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English version of this article (Versión Inglesa)

Por Gigi Newton, entrenadora de maestros, extensión para sordociegos de la TSBVI


En mis viajes por el estado, de visita a niños con sordoceguera en sus hogares y escuelas, siempre controlo los audífonos. Tener los audífonos bien colocados y funcionando correctamente es muy importante para estos niños porque necesitan utilizar toda la información sensorial disponible. Sin embargo y desafortunadamente, muchas veces encuentro audífonos que no funcionan bien. Una vez, al llegar a la escuela al mediodía, controlé el audífono de un niño y descubrí que durante dos horas había estado escuchando un "silbido" porque el interruptor estaba colocado en "T" para cuando se usa el audífono con el teléfono. Efectivamente, los audífonos habían bloqueado toda posibilidad de escuchar otro sonido que no fuera ese silbido. Esto sucedió porque tanto la maestra como su asistente no sabían cómo hacer el control de audífonos. ¡Algo así no debería nunca acontecerle a un niño con una discapacidad auditiva y especialmente jamas a un niño sordociego!

Cuando una clase tiene un niño con discapacidad auditiva, debe tener un estetoscopio para controlar audífonos y un probador de baterías para verificar el funcionamiento de los mismos todos los días. Debería haber también baterías de repuesto. Además, las estrategias y modificaciones al IEP deben incluir la asignación de un miembro del personal que será responsable de controlar los audífonos diariamente. El personal de las escuelas regionales para sordos (Regional Day School Programs for the Deaf) puede hacer una demostración de cómo controlar audífonos.

Existe una cinta de vídeo que puede ser de ayuda llamada Hearing Aid Management Skills for Famili es of Young Children Who Are Deaf or Hard of Hearing (Item #206), y se puede adquirir por medio de Hope, Inc. por $42.00. La explicación y demostración de conceptos básicos y técnicas relacionadas al manejo de los audífonos está hecha por padres consejeros. Esto incluye entender la anatomía del oído, las pruebas de audición, los audiogramas, partes y funciones de los audífonos, colocación en el niño, cómo hacer un control de audición diario en el audífono, cómo establecer el uso continuo del audífono y cómo encontrar la fuente de ruidos y silbidos. Además el curriculum INSITE, Volumen I (pgs. 300-397) también habla del manejo de audífonos. Incluye los mismos temas que la cinta de vídeo, en impresión. Se pueden obtener los dos volúmenes por medio de Hope, Inc. por $90.00. Para ordenar la cinta o la impresión:

HOPE Inc. (Home and Family Oriented Program Essentials)
1856 North 1200 East
North Logan, UT 84341
Teléfono: (435) 245-2888
Sitio: www.hopepubl.com
correo electrónico:

Además se puede obtener de HARC Mercantile, Ltd. un equipo para mantenimiento de audífonos; el que cuesta $40.00 incluye un deshumidificador, un estuche, un estetoscopio, una bomba a aire comprimido para secar audífonos, un pincel pequeño para limpiar la parte de afuera del audífono, una herramienta para remover la cera y un probador de baterías. Otras compañías venden instrumentos semejantes; puede verificar con su audiólogo o distribuidor de audífonos. Información:

HARC Mercantile, Ltd.
http://www.harc.com
Phone - Voz/TTY: (800) 445-9968
Phone - Voz/TTY: (269) 324-1615
Sitio: http://www.harc.com

Primer paso: Verificar daños

Los audífonos reciben golpes, especialmente en manos de niños. Verifique si la estructura no está rajada o rota, si no hay señales de que el audífono haya recientemente visitado el inodoro y que no esté tapado con cera. Si encuentra problemas mayores, notifique a los padres del niño inmediatamente. Los asistentes de clases pueden a veces resolver problemas como quitar cera del audífono, pero otras veces el audífono tendrá que ser devuelto a la tienda. Problemas simples como la ruptura de un cable o la humedad depositada en el audífono, pueden ser resueltos por un buen audiólogo, un ortofonista, o un maestro para sordos y discapacitados auditivos. El personal de la escuela debe recibir instrucción sobre el mantenimiento regular de audífonos y tener en claro quién puede resolver qué tipo de problemas.

Segundo paso: Verificar las baterías

Los probadores de baterías se pueden comprar en ferreterías o comercios del tipo Walmart, Home Depot, o Radio Shack. Algunos probadores sirven para todos los tamaños de baterías y otros están diseñados para las baterías pequeñas y chatas usadas en los relojes y audífonos. No son caros, por ejemplo, un probador para batería de audífono puede costar entre $7 y $10. Los diferentes audífonos usarán diferentes baterías, por lo tanto es importante verificar que el probador esté en la posición correcta para controlar la batería del audífono del niño. El tamaño de la batería está indicado en la misma. En general, todo lo que se necesita es hacer contacto entre el extremo + (positivo) de la batería y el + cable o punta (positivo) del probador y después entre el extremo - (negativo) de la batería y el cable o punta - (negativo) del probador. Habrá algún tipo de indicador que le mostrará si la batería está buena aún o necesita ser cambiada. Debe revisarlas todos los días, aunque haya puesto una nueva el día anterior.

Tercer paso: Usar un estetoscopio para escuchar los audífonos

Luego de haber examinado el audífono y verificado la batería, precisa escuchar la calidad de sonido. No es suficiente escuchar un silbido proveniente del audífono para deducir que funciona bien. Necesita hacer la verificación con un estetoscopio para audífonos que se parece al que usan los médicos, excepto que tiene un acoplador que entra en el audífono. Cuando enciende el audífono puede escuchar la calidad de sonido.

Sería ideal escuchar el audífono todos los días para detectar problemas de sonido que pueden ocurrir como resultado de cortos circuitos, depósitos de humedad o de suciedad u otros problemas. También puede detectar sonidos que indican que el audífono está en posición para uso con teléfono. La compañía HARC Mercantile también vende individualmente un estetoscopio a precio moderado para este propósito. El número de la pieza es HAC-3000A y el precio es de $16.00 más $5.00 de envío.

Verifique que el audífono esté en posición "M" de micrófono, que el volumen esté en la posición más baja y que esté prendido. Ajuste el volumen lentamente, escuche los sonidos del ambiente y luego escuche su propia voz diciendo los sonidos de las vocales, a, e, i, o y de consonantes como b, t, s, sh. Los sonidos deben ser claros. Es un buen momento para enseñarle al niño a controlar él mismo su audífono. Puede hacerlo vocalizar mientras usted escucha; luego de colocado el audífono, usted vocaliza y lo hace escuchar. Esta es una buena manera de trabajar con la vocalización y un ejemplo de actividad en la que el niño aprende a esperar su turno.

Cuarto paso: Controlar si hay silbido

Coloque el audífono en el niño, luego de haber regulado el volumen al nivel recomendado por el audiólogo. El audífono debe encajar firmemente en la oreja y no debe haber silbido. Si lo hay, sáquelo de la oreja y cubra la abertura del canal con su pulgar, luego aumente el volumen y verifique si hay silbido. Si tal es el caso, el audífono tiene un problema; si el silbido ha desaparecido, el problema es que el tamaño del audífono ya no sirve para el niño. En el caso de niños pequeños que crecen rápidamente, es necesario cambiar llos audífonos cada 4 a 6 meses.

Conclusión

Igual que los anteojos, los audífonos no ayudan si no se usan y si no funcionan correctamente. Los niños con discapacidades auditivas no deberían tener que pasar por una situación que agrave su discapacidad, simplemente porque los profesionales no verifican que sus audífonos estén prendidos, funcionando y en la posición correcta. Si usted no está seguro de cómo hacer estos controles en los audífonos del niño, póngase en contacto con los maestros para sordos y discapacitados auditivos o con el comerciante o el audiólogo que recetó el audífono. Así como usted no dejaría a un niño andar en una silla de ruedas que está rota, tampoco debe dejar que utilice audífonos que no funcionan.

by Holly Cooper

Language Concepts

Communication and human interaction as well as the use of tools for learning  must have a solid foundation in concepts.

Children who do not have disabilities learn through direct experience with objects and people, and by observing other people interacting with objects and people.  Later in their development, typical children can learn further concepts by viewing pictures and videos of objects, actions and events.

Children with visual impairments cannot observe the actions of others, cannot observe the objects and actions people talk about, and usually cannot learn from looking at pictures of objects and events.

To attach meaning to words, children with visual impairments must have extensive and repeated experiences with real objects, and how they are used.  Adults teaching or interacting with young children who are blind and visually impaired must provide direct, hands-on experience with objects in their natural contexts, how they function, and ways to activate and use them.

Adults must not just teach kids the names of objects, but how they relate to activities and people.

Adults must make a point to include hands-on contact with objects and the actions of people by bringing the objects to the child or bringing the child to the object action or event (within reason, considering age appropriate issues, and safety)

Children who are very young or have additional disabilities and are not fluent communicators must have repeated experiences with real objects in real situations.  Do not allow yourself to assume that because you have shown the child something once, or even several times, they understand what it is and how it is used.  They may learn only part of the object or situation each time they are exposed.

Don't bombard kids with visual impairments with words.  For young or developmentally disabled visually impaired kids,

  • use short simple sentences
  • think carefully about the literal meaning of commonly used phrases and slang, minimize meaningless or ambiguous words or phrases
  • Use the child's name when you're talking to them.
  • Minimize extraneous noise in the environment (music should be a meaningful part of an activity, otherwise don't have it on, the same with TV and videos.  It's fine as a reward, or as a down time activity.)  Background noise, talk, and music teaches the child not to pay attention, or gives them too much complexity to attach meaning to.

When they are beginning to understand language, tell them simple easily understood information about what is happening:

Here comes your brother, he wants to play with your toy.

You don't want him to?
Don't hit him, say: "No, it's mine"
Can you give him something else to play with?
Pay attention!  When you're in a structured learning situation with the child, minimize your talk with others.
Honor attempts at communication, you don't have to say yes, just say now it's -- time, you can do that during free time

Routines

Routines occur naturally in life at home, work and school.

Leaning skills and concepts in their natural contextattaches more meaning to the content of what is learned, and helps the learner to retain the skills and concepts, and helps kids with blindness and other disabilities generalize the skills and concepts to other situations.

Using routines for learning means we plan events so that they:

  • occur frequently enough to facilitate learning
  • occur at predictable times (after lunch)
  • occur in a predictable fashion regardless of which adult is helping (brushing teeth, preparing morning snack at school)

Being predictable means:

  • The adult can prepare the materials in advance
  • The adult can prepare communication boards or other communication modes or assistive devices for use
  • The child can learn to expect them, and so (eventually) minimize undesirable behavior (like crying or protesting or fixating only on the desired activity)
  • The event (routine) can be "talked" about using symbols, sign language, objects or whatever the targeted mode of communication is, out of context - distant in time and place

Using a symbol for a routine helps build communication, and can be shaped into pre-literacy then literacy activities

Sometimes I hear people say:

He knows he gets free time after lunch, why do they sit him down everyday and say "next is free time"?

We do this because we want him to attach meaning to symbols: words, pictures, object symbols, tactile symbols, natural gestures, simple sign language.

Meaning leads to language, language must be present before literacy can be learned.

Begin to Use Technology for Communication

When you have predictable routine occurring,
When you have established the use of object symbols or other symbols,
Then look for ways to introduce communication devices.

Voice output simple communication devices should be:

  • Prepared in advance
  • Easy to understand and use
  • Accessible to blind and visually impaired students (objects, parts of objects, tactile symbols used as labels)
  • Integrated into a variety of naturally occurring activities
  • Modeled by the adult
  • Used regularly and repeatedly

by Holly Cooper

  • General Discussion: why use tech, what's available?
  • Switch Activated Toys and Devices
  • Switch Accessible Software
  • Alternative Computer Input
  • Low Tech Augmentative Communication
  • Computer Based Communication
  • High Tech Augmentative Communication

Why?

Why Use Technology for preschoolers?

For students with visual impairments we typically use assistive tech to:

  • Modify presentation of learning media to compensate for sensory and motor deficits (such as screen magnification, voice output, and braille translation, switch activated software)
  • Facilitate interaction with peers and others
  • Provide opportunities for recreation and leisure activities
  • Practice and enhance performance of cognitive concepts
  • Assist children in participating in activities of daily living and self care

What's Out There?

Switch Activated devices:

  • These teach cause-effect
  • Can teach specific fine motor skills such as finger isolation, pulling, pushing, etc
  • These can give kids with motor impairments or very young or developmentally delayed kids can have access to using appliances for skills of daily living, art, music, cooking and other skills

Computer programs:

  • Cause effect games for very young or kids with more severe disabilities
  • Educational games that teach colors, letters, numbers, counting
  • Accessible technology for kids with blindness or visual impairments

Alternative Communication Modes:

Gives kids access to expressive communication

  • Can be low tech such as object symbols, tactile symbols, sign language or simple gestures
  • Can be medium tech such as talking communication boards or other devices which are not computer based
  • Can be high tech such as augmentative communication devices such as Dynavox, Enkidu, Prenke-Romick
  • Can be computer based such as Enkidu

Usually higher tech is used with older kids or kids who are not intellectually disabled when used with kids of preschool age.  In my opinion, it takes a child who has almost the intellectual ability of someone who is functioning at a pre-reading level to use an augmentative communication device if they must rely on auditory scanning to select a choice. (this is a very general statement, don't take it as prescriptive)

Switch Activated Toys and Devices

Hardware

Let's take a look at some switches, interfaces and other products you might be interested in. Sources for purchasing these items are in your handout.

  • Ablenet: switches, powerlink
  • Battery operated toys and devices
  • Electric appliances

Switch Accessible Software

Now I'll show you some switch accessible software. These are games and learning programs that can be activated either with a keyboard or remote switch. To use a switch with a computer, you must have a switch interface, and the software you use must be switch accessible. I have listed some makers of switch accessible software in your resources list. If you intend to use software in this manner, be sure the literature describing the program indicates it is switch accessible. Also, find out what switch interfaces make it accessible. You may have to call or email the maker to find this information.

Switch Interfaces

There are a lot of switch interfaces. The one I will show is the Don Johnston Switch Interface Pro. It is sold by a lot of different vendors, and it is able to access a wide variety of software. At this time and in this state, I would guess it is the one used the most.

  • Don Johnston: Switch Interface

Software

I have listed software sources in your web resources list. If you look at the resources page that is called Informational Websites, you will find some resources for free software.

