly wakes up spontaneously to awaken under new conditions


  1. Determine time(s) child routinely wakes up
  2. Awaken child 15 to 30 minutes earlier
  3. Follow a routine procedure with awakened child (hold, console, change diaper, etc.)
  4. Return sleepy child to bed

Things to consider: A child who associates waking up with reinforcing consequences (parents come, play, snack, etc.) is conditioned to be awakened by parents. After the initial retraining, time intervals between awakenings are gradually increased.

5. Bedtime Fading

Problem: Bedtime resistance and night arousals

Goal: To shift a child's natural bedtime to a more acceptable time and reduce night arousals


  1. Eliminate all daytime sleep (sleep restriction)
  2. Determine child's natural bedtime within 15 minutes
  3. Follow positive bedtime routine sequence. Begin the sequence 20 minutes before child's natural bedtime
  4. If child falls asleep within 15 minutes, begin the sequence 15 to 30 minutes earlier the following night
  5. If child does not fall asleep within 15 minutes, begin the sequence 15 to 30 minutes later the following night, then return to step 4 when child begins sleeping

Things to consider: External circumstances and habits can help build associations about going to sleep. It's important to continue increasing the percentage of successful bedtime experiences.

Whatever intervention strategy is attempted, it's important to negotiate a level of cooperation acceptable to both child and adult, then slowly increase expectations. Mutual support between adults is also essential for maintaining perspective, confidence and calm.

Medication and Chemical Intervention

If all other attempts at finding a solution through behavioral intervention have been unsuccessful, the use of medication may be appropriate as a final resort. Medication alone is of limited benefit. It might be a short term solution that provides temporary or intermittent relief from insomnia, or may be used in combination with a more permanent behavioral retraining approach that changes a persistent pattern. When administered over a long period of time, medication can sometimes actually be counterproductive to sleep. It may cause "rebound" insomnia, impede or impair the quality of a person's sleep, and/or produce adverse side effects. Tolerance to medication might also develop, making increased dosages necessary for achieving desired results. Before experimenting with medications or nutritional approaches such as vitamins and herbal remedies, consult with a neurologist, psychiatrist, or physician familiar with sleep disorders.


While learning to get a good night's sleep may be a slow, labor intensive process for you and your child, the results will be well worth the effort. Good luck, good night and sweet dreams!


Adams, L. A. & Rickert, V. I. (1989) Reducing bedtime tantrums: comparison between positive routines and graduated extinction. Pediatrics, 84, 756-761.

Durand, V. M. & Mindell, J. A. (1990) Behavioral treatment of multiple childhood sleep disorders. Behavior Modification, 14, 37-49.

Ferber, R. (1985) Solve Your Child's Sleep Problems. New York: Simon and Schuster.

Finnie, N. R. (1975) Handling the Young Cerebral Palsied Child at Home. 2nd Edition. New York: E. P. Dutton.

Nakagawa, H. Sack, R. L. & Lewy, A. J. (1992) Sleep propensity free-runs with the temperature, melatonin, and cortisol rhythms in a totally blind person. Sleep, 15(4), 330-336.

Palm, L., Blennow, G. & Wetteberg, L. (1991) Correction of non-24-hour sleep/wake cycle by melatonin in blind retarded boy. Annals of Neurology, 29(3), 336-339.

Piazza, C. C. & Fisher, W. (1991) A faded bedtime response cost protocol for treatment of multiple sleep problems in children. Journal of Behavioral Analysis, 24, 129-140.

Rickert, V. I. & Johnson, M. C. (1988) Reducing nocturnal awakening and crying episodes in infants and young children: A comparison between scheduled awakenings and systematic ignoring. Pediatrics, 81, 203-212.

Stores, G. (1992) Annotation: sleep studies in children with a mental handicap. Journal of Psychology and Psychiatry, 33,1303-1317.

Tzischinsky, O., Skene, D., Epstein, R. & Lavie, P. (1991) Circadian rhythms in 6-sulphatoxymelatonin and nocturnal sleep in blind children. Chronobiology International, 8(3), 168-175.

by Jim Durkel

What is a portfolio?

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

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

Why create a portfolio?

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

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

What can be in a portfolio?

