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(Originally published in VIP Newsletter, September 96, Volume 12, Number 3; by The Blind Children's Fund)

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

By Tanni Anthony, Project Director, Colorado Services for Children with Deafblindness


The experience of learning that your child needs glasses can be an emotional one. It is not always easy to learn that your little one will be wearing glasses. The good news, however, is that glasses can make a positive difference in your child's eyesight. This is very good news as it means that your child will have an opportunity to expand his or her world, a chance to see better, and get information in a more efficient manner. Over the years of working with families, the following ideas have been presented as helpful guidelines to parents on the process of introducing glasses to their young child. As far as new glasses are concerned, there are two critical components to check before you begin the process of encouraging your child to wear them.

1. The frames must fit correctly. Some glasses, especially those for aphakia (eyes without lenses due to cataract surgery) can be heavy for young children. The style of the glasses will be important and you may choose a head strap to help evenly distribute the weight of the lenses. Be sure that the glasses do not pinch the child's nose or ears. Monitor the fit to be sure that there are no red marks which may eventually turn into a skin irritation.

2. The lenses must be the correct prescription. An inaccurate prescription is a common problem, but one that should be assessed, if the child does not tolerate wearing the glasses. To have the prescription checked, take the glasses to the optician or the eye doctor who can determine the optical accuracy of the prescription in the lenses against the perspective needs of the child.

Most children will accept their new glasses once they learn that the world looks better to them with the glasses than without the glasses. The goal is to provide them with enough wearing experience that they have an opportunity to discover this information. Recommendations about new glasses include the following guidelines:

The only hands that put on and remove the glasses should be adult hands.

If the child takes them off, be sure that you put them back on; and when appropriate, you take them off. As soon as the child learns that (s)he has control over the glasses, you may lose the battle. Eventually your child may have the maturity to take over this responsibility, but in the beginning it is better to have adult control so that the glasses do not become a plaything or an attention-getting tool.

Begin with small increments of wearing time and gradually build up the child's wearing tolerance.

Choose a time when the child is rested and in a good mood. Be prepared to "tap dance" a little while to keep the child occupied long enough to distract him/her from removing the glasses. Select a highly motivating activity that the child enjoys when introducing the glasses. When the child removes the glasses, stop the activity. Resume the activity when the glasses are back in place.

Make the glasses part of the child's daily routine.

Put them on in the morning as you dress your child and take them off before nap time and bedtime. This is a nice area to explore as far as using the small increments of time. For example, begin with putting the glasses on in the morning as part of the dressing routine and keep them on for as long as the child tolerates, then build to a longer period of time the next day.

See how it goes, be patient but firm.

 First Published Fall 1998

Versión Español de este artículo (Spanish Version)

By Andrea Story, Anchorage, Alaska
(originally published in The National Newspatch, November 1997 reprinted with permission)

Independence is emphasized in much of the literature concerning young children who are blind. In the revised edition of Can't Your Child See? A Guide for Parents of Visually Impaired Children it states that, "The more they (parents) teach the child to function independently in the first three or four years, the less they will have to do later (Scott, Jan, Freeman, 1985)." But how do you "teach" independence to a one-, two-, or three-year-old child without sight? How do you bring the world to the child and how do you teach skills such as putting on a jacket without making the child dependent on constant prompts and cues? It has often been observed that many children with visual impairments, especially those with additional impairments, are much more passive than their sighted peers. They seem to think of themselves not as a doer but as one who must wait for assistance or a prompt.

Literature on young children with blindness often mentions the "fairy godmother" syndrome. The child has little information to make the connections of how and why things are appearing and disappearing within their world. There is also the concern of imitation: how do you show a child how to eat with a spoon if they can't see how others are doing it? The solution offered for these concerns has often been a hand-over-hand guide technique. The adult holds the back of the child's hand and the child is guided to the objects to be explored and guided through the motions of the activity to be learned.

Some have begun to question and reject this method. Dr. Lilli Nielsen of Denmark noticed that children often pulled away when an adult attempted to direct or guide the child's hands. Lilli writes, "I changed my approach so that guiding or leading the child's hand was used infrequently. This resulted in the children seldom withdrawing their hands. On the contrary they became more eager to initiate exploration and examine objects, thus improving their ability to grasp and to use their hands in various ways." (Nielsen, 1992)

Watching Nielsen play with a child, one can see how touching the inside of the child's hand with an object elicits a grasp quickly and much more independently on the child's part than forcibly placing the child's hand on the same objects. Once the child is motivated by the objects, a reach and grasp can be elicited by a sound or vibration nearby. The children she has worked with at her presentations often begin to imitate activities such as strumming a stringed instrument, blowing into a harmonica, or dropping balls into a container. The children's hands were never guided, and they stayed actively engaged for up to an hour. The children's parents, teachers, and therapists are often amazed at how much the child would do for Lilli. A bigger challenge may be the very passive child who moves very little. It will take these children longer to learn, and small steps should be appreciated when they do occur. As Lilli has said, these children do not have time to waste.

Enthused by Nielsen's results, many who attend her lectures focus on equipment such as the Little Room (TM), and yet continue to guide the child's hand. The child's reaction is most often to pull their hands away, or to passively allow their hands to be manipulated. It is an issue that I still struggle with, for although I have seen some wonderful results in using alternatives, I still have to sit on my own hands sometimes to stop myself from guiding a child's hand. Even if I do restrain my own hands, I still have to convince educators, therapists, and parents that there are alternatives. Fortunately, some of the parents I've worked with have had success with getting their children to hold their own bottle, finger feed, and eventually spoon feed without guiding/controlling their child's hands. These successes make me question the standard advice given parents and others about teaching a child without sight.

Hand-over-hand guidance is recommended in most of the literature (or at least there are photos or videos demonstrating it). For a sighted person, it seems an almost instinctual response to guide the child's hands. Some children protest the guidance but eventually come to accept it and wait for "their turn" to explore. How frustrating to have to wait to explore something yourself! One child that I worked with seemed to actually enjoy the hand-over-hand guidance for finger plays and songs but was still quick to push the adult's hands away if the activity or object was unfamiliar to her. Other children seem much more affected by the technique and become more passive, or more defensive, to touch. These children do not repeat the skill by themselves after being guided. It should be considered that this technique of guiding a child's hand has been used too often and too quickly. Often it seems that the sighted person forgets or is unaware of the unique perspective of those that are blind. Martha Pamperin wrote about this perspective on the AER listserv recently.

"As I, a blind adult, go about getting myself a cup of coffee, I may (1) search the shelf tactually to locate cup and coffee pot, before (2) pouring the coffee. This preliminary search is normal for me, especially if I am at the home of a friend. It does not, however, look normal to the watching friend. Often as not, the friend concludes that I am not able to pour coffee and does it for me or watches in amazement as I do it myself. Since a blind person, at the beginning of a task, uses a tactual search to substitute for the visual search made by a sighted person, blind people can "look" unable when they are actually very able indeed."

Martha compares the sighted method vs. the tactual method of putting a jacket on.

"While the sighted kindergartner (1) sees the arm hole where his arm needs to go, and (2) puts his arm right in, the blind child will probably (1) aim his arm in the general direction of the arm hole and touch the front or back of the jacket, feel around to find the arm hole, then (2) put his arm it. It is hard to resist directing the arm into the arm hole or moving the jacket.... The tactual search and the pause for auditory searching may make us look blind, but, surprise, surprise, we are blind. Consider the beauty of gently searching hands and the wonderful awareness of the listening posture. Wait, let it be."

Another educator who is searching for alternatives to controlling hands is Barbara Miles, who presented a workshop entitled "Hands: Tools, Sense Organs, Voice" at the 1997 National Conference on Deafblindness. Barbara listed this topic, among others in her agenda; "skillful ways of touching and inviting touch, including alternatives to "hand-over-hand" techniques." Barbara showed a video in which she gained the trust of a child described as tactually defensive. Barbara used her hands to "invite" and "comment" on objects and activities rather than directing his activity. Her hands followed the child's very gently, and were slightly under the child's hands rather than over them, thus allowing the child to know that his tactile attention was shared. From this hand-under-hand position, the teacher could gently invite the child to touch an object or person without controlling. This freedom resulted in dramatically increased hand activity.

Consider the O&M technique of the sighted guide. We are taught that the sighted guide does not hold onto the blind person's arm and pullthat would take all control away from the one being guided. The guiding must be invited and even then it is understood that the one being guided will have a harder time repeating the route by themselves because the guide-ee is dependent on the guide-er.

Hand-over-hand guidance has been promoted as a catchall solution without much question as how it is done, when, and why. The challenge remains in our work with young children to explore this issue of teaching, yet still promote independence.

If you want more information about the National Newspatch please contact: Marilyn Gense, Oregon Department of Education, 255 Capitol St. NE, Salem, OR 97310-0203, phone (503) 378-3598, ext. 653. (Update 4/2015: Marilyn Gense no longer works for Oregon Department of Education. Please contact Kate Hurst with any questions you may have at )

Return to a Process for Identifying Students with Deafblindness (Birth-22)

As a Teacher of the Visually Impaired, you are aware of the importance of hearing for a child with a visual impairment. The Functional Vision Evaluation and the Learning Media Assessment both consider how the child uses his/her hearing for learning. Here are some things that you should try to determine through parent and staff interviews and/or the student's records. (Adapted from the Checklist for Deafblind Census of Texas)

  1. Does the student have a documented auditory impairment meeting Texas eligibility requirements as cited in the Commissioner's Rules?
  2. Does the student have a documented unilateral hearing impairment (conductive, sensorineural, or mixed) of at least 15 dB?
  3. Does the student have a documented bilateral hearing impairment (conductive, sensorineural, or mixed) of at least 15 dB?
  4. Does the student have a documented syndrome, disease or disorder associated with hearing loss?
    • Bacterial meningitis
    • Cytomegalovirus (CMV)
    • CHARGE
    • Usher Syndrome
    • Down Syndrome
    • Microcephaly
    • Rubella
  5. Does the student have a documented syndrome/disorder associated with a progressive hearing loss?
    • Cytomegalovirus (CMV)
    • Norrie Syndrome
    • Goldenhar Syndrome
    • Hurler Syndrome
  6. Does the student have a diagnosis of a central auditory processing disorder (CAPD) by a speech language pathologist or an audiologist? May also be called central auditory processing problem, central auditory processing dysfunction, auditory neuropathy. ORDoes the family or staff report the child having difficulty understanding what he is hearing?
  7. Is the student at risk for hearing loss? Factors to alert to include:
    • Documented chronic/persistent otitis media
    • Caregivers/professionals who know the child suspect impaired hearing based on:
      • significant and otherwise unanticipated delay in receptive and/or expressive speech-language skills or
      • Responses to full range of auditory stimuli in the environment is less than anticipated
      • Ototoxic medications such as those given for cancer, serious infections, etc.
      • Prematurity
      • Balance problems
      • Family history of hearing loss

Other risk factors include:

  • Drug or alcohol consumption during pregnancy
  • APGAR scores lower than 4 at one minute and below 6 at five minutes (APGAR scores measure newborn vital signs at birth)
  • Low birth weight (below 3.5 pounds)
  • Neonatal jaundice at birth requiring transfusion
  • Craniofacial anomalies
  • Visible malformations of the head, neck or ears including middle and/or inner ear structures
  • Family history of permanent or progressive hearing loss in childhood
  • Childhood injuries (especially skull fracture, sharp blow to the head or ears, loud noise exposure, and items accidentally inserted into ears resulting in damage)

Speech and language development are impacted greatly by hearing impairment. Even mild to moderate impairment can have dramatic consequences, especially if the child also has some type of vision loss. Below are typical milestones for a child with normal hearing according to the Alexander Graham Bell Association for the Deaf and Hearing Impaired. Be sure to visit their website at www.agbell.org for more detailed information.

Average Speech and Hearing Behavior by Age Level

Birth-3 Months

  • Startled by loud sounds
  • Soothed by caretakers' voices

3-6 Months

  • Reacts to the sound of your voice
  • Turns eyes and head in the direction of the source of sounds
  • Enjoys rattles and noisy toys

7-10 Months

  • Responds to his/her own name
  • Understands "mama," "dada," "no," "bye bye" and other common words
  • Turns head toward familiar sounds, even when he/she cannot see what is happening: e.g., dog barking or paper rustling, familiar footsteps, telephone, person's voice

11-15 Months

  • Imitates and matches sounds with own speech production (though frequently unintelligible), especially in response to human voices or loud noises
  • Locates or points to familiar objects when asked
  • Understands words by making appropriate responses or behavior: "Where's the dog?" "Find the truck."