Free Software:

  • SENSwitcher
  • Spell the Fruit/Vegetables
  • Toddler Toy

Commercial Software:

  • RJ Cooper: Rad Sounds, others
  • Judy Lynne Software: Cause Effect Cinema, Match It (not accessible with DJ switch interface!!)
  • Attainment Company: Grooming for Life
  • Laureate Learning: Nouns & Sounds

Talking Books

It's pretty easy to make switch accessible talking books Using Power Point or Clicker 4. I'll demonstrate one with Powerpoint.

  • PowerPoint
  • Clicker 4

The tutorials for making your own talking books are listed in your Resources Informational Websites list. A print copy of the tutorial for using Power Point is included in your handouts for the MIVI workshop.

Clicker 4

I'll show you some examples of what Clicker 4 does. It's got a great built in tutorial that will walk you through the steps of creating communication and choice grids. You can make simple choice making grids, communication grids, grids to write sentences and stories, and of course, talking books.

Alternative Computer Input

  • Switch Interfaces: discussed above
  • Touch Window
  • Big Keys Keyboard

Intellitools

Lots of you have access to Intellitools kits. The Intellitools keyboard comes with pre-made overlays, you can customize your own overlays and do a variety of activities appropriate to students of different age and ability levels. Here's some purchased packages. The presentation tomorrow on tech for MIVI students will cover Intellitools. See your handouts for the MIVI workshop for additional information.

Low Tech Communication Devices

See your resources list.

  • Talking switches, talking communication boards: not computers.
  • Ablenet
  • Big Mack (single message)
  • Step by step communicator
  • Adaptavation
  • Chipper (single message)
  • Sequencer (sequenced messages)
  • VoicePal communication device
  • Enabling Devices
  • Cheap talk (4 messages or more depending on device you purchase)
  • Communicator series
  • Communication builder series
  • Take n' talk series
  • Hip Talk series
  • Compartmentalized communicator series
  • Lots more!
  • Crestwood
  • Talk Back series

Computer Based Communication

There are more and more programs available that allow you to design and use a communication board that lives in a computer. These programs feature voice output, auditory and visual scanning of choices, and accessibility by touch screen, or switch. Our current favorites for kids with MIVI are Clicker 4 and Writing With Symbols. Both programs have all the above features, and have other capabilities as well. Both have good built in tutorials that guide the new user through a variety of activities. For an in-depth description of what Clicker 4 can do for our kids, see the handout in the MIVI section.

High Tech Augmentative Communication

These are actually small portable computers loaded with communication overlays and custom overlay software, and synthesized speech. You really need a speech pathologist who is a specialist in augmentative communication to advise if the child is ready for such a device, and what the best item is for the individual child involved. Usually pre-school aged kids are not developmentally ready, but not always. These devices take a lot of planning to use in the classroom, they take a lot of preparation time to build custom overlays appropriate for the user, and they take time for the adults to learn to use. They are what we aspire to, for some of our students. They are wonderful, complicated and expensive. Usually about $5000. Some are accessible for blind users, but those accessibility features add another level of skill the student who is the user has to attain. I have seen the use of these devices fail again and again. Most often the failure is due to the adults in the environment not believing in the device enough to learn to use it, plan activities around it and structure the environment so it is needed, functional and accessible. Sometimes the failure of the device is due to the child not yet having attained the skill level needed to access it. Sometimes devices are purchased for students for whom they are not appropriate because the adults believe technology can make anything possible. The user must have a good foundation of receptive and expressive language using no tech and lower tech devices before a high tech augmentative communication device is appropriate.

 Although the VI teacher may have other ideas for intervention, the following suggestions may help in getting started. Only the major milestone skills have been addressed; consult with the VI teacher for expanded suggestions. Include parents and other specialists on the planning team; each has invaluable experience and knowledge to contribute.

To help achieve head control:

  • Provide several short periods daily of supervised prone position.
  • While the infant is on his/her stomach, gently lift the child's head with one hand under the chin and the other behind the head; stroke the back of the neck, and talk in soothing tones to the infant; withdraw manual support gradually, as the infant is able to lift his/her head independently.
  • Continue brief periods of prone position, to allow practice of head lifting.
  • As head control increases, provide trunk support with a rolled towel under the child's chest; begin positioning child's forearms under his/her upper torso, providing support and preparation for independent lifting of head, neck, and chest.

To help achieve "reach:"

  • Securely suspend objects with interesting and varied sounds and/or textures within arm's reach of infant, so that accidental "swipes" will make contact with them.
  • Guide the infant's hands toward the objects if necessary, to let him/her know they are there.
  • To help encourage hand use:
  • Encourage mid-line hand use by placing the child's hands on the bottle; play "patty cake"; play with baby's hands at midline.
  • When facing baby, place his/her hands on caregiver's face and talk to him/her.
  • Put sticky-tape on the child's fingers; he/she will try to get it off. (This is a supervised activity only; never leave a child with anything that can be put into the mouth and swallowed.)
  • Place tactually interesting objects in the child's hands for exploration and manipulation. If the child has any useful vision, objects should be high contrast (black and white) for the first few months; colors are not as interesting until about 3-5 mos. and then red, yellow, orange are the most appealing.

To encourage rolling over:

  • From stomach to back: (about 3-4 mos.) When child is on hi0wr stomach, tuck his/her bent arm under his/her chest and assist with roll-over; praise and practice daily.
  • From back to stomach: (about 5-6 mos.) When child is on his/her back, extend one of his/her arms up, next to his/her head; gently roll baby's head over this arm (towards the floor) while lifting the same-side leg, with the knee bent and crossing over the other leg; gently press knee to floor and hip should follow; roll baby over to stomach; praise; practice daily.

Note: Check with the Physical Therapist before doing these exercises if the child has orthopedic impairments.

To encourage independent sitting:

  • From about 3 mos., prop infant with pillows in the comer of a chair, couch, infant seat, or crib - for only a few minutes at a time; infant should not be totally vertical until head control is achieved and back muscles are mature; a backwards leaning is preferable at first.
  • Around 6 mos. (if torso and head control are present), place child in a sitting position between adults legs (child's back to adult's stomach); gently place child's hands, palms down, in front of him/her, to provide independent support; praise, and practice daily; as balance improves, place toys in front of the baby, between his/her legs, and encourage him/her to play with the toys; provide cushions or pillows for support until baby can sit without them (may take several months).

To encourage standing:

  • Around 10- 11 mos., put baby in a standing position next to a couch or heavy overstuffed chair; put toys on the chair or couch, within reach; encourage the child to play with the toys while standing (leaning on the couch or chair); limit time to only a few minutes at first, extending time as the child is able; child may need assistance in sitting down; practice daily.

To encourage walking:

  • Around 11- 12 mos. , place child in standing position, next to a couch or low table; place toys just out of reach, to the left or right of the child; encourage him/her to "side-step" to attain the toys; practice daily.
  • Place child in a standing position, with back against the wall; offer a hand or finger to the child, for support; keep physical assistance minimal, and remove gradually as the child gains in confidence. A small chair, cardboard box, or walker (to push) might be used as practice supports; some toddler push toys (e.g., shopping cart, lawnmower, wagon) can also be used as "bumpers" for toddlers who are blind or have low vision.

To build language:

  • TALK (constantly) to the visually impaired infant and toddler; describe what you're doing (and what he/she is doing) and how (whether the child understands or not; intonation and syntax may be imitated later); repeat sounds the baby initiates. A radio or TV is not the same as the caregiver's direct situational conversation. Do not use a radio or TV to provide meaningful sounds for the VI child.
  • Name things and actions (e.g., "This is a spoon."). If the child is blind, put objects into his/her hands as you name them Let the child explore the objects before taking them away.
  • Give the child time to absorb what is being said; it may take many repetitions for meaning to be attached to labels.
  • As expressive language begins to emerge ("talking" begins), make extra effort to associate labels and objects; let the child manipulate as many things as possible, and encourage him/her to name them. Meaningful language requires direct experience for visually impaired children; it is critical because it will be the basis of formal reasoning later.
  • Remember that it is difficult to learn while someone is talking. A VI child may stop an activity to listen; allow quiet time' occasionally, when thinking & problem solving can take place.

To encourage social interaction:

  • For infants and toddlers who are blind, or who have low vision, it is important to provide extra tactual and - auditory contact (nuzzling, cuddling, conversation); hands-on social contact must be substituted for eye contact and facial expressions.
  • Social behaviors that are normally observed visually and imitated (e.g., waving bye-bye, shaking head "yes" or "no," shaking hands) must be physically demonstrated to the visually impaired child.

To build cognitive ability:

  • Build meaningful language, both receptive and expressive. Language will be the medium of learning later - the means to manipulate ideas, and to "think" - so be sure every word the child learns has meaning to him/her.
  • Make extra effort to answer questions, not so much with words as with demonstrations ("Let me show you.")
  • Many visually impaired children do not know how to ask questions, because the situation or conditions they would ask about are based on visual observation. The caregiver must try to anticipate what the child may not understand, and "show him/her."
  • If you can't bring the world to the child, take the child to the world. Insofar as possible, provide participatory experiences. The visually impaired child should not just hear about the world; he/she must interact with it.
  • Pay special attention to cause-effect situations; demonstrate, or provide hands-on involvement. Every time there is a "What happens when " situation, remember that the visually impaired child does not see "what happens when" and must learn the result first-hand.
  • Talk about sequences. As you prepare dinner, describe what you are doing (e.g., "First we have to get the pan out, then we put water in it; now we can put the potatoes in the pan."). There are many sequential events daily (e.g., getting ready for bed, taking a bath, getting dressed); watch for them, and talk about them. Sequence will be important later, as events are organized in a story, a chapter, or an outline.
  • Don't be too quick to solve a problem for your child; sometimes, give the child time to figure out a solution for him/herself. (Waiting for the child to devise solutions to problems can be frustrating for the caregiver, but it is essential if independence is to be encouraged.) Something as simple as how to get around an obstacle in his/her path can provide a problem solving experience for a child. He/she will have many occasions to use this skill later, and the earlier it is learned and practiced, the better it will be when needed.
  • Enjoy your child. Play games with him/her. Beginning with very simple hiding games (even "peek - a - boo"), progressing to guessing games ("What Am I" and then giving clues), and on to memory games ("What did we do when...?") . Encourage the child's brain to work, and the earlier the better!

Back to Main Page

Next Section of Infants and Toddlers with Visual Impairments by Virginia Bishop

By Cecelia Quintana, COMS

Orientation and Mobility is broadly defined as the ability to move safely and efficiently through any environment. At the adult level, this translates into the ability to independently cross streets, to use public transit systems, to go to work, to go shopping, etc. At the preschool level, students need to develop the concepts and skills which make the above mentioned goals attainable later in life.

Several areas of skill development should be included in a preschool O&M program. All individuals should incorporate these skills into the child's daily routine. This allows everyone to be actively involved in the child's growth and development. Parents, caregivers, teachers, related service personnel, as well as Certified Orientation and Mobility Specialists will be working on the same, common goal. The ultimate goal of the program is to develop a child into a skilled, age-appropriate traveler who understands basic concepts and can begin to apply learned skills to perform more complex tasks.

Below is a list of skill areas considered to be best practice. These areas should be incorporated into an early childhood O&M program.

  • Improve use of visual skills
  • Improve use of auditory skills
  • Improve use of tactile skills
  • Begin learning spatial concepts
  • Begin learning environmental concepts
  • Improve use of gross motor skills
  • Improve use of fine motor skills
  • Beginning use of clues and landmarks
  • Sighted guide techniques
  • Beginning cane techniques
  • Limited travel in residential areas

Only a Certified Orientation and Mobility Specialist should teach the last four items on the above list. Anyone who works with a child with visual impairment is encouraged to incorporate the rest of the skill areas into the child's routine. The following pages are a few games that encourage development of visual, auditory or tactile skills and/or introduce spatial, body, or environmental concepts. Please feel free to use these games as they are, or as a springboard for inventing games of your own. More games will be added as they are invented.


We're On The Move! 
O&M Games for the Very Young Child

Presented by

Linda Lyle, M.A.
Cecelia Quintana, M.A., COMS

 AER International Conference
July 14-19, 2000
Denver, CO

Download an RTF version of the games (for printing) - o&m.rtf (257k)


Twins

Skill(s) Targeted: Visual scanning

What you will need:

  •  Large squares of brightly colored material (approx. 10 X 10)
  • Index cards 

To set up: Determine what positional concepts will be targeted. In the following example we will use, "On" versus "Under". On the index cards write "Find my twin ________". In the blank write things like: "on the desk," "under the chair," "on the shelf", etc. In the door of the room place one piece of material. In the room place the material wherever specified on the card.

How to play the game: In the door of the room, the student will find the material, and the teacher will read the card to them. They will then visually search the room for the matching material and retrieve it.

Modifications: For more advanced students, place 2 pieces of the matching material in the room, only one of which is in the proper place. For example, place a piece of material both on and under the chair and they are supposed to determine which one they should take, and which one they should leave.

  • Find my twin 
    Under a chair
  • Find my twin 
    On a chair
  • Find my twin 
    On a desk
  • Find my twin 
    Under a desk
  • Find my twin 
    On a shelf
  • Find my twin 
    Under a window

All of Me

Concept(s) Targeted: Body Awareness, concept development of orientation words

Ideas:

Body part identification

  • Even while your child is very young, you can begin to help him/her become more aware of his/her own body. Children develop this skill in a specific order: his/her nose, another person's nose, a doll or stuffed animal's nose.
  • When naming body parts, put your child's name in front of the word. Sherri's nose.
  • Touch various parts of your child's body with different textured fabrics or a feather and name them as you do. Let your child do the same to you.
  • Play finger and toe games like "This Little Piggy", "Do Your Ears Hang Low" "Head, Shoulders, Knees and Toes".
  • Use a mirror to see your hair, your nose, your eyes, etc.
  • Adaptations:
    • For older child: place a sticker on a body part and let child name it as she pulls the sticker off.
    • Use hand puppets to find body parts.
    • As child master's body parts on a doll, you can increase the complexity of the task while still reinforcing the identification of body parts. You can ask your child to feed the baby and then wash her face. You can play silly games where you try to feed the baby by putting the bottle in her ear and letting your child correct you.