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

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

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

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

Some hints for organizing the portfolio

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

(Originally published in the June 1994 edition of VISIONS)

Summer 99 Table of Contents
Versión Español de este artículo (Spanish Version)

By Debra Sewell, Teacher Trainer, TSBVI, VI Outreach

Although children play purely for pleasure and not for any goal-directed purpose, they acquire numerous skills during play; Creating fantasies, pretending, interacting with others, moving their bodies, and exploring their environment provide many opportunities to learn. It is important to keep in mind, however, that many children with visual impairments and/or multiple impairments will need to learn "how" to play with toys and games appropriately, as they don't learn this by watching others.

Many games encourage children to develop basic cognitive concepts, e.g. recognition of letters, numbers, colors, shapes, and textures, while also promoting important social skills, such as taking turns, interacting with peers, and participating in group activities.

The following is a list of a few games and skill areas. These are readily available in toy stores and can be played by most blind children with no special adaptations.


Skill Area

Simon Auditory Memory
Perfection Fine Motor
Cootie Fine Motor
Don't Spill the Beans Fine Motor
Hot Potato Social Interaction


Musical/auditory toys are important for a visually impaired child as they offer auditory feedback and stimulation. There are many commercially available musical toys that are designed for a wide range of developmental levels. Chime toys, music boxes and musical instruments are good for developing fine motor skills and wrist rotation, and also learning about cause and effect.



Keyboards Finger Strength and Finger Isolation
Wind Instruments Lip Closure and Breath Control
Instruments to tap (e.g. drums, sticks, blocks, etc.) Bimanual Control
Instruments to Shake Cause and Effect Concepts
See 'n Say Bilateral Hand Use
Spinning Tops Arm and Hand Strength
Jack-in-the-Box Wrist Rotation
Busy Poppin' Pals Various Hand Skills

The selection of games is very important. The games should be aimed at the appropriate developmental level of your child, and adaptations should be made so they are suitable for a particular child, if necessary. Most importantly, the games should be playable with nondisabled peers.

In addition to using games that need no modifications, there are numerous adaptations that can be made to games that will allow blind and visually impaired children access to a wider range of recreation/leisure activities.

Some of these adaptations are:

  1. Divide sections of game boards with glue, or various textures.
  2. Add braille labels to sections of game boards.
  3. Use velcro in sections of game boards and on bottoms of playing pieces.
  4. Braille the instructions and the game cards 
  5. Tape record game instructions.
  6. Braille regular playing cards or game cards such as Uno.
  7. Use textures or glue to mark differences in game pieces.
  8. Add brightly colored stickers to game pieces and game sections.
  9. Mark dice with braille labels or glue dots.
  10. Make a Tic-Tac-Toe board with a cake pan and magnet strips.
  11. Divide checkerboard with glue and mark red playing pieces with texture.
  12. Play Tic-Tac-Toe with pegs and pegboard.
  13. Use a large box lid to define playing space.
  14. Keep score with peg boards, paper clips clipped to index cards or tokens dropped into a container.

Most of these ideas are for adapting commercially available games. Adapted games such as Scrabble, Bingo, Tic-Tac-Toe, Checkers and large print and braille playing cards are also available through the following distributors:

American Foundation for the Blind
11 Penn Plaza, Suite 300
New York, NY 10001
(212) 502-7600
(800) 232-5463

American Printing House for the Blind
1839 Frankfort Ave.
Louisville, KY 40206
(502) 895-2405

(800) 388-3224

Spring 2003 Table of Contents
Versión Español de este artículo (Spanish Version)

By Eva Lavigne and Ann Adkins, TSBVI Outreach

Parents and teachers of students with visual impairments often have questions about how the choice is made regarding a student's literacy medium. They express concerns about whether a student should be primarily a print reader or a Braille reader, and want to know how and when decisions about reading media are made. Dr. Phil Hatlen, Superintendent of the Texas School for the Blind and Visually Impaired, addressed this issue in a previous See/Hear article (Winter, 2001), and stressed the importance of the Learning Media Assessment (LMA) and the role of the teacher of the visually impaired. While the definition and purpose of the LMA are clearly defined by State Board of Education (SBOE) rules and the Individuals with Disabilities Act (IDEA), a definition of literacy is not always easily understood, especially for visually impaired students.