15-18 Months

  • Identifies things in response to questions, such as parts of the body
  • Uses a few single words; while not complete or perfectly pronounced, the words should be clearly meaningful
  • Follows simple spoken directions

2 Years

  • Understands yes/no questions
  • Uses everyday words heard at home or at daycare/school
  • Enjoys being read to and shown pictures in books; points out pictures upon request
  • Interested in radio/television as shown by word or action
  • Puts words together to make simple sentences, although they are not complete or grammatically correct: "Juice all gone" "Go bye-bye car"
  • Follows simple commands without visual clues from the speaker: "Bring me that ball." "Get your book and give it to Daddy."

2 ½ Years

  • Says or sings short rhymes and songs; enjoys music
  • Vocabulary approximately 270 words
  • Investigates noises or tells others when interesting sounds are heard: Car door slamming, Telephone ringing

3 Years

  • Understands and uses simple verbs, pronouns and adjectives: Go, come, run, sing, me, you, him, her, big, green, sweet
  • Locates the source of a sound automatically
  • Often uses complete sentences
  • Vocabulary approximately 1000 words

4 Years

  • Gives connected account of some recent experiences
  • Can carry out a sequence of two simple directions: "Find your shoe and bring it here." "Get the ball and throw it to the dog."

5 Years

  • Speech should be intelligible, although some sounds may still be mispronouncedsuch as the /s/ sound, particularly in blends with other consonants (e.g., "street", "sleep", "ask").
  • Neighbors and people outside the family can understand most of what your child says and her grammatical patterns should match theirs most of the time.
  • Child carries on conversations, although vocabulary may be limited
  • Pronouns should be used correctly: "I" instead of "me" "He" instead of "him"

 

A baby with a visual impairment and wearing a hearing aid plays with a toy.As a Teacher of the Visually Impaired, you are aware of the importance of hearing for a child with a visual impairment.  The Functional Vision Evaluation and the Learning Media Assessment both consider how the child uses his/her hearing for learning.  Here are some things that you should try to determine through parent and staff interviews and/or the student’s records.  (Adapted from the Checklist for Deafblind Census of Texas)

Does the student have a documented auditory impairment meeting Texas eligibility requirements as cited in the Commissioner’s Rules?

Does the student have a documented unilateral hearing impairment (conductive, sensorineural, or mixed) of at least 15 dB?

Does the student have a documented bilateral hearing impairment (conductive, sensorineural, or mixed) of at least 15 dB?

Does the student have a documented syndrome, disease or disorder associated with hearing loss?

  • Bacterial meningitis
  • Cytomegalovirus (CMV)
  • CHARGE
  • Usher Syndrome
  • Down Syndrome
  • Microcephaly
  • Rubella

 Does the student have a documented syndrome/disorder associated with a progressive hearing loss?

  • Cytomegalovirus (CMV)
  • Norrie Syndrome
  • Goldenhar Syndrome
  • Hurler Syndrome

Does the student have a diagnosis of a central auditory processing disorder (CAPD) by a speech language pathologist or an audiologist? 

May also be called central auditory processing problem, central auditory processing dysfunction, auditory neuropathy. 

OR

Does the family or staff report the child having difficulty understanding what he is hearing?

Is the student at risk for hearing loss? 

Factors to alert to include:

  • Documented chronic/persistent otitis media
  • Caregivers/professionals who know the child suspect impaired hearing based on:
    • significant and otherwise unanticipated delay in receptive and/or expressive speech-language skills or
    • Responses to full range of auditory stimuli in the environment is less than anticipated
    • Ototoxic medications such as those given for cancer, serious infections, etc.
    • Prematurity
    • Balance problems
    • Family history of hearing loss

Other risk factors include:

  • Drug or alcohol consumption during pregnancy
  • APGAR scores lower than 4 at one minute and below 6 at five minutes (APGAR scores measure newborn vital signs at birth)
  • Low birth weight (below 3.5 pounds)
  • Neonatal jaundice at birth requiring transfusion
  • Craniofacial anomalies 
  • Visible malformations of the head, neck or ears including middle and/or inner ear structures
  • Family history of permanent or progressive hearing loss in childhood
  • Childhood injuries (especially skull fracture, sharp blow to the head or ears, loud noise exposure, and items accidentally inserted into ears resulting in damage)

 Average Speech and Hearing Behavior by Age Level

Speech and language development are impacted greatly by hearing impairment.  Even mild to moderate impairment can have dramatic consequences, especially if the child also has some type of vision loss.  Below are typical milestones for a child with normal hearing according to the Alexander Graham Bell Association for the Deaf and Hearing Impaired.  Be sure to visit their website at www.agbell.org for more detailed information.   

Birth-3 Months

  • Startled by loud sounds
  • Soothed by caretakers’ voices

3-6 Months

  • Reacts to the sound of your voice
  • Turns eyes and head in the direction of the source of sounds
  • Enjoys rattles and noisy toys

7-10 Months

  • Responds to his/her own name
  • Understands “mama,” “dada,” “no,” “bye bye” and other common words
  • Turns head toward familiar sounds, even when he/she cannot see what is happening: e.g., dog barking or paper rustling, familiar footsteps, telephone, person’s voice

11-15 Months

  • Imitates and matches sounds with own speech production (though frequently unintelligible), especially in response to human voices or loud noises
  • Locates or points to familiar objects when asked
  • Understands words by making appropriate responses or behavior: “Where’s the dog?” “Find the truck.”

15-18 Months

  • Identifies things in response to questions, such as parts of the body
  • Uses a few single words; while not complete or perfectly pronounced, the words should be clearly meaningful
  • Follows simple spoken directions

2 Years

  • Understands yes/no questions
  • Uses everyday words heard at home or at daycare/school
  • Enjoys being read to and shown pictures in books; points out pictures upon request
  •  Interested in radio/television as shown by word or action
  • Puts words together to make simple sentences, although they are not complete or grammatically correct: “Juice all gone” “Go bye-bye car”
  • Follows simple commands without visual clues from the speaker: “Bring me that ball.” “Get your book and give it to Daddy.”

2 ½ Years

  • Says or sings short rhymes and songs; enjoys music
  • Vocabulary approximately 270 words
  • Investigates noises or tells others when interesting sounds are heard:  Car door slamming, Telephone ringing

3 Years

  • Understands and uses simple verbs, pronouns and adjectives: Go, come, run, sing, me, you, him, her, big, green, sweet
  • Locates the source of a sound automatically
  • Often uses complete sentences
  • Vocabulary approximately 1000 words

4 Years

  • Gives connected account of some recent experiences
  • Can carry out a sequence of two simple directions: “Find your shoe and bring it here.” “Get the ball and throw it to the dog.”

5 Years

  • Speech should be intelligible, although some sounds may still be mispronounced—such as the /s/ sound, particularly in blends with other consonants (e.g., “street”, “sleep”, “ask”).
  • Neighbors and people outside the family can understand most of what your child says and her grammatical patterns should match theirs most of the time.
  • Child carries on conversations, although vocabulary may be limited
  • Pronouns should be used correctly: “I” instead of “me” “He” instead of “him”

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

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

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


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

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

What Is Sleep?

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

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

Sleep Problems of Children with Disabilities

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

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

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

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

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

Pencil line drawing of boy in bed."Sleep is Boy"
by
Wendy Haynes
1975

Exploring Sleep Behaviors

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

Sleep Hygiene

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

Collecting Information

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


Daily Sleep Diary

Name:___________________ Date:___________________

Planned Bedtime:__________ Actual Bedtime:__________

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

 

Night wakings:beginendtotal time
#1      
#2      
#3      
#4      
#5      
#6      
    Total time slept (naps and night sleep):  

End of sleep - Wake-up time: _____________

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

Child's mood upon final awakening: __________________________________________

Napsbeginendtotal time
#1      
#2      
#3      
#4      
#5      
#6      
    Total time slept (naps and night sleep):  

Comments and observations:_______________________________________________


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

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

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

Interpreting Information

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


ABC Record of Sleep Problems

Name:_____________________________ Date:___________________

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

Intervention Techniques

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

Behavioral Intervention

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

1. Positive Bedtime Routine

Problem: Bedtime resistance

Goal: To teach a child bedtime cooperation

Procedure:

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

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

2. Graduated Extinction

Problem: Bedtime resistance and night wakings

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

Procedure:

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

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

3. Extinction

Problem: Bedtime resistance and night wakings

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

Procedure:

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

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

4. Scheduled Awakening

Problem: Night arousals and night wakings

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

Procedure:

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

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

5. Bedtime Fading

Problem: Bedtime resistance and night arousals

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

Procedure:

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

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

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

Medication and Chemical Intervention

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

Conclusion

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

References

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

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

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

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

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

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

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

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

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

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

(Originally published in the June 1995 edition of VISIONS)

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

By Millie Smith, Teacher Trainer, TSBVI, VI Outreach


The first significant visual event in a baby's life is gazing at her caregiver's face. The baby is able to focus on objects about eight inches away. This is usually the distance between the caregiver's and baby's faces (Stern, 1977). By six weeks, the baby can look directly at her caregiver and hold the gaze with eyes widening. By three months the baby can follow the movements of her caregiver as she moves about at a distance (Morse, 1991).

The baby's relationship with her caregivers during the first three months of life is not limited to visual experience. Recently, hospitals have discovered that premature infants develop better if they are taken out of incubators for periods of time and held against the skin of the caregiver. The warmth provided this way fosters growth better than that provided by the incubator. Everyone knows the trick of quieting a new puppy by putting a clock in the basket to imitate the sound of a heartbeat. A baby also appreciates these sounds and the babbling and cooing caregivers are inclined to provide. The special significance of eye gaze in early attachment seems to be related to the fact that it is a shared communicative experience between the baby and caregiver. The message sent and received by both parties is usually, "You are wonderful."

There are three basic head positions of the baby that almost all adults interpret the same way. The head at midline with eyes looking straight at the caregiver is interpreted as an invitation for interaction. The caregiver tends to gaze back and coo when the baby's head is in this position. When the baby's head is turned slightly to the side, the caregiver usually thinks the baby is losing interest in her. She may do something to attract the baby's attention, or she may terminate the interaction. If the baby's head is turned sharply, lowered, or thrown back, the caregiver is likely to assume that the baby doesn't want to interact. The message received by the caregiver, sometimes unconsciously, is "Go away." or "Leave me alone." (Stern, 1977).

Caregivers of babies with visual impairments need to be aware that, for them, these head positions must be interpreted differently. Babies with visual impairments may turn their heads to the side because they see better straight ahead with their heads turned. Babies with little or no vision may turn their heads to the side, up, or down because they are listening and touching, not looking. Most caregivers will have to consciously override the strong instinct to interpret these head postures as requests to stop interacting. When a baby has a visual impairment, a better way of determining the right time to stop an interaction might be to read muscle tone, breathing rates, and vocalizations. For some caregivers, it will be a little harder to read invitations to initiate interactions. The direct straight-on head posture that signals readiness for interaction may never appear. Caregivers could wait for other signals like cooing or increases in movement, but some babies may take a while to learn those ways of communicating their desire for interaction. Perhaps the safest thing to do is to initiate interactions frequently without waiting for a request. So far, there is no evidence that babies suffer from too much attention in the first three months of their lives.

Caregivers can also do a couple of things to make it a little easier for babies with visual impairments to gaze at them. First, some parents have reported that they get much better eye contact with their babies when the baby is lying in its crib, rather than sitting up in its seat or being held. The baby can probably see the parent's face more clearly when it is lying down because the face has a clear background behind it - the ceiling. When the baby is more upright, the background behind the parent's face is more complex. The baby has a hard time figuring out what is face and what is furniture, pictures, wallpaper, etc. Second, the baby can put all its energy into gazing when its head is supported properly. If the baby is having to work to stabilize its head or other parts or its body, it has less energy left over for looking.

There is another factor that may influence gaze behavior in babies. Some babies with visual impairments have difficulty handling stimulation from multiple sources. They may compensate for this difficulty by responding to only part of a stimulus. Sometimes the part they respond to is not the part we expect them to find interesting (Morse, 1991). A baby having this difficulty might look at the hairline or an eyebrow rather than the eyes themselves. The caregiver may feel somewhat rejected. In fact, the baby may be trying to simplify its sensory experience. If the caregiver does what most caregivers do, she is gently swaying as she looks at the baby and coos at it. Not only that, she is probably changing her facial expression as she talks to the baby. This is a lot of stimulation. "As the complexity of these simultaneously presented sensory demands increase, the processing difficulties may correspondingly increase." (Morse, 1991) The baby is likely to fall back on her preferred sensory system at these times. If she has a visual impairment, that system is not likely to be the visual one and she may avert her gaze (Morse, 1991). In this case, the message is not "Leave me alone." It is "Give me a little less a little slower."

Caregivers can figure out ways to attach by using the unique visual style of the baby and/or by using other sensory input and types of communication when they realize that head posture needs to be interpreted differently for the baby with a visual impairment. With some adjustment, attachment can begin positively. The baby can learn that she has the power to draw her caregiver closer to her (Pogrund, Fazzi, & Lampert, 1992) and the caregiver can learn to pace her interactions according to the baby's processing needs. Mutual closeness between the baby and her caregivers is the launching pad for the development of skills related to everything else!