Positional words

  • Just as a child learns her own body parts first, a child first learns about positions (up, under, etc.) in relationship to her own body. It is not possible to give a child too much practice in this area.
  • Very young child: Use positional words frequently. "Let's put your sleeper on." "Let's take it off."
    • Early games:
      • peek-a-boo
      • Where's the _____? Name a toy in sight and let child reach for it. "Oh, it's beside your leg." or "It's on your shoe."
      • Where is Thumbkin?"
      • In/Out games: Give child a small container with several objects in it that can be removed. Child will move from dumping to removing one by one. Use out/in often so child will understand the concept.
      • Nesting toys; pots and pans; plastic storage containers all help a child begin to understand positional words relative to something other than his/her own body.
      • As child grows, toys can be hidden under, over, behind, etc. and a game of hide and seek established. Early successes will probably require that the child's body be the location for hiding under, etc. As the task becomes easy for the child, the toy can then be hidden under an object very close to the child and then, with success, further away.
  • The toddler: Once a child begins to crawl and walk, they enjoy putting their own bodies in relationship to other objects. They like to climb on, in, through, around, behind, etc. It is important to continue commenting on the positional relationships that occur between the child and his/her environment. "You're climbing in the box." "The box is around you." "I can't see you. You must be behind the box."
    • Games:
      • Hide and Seek
      • "Where's the Thimble" (revisited)
      • Looking for objects that have been hidden in the beans, inside play dough, picking chocolate chips or small pieces of candy out of cookie dough.
      • Peek-a-boo with a sheet/blanket that covers the whole body
  • Once a child is truly a confident walker, they are ready to start following simple instructions that require them to move throughout familiar areas.
  • A simple way to get practice in for a child with some useable vision, is to place preferred toys within sight but just out of reach. This helps strengthen distance vision as well as gives a child an opportunity to begin to use positional words him/herself.
    • Games:
      • You can send your child to get a diaper (in a familiar location) or send him/her for shoes that are "under Daddy's chair". This builds independence and continues to provide relevant experience for practicing positional concepts.
      • Obstacle courses
      • Swing set
      • Trampoline
      • Follow the String
      • Use hand puppets to tell stories filled with positional concepts. (ex: The puppet can hide behind the box and jump out to startle everyone.)
      • Ring around the Rosie
      • Simon Says
      • Big Ball Fun

from Linda Lyle ©


Balloon Bells

Skill(s) Targeted: Auditory Localization

What you will need: 

  • 10 - 12 medium-sized balloons
  • 5 - 6 small jingle bells
  • 10 - 12 pipe cleaners or long twist ties
  • String

To set up: In order to play this game, your ceiling must have some aspect that will allow you to hang the balloons from it. If you have the standard dropped ceiling with the metal runners and the foam-like tiles, the set-up will be easy. Take the pipe cleaners or twist ties and insert them between a tile and the runner, leaving a small loop that a string can fit through. I like to space them about 3-5 feet apart, and 2 balloons to a small room. Insert a small jingle bell in half of the balloons, and inflate all the balloons. Tie a long piece of string to all balloons, run the string through the ceiling loops and pull the string so that the balloon is hanging just below the ceiling. Make sure that one balloon of each pair has a bell, and the other does not have a bell. If there will be other people using the rooms before or between sessions, tape the strings up high on the nearest wall.

How to play the game: The object of this game is to have the student pull both strings at the same time and be able to tell you which balloon has the bell in it.

Modifications: If it is too difficult for the student to tell which one has the bell, then have them pull the strings one at a time.

from Cecelia Quintana ©


Find the Timer

Skill(s) Targeted: Auditory Localization

What you will need: 

  • One or two kitchen timers that make a ticking sound
  • A number of small toys (Optional)

 To set up: Place a number of small toys in various places around your building.

How to play the game: The object of this game is to have the student find the timer, and thus the accompanying toy. This works best if you have 2 timers, and several different rooms in which to work. Turn on the timer and place it on or next to the small toy. The student must listen for the ticking sound to find the timer and the toy. If you have 2 timers, you may hide the second timer while the child is distracted by looking for the first timer.

Modifications: If your building is too noisy for a timer to be heard, you may wish to try a metronome, a very small radio or some other sound source. You may also wish to try something such as a talking teddy, so that they have to call out to the teddy and it will echo back the child's voice (which it just recorded). Another option may be one of those gadgets that chirps or beeps when you clap your hands.

from Cecelia Quintana ©


Alligator Bridge

Concept(s) Targeted: Auditory localization

What you will need:  

  • Aluminum foil (18-inch-wide best) or other sound-making surface 
  • Blindfold
  • Sound source (such as a rattle, bells, whistle, etc.)

To set up: Place several pieces of the aluminum foil on the ground to make a path, which includes several changes of direction.

How to play the game: One child is chosen to be blindfolded. To set the scene, tell the child who is wearing the blindfold that s/he is returning home after dark, and their only flashlight just broke. Now s/he needs to follow the bridge that goes through the bog (the path of aluminum foil is the bridge) without being able to see it. Although many alligators live in the bog, they will only bother someone if they put one or more feet completely off the bridge. It is completely dark outside, and their only clue for making their way across the bridge is a sound source that leads them in the right direction. The person with the sound source should position himself about 3-4 feet ahead of the child with the blindfold and in such a position that walking directly toward that person will keep the child on the bridge. The teacher and/or the students then sing or chant the following words, which allows the sound-maker enough time to get to the correct position.

"The water's cold, so don't fall in, 'cause that is where the alligators swim."

After one recitation of the words, the child with the sound source makes a sound and the child with the blindfold walks forward directly toward the sound until he can touch it. The process is repeated until the child reaches the end of the "bridge".

Adaptations:

More challenging - You may wish to use 2 sound sources, one which always indicates the proper direction, and one which is always a "decoy", (perhaps it's an alligator who's hungry and trying to drum up some dinner!)

Comments/Suggestions:

This game works better with bare feet, so students can feel the foil as well as hear it.

To involve more students, plant "alligators" at various positions on both sides of the bridge to nip at (tickle) offending toes that may hang over the edge of the bridge.

from Cecelia Quintana ©


Squeaky Toy Tag

Skill(s) Targeted: Auditory Localization

What you will need:  

  • Large, adult-sized sock for each player
  • Squeaky toy for each player
  • Blindfold for each player

To set up: Find a large, open area with no furniture, and a level ground surface. If available, one or more large gym mats could be used for a playing surface.

How to play the game: Two students are blindfolded. Prior to putting on the blindfold the students each put on one of the large socks with a squeaky toy inside positioned directly underneath the foot, so that each time he takes a step, the toy makes a squeak. (You may wish to let your students practice walking around like this before beginning the game.) You will need to have a referee who will help set up the game, signal the start of the game, and watch out for safety during the play of the game. To begin this game the referee will silently position the players somewhere around the edge of the playing area, facing inward. The players may choose to move their squeaky toy for a moment, or the players may choose to crawl to the new location. The referee will say "Start, and the game then progresses as would a normal game of Tag, with one person who is "It" trying to tag the other person. A "Stop" command must be issued when either of the players comes close the edge of the play area. At the signal, the players will freeze, and the referee will reposition the players at the edge of the playing area once again.

Depending on the ability level of the players, you may wish to have a signal that has the players switch roles; so that the player who was "It" is no longer chasing, but being chased.

from Cecelia Quintana ©


The Penny/Nickel Can

Skill(s) Targeted: Auditory Discrimination/Localization

What you will need:  

  • A can and lid with a slit in the top
  • A street with light to moderate traffic from 2 directions.
  • A handful of pennies, and nickels
  • A folding chair for each player
  • 2 small containers such as margarine tubs

 To set up: Set up your chairs side-by-side on a sidewalk next to a street with light to moderate traffic. One player gets a small container with pennies and the other gets a small container with nickels.

How to play the game: The players listen (and watch, if appropriate) for traffic coming from a specific direction. For example, the player on the right will listen for cars coming from the right, and the player on the left will listen for cars coming from the left. (You may wish to start using the words "northbound traffic," "eastbound traffic", etc. so that your students begin to hear these directional terms.) Each time a car comes by, a coin is dropped into the can. For example, if the student on the right has the nickels and is listening for cars coming from the right, then he will drop a nickel in the can each time a car from that direction passes by. And, of course, the student on the left will do the same with a penny for each car that comes from the left. After a specified amount of time has passed, the players return inside and can then enjoy separating the coins into their respective groups, and then determine whether there were more cars from the left, or from the right (or northbound vs. southbound).

Modifications: To make this game a little more complex, you can set up at an intersection and target different concepts, such as: nickels on one street, pennies on the other; nickels for cars that stop, pennies for those that do not stop; nickels for cars that turn the corner, pennies for cars that go straight, etc. This game may also be done under blindfold, if the students are so inclined.

from Cecelia Quintana ©


Let's Get Movin' I

Concept(s) Targeted: Tactile Stimulation

What you will need

  • large blanket or quilt on which you have sewn a variety of textures

How to play the game: Remove baby's shoes and socks. Place baby on blanket so that arms and legs are able to come into contact with a variety of textures as baby moves.

  1. Let baby explore on her own.
  2. Occasionally comment, describing the texture she is exploring.
  3. Follow her lead. 

Adaptations

  1. Let baby explore while dressed only in a diaper.
  2. Use blanket when working with baby on rolling.
  3. Rub baby's body with different parts of the quilt, describing the activity with concept and comparison words (soft, rough, light).
  4. On warm days, move blanket out under the trees so baby can enjoy outdoor play on her blanket.

Comments/Suggestions: Blanket can be made in squares or strips that are sewn together. As baby grows, additional pieces can be sewn on to increase the blanket's size.

If baby shows a strong preference/dislike for certain textures, this can be reflected in the amount of texture on the blanket or in its pattern. For instance, a narrow piece of burlap can be sewn between two larger, more favored textures. In order to reach the preferred textures, baby must encounter the less preferred. The drive to reach a favored texture can be used to encourage touching a less favored one.

from Linda Lyle ©


Let's Get Movin' II

Concept(s) Targeted: Tactile stimulation; independent moving and exploration

What you will need

  • A box, slightly larger in length than your child
    (Parents report that plastic boxes designed to hold Christmas decorations work very well, are inexpensive, and last longer than cardboard.)

To set up: Fill the box about half full of uncooked pinto beans

How to play the game: Introduce beans to child slowly (ex: place her feet in them, or let her explore with her hands.) When she is comfortable, place the child on her back in the beans. Let her explore the way her body feels and the sounds that are made when she moves in this bean pool.

Like water, a child should never be left alone when playing in a bean pool.

Adaptations: 

  1. As the baby grows, small toys can be hidden in the beans; a child can learn to measure, pour, place things in and take out of containers while seated in the bean pool.
  2. Substitute rice, bird seed, plastic balls, leaves for the beans.

from Linda Lyle ©


Let's Get Movin' III

Concept(s) Targeted: Exploration, tactile stimulation

What you will need

  • A heavy piece of cloth (ribbon will do) 2-3 yards long and 1 inch wide (exact dimensions are not necessary;
  • Sew a variety of textures onto this strip of cloth (feathers, velvet, pom-poms, ric-rac, bells, etc.) Sew them on well!
  • Connect the textures so that there is a continuous flow of textured items along the strip.

To set up: Place your baby in a position where he/she is well supported and is able to freely use her arms (a highchair with a tray works well).

 How to play the game: Stretch the strip across the tray so that your baby can touch the strip in front of her. With her hands on the strip, gently pull so that the strip moves slowly under her hands. Comment occasionally on the textures that get a response from her. Move the strip over, under, around her arms and hands.

Adaptations: Vary the movement (sometimes pull, then stop and wait; see what she does with the fabric. Does she look for a favorite part? Does she reach for something on it that she wants? Do her fingers scratch, poke, etc.?)

Other long, narrow items can be used in the same way (ex: hose from the vacuum cleaner, belt, a piece of chain)

For children with some useable vision, consider the things they are able to see and incorporate them into the strip. Consider high contrasting colors (blue/yellow; black/white; red/yellow). For instance, sew red pom-poms onto a strip of bright yellow felt.

from Linda Lyle ©


Other Ways to Get Movin'

Concept(s) Targeted: Tactile discrimination, exploration

Ideas:

  • Mobiles: What to use/Where to hang them
    • Very young infants lay with their heads turned to the side and one arm out. At this age, a mobile can be hung to the side and very low so that the child can use her vision to see the movement of the mobile. The very young child with some vision may notice the high contrast of black/white or black/white/red mobiles.
    • Over the course of 2-4 months, the mobile can be moved so that it is more directly over the baby's head. Again, placing it very low in the crib encourages vision use and will encourage early swiping at the mobile (early arm/hand use and mid-line play).
    • Adaptations:
      • Consider using reflective balls or beads (from a Christmas tree); high contrasting colors.
      • If you notice your baby has a preference for a certain color, use that color (along with others) as a way to attract her visual attention.
      • Look for a mobile that can be wound up to make music. The music can attract her attention as well. If the music component is above the mobile, it can usually be separated from the mobile when she outgrows the toy and a different kind of mobile can be used.
      • Wind chimes make good mobiles.
      • Real objects that your child will need to learn about make excellent mobile toys (ex: measuring spoons, an infant spoon and cup, a pacifier, a favorite rattle).
      • If your child notices light, you can wind a string of Christmas tree lights around the mobile to attract her attention.
  • Jungle gym toys
    • Many of these are commercially available and are not expensive. Before purchasing one, it is helpful to consider whether you will be able to adapt the toy in order to get the toys close enough to your child for successful play.
    • If not, it may be easier to make a frame. To make a jungle gym, you can use a piece of PVC pipe, to make a frame. Instructions can be found on page
    • Some parents have reported success using a heavy cardboard box. They have hung toys from the ceiling of the box and the baby lays on her back in the box for play.
    • Lilli Nielsen has designed a box called a Little Room that provides this type of play space as well.
    • Toys can be hung using pieces of elastic. As your baby becomes more skilled at reaching, she can hold a toy and the elastic permits her to pull the toy toward her for more exploration. When she lets go, it returns to its place and she can find it again (early object permanence).
    • Adaptations:
      • It is a good idea to vary your child's position when playing with these toys. In addition to her back, she can lie on her side, sit in her car seat or another seating system, and even play with them while on her stomach.
  • Keeping things close!
    • Pin interesting textures such as pieces of ribbon, bells to your child's shirt in the center front. Her little hands can begin exploring at mid-line as she plays with these toys.
    • Bright colored socks with a bell sown on them can be used to encourage looking at feet as well as pulling legs up to reach with hands.
    • Hang a crib-safe mirror in your baby's crib and place her close enough to it that she can see herself.
  • Learning to like movement
    • Not all babies enjoy movement in the beginning. For some, the experience stresses their sensory system. For many, because of their low vision or blindness, they do not recognize the signs that they are about to be moved and are caught off-guard. This makes the experience frightening for them. For the baby who cries each time she is moved, the following may be helpful:
      • Give her information before any movement happens. Touch her body with your hands in the places where you touch her to pick her up. (Most babies appreciate a firm touch.) Tell her what you are going to do. Give her a few seconds to process the information. You will be surprised how quickly she learns that this touch means "up" and responds to it by shifting her body to say she is ready for the move.
      • Babies generally feel safer when moving in their parents' arms. Gentle rocking and swaying can be used in the early days to help her adjust to the feel of her body moving in space.
    • Other movement sources:
      • Baby swing
      • Vibrating baby seat
      • Water bed STYLE="text-decoration: underline">(Never leave a child unattended on a waterbed).
      • Baby hammock
      • Swinging in a blanket held by two adults (6 months or older)
      • A ride in the family car

from Linda Lyle ©


Tactile Signs

Skill(s) Targeted: 

  • Environmental awareness, signs
  • Tactile Skills,
  • Fine Motor Skills

What you will need:  

  • 4-5 rooms where a small activity can be set up
  • 4-5 small containers
  • 4-5 activities which have several parts
  • 4-5 materials of different texture
  • Blindfold for each player
  • Rubber cement or other removable adhesive

To set up: Cut each of your pieces of material into 2 pieces. Affix one piece of material to the right side of the doorjamb, where a sign would be placed, or at about shoulder level for the little guys. (I have found that rubber cement is quick, easy to use, effective, and is easily removed from most surfaces including painted walls, paneling, and metal.) Place one part of an activity in that room. Affix the matching piece of material to the lid of one container. In that container, place the matching parts of the activity in that room.