What is the Learning Media Assessment (LMA)?

A learning media assessment is mandated in the State Board of Education Rules for each student who is referred for an initial evaluation to determine eligibility as visually impaired. It is also required every three years as part of the reevaluation process to maintain eligibility. Best practices indicate that the learning media assessment should be an ongoing process and it should be updated as often as needed, sometimes annually for very young students or those whose needs and abilities change.

All students who are referred for evaluation or reevaluation to determine eligibility as visually impaired must receive a learning media assessment conducted by a certified teacher of students with visual impairments. It must include:

  • Recommendations for the use of visual, tactual, and auditory learning media.
  • A recommendation for ongoing assessment when it is needed.
  • A determination of the student's primary learning medium to decide whether the student is functionally blind.

The LMA gathers three types of information on each student:

  1. The efficiency with which the student gathers information from various sensory channels: visual, tactual, and auditory
  2. The types of general learning media the student uses, or will use, to accomplish learning tasks
  3. The literacy media the student will use for reading and writing

The LMA focuses on two phases:

  1. The selection of the initial literacy medium (this phase begins at infancy and continues through the beginning of formal literacy instruction).
  2. The continuing assessment of literacy media (this continues throughout the student's school years).

The learning media assessment is "an objective process of systematically selecting learning and literacy media" (Koenig and Holbrook). This includes the total range of instructional media needed to facilitate learning, and is understandably different for each student. It consists of general learning media (instructional materials and methods) and literacy media (the tools for reading and writing). Instructional materials can include a range of options, such as pictures, real objects, tactile symbols, videos, worksheets, tapes, and augmentative communication devices. Methods can involve modeling, demonstrating, prompting, questioning, pointing, and lecturing. The wide range of possible materials and methods provides for students at all ability levels. The scope and definition of literacy media is more complicated, however. The "tools for reading and writing" generate concerns about print and Braille, prompting many questions about literacy for visually impaired students.

What is "literacy"? What does literacy mean for a visually impaired student?

Most people acknowledge that literacy has something to do with reading and writing. Many recognize the importance of literacy in order to be "an educated person" and realize that success in school and employment are fundamentally linked to the attainment of literacy skills. Braille literacy is directly addressed in the 1997 amendment to the Individuals with Disabilities Act (IDEA). In developing the IEP (Individual Education Plan), the ARD committee must:

& in the case of a child who is blind or visually impaired, provide for instruction in Braille and the use of Braille unless the IEP team determines, after an evaluation of the child's reading and writing skills, needs, and appropriate reading and writing media (including an evaluation of the child's future needs for instruction in Braille or the use of Braille), that instruction in Braille or the use of Braille is not appropriate for the child. [IDEA Section 1414(d)(3)(B)(iii)]

Literacy, however, is more than just legal terminology and involves more than the ability to read and write in Braille. The following definition reveals the role literacy plays in everyday life:

"Literacy is the ability to read and write at a level that would enable an individual to meet daily living needs. Literacy is a continuum from basic reading and writing skills all the way up to various technical literacies. It is different for different people, in distinct times and various places." (Marjorie Troughton, One is Fun, 1992)

This definition indicates the importance of looking at the student individually along a literacy continuum and the value of re-examining literacy needs and skills as the student progresses. Many VI students need an array of literacy tools and perhaps several literacy media to be successful in school. For example, a student might use Braille for note taking, speech output for the computer, audiotapes or a scanner for reading novels, and print for math. Students learn and develop as individuals, not as a group. Their needs may change as they become older and as they approach tasks beyond the school environment. It is important to identify the medium/media which most benefits each student. For example:

  • Some students may benefit most from using print.
  • Some students may benefit from using uncontracted Braille.
  • Some students may benefit from using contracted Braille.
  • Some students may benefit from using both print and Braille.
  • Some students may not be able to benefit from either Braille or print, and may primarily use an auditory medium, tactile symbols, real objects, or other tactual media.