References

Morse, M. (1991). Visual gaze behaviors: considerations in working with visually impaired multiply handicapped children. RE:view, 23, 5-15.

Pogrund, R., Fazzi, D., & Lampert, J. (1992). Early Focus: Working with Young Blind and Visually Impaired Children and Their Families. New York: American Foundation for the Blind.

Stern, D. (1977). The First Relationship: Infant and Mother. Cambridge, MA: Harvard University Press.

by Franziska Naughton and Sharon Sacks

Introduction:

In the average family, the kitchen is the most important room in the house. It is a natural gathering place during meal preparation. Even when the kitchen is tiny, family activity swarms around the cooking center. During clean-up time and after meals, someone is always in the kitchen. This is the place to come for talk, comfort, sharing, togetherness. The child quickly discovers that the kitchen is a good place to be!

Except the blind child. Personal experience and recent research reveal that the kitchen is not the most important room in the house for the blind child. The severely visually impaired student selects the bedroom as the most important room in the house. The bedroom is often the room in which the blind child spends most of his time. From early childhood through school years the blind child spends more time in the privacy of the bedroom than other children.

New parents of a visually impaired child frequently leave the child in the bedroom because it is a safe place. Later, the child is kept in the play pen for the same reason. The kitchen, with all its equipment, is not a safe place. A visually impaired child is discouraged from spending time in the kitchen. What a loss to the child. This room is the focal point of family living. It is the richest learning source in the child's home. No child should be discouraged from spending time in the kitchen. The visually impaired child, more than others, needs to enjoy and learn from the kitchen smells, kitchen textures, kitchen sounds, and kitchen tasks.

In the kitchen curriculum we have attempted to put together suggestions to help parents keep a visually impaired child in the kitchen with them. We begin with general guidelines for introducing the child to touch, taste, sound, and smell. These are basic to growing and learning. Then suggestions are provided for helping the child experience the kitchen environment. Included are daily tasks for the visually impaired child so that he is a helping member of the family work force. Finally, early cooking and clean up responsibilities are listed.

The purpose of this outline is to ensure that the visually impaired student has an equal opportunity to share in the pleasure and skills of kitchen living. Protecting a child from the dangers of the kitchen is like protecting from life itself--the protection can be more damaging than the risky experience. A child who is deprived of experience does not continue to seek new experience. Curiosity decreases and the motivation for learning diminishes. The opposite occurs when the child is encouraged in new experiences, especially in a secure and happy home. Personal feelings of worthwhileness are enhanced with the responsibility of being a contributing family member. The skills of cooking, like other competencies, add to the total self concept and the child is more confident as well as more skilled.

Guidelines

  1. Omit or reduce background stimulation (TV, radio, record player). Meaningless stimulation has no useful purpose, reduces early auditory discrimination and may delay developing close personal relations within the family.
  2. Talk to infant always--spontaneous, natural sounds and words stabilize the auditory environment.
  3. Touch and talk to infant--touch and talk are basis of relationship and are crucial for the establishment of basic trust.
  4. The more persons in the household, the greater the importance of omitting extraneous auditory stimulation so that the child quickly recognizes individual family members. The foundation of learning is a secure and familiar environment and the enjoyment of close human relationships.
  5. Touch, tickle, caress, cuddle, and pat as often as possible.

Baby 0-3 Months:

  1. When infant is not sleeping, keep in most frequently used room.
  2. Stimulate physically often (touch, caress, cuddle).
  3. Powder baby often, changing diapers with murmuring accompaniment. Use lotion and cream.
  4. Introduce water gradually. First step is sprinkling legs, then hands. Next sprinkle bottom and tummy (in warm room with warm water). Immerse in water gradually. Play a little game--dip a hand, dip a foot, dip a bottom. Enjoyment is more important than cleanliness.
  5. Gradually make bath time an extended playtime, enjoying water, toweling, powdering, patting, rolling, etc.
  6. Introduce stimulating objects such as soft furry balls, rattles, shapes, squeezeable toys, and different textures.
  7. Introduce one sweet taste, such-as prepared baby apple sauce, from the age of one month. (Example: one teaspoon daily) Try a new flavor once a month. Quantity eaten is not important criteria. Acceptance of new flavor and texture is goal.

3-6 Months

  1. Dad or Mother can take baby in shower with him/her in protective position. Make enjoyable sounds.
  2. Stimulate physically often (touch, caress, cuddle).
  3. Include baby in family circle at all times.
    1. Keep baby in kitchen during meal preparation.
    2. Include baby next to table (place infant seat at table). Talk and touch during mealtime conversation. (This does not apply if baby is sleeping).
  4. Expose baby to outside environment.
    1. Sleep outside-listen to outdoor sounds
    2. Ride in pram.
    3. Ride in car.
    4. Take outside in all kinds of weather with appropriate dress.
  5. Gradually end restriction on background noise. Use moderation. Whichever medium parents prefer (TV, radio, or record player) can accompany baby's waking hours. However, do not use TV as a pacifier. Babies are stimulated by various sounds, but multiple sounds relationships are confusing. Uninterrupted music is a specific enjoyable experience. Commercial voices add nothing to baby's experience.
  6. The sounds of natural family activities which include the baby are healthy. For example, if Mother and Dad watch TV while infant is awake, include baby in the experience. Hold or talk to baby during listening time. This is a family sharing (and viewing) time. It is not advisable to turn radio or TV on as company for the baby or yourself.
  7. Place the baby in a play pen or ports crib for part of each day. A place other than where baby sleeps is preferable. It is important to distinguish between sleeping time and play time. Put up a mobile and/or play gym.
    Introduce
    varied objects both in the crib and play pen so that baby is rewarded for exploring. If a baby moves around he will find new experiences! Different textures and sound include impressed blocks, squeezables, noisemakers, soft animals, etc.
  8. Begin patterning movements. Stretch arms out and back, two together, one at a time. Move legs out and back, bend forward and back. Move arms sideways, right to left and left to right, across midline.
  9. Place objects in touch with fingers and move objects with hands following and reaching farther and farther, encouraging the infant's exploration of space.

6-9 Months

  1. Start swimming with Mother or Dad (YMCA has infant swim program).
  2. Take everywhere: store, church, walks, office, trips, visits, restaurants.
    1. Tell child where they are going.
    2. Talk while getting ready.
    3. Tell him the purpose of the trip.
    4. Describe activity.
  3. Always listen for identifiable sounds and talk about them; birds, cars, animals, airplane.
  4. Identify movement; feel ball, roll ball, bounce ball.
  5. Expose to new textures; grass, snow, mud, rugs, and upholstery.

9-12 Months

  1. Sit in high chair during mealtime preparation. Place common kitchen utensils such as spoon, cup, plate (plastic), pan, on tray. Alternate with edible textures: bread, cookies, apple, banana, dry cereal, bologna, hard boiled egg--whatever mother is preparing.
  2. Speak to child about everything around him. Keep it simple and be sure to clearly associate the speaking with the appropriate action or object. For example: identify body part appropriately. "Mmm, that feels good in your mouth. Nice mouth." Run your finger around baby's mouth. Kiss baby. Have him feel your mouth. Note: At this moment, the word mouth is being introduced for later use, not for baby's speech.
  3. Introduce regular foods at family mealtimes and during meal preparation. It is not necessary for the child to eat everything, but encourage the child to try everything.

12-18 Months

  1. Introduce warm, hot and cold. This may be done at any time, but preferably before child is walking.
    1. Hold child by running water and change temperature from coldest to warm to hot.
    2. Cold experiences: ice cream, frozen foods, ice cubes, etc.
    3. Hot experiences: pot pie, wet wash cloth, coffee or tea (cup).
    4. Automatically teach NOT cold or NOT hot at the same time to establish difference.
  2. Crawling (If child skips crawling, apply same suggestions to walking).
    1. Allow child to explore everything in kitchen. Remove unsafe items from lower shelves. Note: #2 1/2 can is not unsafe; Child must experiment with heavy, sharp objects.
    2. If possible "give" one bottom shelf section to child for kitchen utensils that he can organize and play with and return to cupboard (pots, pans, plastic dishes, etc.).
      1. Child can choose to play at any time.
      2. If this cupboard is in the way of cook, establish that cupboard is out of bounds during cooking. Note: Activities during first year have established cooking time.
      3. Always put play utensils away with the help of the child. Place in child's hand and model desirable putting away behaviors extensively.
      4. The responsibility for putting away transfers to the child as soon as possible. Learning to put things away?and clean up?takes much practice over a long period of time. The reward for mother is a responsible child who responds to instructions. In the long run mother's patience and persistence results in less work for mother. The reward for the child is increasing independence and self?sufficiency.
  3. Walking (Same as crawling expanding experiences).
    Introduce refrigerator, range, and other appliances. For example: "This is the refrigerator. It's a big box with a door. Inside, food is kept cold." (Open the door.) Let child feel cold things. Sample the milk, fruit, etc. "The refrigerator is big." Lift child up to feel top. It is important not to take any information for granted. Make sure child experiences size and function.
  4. Prepare for good eating habits. Let child examine spoon. When parent feeds child with spoon, let child experiment. Encourage initial attempts to use spoon regardless of mess.

18-24 Months

  1. Start good eating training. Show child proper use of spoon. Place spoon in hand with bowl of spoon facing child. Cover baby's hand with your own. Explore limits of bowl. Tap on outside, inside, and move around center.
  2. Differentiate smells. Bring aroma to child or child to aroma. Cabbage, fish, onion, meat, bread baking, cake and cookies, bacon, applesauce with cinnamon--spicy aromas, vinegar, mint, oranges, lemons, beer, pizza, sauerkraut, wine, etc. Don't forget smelling and tasting everything!
  3. During this period child should have begun to chew solid foods naturally, especially if she has been encouraged as suggested above. If there is difficulty, present a favorite item such as animal crackers or sweet cookie consistently. Show child how to chew. (If child has some sight, demonstrate biting and chewing with exaggerated motion.) Mother takes a bite, then child, etc. Gradually use varied bite size foods such as crackers, cheese, meats. If child is not chewing by 24 months, training time should be increased. Apply specific programming techniques. (Example: Delay feeding time. Use soft foods such as macaroni or spaghettios and keep child's mouth closed.) Important Note! This learning process does not come on demand or overnight. Good chewing and eating habits are a process to be developed over a period of years. It helps to start early and encourage with consistency and patience. Good habits cannot be forced. A positive approach with praise for each forward step insures pleasant and easy growth toward good eating habits.
  4. Movable parts are interesting at this age. Let the child open and close cupboards and drawers. (The sooner the child hits himself and learns how to maneuver, the better--it's all part of the learning process.)
  5. Suggested kitchen objects to move: ice cream scoop with flipper, manual can opener, food tongs, flip lids (empty spice box), push top of detergent bottle.

2-3 Years

  1. Allow child to experience function of moveable parts. For example: spray plants, squirt detergent in bowl, open cans, assist in scooping ice cream.
  2. Begin household chores.
    1. Carry napkins to table.
    2. If samples of food are available, such as carrot stick from salad, "Bring to Daddy, Sister, etc."
    3. Place frequently used utensils where child can reach and ask child to give you: the pan, the measuring cup, serving spoon, etc.
  3. Increase exposure to different textures and tastes. Include child in one or more steps of cooking and baking. Example: softness of flour, grittiness of sugar, moistness of butter, sliminess of eggs, feel of dough. Taste raw dough--mold like clay. Then experience taste, temperature of newly baked product.

3-4 Years

  1. Household Chores:
    1. Teach child to fold napkins.
    2. Bring utensils to table.
    3. Return dishes to kitchen table.
    4. Push food scraps off plates into wastebasket. This is good early training for search­exploring techniques essential to a wide range of activities.
  2. Assist in cooking.
    1. Sir batter, salads, vegetables, etc.
    2. Shred lettuce
    3. Mix powder with liquid, such as chocolate milk, pudding, etc. Child will need to check progress of mixing with fingers. Fingers are a most efficient tool and a blind child learns to substitute touch for sight. The wise parent quickly accepts what might appear to be messy and unsavory as an essential learning step. During child's third year he is also gaining independence in washing his hand's. Helping in the kitchen provides many opportunities to clean hands, too!
  3. Use cooking and baking activities to become aware of time.
    1. Baking cookies
    2. Cooling pudding
    3. Freezing ice cubes.
    Use a kitchen timer to alert child to time period. Adapt timer for visual impairment by raising dots or enlarging minute signs with nail polish or glue, etc.