For example: 

  • In the room place a shape sorter--in the container, place the shape pieces.
  • In the room, there is a metal file cabinet--in the container, magnetic letters/numbers.

How to play the game: The student travels to the door with whatever mode of travel is appropriate for him, then independently locates the piece of material. He then scans the lids of the containers to find the matching material. He is then taken or directed to the area where the activity is set up, and completes the task.

from Cecelia Quintana ©


Follow the String

Concept(s) Targeted: Depth perception, positional concepts

What you will need

  • A long piece of string (5-10 yards); 
  • high contrast with the flooring if needed; 
  • a toy with wheels that can be pushed along the string; barriers (blocks, pillows, etc.)

To set up: Spread the string across the floor; place several barriers across the string.

How to play the game: Explain that the string is a road and we are going to drive our cars on the road. Follow the path of the string, going over or around the barriers. Use positional words related to the action taken around the barrier.

Adaptations:

  • To increase difficulty:
    • Spread the string out in a way so that the child has to travel under, over, behind furniture in order to push the car along the string.
    • Together, create a path with building blocks and drive cars along the blocks. Barriers can be made with blocks as well.
    • Include a step or other changes in surface area when spreading string.
    • Use a raised surface like a balance beam.
    • Make a line in sand with your fingers and try to follow it.
    • Use the string to make wriggly lines.
  • For the child with depth perception problems:
    • Provide additional time to explore all changes in texture, surface area, etc.
    • Use solid barriers that cannot be moved (ex: the edge of a step, a couch leg) so that child can tactually experience and confirm the differences she is seeing.
    • Tape high contrast paper to the floor and let the child push a shopping cart along it. Let him/her crawl, pushing a ball along the paper.

from Linda Lyle ©


More Fun with String

Concept(s) Targeted: Object permanence, follow directions, memory

What you will need

  • A favorite toy or small treat, 
  • a long piece of string

To set up

  • Tie one end of the string to a favorite toy or small treat
  • Hide the toy out of sight
  • Weave the string around the furniture in a way that the child can follow it.

How to play the game: Give child the end of the string and have them follow it to find a surprise at the other end.

Adaptations:

  • If child has language capacity, have them provide a running commentary of their actions, as if he/she were a news announcer on television. "Now I am going around the chair; I am climbing over the pillow, etc."
  • Have the child move in the direction the string is taking him/her and have them predict where they are going. "I think I am going to have to go to the chair next."

from Linda Lyle ©


Wall Pockets

Skill(s): Positional concepts

What you will need:  

  • Several pieces of scrap paper
  • Rubber cement
  • Several pictures and matching-sized blank paper, or
  • Several strips of Braille paper, some with Braille, some without Braille
  • Post-it notes

To set up: Use the rubber cement to affix sets of 2 pieces of scrap paper to the wall, one above the other. Only use the cement on 3 sides, leaving the top side open, so that you have a pocket. (You may wish to test your walls to see of the rubber cement will come off. In most cases, I believe it will.) In each pocket you will place a piece of paper with the top sticking out. For each set, one pocket will have a picture or Braille, and the other will have a blank piece of paper. Next to each set, leave yourself a Post-it note that says which pocket has the picture or Braille in it, either the top or the bottom.

How to play the game: The object of this game is for the student to find the picture on the first try, after the teacher tells them which pocket contains the picture or Braille, either the "top" pocket, or the "bottom" pocket. They get to take home the pictures or a small toy after the lesson.

Modifications: You may wish to change the positional concept to "left" and "right", or "high" and "low", or even "north" and "south" (with north being on the top, as it would be on a map). 

from Cecelia Quintana ©


Positional Racetrack Builders

Skill(s) Targeted:  

  • Positional concepts
  • Visual scanning

What you will need:  

  • Multiple pieces of a car or train track
  • A vehicle which can travel on that track
  • Index cards

 To set up: Determine which positional concepts will be targeted. In the following example we will use, "On" versus "Under". On the index cards write "We are resting ________". In the blank write things like: "on the desks," "under the chairs," "on the shelves", etc. Also include a number on the cards (a number between 1 and 5 works best). Place a card on the floor of the doorway of each room used for the game. Place the correct number of pieces of the racetrack in the rooms in the places specified by the card.

How to play the game: In the door of the room, the student will find the card, and the teacher will read it. The student will then use to clue given to find the pieces of racetrack hidden in the room.

Once all of the pieces have been collected, the student then gets to assemble them and play with the racetrack for a while.

Modifications: If the student prefers to build puzzles, the pieces of a puzzle may be hidden in the rooms. Or multiple pieces of a single game may be hidden in different rooms.

from Cecelia Quintana ©


Eastern Star, Western Sun

Skill(s): Cardinal directions, Matching

What you will need: 

  • A number of small toys
  • Envelopes
  • A large, simple picture of a star
  • A large, simple picture of a sun
  • Several sets of smaller matching pictures of the star and sun
  • 2 small boxes

To set up: Affix the picture of the star to one of the boxes and place the box on the eastern end of a large table or on the eastern side of the room. Place the picture of the sun on the other box and place it on the western end of a large table or on the western side of the room. Place a toy and one of the small pictures in each envelope.

How to play the game: The object of this game is for the student to identify the picture and place both the picture and the toy in the box with the matching picture. (At the end of the game, you may wish to let the student choose one toy from each box to take home.) The teacher's job is to reinforce the use of the words "Eastern" and "Western". Eventually, the pictures will be replaced with and "E" for East and a "W" for West.

Modifications: For the student with no vision, use textures or shapes, rather than the pictures.

from Cecelia Quintana ©


Boat Dock Shuttle

Skill(s) Targeted: Cardinal Directions

What you will need:  

  • A large bowl or small tub with water
  • A medium sized plastic lid that will float on water
  • A toy phone or real disconnected phone
  • A toy bus or car
  • A dozen or more small, light-weight toys
  • A small sign for each of the cardinal directions - "north", "south", "east", and "west"

 To set up: Set up your signs in the appropriate places, either around a large table, or in a moderate-sized uncluttered area. With each sign place an equal number of the toys. Fill the bowl or tub with water and place the lid so that it floats on the water. (This is the boat and the loading dock.) Place your phone and the bus or car (this is the shuttle) near the loading dock.

How to play the game: The student is the shuttle driver, and the teacher plays the role of the passengers. The teacher "calls" the student on the toy phone and asks to be picked up at one of the shuttle stations (north, south, east, or west). The student then takes his shuttle to the correct location, picks up one of the toys, and takes it to the boat dock, where he "loads the passenger" by placing the toy on the floating lid. This procedure is repeated until all of the passengers have been delivered to and loaded onto the boat.

Modifications - If the student is not yet ready for all of the directions, use only 2 or 3 stations. If this is still too difficult, place a different colored piece of cloth at each station. This way the teacher can ask, for example, to be picked up "at the north station with the pink parking lot" or the "west station with the striped parking lot".

from Cecelia Quintana ©


Directional Squares

Skill(s) Targeted: Cardinal directions

What you will need:  

  • 25 of any one of the following items: carpet squares, or chairs, or towels, or cafeteria trays or any other item that can clearly mark a small area.
  • 24 index cards, 3 copies of each of the following phrases:
    • Move 1 space north
    • Move 1 space south
    • Move 1 space east
    • Move 1 space west
    • Move 2 spaces north
    • Move 2 spaces south
    • Move 2 spaces east
    • Move 2 spaces west

To set up: Align the carpet squares (or whatever you are using) in a 5 X 5 grid pattern, (see the diagram below) with enough space between the squares to clearly separate them from one another, but close enough so that one can reach out and touch the surrounding squares.

Diagram:5x5 grid of squares  with equal space between squares

How to play: This is a gross motor adaptation of "Directional Checkers" fromSTYLE="text-decoration: underline">Simon Says Is Not the Only Game, page 31,(Leary & Schneden, American Foundation for the Blind, 1982). Each child begins in the exact center of the grid. Whoever has been selected to be the "caller" (the person who will be reading the cards) selects an index card from the top of the deck. The caller reads the card and the child moves the appropriate number of spaces in the correct direction. The first person that gets a card where the correct execution of the directions makes them move off of the grid is the winner.

Adaptations:

More challenging - it is possible to separate the cards into 2 piles: the north-south pile and the east-west pile, and then have the caller draw 2 cards. This will result in secondary directions (such as northeast, southwest, etc.), thereby requiring the students to identify 2 directions and move in a diagonal direction.

from Cecelia Quintana ©


Sniff 'n' Turn

Skill(s) Targeted: Olfactory

What you will need: 

  • 2 distinctly different scents
  • Change of direction indicators (self-adhesive colored dots do well)
  • Route directions (for the teacher)

 To set up: Set-up and preparation for this game takes much longer than the actual playing time. The teacher must decide on a route and write out the directions as detailed below.

How to play the game: This game involves executing a route based upon scents provided. You may choose to use easily available scents such as spices and extracts. The extracts work well if you soak a cotton ball in the extract, and then wrap it in foil; the spices may be left in their original containers, with the label masked. Each scent indicates a change of direction. For example, oregano could mean "execute a left turn", and cinnamon "execute a right turn". (You could choose to use 3 scents. Then one of the scents indicates that the student should continue in the same direction. However, then you may be risking "sniffer burn-out")

The instructor will need to plan a route that includes several changes of direction. At each change of direction, some kind of marker will need to be placed on the floor (we will call this a Station). For particularly long stretches, you may wish to include a station where you continue on straight. Fluorescent Color Coding Labels which may be purchased at most grocery and/or "super" stores, are self-adhesive, easy to remove, and come in a variety of colors so that it will be fairly easy to find a color to contrast almost any floor color. The teacher should have a route card that indicates each change of direction. It may read something like this: "Station 1 - Lobby - right turn - cinnamon" The student will need a the teacher or another partner who will let him know when he has reached a station (if residual vision is not appropriate for the task) and present him with the appropriate scents. At each station, the partner presents the student with whichever scent is needed until the route has been completed.

Comments: While playing this game, I have found that after about 10-12 sniffs, the nose gets tired and it becomes more difficult to tell which scent is which. Also, I tried 3 different brands of plastic bags, and each had a residual smell which overrode the smell of the item placed inside.

from Cecelia Quintana ©


 

by Judith Davies
APSEA

Table of Contents

Introduction

Sexuality and the Role of Parents

Sexuality includes our entire sense of self as male or female. It affects how we think, how we feel, how we act, and how we relate to others. How we feel about our sexual selves is part of our total sense of self-esteem and how we feel about ourselves influences all aspects of our lives. People who have a healthy sense of sexuality are comfortable with their own bodies. They can give and receive affection, form loving relationships, and enjoy sexual expression. Such people can make thoughtful and responsible decisions regarding their sex lives. Helping children grow up to be sexually healthy adults is a big responsibility and a wonderful opportunity.

As a parent, you are your child's first and most important sexuality educator. You may not have thought about it, but you constantly teach your child about sexuality. The way you speak to, touch, feed, dress, and care for your child shows your attitudes toward the human body and sexuality. The kinds of play and behaviour you encourage, the household chores you assign, and the words you use, tell your child about what it means to be a boy or a girl. Many of these things that you do, send messages about sexuality. The way you live your own life as a sexual person provides your child with a model to follow.

Common Concerns of Parents

Many parents have concerns about the sexuality education of their children. They worry about the messages that their children receive from television, movies, advertisements, books, and friends. They wonder when and how much information to give their children at various ages.

Parents want to protect their children, particularly their teenage children, from the negative consequences of early sexual activity such as unwanted pregnancy, sexually transmitted disease, and sexual coercion. Many parents are uncomfortable with sexual language and find it difficult to discuss this part of life with their children. They may have been raised in homes where sex was not mentioned and so have never learned from their own parents how to talk about the subject. Nevertheless, children tell us that they prefer to get their information about sexuality from their parents.

"The Parent Kit," available from Planned Parenthood Nova Scotia, is an excellent resource to help parents develop the skills they need to talk comfortably about sexuality to their toddlers, children, and teens. Many excellent books and videos are available at bookstores and libraries, including the library at the Atlantic Provinces Special Education Authority (APSEA). Planned Parenthood, the Nova Scotia Department of Health, and Health Canada have produced pamphlets giving information on all aspects of sexuality. Feeling informed gives parents the confidence to answer their children's questions. Talking about sexuality with children works best when you begin early and continue to keep the lines of communication open.

The Effect of Visual Impairment on the Development of Sexual Understanding

This guide has been written to address the special concerns of parents of children who are visually impaired. Children with visual impairments follow the same pattern of sexual development as sighted children and they need to receive the same information about sexuality. Vision plays a major role in concept development and so your child may need help to fully understand about sexuality. The earlier the age at which children lose their vision, the greater the extent of vision loss, and the presence of other handicapping conditions affect the amount of extra help needed. Every child is unique and parents are the best judges of their children's needs.

Sighted children learn a great deal about sexuality through casual observation. Children with visual impairments cannot see the differences between boys' and girls' bodies, various body shapes and sizes, and pregnancy changes. They cannot observe these and other developmental changes over the life cycle. They may have limited knowledge of gender roles and fashions, male-female attractiveness factors, toileting practices, and appropriate displays of affection. Parents of children with visual impairments must teach them about these topics.