The degree to which a given student uses a specific medium will be influenced by many factors: age, general ability, visual and tactual functioning, visual prognosis, motivation, academic/nonacademic demands, environmental conditions, personal and interpersonal factors (such as an acceptance of one's blindness), reaction to societal attitudes about blindness, and/or a lack of exposure to Braille (Caton, APH, 1991). Each student with a visual impairment has a unique personal journey to literacy that should include all the necessary literacy tools and media to meet school and daily living needs. It may take an extended period of time for a visually impaired student to master the multimedia he or she will be required to use. Planning and preparing for a student's literacy needs throughout his life is a challenging yet important task.

How are these decisions about literacy made? How does the LMA indicate which students might benefit from using print and which might benefit from using Braille?

It is clear that decisions about literacy media are to be made based on the assessed needs of the student and not on other factors such as the availability of a teacher of the visually impaired, financial considerations, convenience, or any other outside factor. The learning media assessment is a process of gathering objective information to provide a basis for selecting appropriate learning and literacy media for blind and visually impaired students. Objective data is collected from many different observations and is used to make decisions about the student's learning and literacy needs. Parents are key members of the educational team, and parent observations and parent interviews provide valuable information to include in the decision-making process. It is important for teachers and parents to work together to gather information, increasing the accuracy and effectiveness of the LMA. Results of the LMA guide instructional planning and programming to insure that each student gains literacy skills in a medium or media (print and/or Braille) and develops an array of literacy tools to meet school and daily living needs.

A valuable reference to help with making these decisions is a publication entitled Learning Media Assessment of Students with Visual Impairments: A Resource Guide for Teachers, by Alan Koenig and Cay Holbrook (1995). It provides a process and rationale for conducting learning media assessments, and has a variety of forms for gathering objective data. This text also reveals the characteristics of students who might be likely candidates for a print or a Braille reading program (page 43):

Characteristics of a Student Who Might Be a Candidate for a Print Reading Program:

  • Uses vision efficiently to complete tasks at near distances (reaches for object on visual cue, explores toy or object visually, discriminates likenesses and differences in object or toy visually, identifies object visually, etc.)
  • Shows interest in pictures and demonstrates the ability to identify pictures and/or elements within pictures.
  • Identifies name in print and/or understands that print has meaning.
  • Uses print to accomplish other prerequisite reading skills.
  • Has a stable eye condition.
  • Has an intact central visual field.
  • Shows steady progress in learning to use her vision as necessary to assure efficient print reading.
  • Is free of additional disabilities that would interfere with progress in a conventional reading program.

Characteristics of a Student Who Might be a Candidate for a Braille Reading Program:

  • Shows preference for exploring the environment tactually (explores object or toy tactually, uses tactual means to travel and explore the environment, etc.).
  • Efficiently uses the tactual sense to identify small objects.
  • Identifies her name in Braille and/or understands that Braille has meaning.
  • Uses Braille to accomplish other prerequisite reading skills.
  • Has an unstable eye condition or poor prognosis for retaining current level of vision in the near future.
  • Has a reduced or nonfunctional central field to the extent that print reading is expected to be inefficient.
  • Shows steady progress in developing tactual skills necessary for efficient Braille reading.
  • Is free of additional disabilities that would interfere with progress in a conventional reading program in Braille.

Other Factors to Consider in Determining a Student's Literacy Medium/Media:

Debra Sewell, of TSBVI, lists these considerations:

  1. School requirements:
    • Can the student "keep up" with peers?
    • How much time is spent completing homework?
    • How much energy is spent completing work?
    • Is the workload being reduced?
    • Is there enough practice with meaningful text? (extended reading, not just line by line reading, such as on worksheets)
    • Are the skills adequate for the future?
  2. Are there (diagnosed or undiagnosed) reading problems?
  3. Are there neurological issues? (such as reduced fine motor skills, etc).
  4. What is the availability and use of optical devices?
  5. What is the portability of optical devices?
  6. Is the student motivated to learn?

What is the Continuing Assessment phase of the LMA?