4-5 Years

  1. Household chores:
    1. Learn correct table placement and help set table.
    2. Put cheese on crackers; meat on bread.
    3. Spoon out jelly on bread. (This will probably be messy but will • prepare child for later tasks and is a tasty job.)
  2. Use left and right side orientation skills. The knife goes on right side of plate. The fork goes on the left side. Cup goes in front of the knife. Chair goes behind the plate.
  3. Set standards of appropriate table behavior. Because of the importance of practice, the family of the visually impaired child will benefit if meals are regularly scheduled together and high standards of behavior maintained. Learning good manners is important for later socialization away from home. Socially acceptable eating habits and manners are the right of every blind child. They don't come naturally. Good habits are taught.
    1. Use "please" and "thank you" regularly.
    2. Pass food around table rather than always serve child. For example: teach child to take one roll--not to feel every roll.
    3. Wait for child to ask for helping--don't anticipate every need.
  4. Introduce fork. Use of spoon is now well established. In teaching use of fork, identify and maintain appropriate use. For example: insist that fork is used for meats and pancakes. Do not let child revert to fingers. A stabbing motion (enjoyable) is used until child is comfortable. With greater practice, the child should be encouraged to use a slower, smoother, rhythmic movement. At this age child will use one hand to locate bite size food and the other to pierce food.

5-6 Years

  1. Household chores:
    1. Increase independence in completing previous tasks
    2. Fill glasses with assistance (during early years buy quart containers or transfer from larger containers to pitcher).
    3. Spread butter, peanut butter, jelly.
  2. Table manners:
    1. Serve own food at table. Practice appropriate amount on spoon.
    2. Discourage use of hands to eat. Use spoon and fork. Don't rush. Allow extra time at family meals. Make the dinner hour a pleasant family sharing time allowing plenty of time for child to carry through good manners. (Blind child needs time for eating. An extra 15 minutes built into each mealtime really pays off.)
  3. Supplement cooking tasks by discussing the different textures of foods through changing conditions. Example: Cookies changing from soft to -- hard through baking--cooling process, renew and review touching, molding, smelling, tasting with more emphasis on change. Making pudding and ice cubes become part of child's science education. Later, ask Dad or brothers or sisters to share these activities and talk about chemical and physical properties.
  4. Begin simple cutting tasks: celery, carrots, bananas.
  5. When liquids are spilled, child mops up with sponge, cloth or paper towel. Keep equipment in place and in easy reach. Child learns to find sponge, or cloth or to take paper towel from roller. Wiping up can be fun. Keep this job pleasant. Don't strive for perfection!

6-7 Years

  1. Household chores:
    1. Set the table automatically.
    2. Help make salad or other vegetables, such as dicing carrots, slicing beans, breaking up cauliflower.
  2. Squeeze orange, lemons, limes. Convert to fresh orange juice and make preparation a special job. Good opportunity for recognition (and freshly squeezed orange juice is special).
  3. Table manners:
    1. Begin cutting easy food at able (cooked vegetables such as potatoes, carrots, broccoli,asparagus; ground meats).
    2. Introduce soup.
    3. Continue introduction of varied signs, shapes, and textures of food.
  4. Teach table wiping techniques. Start with crumbs scattered on a small amount of surface. Sweep up crumbs with hand into one place. Sweep into hand or crumb tray and put in wastebasket. Then introduce sponge or cloth and gradually expand task to include larger expanse of table.
  5. Empty small wastebasket into larger trash container. Alert child to small objects that miss the larger container. Finding the "dropped" object provides a practical, meaningful reason to develop search and find techniques. Methodical and efficient sweep and find motions are learned through trial and error in relevant tasks.

7-8 Years

  1. Household chores:
    1. Dry dishes.
    2. Put away dishes.
    3. Use can opener.
  2. Fix hot dogs.
  3. Make lemonade from frozen concentrate.
  4. Prepare Koolaid.
  5. Table manners: Practice particular skills of eating unusual foods.
    1. hot dogs--keeping bun turned up so condiments don't fall out.
    2. tacos--same problem.
    3. ice cream bars--rate of eating.
    4. spaghetti (introduce--requires a lot of practice).

8-9 Years

  1. Household chores: Washing dishes is a daily job present in every household from infancy through adulthood. It can be an easily accomplished, pleasant task that is completed as a matter of course. Dishwashing can also be viewed as an unpleasant or menial task. It is worth spending family time to insure that this valuable skill is learned in a pleasant way in an atmosphere of good will and fun techniques:
    1. Prepare sink or pan with hot soapy water.
    2. Prepare second sink with clean water.
    3. Wash dish with sponge or cloth, feeling the surface with hand, checking for grease or grit. If plate is not squeaky clean, it should not be rinsed.
    4. Rinse and drain.
    5. Allow plenty of time and plenty of help. Child first learns to dry and put away. Assign washing first as a helper. Then gradually increase responsibility over a period of years. At age 8, child can wash easier dishes and someone else can finish pots and pans. When dishes are put in rack unclean, cheerfully ask child to redo. Maintain standards and cut down on quantity if child has difficulty.
  2. Assist food preparation and baking by measuring required amounts: 1, 1/2, 1/3, 1/4 measures needed. Use only level dry measurements in beginning.
  3. Practice cracking eggs in bowl for scrambling eggs.
  4. Table manners:
    1. Encourage good posture while eating.
    2. Establish clues to appropriate distance from food. Head should not be above table over food. Head should be upright and hands moved from plate to mouth.

Establishing Skills for Independence

During the intermediate grades (latency age) and junior high, the student's world is moving outward from the home into the school and community. The student measures his skills and accomplishments in comparison to his peers. During these years it is vital that the visually impaired child acquires comparable competencies. He needs to develop as much independence as possible. It is as a self­

functioning person that he gains acceptance as a member of his peer group. The kitchen skills introduced in the primary years need further practice and growth toward independent living. If the student is not now familiar with cooking and clean-up, use earlier suggestion and move along toward the independent skills listed for later years.

9-10 Years

  1. Start range cooking. The adult's fear of being burned must be Reemphasized. Learning to use heat is an essential skill. A person cannot cook without heat. Using an electric or gas burner is a skill to be learned like any other skill. Everyone, sighted or unsighted, is burned at one time. Don't protect a blind child from using the stove. Burns are part of learning process. Introduce range, pointing out location of all parts. Teach first the use of top burners. Establish­feel-all four burners, front and back, left and right. Ask student to find right burners, left burners, left front, left rear, etc. (This is a difficult concept for many children and requires a lot of practice.) Identify the knobs which turn on the heat. Depending on level of knowledge, it is important to explain connection of switch to source of power. Correlate each knob with each burner (omit oven knob for time being). Turn knob on.
    • Gas: Place child's hand under yours near burner, but not close enough to scorch. Listen for sound of pilot igniting burner. Feel intensity of heat, moving hand away and toward burner.
    • Electric: Burner takes longer to heat up and change temperature. Some cues that might help: on some models, a click can be heard as knob is turned) levels of heat are determined by position of clock hands - as the knob is turned counter-clockwise, heat level is increased.

    When burner is off, practice placing various size pans on the burner. Remind child that when cooking, the food must be in the pan before turning on the burner. Teach appropriate burner levels for particular cooking jobs.

    Oven cooking. First mark or raise the spots on circular temperature range. (250°, 350°, and 450° is recommended). Then place raised sign on pointer. Teach child to match pointer with degree of temperature (at or between raised spots). Experiment with the feel of low - medium - and high oven settings Particularly important is practice in experiencing the heat felt on opening oven door.

    Keep pot holders at easily accessible location to oven. With cold oven, practice putting various sized pots and pans in oven. Some pans require one hand, others two hands. After practice with cold oven, start baking projects, following directions.

  2. Table Manners:
    1. Continue cutting skills at table with more difficult meats such as sliced beef, pork and lamb.
    2. Insure that child routinely uses napkin independently. Teach child to unfold napkin and cover lap. Napkins can be secured under belt or over top of pants. Alternately, if desirable, child learns to tuck napkin under collar to cover front of shirt or dress.
  3. Ice cream cones and popsicles. Check on eating techniques. These popular foods can and should be eaten in a presentable way. Emphasize that to be acceptable this is a timed job, the time limits being set by the temperature. Try a little scientific experiment Leave 3 popsicles in different locations:
    1. the refrigerator
    2. kitchen table
    3. a sunny spot.

    Ask student to check rate of melting and why. Also, make your own popsicles.

10-11 Years

  1. Household Chores: Sweep floors. Push brooms are easier for the blind child. Using same techniques as table wiping, implement a methodical approach. Push toward one central wall and then into one pile. Use a damp paper towel to pick up debris.
  2. Peeling fruit: By this time, child is peeling his own banana and orange and independently disposing of peel. Introduce paring and dicing of apples and pears. A corer is a useful tool for fixing more than a single apple and pear. A peeling knife is a difficult instrument to use well. A large amount of practice on fruit is preferable before trying to pare potatoes. Paring is an optional skill as there is a trend to use skins as much as possible. Fruit salads are a delightful opportunity to use cutting, dicing, coring, washing, and peeling skills with pleasure for all eaters.
  3. Transferring Liquids: Disposable hot liquids should be drained through a colander, such as excess liquids on noodles. Ladling soups and sauces requires more practice. Remove soup pan from stove. Place soup bowl next to pan. (Try technique with cold and warm soup before attempting hot liquid.) Place finger on rim of bowl to gauge correct position of spoon and height of liquid in bowl.
  4. Provide increased opportunities to measure dry and liquid foods.
    1. Recommend metal cup measures with handles. Bend handle so that it becomes a scooper. Scoop measure into bin and level with finger (experience) and then knife. The same technique applies to measuring spoons. Place salt in full-mouthed container or learn to pour over sink.
    2. Use the same metal measures for liquids. If measuring from a large liquid container, measure can be used as a scoop. If pouring liquid is preferable, place measure in larger bowl or plate to handle overflow.
  5. Introduce cutting meat away from bone. Begin with removing only main portion of chop or, chicken breast. Let child finish by eating off the bone. Gradually raise standards.

11-12 Years

  1. Label can goods and boxes in braille (or large print) so that student can easily find foods for himself and mother.
    Note: Purchase Braille-On and type braille sign; to attach to boxes, cans, frozen foods. A more convenient and reusable system is to attach Braille-On tapes to small magnets. The magnets can then be attached to cans. When can is used, place magnet in small container for re-use.
  2. Inform student on gristle and fat. Allow plenty of time to handle fatty meat by hand. Instruct on how to use fork to identify softer, fatty edges if child does not like fat. Practice trimming chops and steaks as needed.
  3. Broil meats. Follow guidelines for introducing burners and oven. Introduce uncooked meats. Broiling can begin with hot dogs and hamburgers before solid raw meat. Raw steak and chops should be experienced and the changes noted similar to cooking tasks described in #3 under 5-6 years. Note fat and practice trimming raw and cooked.
  4. Begin paring potatoes and carrots. For introduction to peeling, see fruits - age 10-11 - Under #2.

Ages 12 and Up

  1. Establish a braille (or large print) cooking file. The first section is standard package directions frequently used, such as directions for preparing orange juice, TV dinners, pot pies, hamburger help, macaroni and cheese, etc. Another section is recipes, starting with the easiest (hot dogs, popcorn) and accumulating as child gains experience. As interest increases, cooking becomes not only a rewarding experience, but also a life-long interest and hobby.
  2. Introduce electrical appliances. It is preferable to introduce electrical appliances after a child has experienced and/or mastered the mechanical motion himself. Safety rules are easily understood if action is thoroughly experienced. Then the only difference is the speed of automation and safety rules.
    1. Can opener
    2. Orange juicer
    3. Mixer
    4. Blender
    5. Ice crusher
    6. Coffee maker
    7. Hot dog maker
    8. Hamburger maker
  3. Table manners: Good table manners are always important for socialization. Eating with fingers is inappropriate.
    1. Use a knife or roll to push vegetable or meat to fork in an attractive way to clear plate. The knife is more difficult but is always available. Knife skills are attainable and desirable.
    2. When a plateful of food is presented without identification, student should politely ask another person to explain location of food on plate. At home, with family, this routine is accepted practice. Occasionally forget to provide information so child will learn to ask. Then in restaurants and other homes, he will do this naturally without embarrassment.
    3. A part of adolescent social life includes stopping at ice cream shops and hamburger drive-ins. The blind child needs this experience with family so that he is comfortable ordering and eating in public places. Insure as much independent practice of these important social skills as possible.
  4. Grocery shopping: Everything we have said about exploring and experiencing kitchen foods, smells, temperatures, etc. applies to shopping in your local grocery. If the student has been going to the store regularly, he is familiar with the organization of the store. Now is the time to teach more specific shopping skills if it hasn't been done already.
    1. Encourage child to feel each item purchased. Let her feel surrounding items.
    2. Categorize foods according to type of food, Storage conditions, etc. For example, bacon and prepared meats of many different textures and types of packages are in the cooler. Touch and talk about all the different products. Don't hesitate to squeeze a squeezable product! Encourage the child to explore all the details of texture, shape, temperature, and size.
    3. Gradually assign more responsibility during shopping trips.
    4. Send to store on own. Use wagon or cart to carry groceries home.
    5. Increase number and variety of errands so that student becomes familiar with all the shops.
  5. Organize for independence. It is helpful to organize the refrigerator, freezer, and cabinets so that foods can be found easily. It discourages independence and initiative if a large part of finding a snack or preparing a dish depends on locating what you want. The frustration of locating needed foods can be avoided by systematic organization. It's a touch, ongoing job to keep a refrigerator separated into specific food sections, but its a worthwhile effort.