Many parents worry about telling their children too much, too soon, so they wait for their children to ask questions about sex. They believe that these questions show that their child is ready for the information. Many times the questions asked by children are the result of something they have seen. Children with visual impairments are less likely to ask such questions about sexuality until long after they should have the information. Experts in child development assure us that children are unharmed by early sexual information. They tell us that children only absorb what they can understand at the time and ignore information they are not ready to understand. This explains why children often ask the same question again, often with time having elapsed between each asking, before they seem satisfied with the answer.

Children who are visually impaired have limited access to the information their friends receive from television, movies, books, and magazines. Sometimes you may think that is just as well. However, when you describe the sexual action on the screen or read descriptive passages to your child, you create the opportunity to talk about your beliefs and values surrounding the particular activity in question. Many parents who are, at first, hesitant to talk about sex and, in particular, to use explicit sexual language, say they become more comfortable with practice. Other parents recommend starting to talk to children about sexual matters early, when less embarrassment is likely.

North American taboos against touching add yet another dilemma. The most efficient way for children without sight to learn is through the sense of touch. They learn best when allowed to explore and manipulate real objects. When this is not possible, models of objects accompanied by careful verbal explanations are the next best alternative. Children who are visually impaired often develop misconceptions about human anatomy. They may understand the characteristics of their own sex, but be completely unaware of those of the opposite sex. Letting young children explore their own bodies and those of others in natural family settings while bathing or dressing will inform children of the differences between the boys and girls. Experts tell us that tactile exploration by children who are visually impaired is no more sexually stimulating than seeing people nude is to sighted children. Of course, actual touching of bodies becomes less appropriate as the child grows older. Anatomically approximate dolls, models, mannequins and even sculptures may help older children understand human anatomy.

Sexuality Education Begins at Birth

The Development of Trust

New babies are completely dependent upon their parents for survival. When parents meet their infants' needs in loving and consistent ways, their babies develop a sense of trust. That trust is the basis for future loving relationships, so important to human happiness. Babies who receive lots of warm cuddling and touching find it easier to be close to other people when they grow up. Babies who are visually impaired need even more direct contact to feel loved, wanted, and worthwhile. Touch is the first way that you and your baby will communicate. Breast-fed babies receive lots of skin contact. Should you choose not to breast-feed, you can still hold, stroke, and talk to your baby during feedings to show your love.

Feeding, bath, and play times provide wonderful opportunities to communicate and interact with a new baby. Many parents of babies who are visually impaired worry that it will be harder to "get to know" a baby who cannot see. Babies with visual impairments show their parents that they like or do not like what their parents are doing in subtle ways. The baby who is visually impaired pays close attention to what you say or do by sitting or laying quietly with little or no movement. Your baby may also turn her or his face or body towards you, open eyes or mouth wide, and lean against you to let you know that he or she likes what you are doing. She or he may turn or lean away from you or begin to fuss when tired of the game. "Dancing Cheek To Cheek" is an excellent booklet that teaches parents of visually impaired infants how to get to know their baby.

Use of a baby carrier (the soft kind without the aluminum frame permits the closest contact) allows you to be in physical contact with your baby as you go about daily activities. At the same time, the baby experiences your body movements and the smells and sounds of whatever you might be doing. In a carrier, the baby is handy for you to share small tastes of foods you may be preparing or to grasp objects you might want to give. Inuit parents have raised happy infants this way for centuries!

As your baby begins to talk, she or he will want to know the names of things. It's fun to play games that name body parts like finding little toes as you pull off a sock or hiding hands inside a mitten. Be sure to teach "penis," "vulva," and "anus" along with "eyes," "nose," and "mouth." When you do not name the genitals, your child learns that there must be something "bad" or unmentionable about those parts of their body. It is best to use the correct words for body parts and functions. Names like "wee-wee" for the penis may sound cute when your child is very young; however, other people may not understand these words and other children may ridicule your child if she or he uses childish words later on. Your positive attitude toward your child's body and its functions will help your youngster develop a healthy attitude about her or his body and sexuality.

You can begin to help your child become aware of his or her body at a very early age. Traditional songs and body touching games like the three below are a delightful way to begin. APSEA has many booklets that contain excellent suggestions for activities for you and your child (see "Resources for Parents of Children with Visual Impairments").

Games to Play with Babies

Body-touching games can be most comfortably and safely played by sitting on the floor, with back supported and knees bent. Cradle the baby in the "V" formed by your legs and abdomen.

This Little Piggy

This little piggy went to market, this little piggy stayed home,

This little piggy had roast beef, this little piggy had none,

This little piggy went "wee, wee, wee," all the way home.

(Touch each toe in succession as each phrase is said using a lilting, rhythmic tone. On the last line run up babies' leg with fingers to gently tickle the tummy.)

'Round and 'Round the Garden

'Round and 'round the garden, like a teddy bear,

One step, two steps, tickle under there!

(Trace a circle shape in the child's open hand while reciting the first line; accompany the second with "finger steps" up the arm to tickle gently underneath.)

Pat-a-Cake

Pat-a-cake, pat-a-cake, baker's man,

Bake me a cake as fast as you can,

Pat it and roll it, and mark it with "B,"

And toss it in the oven for baby and me!

(Clap the child's hands together for first two lines, speeding up at "fast." Then pat knees, roll arms together, trace a "B" in the baby's palm, and toss arms over his head for the last line.)

Sexuality Education for Pre-School Children

Development of Gender Awareness

By the time children are two or three years old they can usually identify themselves as male or female. Awareness of the differences between boys and girls and men and women develops gradually, largely through observation. What children see prompts them to ask questions. When they receive the answers to their questions, they form a more thorough understanding of what it means to be male or female.

Children who are visually impaired usually need help in forming these concepts. Your child, for example, should be encouraged to explore her or his own body and to learn the correct names for all body parts. Have your child locate opposite-gender body parts on the opposite gender parent or on anatomically accurate dolls, whichever you feel more comfortable with. Natural settings are best. Differences in anatomy can be discussed while toileting, bathing, or showering with your child or when siblings bath or dress together. You can let the child "help" change a baby's diaper. If there are no younger siblings in the family, perhaps you could explain your child's need to learn about gender differences to a friend who has a baby.

Be sure that your child can correctly identify her or himself, family members, and friends as male or female. Discuss the characteristics that help discriminate between the sexes. Include names, voices (in adults), physical differences between boys and girls and men and women, scent, and gender specific articles of clothing. Gender differences may be more vague today but some still exist. Talk about sex-linked words such as "aunt," "uncle," "brother," and "sister," to be sure that your child understands the sexual connection. It is important to remember that children who are visually impaired often use words correctly without any real understanding of their meaning. Questions like, "How do you know that Uncle John is a man?" or "How will we know if our new baby is a boy or a girl?" may help you determine how much your child understands and will help you find out what information you need to teach.

You can help your child form gender concepts during art activities such as body tracing. Have your child lie on a large piece of paper while you trace around her or his body. Add details such as facial features, hair, finger and toenails, the navel, nipples, and genitals using felt markers if they are visible to your child. When the child cannot see, use sturdy paper to cut out the body shape. Glue on tactile details such as buttons or felt pieces for eyes, nose, and mouth, yam hair, pumpkin seeds for nails, snaps for nipples and so on. You can use one long balloon (stuffed with cotton batting) and one round balloon (put in two marbles for testes) to make the penis and scrotum and use yam to show the outline of the vulva. Another day, you can make a figure of the opposite sex for comparison. Your child can locate the different body parts on these figures as you name them.

To increase children's understanding of clothing worn by children and adults of both sexes, have your child help fold and sort the laundry. You can help your child form separate piles for each family member. As you work, you can point out differences in textures and sizes in men and women's clothing. Explain that some items are gender specific, such as bras, slips, undershirts, and jock straps. Show little girls the purpose of the fly in men and boys' underwear. They can put a finger through the opening to see how a penis fits through. Little boys can learn that only women need to wear bras because only women have breasts.

Finding Out about Babies

Children normally begin asking questions about sex at around three or four years of age. They are especially interested in babies and where they come from. Parents should answer these questions simply and accurately. At first, tell children that babies grow in a special place in the mother's body and that it takes a mother and a father to make a baby. You might explain, if your child seems interested, that an egg in the mother's body joins with a sperm from the father and that the baby then grows in the mother's uterus. It is important not to use terms like "seed" for sperm (the child may worry that eating seeds in fruits and vegetables could cause a baby to grow). Also do not use "tummy" when talking about the uterus (children sometimes think that the baby is being showered with food whenever the mother eats). If your child is curious about how the egg and the sperm get together, you can go on to explain, "Daddy's sperm are made in his testicles and come out through his penis. Mommy's vagina is an opening to her uterus, where her egg is. When Daddy puts his penis in Mommy's vagina, the sperm go up inside and join with the egg." Because these ideas are difficult for children to understand, parents usually need to tell them this story often. You can add more details, as your child seems ready.

If you are expecting a new baby, you have a wonderful opportunity to share with your child the joy and anticipation of a new family member as well as the physical changes taking place in your body. Children who are visually impaired love to feel the swelling of their mother's abdomen and the movement of the baby inside. If you do not anticipate having more children, perhaps a trusted family friend would be willing to share her pregnancy with your child. Children rarely tire of hearing the story of their own birth, told in a loving way. There are many children's books written about babies and birth that you and your child can read together. Some of these books are available in twin-vision format from the library at APSEA. You might also consider breeding your family pet to stimulate questions about conception and birth.

Good and Bad Touch

Children need to be touched, cuddled, and held to feel loved and valued. When you show your child your love, you are also teaching her or him how to love and value others. Children learn appropriate ways to display affection to non-family members mainly by watching others. Your child cannot pick up these cues and you will want to talk with them about whom it is OK to kiss, hug, or touch.

This is a good time to discuss "good" and "bad" touch. Your child is likely to receive touching not normally experienced by children who can see. Necessary tactile teaching methods such as hand-over-hand and traveling sighted-guide may make your child less sensitive to feelings about inappropriate touch. Be sure that your child understands that she or he has the right to refuse any touching that is unwanted. Respect that right yourself, and insist others will do so as well.

To help your child learn which touches are and are not appropriate, you can play the "What If?" game. Ask, "What would you do if someone asked you to touch his penis?" or "What would you do if someone asked you to go into their house for cookies?" Talk about what your child should do if these things happen. Play the "no" game to give your child practice in refusing requests. Take turns asking each other to do favours Oust pretend), while the other says "no" in different ways. When it is your turn to say "no," you can model assertive ways to refuse requests.

You can also read books written especially for young children about self-protection and personal rights regarding her or his body.

One kind of touch that concerns many parents is masturbation. Most children will masturbate for pleasure; in fact, masturbation is a normal sexual activity throughout the life cycle. Children who are visually impaired do not masturbate more than other children, but parents are often more aware of the activity because of closer supervision, the child's inability to determine a parents whereabouts, and the effect this activity may have on others. Children may also turn to their own bodies for stimulation if they are less able to interact with their environment. Children who are interested and involved in the world around them are less likely to masturbate. You may want to remind your child that although it is okay to masturbate, it is not okay to do so in public. This is a good opportunity to teach about public and private places--a difficult concept for children who cannot see. Your child needs to understand "when" as well as "where" privacy can be ensured.

Sexuality Education for School-Aged Children

Getting the Facts

School-aged children are curious about sexual matters. It's important to let them know that you want to answer any questions they might have. Children of this age gather facts about sexuality from school, friends, television, movies, books and magazines, as well as from home. Children who are visually impaired do not have the same easy access to these sources of information, as do their friends. It is wise to ensure that your child's understanding about sexuality is on a par with that of her or his friends. Children are quick to reject those playmates whom they deem to be less sophisticated than themselves. To help your child develop understanding about sexual matters, you can read books about sexuality together. You can provide your child with books in a format that she or he can read independently. The library at APSEA has many such books available. Also you can describe displays of affection that take place on the screen when you are watching television or movies with your child. This is a good opportunity to reinforce the kinds of behaviour that your family considers to be appropriate in various settings and also comment on those you consider to be inappropriate.

Appropriate Behaviour

Children who are visually impaired have difficulty learning about socially acceptable demonstrations of affection and sexual expression. People send many non-verbal messages such as facial expressions, body postures, and gestures that let others know when they approve or disapprove of certain behaviours and whether they welcome gestures of affection. These cues are not available to children with visual impairments. Talk to your child about the ways that sighted people let each other know when they do or do not want to be hugged or kissed and how they might show that they do or do not like certain kinds of behaviour. Teach your child when, where, and how to express affection for others and explain the effect of inappropriate displays on other people. Enlist the help of relatives, friends, and people who are unknown to your child to give her or him opportunities to practice interacting with different people in different situations. Ask these "helpers" to comment when they do and do not like certain behaviour. Statements such as "My what a nice 'hello' hug for Aunt Sue!" and "I'd love to shake your hand, but I don't usually hug little girls I've just met--would you like to shake hands?"

Between the ages of five and eight, children generally become modest and will request privacy in toileting, bathing, and dressing. You may have to teach your child that people like to be alone for these and other activities (such as masturbation). Help your child ensure that she or he is "in private" by teaching her or him to close bathroom and bedroom doors, and to knock before opening closed doors. You may need to gently remind your child many times before this skill will be learned as she or he does not have the visual reminders available to sighted children.

It is common for children of this age to seek friendships with members of their own sex and to show strong interest in sex role stereotypes. Your child is continuing to sort out what it means to be a boy or a girl, a man or a woman. Gender role expectations are changing in society today. Many parents want their boys and girls to grow up free to follow their personal interests and to pursue any career of their choice. Language is a good place to start. Use words like "firefighter" and "police officer" to replace "fireman" and "policeman." Encourage your child to play with toys and engage in activities that were traditionally considered appropriate for the opposite sex. Make sure that household chores are not assigned according to sex and that family rules are the same for both sons and daughters. Children learn gender roles more by watching and imitating their parents than by any other way. Children who are visually impaired may have limited or distorted ideas about sex roles. Discuss the traditional roles of men and women, how those roles are changing today, and the implications of those changes. When choosing children's books, look for those that do not support gender-role stereotypes. Pick books that use language that includes both sexes. Recently, many books have been written that feature both sexes in adventurous and powerful roles as well as nurturing and supportive ones.