In the continuing assessment phase of the LMA, the educational team will consider the appropriateness of the initial decisions and examine the student's need to develop new literacy skills. The continuing assessment phase annually collects and examines:

  • The results of any new medical information to determine if there has been a change in visual functioning since the last review
  • Reading rates and reading grade levels, to determine whether the student reads with sufficient efficiency to perform academic tasks successfully
  • Academic achievement, to determine whether or not the student is making academic progress in the current medium
  • Handwriting skills, to determine whether or not the student is able to read his or her own handwriting and whether or not the handwriting is legible to others
  • The effectiveness of the student's existing array of literacy tools, to determine whether instruction is needed in additional literacy tools to meet current or future literacy needs
  • Diagnostic teaching allows for ongoing assessment of the appropriateness of the initial decision about literacy. If a student is not making adequate progress, the educational team might consider adding supplementary literacy tools or changing the primary literacy medium. Additional instruction may be needed in new methods or the use of new materials. Diagnostic teaching will continue to evaluate the student's efficiency with literacy tasks.


It should be evident that the determination of a student's literacy medium/media is not an "either/or" decision. Nor is it a final one. Students change, as do their needs for different types of information. More and more visually impaired students are realizing the benefits of using both print and Braille, and many supplement their reading with auditory information. Supplementary literacy tools, such as E-books and materials on CD-ROM, are helpful as students approach tasks requiring increased reading and writing skills in higher education. All students need access to a variety of literacy tools. This is no less true for visually impaired students. Future See/Hear articles will not only address the increasing variety of literacy methods and materials available for VI students, but also the use of dual or multiple media and the importance of ongoing, continued assessment.


Caton, Hilda, Ed. (1991). Print and Braille Literacy: Selecting Appropriate Learning Media. American Printing House for the Blind.

Koenig, Alan J. and Holbrook, M. Cay. (1995). Learning Media Assessment of Students with Visual Impairments: A Resource Guide for Teachers. Austin: Texas School for the Blind and Visually Impaired.

Sewell, Debra. Workshop Presentation, "The Fine Line Between Print and Braille". Austin: Texas School for the Blind and Visually Impaired.

Troughton, Marjorie. (1992). One is Fun: Guidelines for Better Braille Literacy. Ontario: Canadian National Institute for the Blind.

Winter 2002 Table of Contents
Versión Español de este artículo (Spanish Version)

By Catherine Nelson, Clinical Instructor of Special Education, University of Utah

Marisa is six years old, deafblind and has cerebral palsy. Testing results describe her as "untestable with probable profound mental retardation and severe behavioral problems." Marisa's standardized evaluation got off to a bad start, when her mother was asked to leave the testing room and Marisa began to scream when she could not locate her. The assessor came up from behind and put his arms around Marisa in an attempt to comfort her. Startled and upset by the unexpected touch of a new person, Marisa managed to get her mouth on the assessor's hand in time to deliver a hard bite. The assessment continued when both Marisa and the assessor stopped screaming. But Marisa again became very upset when she could not understand what was being asked of her and what she was supposed to do with the strange objects that were being pressed into her hands. She had no idea what the assessor was asking of her. She could not perform many of the required skills because her visual, auditory, and motor impairments had severely limited both opportunities and motivation for learning. Marisa's score was far outside of the range of test norms, and her extreme agitation made any results unreliable. Sadly, at the end of the stressful day, her teachers and parents were led to believe that Marisa was both incapable of learning and severely behaviorally disordered.

Fortunately, such a scenario does not have to happen. In the 1960s, Dr. Jan van Dijk and his colleagues in the Netherlands developed strategies for assessment that look at the processes through which children learn, rather than individual, discrete skills. Such processes include the (a) ability to maintain and modulate state, (b) preferred learning channels, (c) ability to learn, remember, and anticipate routines, (d) ability to accommodate new experiences with existing schemes, (e) approach taken to solve problems, (f) ability to form social attachments and interact with others, and (g) communication modes.

The techniques used to obtain such information are guided by the child and thus avoid the unhappy situation that Marisa was presented with. The foundation of this assessment is the establishment of a relationship between the assessor and the child that builds from a secure base. The children assessed are never unduly stressed by having those with whom they feel secure leave before the new relationships are developed. They are given time to explore and become comfortable in new environments. The child's interests and abilities determine what materials are used and the direction the assessment takes, thus increasing both motivation and understanding. The assessor is responsible for adjusting his/her emotional level and communication to those of the child. Child-guided strategies are conversational in nature and often begin with establishment of an interactive routine. The assessor imitates what the child is doing, and adds new information as turn-taking routines are built. Communicative signals are elicited by stopping the pleasurable routine and waiting for the child to signal continuation. In this fashion, children are able to demonstrate their abilities to learn, and the methods through which they can best be taught are identified. It is from this information that meaningful educational plans can be developed.