The suggestions we have made are not rules to be rigidly followed. Each child in each situation is different. With creative thinking, you as parents can provide appropriate experiences and opportunities for individual growth. We welcome additions and revisions to the above suggestions and would be delighted to hear from you.

Sharon and Fran 1/4/78

 

Self-Determination Units and Lessons

Use with How Does My Vision Affect My Access to Information, Lesson 6

Eye with image of the world in place of the iris.

Activities and Things I Do on My Own or with TechnologyActivities and Things I Ask Others to Help Me WithActivities and Things I Cannot Do at All
     
     
     
     
     
     
     
     
     
     
     
     
     

Sharon K. Nichols, Assistive Technology Consultant, TSBVI Outreach

Abstract: This article describes educational and entertainment computer games available for students who are blind or visually impaired.

Key Words: Blind, visually impaired, computer games, accessible games, educational games, resources.


How many times have you heard your child or student ask for computer games which are accessible? Did you know that they do in fact exist? Or are you still struggling to view playing computer games as a viable learning experience? While I might agree that students might benefit from more educationally sound games, accessible computer games offer a "fun" way to learn computer skills. It is also important to remember that games may require the player to apply, and therefore develop, such skills as information and resource management; strategic planning; and thinking skills.

You are not alone in your concern about computer games, but that has not stopped computer gaming from becoming a multi-billion dollar industry. According to "Off to college to major in ... video games?", an article in the Christian Science Monitor, "video games seem to be gaining academic stature". The article goes on to state that, "A few big-name universities are toying with the serious side of video games. The Massachusetts Institute of Technology, the Georgia Institute of Technology, and Carnegie Mellon University offer curricula on video-game criticism, games as educational tools, and game design." For more of the article, go to .

But I digress. There is still the question of your student or child who is visually impaired having access to quality, accessible games. I will take this opportunity to familiarize you will the wealth of choices available for accessible games. The games are listed in alphabetical order, with no preference or ranking. Please read the accompanying web pages for game information and pricing.

  • Bavisoft Software for the Blind and Visually Impaired - "Bavisoft has amazingly and irrevocably changed the computer gaming industry. In place of graphics, our audio games are powered purely with sound imagery, opening a new world of entertainment for the blind and visually impaired. Utilizing the skills of professional programmers, sound engineers, musicians, and voice talent Bavisoft provides game players with unparalleled music and sound quality, creating a gaming experience like they've never imagined possible. Absolutely no vision is required to play these games!"
  • BSC Games - "We specialize in creating accessible computer games for the blind or visually impaired. We use the latest Microsoft DirectX technologies in our games to bring quality entertainment to our customers at extremely competitive pricing. BSC Games is owned and operated by Justin Daubenmire, who himself is blind."
  • Code Factory - Maker of Mobile Speak software for cellular phone accessibility, this company also offers educational and entertainment games.
  • Draconis Entertainment - "Draconis Entertainment is dedicated to delivering high quality entertainment products to both sighted and non-sighted persons, with a focus on accessible computerized audio games for the blind and visually impaired."
  • Games for the Blind - "Accessible Games SV are designed specifically for visually impaired and blind computer users. I am totally blind and wrote these games myself." The games are self-voicing and do not require a screen reader.
  • Future Boy! - This game is not specifically designed for students who are blind or visually impaired, but you can set the prompts to be spoken from the Options menu. This game requires a screen reader, such as JAWS or Window Eyes for full accessibility.
  • National Federation of the Blind "Games and Entertainment Files"
  • Audio Games - This site is a database of all available audio games. Not all links on this site are valid, so use at your own discretion. This web site also has a link to Audyssey Magazine, a magazine dedicated to blind and visually impaired gamers.

I hope this information is useful, and don't forget Christmas is coming!

This document is designed to help educational teams develop appropriate IEPs for students with DeafBlindness.  Indicators not present may indicate a training need for the team.  The presence of these indicators demonstrates a well-designed IEP in areas related specifically to the impact of DeafbBindness.  Other factors indicating a quality IEP in general are not covered here.

(Originally published in Spring 2005 SEE/HEAR Newsletter)

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

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

Keywords: Programming, Braille, literacy, reading, enrichment


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

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

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

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

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

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

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

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

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

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

Resources

Games

Magazines and Newspapers, Book Loans

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

Books

Story Tellers

Renaissance Learning: Accelerated Reader

By Kate Moss and Stacy Shafer, Education Specialists, TSBVI Outreach

Abstract: This article focuses on Phase IV and V of Lilli Nielsen's five educational phases of educational treatment outlined in her book, Are You Blind?, and how the Active Learning principles can be incorporated into activity routines.

Key Words: programming, blind, deafblind, visually impaired, Active Learning, Lilli Nielsen, activity routines


In Dr. Lilli Nielsen's book Are You Blind? she outlines the five phases of educational treatment we can use to help the child with blindness or deafblindness grow emotionally and develop cognitively. The purpose of using the techniques of the first three phases is to establish "an exchange and balance between periods of interaction and sound self-activity, between dependence and independence." In Phase IV, which Dr. Nielsen calls "sharing the work", she describes a child who is at a place where he is ready to learn that taking action and interacting with others is within his capabilities.

If we think about the child at each of these educational phases we can see the progression:

Phase I - The child is very inwardly focused, engaging in self-stimulation, with very limited experiences with objects in the environment, and who is very reluctant to engage with others except the most trusted adult (usually a caregiver).

Phase II - The child is somewhat more interested in his environment and others and can be engaged in brief interactions around high-interest objects or actions or "start-stop-start" games such as patting, swinging, bouncing, rocking, etc. He is still somewhat withdrawn, has limited interests, has limited ways to make contact with others, and has limited things he can do with objects. He can "play" along side the adult and show some interest in what the adult is doing, but does not try to imitate the adult.

Phase III - The child is interested in more interactive types of games (sometimes referred to as "you to me and me to you" ) where he can take a turn, although he may not be able to initiate these games. Many of these games have imitative elements. The child may take time out from the game to process the experience or explore independently, but will come back to the adult to continue the game. He is interested in his environment and other adults and may fuss when the activity comes to an end.

Phase IV - The child is ready to learn that taking action and interacting with others does not mean he has to do everything or do it perfectly. He has confidence in some of his actions or activities. He is beginning to understand time and a sequence of events and will often become upset or act threatened when familiar activities are changed.

Phase V - The child is ready to learn that his own actions have consequences. He generally feels secure interacting with others and though he still may have difficulty initially handling change, he is showing more coping skills. He should have an emotional age of two years before attempting to work with him at this phase. (Nielsen, 1990)

Dr. Jan van Dijk, in his approach to working with deafblind multiply disabled children, also emphasizes the importance of establishing a relationship and learning to read the child's subtle communication as a first step. Similarly he uses co-active movement following the child's lead to engage the child in interaction. He develops anticipation through building structured activities and routines; then slightly changes something in the routine to introduce novelty and learning. All along his goal is to build the child's self-esteem and confidence in his abilities to do for himself and to interact with others. Specific communication skills are tied to these experiences as concepts are developed through experiential learning. (van Dijk, 2001)

Best practices teach us that throughout the child's development in these early stages, routines and turn-taking interactions play a critical role. For example, all children participate in basic care-giving activities such as bathing, diapering, and feeding. Through these care-giving activities that occur daily, the child begins to establish a memory and can anticipate events. Later on, through participation in simple turn-taking games that are done in a routine way, the child is able to cause the adult do something pleasurable by taking an action of his own. Still later in his development, the child is able to take part in a simple series of actions that result in some desired outcome through more structured routines. Finally the child develops independence in completing the steps of the routine he has spent time "helping" the adult to complete.

Phase IV - Sharing the Work or Level I Routines

In her book, Communication: A guide for teaching students with visual and multiple disabilities, Linda Hagood describes three levels of routines, and the child at Phase IV is just at Level I. In the Level I routine she describes an activity that:

Uses short, easy, predictable steps.Has a consistent beginning and end.Occurs at a consistent place and time with consistent objects and person.Is based upon the interests of the child.Is done with the adult in close proximity.Focuses on relationship building.Does not have the expectation of the child completing the activity on his or her own.Uses non-language forms such as objects, vocalizations, touch cues, etc.Views non-communicative behaviors as having communicative intent.

When a child is engaged in an Active Learning approach, it is at Phase IV when we begin using activity routines to supplement his independent exploration activities and simple interaction times with an adult.

At this phase the child should exhibit confidence in performing some actions or activities and have some beginning understanding of time and a sequence of events. When the child is demonstrating these traits, you can begin to include some routines where you expect the child to play an active part into a portion of each day. For example, he might show some anticipation of a familiar set of steps used in making his breakfast by trying to help pour the milk in his cup when the milk carton is opened. He may also become upset when he discovers that the carton contains orange juice and not milk.

Select a Motivating Activity

So how do you begin? As a first step, try to select activities that are motivating to the child. Think about the things (the objects) the child most enjoys playing with in independent exploration or in times when you are interacting with him. Are there activities you can design that will incorporate these materials? For example, if the child is interested in wire whisks, could you use a whisk to make instant pudding? Also consider the kinds of actions the child finds interesting. Can some of these actions be included in the routine you design? If the child likes to bang the whisk on another object can you have him bang the whisk from the finished pudding on the side of the bowl?

Pick an activity that is simple, one without a lot of complicated steps. Some of the payoff for participating in the routine needs to be apparent to the child from the beginning — "I get to play with the object I like." Additional perks for hanging in there until the end of the activity should also be included along the way — "I really like chocolate. I like banging the whisk on the side of a bowl with my teacher. I like to tear open cartons."

Organize the Materials

Participating in a routine with a child requires your undivided attention so you can respond to him emotionally and not miss any of his comments or reactions. Make sure you have all the materials you will need collected before you begin the activity. Think about the space where you will do the routine. Is this a space where the child feels comfortable and is not distracted by events or people? Is the area set up so that you can be at the child's level, even if that means sitting on the floor? If the child can't or won't sit, can he physically access all the materials and complete an action? This might mean covering the floor with a protective cloth if the activity is likely to get messy. Will the child help you collect some of the materials or is that too much to ask of him at this point? Get everything ready before you ask the child to come "play".

Provide Time to Explore

Give the child time to explore the space and the materials you will be using during the routine. Be sure to let him explore it in his own way and not the way you think he should explore it. If possible, let the child experience his own exploration of the objects outside the routine before introducing it into a structured routine.

Share in his exploration by having a duplicate set of materials for you to use or by giving joint attention to the object. For the visually impaired child this is often demonstrated through a shared tactile experience using a hand-under-hand approach (Barbara Miles, 1999). For example, if he bangs the wire whisk on the table, have one you can bang along side him. If he puts his hand in the water, put your hand in there with his so that he knows you are aware of what he is doing. Don't hurry him in his exploration — this means you need to allow plenty of time for the routine.

Set up the Sequence

It is necessary to the child to provide a clear sequence of steps in the activity. Using a slotted box like the ones typically used for a daily object calendar works well. Place an object you will use in each step in sequential slots of the box. Organize them from left to right so the child can find his way to the next step easily as each step is completed. Provide a finish basket or box to discard the object after you have completed the step. After he becomes more familiar with the routine the child may be able to help you load the objects into the slots after he has thoroughly explored each one. If not you may quickly review each one that you have pre-loaded into the slotted box so he knows where each object and action occurs in the sequence.

Complete the Steps

As you introduce each step, give the child a little time to re-explore the object before asking him to "help" complete the step. Then you can give him the word or sign for the object and model what you are going to do such as pour, stir, throw, tear open, etc. In the beginning the tasks you are asking him to complete can be completed in a few seconds up to a few minutes without any consideration for how perfectly the child can complete them. Be sure he understands which parts you are asking him to complete and which parts you will do. Most importantly, give him plenty of time to attempt to do the step before helping him complete it.

Modeling using a hand-under-hand approach during the routine, allows him to access what you are doing without making demands upon his hands to do all the work. If the child wants to explore the object a bit more after you use it, let him, but finish each step by helping to place the object in the finished box. Going back to the left-most slot and feeling for the next object can be beneficial in encouraging the child to look for the next "step" in the routine. (This is the perfect time to begin to introduce the concept and language of "next".) Eventually (after many times helping you do the action) the object should prompt the child to take the action independently. Wait silently and patiently!