The friendships of childhood allow children to develop the social skills they will need to form and maintain meaningful relationships. It is also true that good social skills are needed in order to make friends. Children who are visually impaired can master the skills they need to make and keep friends. Again, many social skills are learned through imitation of others by sighted children whereas these skills must be taught to children who are visually impaired. Whenever possible, expect your child to behave according to the same standards that are typically expected of children in her or his age group. Children who are visually impaired must learn to face the person speaking or being spoken to. Consistently position your child so that you are facing each other when you speak. If the head drops or turns away, stop talking and wait quietly until your child turns back towards you. Tell your child that you do not know whether she or he is listening or talking to you when she or he looks away.

Mannerisms such as rocking and eye-poking will make it more difficult for your child to be accepted by peers. These behaviours are less likely to become a problem when children are actively involved with their environment. Children should be told honestly that certain behaviours are socially unacceptable. It is much easier to learn these lessons in the secure surroundings of home than it is elsewhere. Be positive; seek opportunities to let your child know when she or he has done something correctly. This approach will encourage your child to continue the desired behaviour and will enhance self-esteem. Constant reminders of poor behaviour are likely to have the opposite effect.

Many parents have found it helpful to discuss social development with their child's classroom teacher. Often, simple changes in classroom seating arrangements and routines can make a big difference in how well a child with a visual impairment is able to participate in the social life of the classroom. Many special education teachers feel that cooperative classroom settings favour the full inclusion of children with special needs. You may want to seek out teachers who stress a cooperative learning approach for your child. At Individual Education Program (1EP) meetings, let the school know that you consider social development an important goal for your child.

Self-Esteem

How children learn to feel about themselves influences their happiness, their accomplishments, and their ambitions. High self-esteem results when children know they are unconditionally loved and accepted, especially by their parents. They also need to believe themselves to be competent people. Children who arc visually impaired may think that they are less attractive and less capable than sighted children. Many children who are visually impaired assume the worst about their appearance because they cannot see in a mirror. Tell your child how she or he "looks" to others. If she or he has useful vision, purchase a magnifying mirror to allow your child to gain a more realistic idea of her or his facial features. Children who are visually impaired do not see the mistakes made by others and may believe that sighted people never make mistakes. Your child may feel that her or his achievements are less worthy than those of others and may become discouraged from trying. Let your child know when you or someone else has made a mistake. Say, "Oh dear, look at the mess I made while pouring the milk! I'll have to clean that up, won't I?"

Parents want their children to develop competence and independence, but they also want to protect them from harm and failure. This desire to protect may be even stronger when the child has a disability. Try to set realistic expectations and encourage your child by letting her or him know that you believe in her or his abilities. Set tasks that you are sure your child can master so that she or he experiences many successes. Instead of sheltering your child from failure, teach that mistakes are simply a part of learning. Whenever possible, your child should learn the same skills of independence as those typically learned by other children of their age. Give your child choices such as, "Which shirt would you like to wear to school today--the one with the pockets or the turtle-necked one?" Children who learn to make decisions early in life are better able to make sound choices later when peer pressure becomes an issue. High self-esteem is closely linked to responsible sexual decision-making.

Puberty

Children may enter puberty any time between the ages of nine and fourteen. Girls experience changes an average of two years before boys. There is some evidence that girls who are totally blind may begin to develop approximately one year earlier than those with sight or light perception. Your child needs to know well ahead of time what changes are likely to occur and why they do. Reassure your child well in advance that these changes are a completely normal part of growing up. Talk about the different shapes and sizes of breasts and penises, emphasizing that all are attractive and that there is no best size or shape. You can request permission to have your child touch sculptures at your local art gallery--most galleries are receptive once your child's special needs are explained. Store mannequins can sometimes be purchased for a reasonable price although they are much less realistic. The Judith Franing Company produces 18 inch, anatomically correct rag dolls called "Effie Dolls." The pregnant female doll in this set can be used to show your child the birth process and to explain menstruation. Let your son or daughter handle sanitary pads and tampons as you explain their use. Your daughter needs to learn about personal hygiene, keeping track of her menstrual cycle, and how to use sanitary pads and tampons. Your son needs to understand what they are for and how they work.

If your child is anticipating a short-term placement at APSEA, you can request that sessions on sexuality be included in her or his program. The resource center has available lifelike anatomical models (produced by the Jim Jackson Company) of the male and female human reproductive systems. The collection also contains the female reproductive system in cross-section, including the embryo and fetus at different stages of development. These models permit tactile examination of internal and external sexual organs to help children better understand reproductive anatomy (both their own and that of the opposite sex), conception, pregnancy, and childbirth.

There are many books about puberty that you can share with your child. "The Growing Up" video series produced by the National Film Board of Canada contains three animated films including one on puberty changes, one on reproduction, and one on feelings. These videos are designed for families to watch together and feature young children's questions about sex and sexuality. Many children who are visually impaired attribute all of their problems to their visual condition. It is important that they have opportunities to learn that some difficulties are common to all children and are simply a part of growing up.

Sexuality Education for Adolescents

Talking with Teens about Sex

Adolescents experience many physical and emotional changes that are often confusing. As a result, they have times of self-doubt as well as self-discovery. Teens tell us that they want to learn about sex and sexual matters from their parents although they are often unsure about how to initiate conversations about sex. They are afraid that if they ask questions, their parents may conclude that they are or intend to become sexually active. Research has shown that when parents willingly discuss sexuality with their teens, their children tend to delay their first sexual intercourse, adopt attitudes similar to their parents, and are more likely to use contraception when they do become sexually active.

You can show your teen that you are an "askable" parent by starting conversations about sex yourself Use newspaper articles or news reports, TV shows, videos, or even the words to popular music as openers. Ask for, listen to, and respect your teenagers' opinions and feelings, even when they are different from your own. Don't preach, but don't hesitate to express your own opinions and feelings about values and standards of behaviour. Keep the lines of communication open. Teenagers are trying to discover who they are and what kinds of relationships they should be having with others--what you say matters to them.

Many parents worry that they do not know the answers to the questions their teens ask about sex. Libraries (including the one at APSEA) and bookstores have books that help parents talk to their teenagers about sex. Parents can to provide their teenagers with accurate information in a format they can use.

The peer group plays an essential role in helping teens move from the dependence of childhood to the independence of adulthood. Without the support of peers, most adolescents would find it too difficult to separate from their families and become independent adults. It is with peers that teens test their new feelings, ideas, social skills, and physical abilities. Because teens have to win the respect and friendship of their peers (unlike family members who are expected to love them unconditionally) these interactions give them a more realistic idea of interpersonal relationships. Eventually, as they become more comfortable with the new adult they are becoming, teens again separate, this time from their peers, to reestablish their relationship with their parents on a more adult-to-adult basis. It is an exciting process, although one that can produce many strains within the family, especially if parents have concerns about the young people with whom their teenagers are spending time. Parents cannot choose their children's friends for them, but they can provide opportunities for their teens to relate to young people whose values and beliefs are similar to those they wish for their children. Parents of teens who are visually impaired need to encourage their teens to join youth and activity groups in the community, school, and church to ensure that their teens have the positive opportunities they need to interact with peers.

Talking to teenagers who are visually impaired about sexual matters helps them understand that you accept them as, and expect them to be, sexual persons. They may not always get this message elsewhere. Many sighted people believe that people with disabilities are asexual and should not be dating. Your child needs to talk about the negative attitudes towards visual impairment and disability that they may encounter. Use role playing to teach your teen to assertively and appropriately answer the questions and concerns of dating partners and their parents. Your teenager can also learn coping strategies by talking about dating experiences with older teens who are visually impaired.

Dating

Dating provides teens with opportunities to get to know and share experiences with members of the opposite sex. This contact is important for teenagers who are visually impaired. You may not have thought about it, but when you were teaching basic social skills, manners, and appropriate behaviour, you were already preparing your child for dating. Teenagers who have had opportunities to develop hobbies and interests are more interesting dating partners. Conformity is very important to teens. Although you cannot change the fact of your child's visual impairment, you can take steps to ensure that she or he knows what styles of clothing, hair, make-up and accessories other teens in school are wearing. If you don't know what is fashionable in your area, enlist the help of a slightly older teenage friend of your daughter or son. The chances are, your teenager will be more likely to accept advice about fashions from a friend than from a parent!

Teenagers who are visually impaired are very dependent upon their friends for information about who is "cute" or "interested." Many dating behaviours are visual. Flirting, for example, is mainly accomplished through eye-gaze, facial expression, and body posture. Your teen can learn how to flirt, but it won't be possible to see the messages sent by others. Young people who are visually impaired must depend on verbal communication and the information they get from friends to tell them whether another person is interested in meeting them. Of course, they need to know about flirting in order to ask friends in the first place.

The feminist movement has resulted in a number of changes in the dating scene. Today, it is as acceptable for young women, as it is for young men, to initiate a date. You can encourage your daughter as well as your son to pursue desired friendships. Many teens prefer to go to movies, dances, sports events, and to each other's homes in groups that may or may not include "couples" and usually include unattached members. Teenagers say that they feel more comfortable and less self-conscious with this form of dating. Group dating may mean that adolescents with visual impairments will have more opportunities to date and interact with their peers.

Mobility is critical to successful dating. When teens who are visually impaired, especially young men, talk about dating it is their inability to obtain a driver's license that they mention most often. The driver's license represents independence and adulthood and its lack is sorely felt. Your teen will need to talk about her or his feelings of frustration. Help your teen plan how to manage transportation on dates. Solutions that some families have found include having a parent or older sibling provide chauffeur services, permitting the "date" to drive (her or his own or your family car), public transportation, a tandem bicycle, and double-dating (your teen can offer to pay for the gas). Of course, the family car also provides privacy. You can be sensitive to teenagers need for a private place to talk and freely express their feelings for each other by making the family room or den available.

Concerns for Safety

Many teens with visual impairments complain that they are over-protected by their parents. It is normal to worry about safety, but denying normal social activities will not protect your son or daughter. It is through social interactions that she or he learns how to deal with people and to handle different situations. Teenagers who are visually impaired should have the same rules and curfews as their sighted brothers or sisters. Excellent mobility skills are vital to dating safety. A teenager who is totally dependent upon others for travel may find her or himself in a dangerous situation if suddenly left alone for any reason. Make sure that orientation and mobility skills are included in your teenagers' IEP.

Teenagers with visual impairments may not clearly understand what constitutes an acceptable date. You can start with books about teens and dating experiences. Talk about personal rights and sexual abuse. Role play different scenarios to give your teen practice in dealing assertively with peer pressure. Ask your teen how she or he would handle a difficult dating situation and then problem-solve for solutions. Some parents have found that classes in assertiveness training and self-defense have been useful for teenagers with a visual impairment.

Getting the Information

Teenagers want and need more detailed information about sexuality. They need to understand the basic physical concepts of sexual intercourse, conception, pregnancy, and the birth process. They also need to learn about contraception and abortion. They need to know how AIDS and other sexually transmitted diseases are transmitted, prevented and treated. They need to develop decision-making skills based on an understanding of personal rights and assertive behaviour. There is wide variation in school sex education programs across the Atlantic Provinces. Parents will want to know what information their children are receiving. The vast majority of parents approve of sex education in schools, but unfortunately, schools more often hear from the few parents who object. It is important to let your school know your views on this issue.

Even the most thorough sexuality education programs may not meet the needs of teenagers with visual impairments. When one young man without vision was asked about the raised line diagrams used in his sex education program, he replied "I didn't really have any idea of anatomy, I mean, 1 could label the diagrams okay. I just memorized the order they were written in and filled them in on the tests!" Many young women, even after completing sexuality programs, believe that the vagina and urethra are a single opening. The fact that teens with visual impairments are able to pass course requirements may not mean that they understand what has been taught. These misunderstandings are mostly due to their inability to see the diagrams used to teach these concepts.

Live models provide the most accurate information about the physical aspects of sexuality. However, most parents, teachers, and teens themselves would be very uncomfortable with this approach. The next best thing is the use of anatomical models such as the life-like models of reproductive anatomy produced by Jim Jackson and Company. These models are used in sexuality classes at APSEA to teach basic concepts of reproductive anatomy. You can request a short-term placement at APSEA were your teenager can study the models comfortably with a small group of teens who have similar needs.

When models are unavailable, you can use comparisons to objects that are already familiar to your teenager. For instance, you can compare the non-pregnant uterus to an empty balloon; the pregnant uterus to a water-filled balloon with the baby floating inside; the cervix to the neck of a balloon; and the scrotum to a balloon with two marbles. Childbirth can be explained by pushing a life-size baby doll through a child's turtleneck T-shirt. Squeeze the neck of the shirt opening (the cervix) closed to begin and then let it open slowly as the baby's head pushes through. Explain that the walls of the vagina can stretch in the same way to allow room for the baby to pass through. If you have an artistic flair, you might try modeling genitalia from clay. Let your teenager try to copy your models to determine whether or not the concept is understood.

A clear understanding of anatomy is necessary in order to learn about the symptoms for sexually transmitted diseases. Many of these symptoms are visual (rashes, painless chancres, and changes in the colour of vaginal discharge). It will be especially important to teach children with visual impairments about the non-visual symptoms of STD's. They need to know about high-risk activities and where to go for diagnosis and treatment. Some teenagers who are visually impaired tend to be passive. Passivity leaves people more vulnerable to sexual exploitation, abuse, and at greater risk of contracting AIDS and other STD's. Talk to your teen about your concerns for safety. Find out whether your school curriculum includes opportunities for teens to develop skills in assertive sexual decision-making. If not, you can role-play different scenarios with your teen. There are good suggestions offered in Marion Howard's book, "How to Help Your Teenager Postpone Sexual Involvement."

The best method of teaching about safer sex and contraception is to allow teenagers to examine the various devices available. Ideally, their use should be explained using the life-like models already described. Teenagers should be allowed to practice placing a condom on a penis model. These devices are available for instruction at APSEA Your local Planned Parenthood Association can also provide instruction in the use of contraceptive devices.

Teens whose visual impairment results from an inherited condition have questions about their choice to have children. If the impairment accompanies other medical concerns they may wonder if they will be able to have children at all. Parents sometimes hesitate to discuss these issues with their children for fear of adding to their many problems. However, it is almost always easier to deal with any difficulty when it is possible to discuss it openly with someone who is caring and understanding. Ask your teen if she or he has any concerns they would like to discuss. You can talk to your family doctor about genetic counselling. Encourage your daughter to ask questions about her ability to bear children. Your son may wonder if he will be able to father children. The decision to parent should be an informed one.

Staying in Touch

The most important thing is to keep talking and to remember to include sexuality issues in your communication with your teenager. Clearly state your values and beliefs about sexual standards of behaviour. The model you provide is important to your teen in sorting out her or his own values and beliefs. Listening is more meaningful than talking. Your teen needs to feel that her or his feelings and opinions are respected and worth listening to. Tell your teen that you have confidence in her or his ability to make responsible choices about sexual activities and relationships.