Because the child guides this holistic process, there are no standard materials or instructions. In order to help professionals and parents learn the assessment process, Dr. van Dijk and I developed an interactive CD-ROM entitled Child-Guided Strategies for Assessing Children who are Deafblind or have Multiple Disabilities. The CD uses more than 40 video clips of six children to demonstrate these strategies and their implications for intervention. Users are asked to answer questions pertaining to the video clips, each of which demonstrates several specific assessment techniques. The answers are then discussed, and if more in-depth information is desired, relevant literature is accessed by the click of a button. After getting an overview of the process, the user can interactively view two complete assessments and participate in designing intervention plans for the children being assessed through an interactive question and answer format. The CD-ROM contains an index of many terms having to do with deafblindness and each term is defined, explained in depth and illustrated with video clips. Twelve full text articles by Dr. van Dijk and his colleagues, that explain the "van Dijk" approach to assessment and intervention with children and youth who are deafblind, are also included in the production. (Note visit the APH website at ) 

All children can learn, but it is our responsibility as educators and parents to discover how they learn best. Through the techniques developed by Dr. van Dijk, children such as Marisa will have the opportunity to demonstrate what they can do. Most importantly, as effective methods for intervention are designed and implemented, they will have the opportunity to realize their full potential.

(Originally published in the June 1995 edition of VISIONS)

Summer 99 Table of Contents
Versión Español de este artículo (Spanish Version)

Adapted from a presentation by Susan S. Simmons, Ph.D.

A number of years ago I began referring to myself as a "Developmental O&M Specialist." I choose this term because many O&M Specialists seem to come from one of two schools of thought when providing services for young children. Since most of us were trained from the adult model, if the person does not have a background in child development the tendency is to take adult skills and try to simplify them for children.

I was a child development specialist who became an O&M. When I went through my training I couldn't help but think of ways to implement some of the techniques in a very different manner with young children. Because of this difference in background, I think in terms of child development instead of O&M development.

In the past ten years or so many people have published articles, curricula, assessment tools, as well as ideas on how to effectively work with young children who are visually impaired. I have had the wonderful opportunity to speak at numerous conferences on this topic, and I have found that discussing O&M in the context of a child's development is very well received.

It is vital that we think about O&M differently when teaching young children as opposed to adults. We need to realize that everything we do with children under five years of age is related to their understanding of space or their ability to move through space. For that matter, sighted children at this age also focus on learning about where they are in space and how to make their body move through space.

The most important factor in developing a successful O&M program for preschool children is the philosophy that independence permeates everything you do.

So, what is O&M for preschool children?

Here are a few areas not usually associated with traditional O&M:

  1. O&M is our attitudes, and the attitudes of all who come in contact with this child.
  2. O&M is our commitment to that child's independence at whatever level she is capable.
  3. O&M is the language we all use with our children and how, even subconsciously, we encourage independence.
  4. O&M is valuing the child's skills. Our values often clearly indicate that anything short of being able to see the environment is a disappointment.

A few words about canes

It is absolutely normal for all young children to want to do things for themselves. We often brag about all the things that the sighted child can do independently. It is critical to develop the same expectations and opportunities for the child who is visually impaired. The child's self-image and the attitudes of those who work with her will be greatly influenced by the O&M Specialist's attitudes and expectations, especially as they relate to the use of canes.

I get very excited about teaching cane skills. A cane can be one of the simplest tools a child uses for independent travel skills. As the child develops, so will her cane skills. As she begins to have more body control, she will exhibit more cane control, and more complex techniques can then be introduced. These decisions are made based upon the child's environmental needs as well as her emotional readiness.