Be Mindful of Pacing

Though you don't want to rush the child through the activity, you also don't want to lose him by dragging things out too long. This is where your teaching becomes an art; you have to be a keen observer of the child's emotional state. You know the child and can read his signs of boredom, anxiety, or pleasure. Allow more time for his "fun" parts and move more quickly through steps that are less pleasurable.

Clean Up and Put Away

To whatever degree the child is capable have him help you collect materials and clean up the space. At first this might simply mean helping you get a key item from its place or put the object representing the activity in the finished basket. If he can carry dirty materials to a sink or throw a water toy into the bucket, get him to do that much. Over time, he should be able to take on greater responsibility for collecting and putting away the materials.

After the Activity is Completed

Take a few moments after the activity is done to "talk" about how the child helped. Don't overly praise him, just comment on his successes and what you did together. If the child is using a calendar system at an anticipation level (at least), you may be able to reflect on the activity before you place the representing symbol in the finished box or basket.

Throw a Curve Once the Routine is Well-Established

When the routine has been completed a number of times and the child is definitely familiar with both the materials and the steps, it may be time to throw him a curve. For example, change the container that holds the milk, put bubble bath into the water, get a very large wire whisk or a very small one. Don't change too much too quickly. You will likely see some surprise or even anxiety when he encounters the change. This surprise will provide a great topic for conversation. It also will expand the child's knowledge of objects and /or actions based on a very familiar, understood event. This is the way we all learn the best, not too much new to take in at one time.

Conclusion

Using routines is an invaluable tool when working with children who are developmentally delayed. A well-designed routine provides a great structure for learning. Incorporating Active Learning principles into the routine is also helpful. Just remember some of the points Dr. Nielsen mentions:

Help the child learn that to be the one who does something does not necessarily mean that one has to do everything or do it perfectly.The abilities the child has been successful with in previous educational phases form the basis for deciding which activities can be used for the technique of sharing work.Keep tasks short (few seconds or minutes) initially, accept whatever the child does as correct.Explain each time which parts of the activity the adult will perform and what the child will do.Give plenty of time for the child to initiate the task and wait silently and calmly — be neutral.Let the child know how long the activity is supposed to last.Try to keep the environment the same or only make gradual changes.Before going to more complicated and longer lasting activities the choice of technique for every part of the activity should be given careful consideration.

References

  • Hagood, Linda. Communication: A Guide for Teaching Students with Visual and Multiple Disabilities. Texas School for the Blind and Visually Impaired, 1997.
  • Miles, Barbara and McLetchie, Barbara. Developing Concepts with Children who are Deaf-Blind. DB-Link, 2004. http://www.tr.wou.edu/dblink/lib/concepts.htm
  • Miles, Barbara. Talking the Language of Hands to Hands. DB-Link, 2003. http://www.tr.wou.edu/DBLINK/lib/hands.htm
  • Moss, Kate. "Five Phases of Educational Treatment Used in Active Learning Based on Excerpts from Are You Blind? by Dr. Lilli Nielsen." Texas School for the Blind & Visually Impaired, See/Hear, Volume 9, No. 2, Spring, 2004.
  • Nielsen, Lilli. Are You Blind?, SIKON, 1990.
  • Van Dijk, Jan. Development Through Relationships. DB-Link, 2001. www.dblink.org/lib/topics/vandijk3.htm
  • Van Dijk, Jan. An Educational Curriculum for Deaf-Blind Multi-Handicapped Persons, DB-Link, 2001. www.dblink.org/lib/topics/VANDIJK-a2.htm

<search results here>

The following are instructions and recipes found on the packages of commonly available "box" and frozen meals, snacks, desserts, etc.

ALL recipes in MS Word (.zip 1.15mb)

Brand-named Pre-Packaged Meal Instructions and Recipes

gigi 175x249Providing instructional services to infants, toddlers and preschoolers is very different from providing services for school-aged children.  This page offers a variety of resources to help teachers and parents of children with visual impairments and deafblindness to get things off to a good start. 

Articles and Resources

Assessment

Family Life

Intervention Strategies 

Laws

 

Family Life

Laws

Assessment

Understanding where the infant or preschooler is currently functioning requires extensive assessment. Here are some VI specific assessment to help with that task.

Intervention Strategies

The TVI and COMS roles focus on the Expanded Core Curriculum areas listed below. Here you can find links to a variety of resources to help with instruction and to support the infant or preschooler at home and in the community.

General Information 

Assistive Technology

 

Career Education

Compensatory Skills

Literacy

Math

Pre-braille

Science

Some of the most important concepts in science begin with the baby exploring his body and his world.  It is also a wonderful way to enjoy a hands-on experience with any child who is visually Impaired or deafblind. Just remember that "hands-on" activities and "active learning" are key for these youngest scientists.

Social Studies

Communication

Recreation and Leisure

Orientation and Mobility

Self Determination

Sensory Efficiency

Gustatory and Olfactory
Hearing
Proprioception
Touch
Vision

 

Social Interaction

Independent Living

Articles and Resources

Looking for resources and articles about infants, toddlers and preschool-aged children who are visually impaired?  Check out some of our favorites.

Resources

Articles

 

Developed by Chrissy Cowan, TVI

 

A telescope is a small telescope which enables a student with a visual impairment to see print, pictures, diagrams, maps, faces and demonstrations when (s)he is seated at his/her desk. The following are some facts and adaptations which need to be considered if a telescope is being used:

  1. A telescope severely restricts the visual field.  The student will be taught by the TVI (teacher of students with visual impairments) to scan to pick up all visual information and increase visual memory so (s)he can copy more quickly and efficiently.
  1. A telescope is typically used for distance tasks only.
  1. Copying while using a telescope is laborious, and it will take the visually impaired child longer to copy from the board/charts, etc.  You can adapt by modifying the length of the assignment.  Some ways of doing this include:
    1. assigning even or odd numbers of problems
    2. allowing the student to write only the answers to questions rather than re-copy entire sentences, questions, and/or paragraphs
  1. When a student is using a telescope, walking up to the board/chart should be discouraged.  This annoys other students and severely hinders speed, continuity of thought, and proficiency when reading or completing an assignment.
  1. Singling out a visually impaired student’s desk (to place him/her closer to the board) is discouraged due to social reasons.  A telescope will enable the child to sit within the group at all times.
  1. Telescopes break easily and should be worn around the neck when in use (EXCEPT in physical education and/or while on the playground) and stored in a case otherwise. Please encourage your children to keep their telescope out of sight when the room is empty.
  1. Encourage the student to take the telescope to other school events, e.g. assemblies, film presentations, athletic games.
  1. Do not allow other children to handle the telescope.
  1. Do not allow the telescope to be taken home with the student unless arrangements have been made with the TVI.
  1. A student who is using a telescope should be seated facing the boards/charts to allow straight-on viewing.  This also enables the child to rest his/her elbow on the desk while he is looking through the telescope.

A Model of Individual Support to Provide Appropriate Access to Education for Students who are Deafblind

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Contents include:

Prepared by Texas Deaf-Blind Outreach, December, 2000

These documents have been designed to help families and school districts in Texas make decisions about using an intervener in the school setting for a student who is deafblind.

Based on original documents created by families, educators, and administrators at a series of Intervener Planning Meetings held in 1993-1994, co-sponsored by Texas Deaf-Blind Outreach and Texas Tech University.

For more information on interveners contact Texas Deaf-Blind Outreach.

Texas Deaf-Blind Outreach
Texas School for the Blind and Visually Impaired
1100 W. 45th Street
Austin, Texas 78756
Phone: (512)206-9103 (Voice)
(512)206-9188 (TTY)
FAX: (512)206-9320
Outreach - deafblind

Texas Deaf-Blind Outreach is located at the Texas School for the Blind and Visually Impaired, and is supported by grant funds from the U.S. Department of Education, Office of Special Education Programs (OSEP), administered through the Texas Education Agency. Opinions expressed herein are those of the authors and do not necessarily represent the position of the U.S. Department of Education. The Texas School for the Blind and Visually Impaired does not discriminate on the basis of race, color, national origin, sex, religion, age, or disability in employment or the provision of services.

What is an Intervener?

In educational settings, an intervener is a staff person who provides individual support to a student who is deafblind. The term "deafblind" refers to a combination of a vision impairment with a hearing impairment that affects the way a student is able to access information and function in the educational environment. Even mild impairments can have a profound effect when combined with another sensory loss. A student with deafblindness is defined by the state for educational purposes in 19 TAC §89.AA, Commissioner's Rules Concerning Special Education Services, §89.1040(c).

There is an array of instructional models regularly used within traditional general and special education settings that may potentially provide the unique instructional support needed for a child with deafblindness. However, when traditional models fail to provide access to appropriate services, another option for the IEP committee is to designate a support staff as an intervener assigned to the child.

An intervener is a paraprofessional with specialized skills and training who is designated to provide direct support to a student with deafblindness for all or part of the instructional day. The intervener supports the existing service delivery model in implementing the student's IEP. The decision to use an intervener is based on the level of support a student currently needs to effectively participate in his or her instructional environment. Additionally, if a student with deafblindness requires extensive and novel modifications to the existing educational model, the services of an intervener can be used to simplify the process for the other members of the educational team.

Though the use of interveners for students with deafblindness is relatively new in Texas, the effectiveness of the model has been validated through widespread use for many years in Canada, and more recently in Utah and several other states. On its web site, the Canadian Deafblind Rubella Association defines this kind of intervention as "the process that allows individuals who are deafblind to receive visual and auditory information that they are unable to gather on their own in a way meaningful to them such that they can interact with the environment and thus be enabled to establish and maintain maximum control over their lives."

In an article on Utah's program to provide interveners in schools, the following basic definition of an intervener is given. "An Intervener is specially trained to provide clear and consistent sensory information to an individual who is deafblind, compensating for both vision and hearing loss in such a way as to facilitate and enhance learning and interaction with the physical environment and with society. An intervener acts as the eyes and ears of the individual who is deaf-blind, making him or her aware of what is occurring and attaching language and meaning to all experiences. An intervener intercedes between the individual who is deafblind and the environment in such a way so as to minimize the affects of multisensory deprivation, and to empower the individual to have control over his or her life." (Henderson & Killoran, 1995.)

Understanding what an intervener is, and why this support model has evolved and is becoming more widely used, begins with understanding the needs of children and youth who are deafblind. Deafblindness, or the combination of visual impairment with hearing impairment, often presents unique challenges to educators and others working with a child. The role of the intervener is to join with the entire educational team to meet those challenges by providing individual support for the child.

(Paddi Henderson & John Killoran, "Utah Enhances Services for Children who are Deaf-Blind," Deaf-Blind Perspectives, Fall, 1995)

In summary, an intervener is defined as follows:

  • An intervener is one of an array of strategies and services which can be used to effectively meet the educational needs of a student who is deafblind;
  • An intervener is a paraprofessional with specialized skills and training in communication and other issues related to deafblindness, who works as an essential member of the student's educational team;
  • An intervener works individually with a student who is deafblind within any educational setting as determined by the IEP;
  • An intervener provides access to information, environments, and materials the student might otherwise be unable to access or understand due to sensory impairments;
  • An intervener communicates with a deafblind student using methods and strategies that are effective for the individual student;
  • An intervener guides the student through activities and hands-on exploration of materials as appropriate based on individual learning styles;
  • An intervener provides modifications to lessons as needed by the child and specified in the IEP.

The Unique Educational Needs of Children With Deafblindness

Individuals with deafblindness have unique life-long needs for support that must be addressed in order for them to function in a world driven by sight and sound. Consistent with this, they have unique needs within the educational system. The information that follows outlines some of these needs as well as services which impact quality education for students with deafblindness.

Around 700 school-aged children from throughout Texas were identified on the 1999 Texas Deafblind Census. Due to the low incidence of this disability, these students are generally unique among the population of students with developmental disabilities within a given community. Most districts understandably build programs and hire staff targeting the majority of children with disabilities in their particular area, without planning programs for students with unusual needs.

Assessment

From the beginning, the school system often finds its resources in deafblindness to be inadequate. Assessing the skills of these children can be difficult since assessment instruments are generally not normed for this population. It is often impossible to adapt these materials to test children with deafblindness without negating the test's validity.

Another problem in assessing skills and providing instruction to children with deafblindness is the difficulty in engaging them and drawing them outside of themselves. The need to feel safe in a world that alternately "comes at you" or "disappears in thin air" often sends these children inside themselves. They may be unresponsive during testing unless they are working with someone with whom they have bonded.

Unique Instructional Strategies

Instruction for students with visual impairments usually relies heavily on information received through the auditory channel. For example, a child with visual impairments learns to use sounds to supplement whatever visual information is present in order to identify places and things and move from place to place. However, a child who is also deaf can not use this technique to compensate for vision problems. For this reason, the ability to identify things, or even to be aware of things that are beyond arm's reach, is greatly reduced.