In Closing

Children who are visually impaired have the same need for sexuality education as do sighted children, but it may be more difficult for them to get the information they need to develop their full potential as sexually healthy and responsible adults. This guide has been written to help parents of children with visual impairments ensure that their children reach these goals. A research paper entitled Sexuality Education for Children with Visual Impairments including an extensive list of references; as well, a video on the same topic has been produced, These and other resources listed in the following section, "For More Information," are available by contacting the library at APSEA. Comments and questions from parents are always welcomed.

For More Information

Note: Resources marked with an * are available from the APSEA Library. Most resources available from the APSEA Library can be obtained in large-print, audio-tape or braille formal on request.

Resources for Parents of Children with Visual Impairments

Infants

*Heart to Heart: Parents of Blind and Partially Sighted Children Talk about Their Feelings, Blind Childrens Center, 4120 Marathon Street, P.O. Box 29159,Los Angeles, California 90029-0159

*Learning to Play: Common Concerns for the Visually Impaired Child, Blind Childrens Center, 4120 Marathon Street, P.O. Box 29159, Los Angeles, California 90029-0159

*Talk to Me I and II by Blind Childrens Center, 4120 Marathon Street, P.O. Box 29159, Los Angeles, California 90029-0159

*Touch - The Language of Love, Johnson & Johnson Baby Products Company, Grandview Road, Skillman, NJ 08558

*Dancing Cheek to Cheek: Nurturing Beginning Social, May and Language Interactions, byL. Meyers and P. Lansky, Blind Childrens Center, 4120 Marathon Street, P.O. Box 29159, Los Angeles, California 90029-0159

*Move With Me: A Parents Guide to Movement Development for Visually Impaired Babies, Blind Childrens Center, 4120 Marathon Street, P.O. Box 29159, Los Angeles, California 90029­

*Rhymes to Develop Body Image, by Langston Hughes, APSEA

Children of All Ages

*Sex Education of the Visually Impaired Child. The Role of Parents, by C. S. Schuster, Journal of Visual Impairment and Blindness, 80(4), 675-680, 1986.

*Sexuality Education Methodology, by J. Neff, In S. Mangold (Ed.), A Teachers Guide to Special Needs of Blind and Visually Impaired Children, New York: American Foundation for the Blind, 1982.

*Nurturing High Self-Esteem in Visually Handicapped Children by S. Mangold, A Teachers Guide to Special Needs of Blind and Visually Impaired Children, New York: American Foundation for the Blind, 1982.

*Social Skills, by K. M. Heubner. In G.T. Scholl (Ed.), Foundations of Education for Blind and Visually Handicapped Children and Youth: Theory and Practice, New York: American Foundation for the Blind, 1986.

*Sexuality Education for Children with Visual Impairments byJudith Davies, Atlantic Provinces Special Education Authority, 1995. [video, audio taped formats]

Adolescents

*Use the Common Senses: Childbirth Education for Blind and Visually Impaired Persons by B. Bobek, Journal of Visual Impairment and Blindness, 78(8), 350-351, 1984.

*The Adolescent Visually Impaired Female by S. Mangold and P. Mangold, Journal of visual Impairment and Blindness, 77(6),250-255, 1983.

*Sexual Well-Being. A Goal for Young Blind Women by Jan Neff, Journal of Visual Impairment and Blindness, 77(6), 296-297, 1983.

Resources for All Parents

Books

The New Family Book A bout Sexuality by Mary Calderone and Eric Johnson, New York: Harper and Row, 1989. Information about sexuality and sexuality teaching.

Raising a Child Conservatively in a Sexually Permissive World by Sol and Judith Gordon, New York: Simon & Schuster, 1989. A parents guide to sexuality teaching.

*Your Childs Self-Esteem by Jean Illsley Clarke, New York: Harper Collins Publishing Company, 1978 . Ideas to encourage children to be the best they can be. [print, taped formats]

*How to Help Your Teenager Postpone Sexual Involvement by Marion Howard, New York: Continuum Publishing Company, 1991. Straightforward suggestions to help parents prepare their children to make wise choices regarding their sexuality. [print format]

Talking With Your Teenager.- A Book for Parents by Lori Zeigler-Wildflower, New York: Random House Press, 1983. This book covers strategies for successful communication, changes during puberty, and other sexuality issues.

Raising Sexually Healthy Children: A Loving Guide for Parents, Teachers, and Caregivers by L. Leight, New York: Rawson Associates, 1988. A guide to sexuality education.

An Easy Guide to Loving Carefully by Lynn McKee, Winfred Kempton and Lynne Steiggall, Santa Cruz: Network Publications, 1987. This is an easy to read book about women and men's bodies, sexual health, and birth control.

Pamphlets

*Sexuality and Your Disabled Child by Sue MacLeod, Planned Parenthood, Nova Scotia, 1985.

*Parents Can Build Children's Self-Esteem by The Parent Institute, VA, 1991.

*Talk Sex by The N.S. Department of Health, N.S.

*The Stork Didn't Bring You byBarbara J. Jones, N.S. Department of Health, N.S.

*We need to know about AIDS: A Guide for Parents on Talking with Their Children about AIDS by Health and Welfare Canada, 1991.

*Sexual Abuse and Your Child by Child Abuse Research and Education, Canada, 1990.

*Talking With Your Son about Birth Control by Kay Clark, Network Publications, CA, 1985.

*Talking With Your Daughter about Birth Control by Patricia Rain,Network Publications, CA, 1985.

*Now That I Know ... What Do I Do: Information for Parents, Family and Mends of Those WhoAre Lesbian, Gay or Bisexual by The Gay and Lesbian Association, Nova Scotia, 1993.

Kit

The Parent Kit: A Family Guide to Sexuality Education(revised edition), Planned Parenthood Association of Nova Scotia, Halifax, NS, 1991. This unique resource is designed for groups of parents to learn together to talk comfortably and confidently to their children about sex.

Video

*The Growing Up Series,National Film Board of Canada, Ottawa, Canada, 1989. A series of three videos designed for parents to watch with their pre-adolescent children. It serves as an introduction to sexuality education. [video format]

Resources to Share with Your Children

Books for Young Children

*The Bare-Naked Book by Kathy Stinson, Willowdale: Firefly Books Ltd,, 1986. A book about bodies for very young children in large print with clear illustrations. (large print format]

Bellybuttons are Navels by Mark Schoen, Prometheus Books, 1990. A book about body parts for very young children.

Did the Sun Shine Before You Were Born? by Sol and Judith Gordon, Fayetteville: Ed-U Press, 1979. Written for children ages 3-7 years. This book talks about the family, affection, reproduction, birth and growing up.

Girls are Girls and Boys are Boys by Sol and Judith Gordon, Fayetteville: Ed-U Press, 1979. Talks about the differences and the similarities between the sexes.

*How You Were Born by Joanna Cole, New York: Mulberry Books, 1984. Written for young children with an introduction for parents. This book answers children's questions about how an egg grows to become a baby and how a baby is born. [twin-vision format]

*So That's How I Was Born by Robert Brooks, New York: Simon & Schuster Books for Young Readers, 130 Avenue of the Americas, 1983. Written for young children with an introduction for parents. This book provides an excellent model for answering children's early questions about sexuality. [twin-vision format]

*The Berenstain Bears New Baby by Stan & Jan Berenstain, Toronto: Random House of Canada Limited, 1974. A story for young children who are expecting a new baby in the family. (twinvision format]

*Where Did I Come From? by Peter Mayle, Toronto: George McLeod Limited, 1975. An amusing look at bodies and reproduction for children of all ages in bold print. [print, taped format]

A Better Safe Than Sorry Book by Sol and Judith Gordon, Fayetteville: Ed-U Press, 1984. A book to help young children protect themselves from sexual abuse.

*My Body is Private by Linda Girard, Martin Groves: Albert Whitman and Company, 1984. This book helps children understand their personal rights about their bodies. [twin-vision, taped form at]

*Come Sit by Me by Margaret Merrifield, Toronto: Women's Press, 1990. An educational storybook about AIDS and HIV infection for small children ages 4-8 and their caregivers. [large print format]

*Tiger Rowers by Patricia Quinlan, Dial, 1994. A little boy remembers his beloved uncle and the good times they had before his death from AIDS. Written for children 5 years and up. [print, taped formats]

*Amazing Grace by Mary Hoffman and Caroline Binch, London: Frances Lincoln Limited, Apollo Works, 1991. This book tells the story of a little girl who with the help of her mother and grandmother discovers that she can do anything she wants. [twin-vision format]

*The Paper Bag Princess by Robert Munch, Toronto: Annick Press, 1980. In this story the tables are turned when the princess rescues the prince. [twin-vision format]

*William's Doll by Charlotte Zolotow, USA: Harper Trophy, 1972. Written for children 4-8 years. A little boy's grandmother understands why boys and girls should play with dolls. [twinvision format]

*Piggybook by Anthony Browne, New York: Alfred A Knopf, 1990. A family takes another look at gender roles. [twin-vision format]

Books for Pre-Teens

*Asking About Sex and Growing Up: A Question and Answer Book for Boys and Girls by Joanna Cole, New York: William Morrow and Company ltd., 1988. This book is written for preteens in a straight-forward question and answer format. [print, braille formats]

Let's Talk About.. S-E-X by Sam Gitchel and Lori Foster, Planned Parenthood of Fresno, Suite E, 633 North Van Ness Avenue, Fresno, California, 93728, 1986. A read and discuss guide for people 9-12 and their parents.

The What's Happening to my Body Book for Boys by Linda Madams with Dane Saavedra, New York: Newmarket Press, 1984. A book about puberty for boys.

The What's Happening to my Body? A Growing Up Guide for Mothers and Daughters by Linda Madaras and Area Madaras, New York: Newmarket Press, 1983. A book about puberty for girls.

*What's Happening to Me. Answers to the World's Most Embarrassing Questions by Peter Mayle, Toronto: George McLeod Limited, 1975. An amusing look at puberty. [large print, taped format]

*Are You There, God? It's Me, Margaret by Judy Bloom, New York: Dell Publishing, 1970. This tells the story of a young girl entering puberty. [print, taped formats]

Books for Teenagers

*How Sex Works by Elizabeth Fenwick and Richard Walker, Toronto: Macmillan Canada, 1994. A clear, factual, and helpful guide to growing up physically, emotionally, and sexually. [print, taped formats]

*Hearing Us Out: Voices from the gay and Lesbian Community by Roger Sutton, Toronto: Little Brown and Company, 1994. A moving book for and about gay and lesbian teenagers.

Degrassi Talks on Sexuality by Peter Carver (Ed.), Toronto: Boardwalk Books Inc. and Mint Publishers Inc., 1992. Teens talk about how sexual maturing brings embarrassments, crises, moments of joy and disaster as they struggle to find their sexual identity. [print, video taped format]

Degrassi Talks on Sex by Peter Carver (Ed.), Toronto: Boardwalk Books Inc. and Mint Publishers Inc., 1992. Teens talk about the challenges of sexual activity in the 1990s. [print, video taped format]

DegrassiTalks on Abuse by Peter Carver (Ed.), Toronto: Boardwalk Books Inc. and Mint Publishers Inc., 1992. Teens tell how they deal with physical, sexual and emotional abuse and survive. [print, video taped format]

*Teen Esteem by Pat Palmer, Toronto: Impact Publishing, 1989. A book to help teens understand and improve the way they see themselves. [print, taped format]

Pamphlets

*AIDS: Everyone Needs the Facts by AIDS and Disability Action Project, Vancouver: B.C. Coalition of People with Disabilities, 1991. [braille, taped formats]

*The Facts of Life in the '90s Scarborough: Julius Schmid of Canada, 1991

*Date Rape by Gayle Stringer, Network Publications, CA, 1985.

*Talking With Your Parents about Birth Control by Jane Haitt Consultants, Network Publications, CA, 1983.

*I Think I Might Be Gay ... Now What Do I Do? by The Gay and Lesbian Association, Nova Scotia, 1993.

*I Think I Might Be a Lesbian...Now What Do I Do? by The Gay and Lesbian Association, Nova Scotia, 1993.

*I Think I Need More Info: Where Do I Go? by The Gay and Lesbian Association, Nova Scotia, 1993.

*I Want to be a Mother, I Have a Disability, What A re My Choices? Toronto: DAWN Ontario, 1993.

*Am I Parent Material? by Carol Baker, Santa Cruz: Network Publications.

Tape

*Start Smart: A Guide to Sexuality by Richard Borodsky and Louise Andree Saulnier, Planned Parenthood Manitoba. [taped format]

Anatomically Correct Models and Dolls

Discovery Dollsc/o Monique Felder, 167-44 145th Ave., Springfield Gardens, NY 11434, (718) 712-2057: models for sex education

*Effie Dolls - Mrs. Judith Franing, 4812 48th Ave., Moline, IL 61265, (309) 764-3048: child size and anatomically correct rag dolls

Jim Jackson and Company, 33 Richdale Ave., Cambridge, MA 02140, (617) 864-9063: reproductive anatomy models

*Louise Kool & Galt, 91 Armstrong Ave., Georgetown, Ont., L7G4SI, 1-800-668-4302: anatomically correct dolls and gender specific clothing

Teach-A-Bodies , 2544 Boyd Street, Ft. Worth, TX 76109, (817) 923-2380: models for sex education

Web Sites

You might not know it, but individuals who are blind, visually impaired, and deafblind use web sites to access the world; however, many web sites, old and new, are either totally inaccessible or partially so. When educational sites are inaccessible, this creates an inequality, another barrier for persons with disabilities to endure. When web sites are designed from the ground up using W3C standards-based mark-up with an eye towards accessibility issues, a web site has a better chance of being a portal to the world versus a black hole, an empty page.

Online and Digital Instruction

There has been an upsurge in the number of companies and non-profits promoting educational software, online courses, and learning management systems. Some of these products have been designed with accessibility and usability standards from the ground up; some are retrofitting after discovering problems; and others are blithely unaware. Section 504 of the Rehabilitation Act of 1973 is not ambiguous--any product used should not leave people with disabilities at an educational disadvantage. Entities working within the educational market need to work within the legal framework of our field. Click on the following link to learn more about accessibility for online and digital instruction.

Media Players

Some might ask: Why would an individual who is blind or deafblind need access to content from a video or audio file? Much original content, including promotional, instructional, and entertainment is created with video cameras or audio recorders. Many people love to learn by watching; ours is a multimedia culture. Media clearly needs to be made accessible to people with disabilities in order for them to experience and to learn along with everyone else. The problem is often threefold: no captions, no audio description of the video, and a player that cannot be accessed by screen readers thus rendering the controls (play, pause, rewind, etc.) unreachable or the player invisible.