In my experience, families are either very interested in their child learning to use a cane or highly resistant to the introduction of the cane. It is very important for professionals to tune into the concerns of the family. Many families may feel that a cane will bring too much attention to their child. They may find it embarrassing if people stare, watch their child, or stop and ask questions. Some parents feel that if they hold the child's hand and lead them around, other people will not notice that the child is blind or visually impaired. Although these feelings are an understandable part of the acceptance process, it is vital to work through them with the family.

Suggestions for encouraging independence in the home and classroom

  • Mark children's chairs and "cubbies" with an indicator, such as a shape. Then a child will not only be able to distinguish her own chair or cubby, but can also identify other children's. This technique also helps children learn about sequencing.
  • Encourage independence, but make adaptations for safety. For example, a rug placed near a step or doorway can cue the child to slow down. For children with functional vision, you can use rugs with color contrasts to alert them visually.
  • Keep toys in categories and in specific places so children can go and get them without your assistance, e.g. keep all of the musical instruments in the big basket by the window, or keep the carpet squares for music on the bookshelf. This offers children the opportunity to go and get things they want for themselves.
  • Don't be afraid to rearrange the classroom or home environment (obviously you don't want to be rearranging the environments on a monthly basis). It is not a bad idea, however, to do it a couple of times per year depending upon the abilities of the children in your class. Reorient the children to the new arrangement, and make it an exciting experience to explore and look for favorite items. This reduces rigidity, and offers children the opportunity to learn a new arrangement in a familiar setting.
  • Avoid carrying kids as much as possible. They need to experience rolling, crawling, walking, trailing, and changes in textures. Whenever possible, let them travel to places on their own.
  • Use natural sounds available within the environment when establishing auditory cues. It is really easy to fall into the habit of tapping on walls and furniture. Instead, if the child is walking or crawling to the bathroom, turn the water on and off in the sink. Entice her to listen, e.g. turning a sound on and off makes it easier to localize.
  • Pay attention to your orientation when you want a child to follow your voice. If they are following a wall, you follow the wall and face the child. It can be really helpful to be down at the child's level, which makes your voice very easy to localize.
  • Encourage a child to trail or walk using sighted guide everywhere she goes! The more she practices these techniques in familiar environments, the more likely she'll be able to use them in unfamiliar environments. For example, to help her get into the habit of trailing in familiar environments, as you enter buildings ask, "Where's the wall?"
  • Talk about sequences of rooms, toys, etc. whenever possible. This will help the child learn to think sequentially, i.e. what comes next.
  • Make a habit of pointing out environmental changes, or ask the child to tell you about environmental changes. For example, the tile floor changes to carpet, sounds change, etc. These skills help build environmental awareness.
  • Encourage the child to use riding toys.
  • Give the child opportunities to climb on various structures and explore new environments.
  • Vary environments as much as possible; sandboxes, grass, trees, mud puddles, ice, snow, rain, etc. Looking for worms after a rain is a big thrill for very young children!
  • Help children be "detectives" as they investigate and identify sensory information. Instead of telling them what is in their lunch box, tell them, "Smell the sandwich," "Touch the fruit," etc. At snack time offer two or three kinds of juices, and ask what kind of juice is in the glass? The children can first smell, then taste their juice to identify it.
  • Use spatial and directional concepts as much as possible, e.g. right and left can be used in conjunction with "side" as in "The door will be on the right side of the wall," or "The door will be on my side to the left." When giving directions, use terms such as "in front of," "behind," "above," "below," and "next to" with children who can learn these concepts.
  • Make all activities functional. Walking to the front of the building may be meaningless to a young child, but going to the water fountain may be very interesting.
  • Try to incorporate a sense of adventure and excitement about everyday discoveries.
  • Help your students practice auditory discrimination skills in naturally occurring situations. For example, someone entering a classroom may say, "This is Susan." It is more natural for the classroom teacher to greet the person, e.g. "Hi Susan," or, once she speaks, to ask one of the children to name the visitor. Many kids are very good at identifying familiar people but do not have enough opportunities to practice the skill with people they don't know as well.
  • Use visual landmarks that have high color contrasts with children who have low vision.
  • Arrange furniture to limit the amount of open space. It is easier to navigate a room if landmarks, such as furniture, help break up the space. It is more difficult to remain oriented in a room with large amounts of open space. Put furniture in useful and reasonable places. Just keep in mind, the less open space the better.