Similarly, instruction for a child who is deaf or hard of hearing relies heavily on the use of vision. For example, language development and instruction for students who are deaf or hard of hearing can involve sign, fingerspelling, speechreading, or spoken language. Accessing and understanding instruction depends on the ability to clearly see the hands and faces of other signers or the lips of other speakers. Even a child with a mild visual loss faces difficulty in trying to gather complete information.

Because instructional strategies for students who are blind or deaf are in many cases based on supplementing one sense with the other, those strategies are often ineffective for students who are deafblind. Working with a student who is deafblind requires the use of strategies that are different from the strategies used with students who are either blind or deaf, not simply a combination of those strategies.

Travel and Exploration of the Environment

Children with deaf-blindness have difficulty learning through observation or independent exploration. As a result, they are likely to have an experiential and conceptual base that differs significantly from typical children, or children with other disabilities.

A student's ability to become oriented within an environment and to travel through it independently is deeply affected by deafblindness. For example, a student with the single disability of a vision impairment is taught to use hearing to determine where he is or orient to the area he is approaching. Auditory techniques may not necessarily be safe or effective if a child has even a mild hearing loss. Alternate strategies for teaching a child to use different environmental cues are needed for students with dual sensory impairments.

Without enticement from sights and sounds, a child with deafblindness may also be less likely to explore and interact with the world. This has great impact on cognitive and social development, as well as language.

Adaptive and Assistive Devices

Children with deafblindness use a variety of adaptive/assistive devices. Knowing how to use and keep this equipment in working order is no small accomplishment. For example, a child may use one or all from a list of devices including a hearing aid, an FM auditory trainer, glasses, a monocular, and a cane. Students may use a vibrating alarm clock or braille watch. Communication devices range from a low-tech picture book to a high-tech braille notetaker or computer. The child and staff must all be trained to use these devices.

Access to Information

When the eyes and ears distort or omit incoming information altogether, a child may only perceive and comprehend fragments of any situation or experience. Children with deafblindness have difficulty learning through observation or independent exploration. As a result, they are likely to have an experiential and conceptual base that differs significantly from typical children, or children with other disabilities. Students who are deafblind must be supported in filling the information gaps that continuously result from sensory losses. They require additional time with carefully engineered "hands on" activities to access information that other children pick up incidentally from other people, objects, and the environment.

Communication

Communication is one of the main areas which is critically affected by deafblindness, and is usually the highest priority in their educational programming. These children's communication systems typically contain a variety of forms which can include signals, tactile sign language, object symbols, tactile symbol systems, Braille, and many others. Each child's system must be individually designed and used with a high degree of consistency across the day. The development of good communication strategies and systems for students with deafblindness frequently requires training for those working with the child since few have preparation for or experience with this population.

Each child's [communication] system must be individually designed for him and used with a high degree of consistency across the day.

Behavior

To address the underlying cause of these behaviors, one must have an under-standing of the ongoing effects of sensory deprivation and an ability to modify the child's instruction to offset these effects while building additional skills.

Frequent stress and frustration that may be experienced by children due to the effects of deafblindness can result in behavior that becomes either withdrawn and passive or volatile and potentially combative. Additionally, abusive or disruptive behavior may serve as the only effective communication strategy for a child who does not know more acceptable ways to communicate. To address the underlying cause of these behaviors, one must have an understanding of the ongoing effects of sensory deprivation and an ability to modify the child's instruction to offset these effects while building additional skills.

Additional Disabilities

Many children have other disabilities along with deafblindness, so consideration must be given to different or additional needs and strategies for support. For example, a combination of factors may cause children to dislike being touched, limiting their ability to gather information tactually. Some medication can affect vision and hearing. Ongoing medical problems may make vision or hearing loss progressively worse.

Consistency and Routine

Children with deafblindness learn best when information is presented in a consistent fashion from person to person, place to place, and over time. Using consistent activity routines with many opportunities for practice and repetition is essential. This places some additional burdens on the staff, who must work together closely in order to provide consistency and coordinate support. Planning time as a group is critical. Additionally, information and input from the family is vital to a well-coordinated program.

Roles in the Educational Team

Typically, staff who may serve a child with deafblindness include: teacher of the visually impaired; teacher of the hearing impaired; orientation and mobility instructor; intervener; classroom teacher (general education and special education) and instructional aide; behavior specialist; diagnostician; and often occupational and physical therapists as well as other related service staff such as a speech/ language therapist and audiologist. Often finding adequate time for the staff and the family to meet together, share information, and plan is quite difficult. This may result in communication breakdowns, not only between the staff and family, but also between the various staff members. To further complicate a difficult situation, each year new staff may become involved with the child.

Children with deafblindness learn best when information is presented in a consistent fashion from person to person, place to place, and over time.

Professional Expertise

Most educational staff have had few if any prior opportunities for specific training in the area of deafblindness. It is rare to have a teacher certified or explicitly trained in deafblindness within a local school district. There is no recognized certification or endorsement through the Texas Education Agency in the area of deafblindness. There is only one university program in Texas offering course work specific to the area of deafblindness. Furthermore, because there are few jobs specifically in the area of deafblindness, the state's ability to utilize these graduates as well as recruit trained individuals from other states is greatly reduced.

Often districts can not meet the unique learning needs of a child with deafblindness without additional training to make appropriate program modifications. In order to design and provide the necessary modifications and supports, most school districts look to outside consultants on deafblindness to provide training to their staff through an inservice model. Districts may utilize assistance from the Regional Deaf-Blind Specialists located at each of the Education Service Centers, or Texas Deaf-Blind Outreach at the Texas School for the Blind and Visually Impaired in Austin. Texas Deaf-Blind Outreach is a training project funded by the Texas Education Agency through a Federal IDEA grant on deafblindness.

Conclusion

Although children with deafblindness present unique challenges to those who are charged with providing them appropriate education, it is important to state that these children can learn. If these children and the educators working with them are given the proper supports, they can make terrific strides. Using appropriate strategies and proven models of support can enable a student who is deafblind to make the most of educational opportunities and be prepared for an enjoyable and productive life.

How Interveners Differ From Other Typical Support Staff

Different job titles are used to describe staff members who support students receiving special education services. The "intervener" is a title exclusively used for a paraprofessional who specifically supports a student with deafblindness. Due to the unique nature of support needed by a child who is deafblind, the responsibilities, expectations, schedule, and training of an intervener differ from what is more commonly seen in other special education staff assignments.

Contrasting an intervener with an instructional aide

  1. The intervener is trained in communication and support strategies unique to students with deafblindness.
  2. Because the intervener must have specialized knowledge and skills to implement the IEP of an individual student who is deafblind, the intervener must be released from duties to participate in training related to deafblindness. This may encompass training provided on-site, and workshops held off-campus, as well as out of town.
  3. The intervener's primary responsibility is to implement the child's IEP by providing access to information, materials, and environments. The intervener may not be pulled to perform other duties (lunchroom or bus duty, substituting for other aides or teachers who are absent, etc.) if it interferes with implementing the IEP.
  4. Because the intervener receives training to perform specialized tasks, and students who are deafblind have difficulty trusting and understanding new people, the intervener must not be considered interchangeable with other paraprofessionals when making duty assignments. One intervener consistently works with a student across different settings, and over a long period of time.
  5. The intervener is present and participates in all staffings and IEP meetings related to the child with deafblindness. This may involve preparing reports, as well as participating in discussions when the team formulates and evaluates programming.
  6. The intervener needs scheduled preparation time which may be used for: observation of general education classes to prepare for the inclusion of the student; making or purchasing adaptive materials; lesson planning; reviewing and recording data; preparing reports; reviewing training materials; or meeting with related service staff and IEP team members.

Contrasting an intervener with a sign language interpreter

  1. A child with deafblindness may or not need the services of a certified interpreter, based on factors such as language ability, instructional arrangement, and IEP goals. For example, a student who uses sign fluently in an academic program requires an interpreter, while a student whose use of sign is emerging is served appropriately with a staff member proficient in sign, but not necessarily certified. Some students with deafblindness use communication forms other than sign altogether, such as speech or tactile symbols. 
    Please note: In cases when a certified interpreter is required, the student's needs related to deafblindness may require the use of skills and strategies in addition to those of a typical interpreter in order for the child's IEP to be fully implemented. In these cases, an interpreter with additional training, skills, roles, and responsibilities is acting as an intervener.
  2. Rather than relying on one uniform communication form or language, such as sign, an intervener must know the individual student's unique communication system. Students who are deafblind may use sign, tactile sign, speech, braille, picture symbols, tactile symbols, objects, gestures, signals, or some combination of these and other communication forms. The intervener must be well versed in the student's individual forms of communicating both receptively and expressively.
  3. When a student who is deafblind uses sign language, it may be modified from sign typically used for students who are deaf or hard of hearing. Signs may need to be presented within a few feet from the student in order to remain within the his or her visual range. The signs used may need to be reduced so they can be entirely seen within a very narrow visual field. The student may need to receive sign tactually. Signs may need to be paired with other communication forms for clarity. Making these modifications may be unfamiliar to a typical interpreter.
  4. A student with deafblindness may miss a significant amount of environmental information in addition to what is being said by others. For this reason, the intervener does much more than interpret what is being said. The intervener supplies additional information about what is happening around the student.
  5. Because a student who is deafblind misses significant environmental information, he or she may not have as complete a conceptual understanding of topics being discussed as someone who has complete use of one or both distance senses. Consequently, the intervener supplies conceptual background information to supplement what is being said in class.
  6. An intervener must be familiar with basic orientation and mobility strategies such as sighted guide, and take responsibility for assisting the student in moving from place to place when necessary.
  7. Students who are deafblind have difficulty trusting and understanding new people, so interveners are not interchangeable. One intervener consistently works with a student across different settings, and over a long period of time.
  8. The intervener is present and participates in all staffings and IEP meetings related to the child with deafblindness. This may involve preparing reports, as well as participating in discussions to formulate and evaluate programming with the team. Interpreters do not typically have this role.
  9. In contrast to a typical interpreter, the intervener needs preparatory time which may be used in the following ways: observation of general education classes to prepare for the inclusion of the student; making or purchasing materials; lesson planning, reviewing and recording data; telephone follow-up related to the student's needs; preparing reports; reviewing training materials; or meeting with related service staff and IEP team members.

Who Should Have an Intervener?

The foundation of appropriate educational support for a student with deafblindness is a strong IEP that addresses unique needs related to deafblindness and outlines necessary instructional modifications. The question of using an intervener should be addressed by examining the student's progress with the IEP and the ability of available personnel to supply appropriate modifications within any potential instructional arrangements being considered.

The nature of supports and modifications necessary for an individual student with deafblindness to benefit from instruction are based on two things:

  1. the needs of the individual child; and
  2. the potential for the child to access instruction within available educational settings and instructional models.

An intervener is a staff person designated to provide direct support to a student with deafblindness for all or part of the instructional day. The intervener supports the existing service delivery model in implementing the student's IEP. The decision to use an intervener is based on the level of support a student currently needs to effectively participate in his or her instructional environment. Additionally, if a student with deafblindness requires extensive and novel modifications to the existing educational model, the services of an intervener can be used to simplify the process for the other members of the educational team.

The question of an intervener should only be addressed after the child is assessed, the IEP is developed, and the available service delivery options are reviewed.

The following considerations will assist school districts and families in deciding the level of instructional support that would be most helpful in the child's learning process.

Variables in deciding appropriate level of support with regard to individual student needs:

  1. Social/emotional needs of the child. Example: Some children with deafblindness have extreme difficulties in relating to or responding to people in general. They may become accustomed to isolation when reduced sensory information separates them from others. In such cases, a child may turn inward and withdraw from human contact, or in some cases become combative when another person approaches. Some seem to recognize a few, but not most of the people who interact with them. Sometimes limiting the number of staff who work with the child is helpful. Giving a child the opportunity to build a strong relationship with one person can provide a base for gradually accepting others.
  2. Degree and complexity of sensory loss. Example:If a child is completely without sight and has a hearing loss that causes great distortion of sound, he or she relies heavily on the sense of touch to gain information. In this situation, a person to carefully guide the student through hands-on experience with new activities is frequently needed.
  3. Student's overall instructional profile. Example: Can the student learn in a group none/some/all ofthe time? Does the child require a high degree of consistency in learning that prohibits numerous people working with the student on the same task? Does the student need to become comfortable with a particular task or lesson taught by one person, before others can begin to provide support on the same lessons?

Variables in deciding the need for additional support with regard to educational settings and resources:

  1. Existing special education services are appropriate for the other children with disabilities on the campus, but not a good match for the one child with deaf-blindness in the district. Example: The child with deafblindness is in a classroom with one teacher and ten teenagers who read on a 5th grade level, can learn in a large group, and go alone to some general education classes. The teacher feels that she cannot serve the child with deafblindness without additional staff.
  2. The programming recommended by the IEP committee places such demands on the staff for inservice training and material adaptation/preparation, that the IEP is at risk for not being implemented. Example: The child is served by eight people who are unfamiliar with van Dijk methodology, calendar systems and adaptive listening devices, all of which play a large role in her programming. The amount of inservice it would take to build adequate skills across the group is prohibitive in light of their other duties. The calendar system will take hours to develop and no one has time or is really sure how to start.