Section 504 Compliance

What does one do with the information above? School districts, administrators, teachers, parents, and students can start by becoming familiar with Section 504 of the 1973 Rehabilitation Act. If new websites and software are being introduced in an educational setting a good question to ask salespeople, developers, and other interested parties is a simple one: Is this technology Section 504 compliant? What accommodations have been made to make the product accessible? Below are educational links on Sections 504 and 508.

Accessibility Links for Sections 504 and 508

      Web AIM on 

Rehabilitation Act of 1973--by Web AIM

      Special Education in Texas 

Section 504--by TEA

      Texas Project FIRST on 

Section 504 and Parents--by Family to Family Network

      Open Source definition for 

Section 504--by Wikipedia

by Kate Moss, Family Training Specialist, TSBVI Outreach

Originally published in 2009 in the See/Hear newsletter.

Usher Syndrome is one disorder that comes to mind readily for professionals in both the field of vision and hearing when they think of syndromes which result in dual sensory impairment or deaf-blindness. However, there are many syndromes that have both vision and hearing impairment as part of the conditions that define the syndrome. It is important to be aware of these conditions, since one of the sensory disabilities is often times more evident than the other. This situation makes it easy to overlook the impact of the combined vision and hearing loss.

Below some of the more common syndromes, which can manifest with both vision and hearing loss, are described. If you are interested in obtaining more detailed information about any of these conditions, you may contact: National Organization for Rare Disorders or search the web for organizations under the specific syndrome name.

Most of the information about these syndromes comes from reports provided by NORD. The exception is the information on Congenital Rubella Syndrome which comes from a booklet, "Congenital Rubella Syndrome: Health Care Challenges" written by Dr. Steven Parker from Boston University School of Medicine in collaboration with Perkins School for the Blind, Helen Keller National Center and St. Luke's-Roosevelt Hospital. This publication is available through Perkins School for the Blind.

Alport Syndrome

Alport Syndrome is a group of hereditary kidney disorders. They are characterized by progressive deterioration of the glomerular basement membranes which are microscopic parts of the kidney. This deterioration may lead to chronic renal (kidney) failure causing excess waste products in the blood (uremia). Eventually severe renal failure may develop. Ureamia and kidney failure may cause heart and bone problems.

Abnormalities of the eye may occur in the juvenile forms of Alport Syndrome. The surface of the eye's lens may be cone-shaped (lenticonus) or spherical (spherophakia). The lens of the eye may be opaque or cloudy (cataracts). White dots may appear on the retina (retinal macular flecks or fundus albipunctatis). Children with Alport syndrome may be nearsighted (myopic).

Type I, Type II and Type VI Alport Syndrome includes kidney disease with nerve deafness and eye abnormalities. The difference between these two types is that Type I is a dominantly inherited juvenile form and Type II is an X-linked dominant juvenile form. Type VI is the autosomal dominant juvenile form.

Cytomegalovirus (CMV)

Cytomegalovirus Infection is a virus infection occurring congenitally, postnatally or at any age. CMV ranges in severity from a silent infection without consequences, to a disease manifested by fever, hepatitis, and (in newborns) severe brain damage, and stillbirth or perinatal death.

Symptoms of CMV are also highly variable as well. The infection may be manifested only by CMV in the urine in an otherwise healthy infant. At the other end of the extreme, hemorrhaging, anemia, or extensive liver or central nervous system damage may occur. Infants born with a severe form of the disease typically have a low birth weight and develop fever, hepatitis with jaundice, and hemorrhages into the skin, mucous membranes, internal organs, and other tissues. Enlargement of the liver and spleen, decrease in number of blood platelets, inflammation of the choroid and retina, abnormal smallness of the head, and calcification around the veins of the cerebral portion of the brain may occur. Motor defects, spastic paralysis on both sides of the body, blindness, deafness or seizures may develop.

Vision loss in these children is related to scaring of the choroid (the dark brown vascular coat of the eye between the sclera and retina). Hearing loss in these children is sensorineural. Even though CMV infection may not be apparent in some infants, it may later cause hearing loss.

CHARGE Association

CHARGE Association is a very rare disorder characterized by a variety of symptoms. At least four of the following six characteristics must be present for the diagnosis of CHARGE Association: 1) Absence of some eye tissue, including the iris (Coloboma); 2) Heart disease; 3) Absence of the opening between the nasal cavity and the back of the throat (Atresia of the choanae); 4) Retarded growth and development and central nervous system abnormalities; 5) underdevelopment of the Genitals; 6) Ear abnormalities and hearing loss. The six letters of each of these conditions make up the name CHARGE.

Down Syndrome

Down syndrome is the most common and readily identifiable genetic condition associated with mental retardation. It is caused by a chromosomal abnormality. One additional chromosome is present in each cell. This extra gene material changes the development of body and brain.

About half of these children have congenital heart disease. There is an increased incidence of respiratory problems. Recent studies have shown that there are more eye and ear problems in individuals with Down Syndrome. Eye problems associated with this syndrome are myopia and "Brushfield" spots (gray or pale yellow spots at the periphery of the iris). These individuals may have either sensorineural, conductive or mixed types of hearing loss.

Marshall Syndrome

Individuals with Marshall Syndrome have a distinct flat sunken midface with a flattened nasal bridge or "saddle nose". Their nostrils turn upward, there is a wide space between the eyes, and the upper portion of the skull is thicker than normal. Calcium deposits may also be found in the skull. Eye defects found in these individuals include nearsightedness, cataracts, and eyeballs that appear to be larger than normal because of the wide space between the eyes. Some people with this syndrome may also have crossed eyes, a condition in which the line of vision is higher in one eye than the other called hypertropia, retinal detachment, or glaucoma. Hearing loss may be slight or severe and is sensorineural.

Rubella Syndrome

If a pregnant woman contracts rubella, the virus can infect her fetus. Such an infection is especially dangerous in the first 4 months of pregnancy, causing damage to the developing organs. Although any part of the body can be affected, the eyes and ears seem to be especially susceptible to damage from a rubella infection.

Babies born with Congenital Rubella Syndrome vary greatly from one another. Some are only mildly affected while others have significant disabilities. Some of the problems associated with CRS include sensorineural hearing loss, visual problems such as cataract, inflammation of the retina (retinopathy), nystagmus, small eyes (microphthalmia), and occasionally optic atrophy, corneal haze, and glaucoma. These individuals may also experience hearing problems, neurological problems, growth problems, and other disabling conditions. In later life some individuals also experience glaucoma and detached retina.

Stickler Syndrome

Stickler syndrome is a genetic disorder inherited as a dominant trait. Initial symptoms of Stickler Syndrome may include a broad, flat, sunken bridge of the nose which makes the face look flattened. A cleft palate and small jaw may also be present. In addition, sensorineural deafness may develop. Eye defects may include a high degree of nearsightedness (myopia), irregularities of the lens (astigmatism), and changes of the optic disk. Cataracts, detachment of the retina and blindness may develop during the first decade of life. A form of glaucoma called glaucoma simplex may also occur.

Bone abnormalities in joints such as the ankles, knees and wrists usually occur. During childhood, individuals may experience stiffness and soreness after strenuous exercise. Swelling, redness and a feeling of heat may occur occasionally, leading to cracking and temporary locking of the joints. Incomplete dislocation of the hips is another frequent occurrence.

Other Syndromes

There are many other syndromes and conditions that are associated to some degree with combined vision and hearing loss. Some of these include:

  • Duane Syndrome
  • KID Syndrome
  • Leber's Syndrome
  • Norrie's Disease
  • Pierre-Robin Syndrome
  • Trisomy 13

Of course, vision and hearing loss may occur in children with any type of syndrome or condition in the same way that vision and hearing loss occur in the non-disabled population. However, in syndromes and conditions known to have related vision and hearing loss, we must be certain to provide ongoing, periodic assessment and monitoring of vision and hearing function.

Why is it important to know about syndromes?

1) Specific characteristics of a syndrome may have implications related to educational programming.

Obviously syndromes which have associated vision and hearing impairment can require a great deal of specific modifications to classroom instruction. Understanding the exact visual and auditory functioning of a child in the classroom and home environment can help us to provide these modifications. For example, with Usher Syndrome Type II the child may require the use of an auditory trainer. The child with Type I Usher will probably need a sign language interpreter, may need to be positioned at a specific distance from another signer, and/or may need instruction in the use of tactual signing.

Other conditions associated with a syndrome may direct the focus of instruction. For example, children with CHARGE Association may not have the physical ability to control urinary function until they are older. Trying to potty train a child with this condition at an age of 2 or 3 will likely prove frustrating to both the child and the caregivers. Knowing this, potty training may not be a priority for instruction in the early years of the child's life. Further, the classroom teacher may need the support of a paraprofessional during regular bathroom times in order to change the child's diapers. Consideration may also need to be given to providing a private space for the child during this activity that would not ordinarily exist in the classroom.

2) Specific characteristics of a syndrome may have implications related to career choices.

Some career's require good vision or hearing such as an airline pilot, an architect, or a truck driver. Many jobs can be modified or special technology can make jobs accessible even to individuals without vision or hearing. Sometimes specific jobs in a field may be accessible to an individual with disabilities while other jobs in that field are not accessible. The more information the student, his family, and career counselors have about a typical pattern of progression associated with a particular syndrome, the better prepared they are to make good decisions about future career choices and current programming.

3) Specific characteristics of a syndrome may have implications for ongoing medical follow-up.

Many syndromes such as Congenital Rubella Syndrome have a delayed onset of symptoms associated with them. For example, an individual with CRS is at higher risk for developing glaucoma and diabetes. They are also at risk for having detached retinas. Knowing this, regular eye examinations and medical examinations may help to detect these problems early on so the individual may receive proper medical treatment.

Sticklers syndrome often has hip dislocations associated with it. Knowing this, there may be a need to restrict some physical activities which may put the individual at risk. Other syndromes such as Cornelia de Lange may have gastrointestinal problems associated with them which may require special diets or medicines to prevent more serious conditions from developing.

Whatever the condition or syndrome is which results in long-term disabilities, the more we know about it the better off we are in helping the child. It is sometimes difficult to get a clear diagnosis of specific syndromes, but genetic testing and counseling can be very helpful. Your pediatrician or hospital may be able to refer you to a genetic counselor. Other resources to find out more about genetic testing are the National Society of Genetic Counselors and Genetic Alliance.

 

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Chrissy Cowan, TVI

Texas School for the Blind and Visually Impaired

 

General

 

  • Your VI teacher (TVI) should give you a copy of the Functional Vision Evaluation and Learning Media Assessment with detailed information about how your particular student uses his/her vision

  • Students with low vision should be encouraged to use their eyes to the maximum. Vision is not diminished by use

  • A student with albinism will be sensitive to the light and will sometimes require an adjustment period of about 10 minutes when he or she comes in from being in the sun

  • Allow the student to adjust his/her work to a position that he/she is most comfortable with

  • Do not use large print materials when regular print will suffice

  • Whenever an assignment refers to a picture (as in math workbooks) allow the student to look at the picture in a regular print book. The large print process distorts pictures

Reading the Board

 

  • Seat student near the board (within 3 to 5 feet) and in a central location, but within a group of students

  • Verbalize as you write on board

  • If possible, provide a copy of what you have written on the board to the student

  • Have another student with good handwriting copy off the board and make a copy of these notes.

  • Allow student to use a telescope supplied by the TVI (if this is done the student will probably need to be seated back away from the board to increase his/her visual field)

  • A clean board makes a better contrast and is easier to read

  • Avoid red/orange/yellow markers when writing on charts/white boards

Overhead Projectors/Video

 

  • Seat student close to the screen

  • Provide student with your overhead projector sheet or master copy so he or she can read and/or copy from it

  • Use a dark (preferably black) Vis-à-vis pen on the overhead sheet

  • Discuss movies thoroughly afterwards to make sure the student understands major concepts presented

  • A darkened room provides more contrast

  • Move the projector closer to the screen to produce a smaller, more distinct image

  • Make a good photo copy of your master

  • Do not use red ink

  • Record the assignment, provided that the student can function as well with a recording

  • Please be sure that your tests are completely legible. Ask the student to read parts of the test to you privately to be sure he or she can see all parts of the test

  • Give the student a little extra time

  • Avoid handing the student a paper and saying, “Do the best you can”. This only cheats the student out of the continuity of your lesson and can be frustrating

Illumination

 

  • Light intensity can be regulated by adjusting distance from the window or light source

  • Artificial lights should be used whenever brightness levels become low in any part of the room.

  • Avoid glares on working surfaces (a piece of dark colored paper taped to the entire desk surface diminishes glare off the desk)

Seating

 

  • Avoid having students work in their own shadow or facing the light

  • Students may need to change their seats whenever they desire more or less light

Contrast

 

  • White chalk offers more contrast on a clean chalkboard

  • Dry erase boards used with dark markers offer better contrast

  • Soft lead pencils and felt-tipped pens with black ink are recommended for use on unglazed light and tinted paper

  • Good contrast and white space between lines of print offer the best viewing comfort for lengthy reading assignments

  • Avoid using red/orange/yellow on Smartboards

Tests

 

  • Tests should be dark and clear

  • If there is a time element, please remember that a person with poor sight will frequently be a slower reader than a person with normal sight of the same intelligence. His or her eyes will tire much faster, so tests in the afternoon can be particularly difficult to read

  • On timed drills allow at least double the time for a student with low vision. Ideally they should be untimed

  • If the student is comfortable performing orally, tests could be given orally by another person who fills in the blanks. Please be careful here, as some people are not auditory performers, and it is a misconception that all blind and low vision students can perform better auditorily.

Physical Education/Recess

 

  • Check with TVI to see if there are any restrictions of activity or on visual fields

  • Ball Sports: practice catching, kicking, and batting with students to check whether or not he/she can see the ball in time to catch, kick, or bat

  • Use audible goals and/or balls (available from TVI) or use a radio as a goal locator (as in basketball)

Art

 

  • Students with a visual impairment should be expected to participate in art. Consult with the TVI on adaptations for the art curriculum

Mobility and Orientation

 

  • Allow student to explore your room during the first week and whenever you make any major changes

  • Show student where his or her desk is, where materials are located, papers turned in, etc.

  • Point out the restrooms, water fountains, library, office, cafeteria, gym, and bus stops and ask that braille labels be placed outside each entry for blind students

  • Contact O&M specialist for detailed information