Suggested Job Description

Position: Intervener for Student with Deafblindness

An intervener is a staff position designated to provide direct support to a student with deafblindness for all or part of the instructional day as determined by the student's Individual Educational Plan (IEP). The decision to designate an intervener is based on the level of support needed by a student to participate effectively in his/her instructional environment(s) as described by the IEP. The intervener works cooperatively with parents and a variety of direct service providers and consultants including: classroom teachers; teachers of children with hearing impairments, visual impairments, or severe disabilities; speech therapists; occupational and physical therapists; orientation and mobility instructors; and other professionals as well as paraprofessionals.

Rationale: A child who is deafblind needs to have the opportunity to develop a personal relationship with a person who will consistently be available to interpret the world for the child. The child must have continual access to a person who communicates effectively so that the individual can develop a sense of trust and security that will enable the child to learn. Many students with deafblindness require extensive and novel modifications to an existing educational model. The services of an intervener can be used to individualize the process. An intervener serves as a bridge to the world for a child who has deafblindness.

Qualifications: Experience with and/or desire to work with students with sensory impairments. Must be willing to participate in ongoing training in the area of deafblindness.

Reports to: Appropriate administrative staff

Supervises: None

Responsibilities: The intervener assists a student with deafblindness to actively participate in activities and provides a supportive and effective environment in which the student can learn. The intervener provides this service within the guidelines of the school, as set forth in its policies and procedures. The intervener works under the direction and supervision of the classroom teacher, and participates as a full educational team member in developing and implementing the student's IEP.

Specific Duties Include: The Intervener's specific duties will be individualized according to the needs of the child and the profile of the current educational placement. Typically, duties may include:

  • Has the primary responsibility to provide direct support to a student with deafblindness during all or part of a school day as part of an educational team, and as indicated in the student's IEP;
  • Follows the student's IEP and the modifications and instructional techniques recommended by related service staff;
  • Become proficient in students' individual communication methods and strategies;
  • Creates instructional materials as needed;
  • Accompanies and supports the student during community-based instruction;
  • Visits or provides instruction in the student's home as deemed appropriate by the IEP committee;
  • Maintains communication between home and school, and keeps a daily log of information about the student and his or her activities;
  • Participates in IEP meetings and student staffings;
  • Participates in the assessment of the student and in the preparation of IEPs, progress reports, behavior plans, data collection, and other documentation for program monitoring;
  • Participates in site-based, regional, and statewide training in the area of deafblindness;
  • Works to attain proficiency in all items listed on the "Intervener Portfolio Summary" self-assessment;
  • Serves as a resource to other staff on issues related to deafblindness.

Work Attitudes:

  • Feels comfortable working in close physical proximity to students while frequently using touch to communicate with and instruct students who are primarily tactile learners;
  • Demonstrates emotional maturity, stability, ability to perform under stress, and frustration tolerance;
  • Shows ability to exercise good judgment, cooperation, tact, and discretion in dealing with the student, family, and others;
  • Shows interest in developing additional knowledge and skills;
  • Follows team decisions, established policies and procedures, and designated lines of communication and authority.

Important Issues for Schools Using an Intervener

Roles of the educational team

  1. Because the intervener should receive special training on issues related to the education of a student with deafblindness, he or she becomes a valuable member of the educational team. Through the course of close daily contact with the student, the intervener also becomes an expert on communication and support for the individual student. For this reason, professionals from certain disciplines may want to seek information from as well as collaborate with the intervener in some situations. At first, these professionals may be unfamiliar or uncomfortable with this role while working with a paraprofessional. All members of the team should learn about interveners and plan how to best make use of the intervener's unique qualifications and position.
  2. The intervener will be working as part of a transdisciplinary team, which will be needed to plan an appropriate program for a student with dual sensory impairments. This team might include the intervener, the student and family, general and/or special education teachers, consulting/related service staff, general education administrators, special education supervisor, etc.
  3. This team should include professionals such as a teacher of the visually impaired, orientation and mobility specialist, and deaf educator, as well as therapists based on any additional disabilities or needs.
  4. The intervener is a critical part of the team, and should be included in team planning. Since the intervener usually is the consistent person across educational environments, he or she is in a unique position to both provide and disseminate information about the student. The intervener will be responsible for carrying out recommendations made by consulting professionals, and making continuous adaptations to lessons throughout the day. For this reason, the intervener must meet directly with team members on a regular basis.

Support and Supervision

  1. A decision must be made about who will be the intervener's direct supervisor. This may not be obvious if the student changes classrooms or settings during the day. Possible supervisors might include the classroom teacher, resource teacher, special education coordinator, counselor, etc. Lack of a clear chain of supervision can make the intervener feel powerless and unsupported.
  2. The intervener will need on-going support in implementing modifications, obtaining adaptive aids, coordinating with the educational team, interpreting recommendations from consulting staff, brainstorming activities and strategies, finding training opportunities, and many other situations throughout the school year. This would also include emotional support during difficult or frustrating periods. This support could come from a variety of sources, but because the intervener is often isolated, he or she should know where to go when in need of any of these kinds of support.
  3. The position of intervener may be unique on a campus or in a district. This intensifies the feeling of isolation. For that reason, it is helpful if the intervener has the opportunity to be in contact with other paraprofessionals serving in this role at other locations. Texas Deaf-Blind Outreach at Texas School for the Blind and Visually Impaired offers annual meetings or workshops with strands designed for interveners.

Training

  1. The intervener will need specialized skills and knowledge in order to effectively do his or her job. "Intervener Portfolio Summary ", a document developed to plan training in Texas, can provide guidance in assessing an intervener's skills and training needs. The skills needed center around communication forms used by the student and providing meaningful access to information from the environment.
  2. Training can be provided through a variety of sources, and in a variety of formats. Each regional Education Service Center has designated Deaf-Blind Specialist. This person should be able to inform the district of upcoming training opportunities. Workshops and consultation may be available locally. Other workshops sponsored by Texas Deaf-Blind Outreach may be available on a regional or statewide basis. Some training materials are available in print or video.
  3. The district should expect to set aside some funds to provide access to training for the intervener. Some financial assistance is available from Texas Deaf-Blind Outreach to facilitate training an intervener working with a student listed on the Texas Deafblind Census.

Intervener Certification

  1. In Canada there are university training programs providing coursework leading to certification for interveners. No formal system of certification currently exists in the USA. However, several states are taking steps toward formalizing intervener preparation. College credit courses for interveners are offered or planned in Minnesota and Utah. Ski*Hi Institute in Utah has produced an extensive intervener training manual and has mandatory attendance at monthly intervener training courses funded by the state.
  2. Plans have been made to allow interveners in Texas to access coursework from other states through distance education. Colleges in Texas may in the future offer classes such as these. In the future it may be possible for districts to locate skilled individuals certified to be interveners for students with deafblindness. Until that time, Texas Deaf-Blind Outreach, the regional Education Service Centers, and school districts must work together to provide numerous in-service opportunities to ensure that interveners have the skills needed to work effectively with students who are deafblind.

The Intervener's Schedule

  1. The intervener's schedule is based on the needs of the student. An intervener should be available to the student whenever necessary to insure that the IEP is implemented and the student has access to the information present in the environment. This may be for all or part of the school day as decided by the IEP committee, based on the nature of the educational settings and activities called for in the IEP.
  2. The intervener's work schedule should include time for planning as often as necessary. For example, the intervener needs time to gather and assemble modified materials. Additionally, time may be spent meeting with other members of the educational team, accompanying team members on home visits, and recording data for the team's review.

Broadening the Student's Social and Support Circle

  1. Unlike traditional models in which staff make efforts to fade, giving way to natural support in the classroom and other school environments, in many situations it may be inappropriate for the intervener to fade. The intervener is the communication link between the student and others in the environment. When others are unfamiliar with the student's language or other communication forms, the intervener must be close at hand to interpret.
  2. Because it is necessary for the intervener to be so closely involved in interactions, there is danger that the intervener will become a barrier to social exploration for the student. The intervener must be aware that his or her role is to facilitate interaction by acting as a bridge between the student and others, rather than insulating the student from peers, other professionals, and community members.
  3. The intervener should attempt to expand the student's allies among other professionals by providing information about deafblindness and facilitating communication.

Financial Considerations

  1. Because an intervener may be a necessary support for students who are deafblind, school districts should consider the number of students identified on the deafblind census when planning budgets.
  2. Interveners require specialized skills and training to be effective. Consistency, or lack of employee turnover, is also a concern since students who are deafblind have issues with trust and unique learning styles. For this reason, districts should consider a salary step that will aid recruitment and retention of quality interveners.
  3. Interveners have a unique role with a low incidence student population. Training needed may not be available locally. Districts should be prepared to budget or seek funds for on-going training opportunities for the intervener. One source of financial assistance for intervener training is Texas Deaf-Blind Outreach
  4. Interveners frequently need supplies to make materials for curricular adaptations so the student can have access to instruction. These may be common items (such as velcro strips for making tactile symbols), or more unusual items (such as a potted plant for a student to explore tactually while the rest of the class learns through pictures and lecture.) The intervener should have access to a supply budget to provide these adaptive materials.

Substitutes

  1. Students who are deafblind need consistency in order to trust, understand, and communicate effectively with a person providing support. For this reason, interveners should not be reassigned or pulled for alternate duty without good cause.
  2. However, the role of the intervener requires him or her to be away from regular duties from time to time. For example, interveners need to attend IEP planning meetings and training.
  3. For times that the intervener must be away from the student, an appropriate back-up plan must be in place. Someone else in the school, or a readily available substitute, should receive training in the student's communication style and support needs. The alternate(s) should be trained and introduced to the child by the intervener, especially when trust and bonding is an issue.

Administrative Checklist

When Assigning an Intervener

Student: ______________________________

Intervener: ____________________________

The following considerations should be addressed before the intervener begins working with the student.

____ 1. The intervener's skills have been assessed, and an individual training plan developed for the intervener. (See "Intervener Portfolio Summary.")

____ 2. The chain of supervision is clear, and all members of the student's educational team are aware of their own roles, and the role of the intervener.

____ 3. The intervener knows where to go for all kinds of support and assistance when needed.

____ 4. The intervener has a schedule which accommodates the student's needs, and provides the intervener with time to plan and meet with other team members as often as necessary.

____ 5. The intervener has access to funds for needed instructional materials.

____ 6. There is a procedure for the intervener to gather and share information with other people and broaden the child's base of support.

____ 7. The intervener is familiar with procedures to collect data and demonstrate the child's progress.

____ 8. Adequate back-ups have been identified, oriented, and made available for times the intervener is not present.

Bibliography of Additional Materials on Interveners

Alsop, L. (Ed.). (in press). Understanding Deafblindness: Issues, Perspectives, and Strategies. Logan, UT: Ski-Hi Institute.

This two volume manual is a comprehensive training resource designed interveners and families of children with deafblindness. Among the twenty-four units on topics related to deafblindness, "The Intervener" covers training needs, responsibilities, attitudes, and effective strategies for working with children.

Alsop, L., Blaha, R., & Kloos, E. (2000). The Intervener in Early Intervention and Educational Settings for Children and Youth With Deafblindness. Monmouth, OR: NTAC.

This NTAC Briefing Paper was developed and reviewed by people from throughout the country, and provides the first national statement on the use of interveners in schools and early intervention settings. Available online  through DB-LINK at 1-800-438-9376.

Deafblindness and the Intervener (1998) Logan, UT: Utah State University.

This videotape shows interveners working with students who are deafblind, and has interviews with parents, educators, administrators, and interveners. Available from Hope Publishing, Incorporated; (435)752-9533; www.hopepubl.com/.

Henderson, P. & Killoran, J. (1995). Utah Enhances Services for Children Who Are Deaf-Blind. Deaf-Blind Perspectives, 3(1), 3-6.

This article focuses on the needs of students with deafblindness, and advocacy leading to legislation providing funds for intervener services in Utah.

Watkins, S., Clark, T., Strong, C., & Barringer, D. (1994). Effectiveness of an Intervener Model of Services for Young Deaf-Blind Children American Annals of the Deaf, 139(4), 404-409.

In this study, interveners were shown to help children develop interactive behaviors instead of isolated, defensive, or self-stimulatory behaviors. Quantitative and qualitative data support the effectiveness of intervener services for young children who are deaf-blind.

You and Me: A Five Part Video Series About Educating Children Who Are Deaf-Blind. (1995). Monmouth, OR: Teaching Research.

Though this video uses the term "interpreter-tutor", the function of the support model used is parallel to an intervener. The video shows an intervener working with a student who is deafblind in an inclusive setting.