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Module: Communication and Emergent Literacy:
Early Intervention Issues

Session 5: Interventions to Facilitate
Emergent Literacy

Deborah D. Hatton, Ph.D.
Wendy K. Sapp, Ph.D.

Major Points

A. Review of emergent literacy

Emergent literacy is a developmental process that begins at birth in which children acquire the foundation for reading and writing. Though children with disabilities, including children with visual impairments, face challenges in developing emergent literacy skills and concepts, they can and do experience literacy success when provided with appropriate support and modifications.

Emergent literacy begins at birth (Erickson, 2000; Morrow, 2001; Whitehurst & Lonigan, 1998). Whitehurst and Lonigan use the term emergent literacy to emphasize that “the acquisition of literacy is best conceptualized as a developmental continuum, with its origins early in the life of a child, rather than as an all-or-none phenomenon that begins when children start school” (1998, p. 848).

Families are essential to the development of emergent literacy (McLane & McNamee, 1991; Payne, Whitehurst, & Angell, 1994; Rosenkoetter & Barton, 2002). Children’s first exposure to reading and writing typically is in the home. Researchers have repeatedly found that the home literacy environments of toddlers and preschoolers have measurable effects on later literacy skills (Marvin & Mirenda, 1993; Payne, Whitehurst, & Angell, 1994; Weinberger, 1996).

Reading, writing, speaking, and listening develop concurrently and interrelatedly (Koppenhaver, Coleman, Kalman, & Yoder, 1991; International Reading Association & National Association for the Education of Young Children, 1998). Similarly, Whitehurst and Lonigan note that “reading, writing, and oral language develop concurrently and interdependently from an early age from children’s exposure to interactions in the social contexts in which literacy is a component, and in the absence of formal instruction” (1998, p. 849).

Components of emergent literacy

In our survey of the literature, we have identified six key components of early literacy that early interventionists, parents, and caregivers should consider to facilitate emergent literacy in children ages birth to 3 years:
oral language (especially listening comprehension, vocabulary, and narrative knowledge),
phonological awareness,
concept development,
knowledge of the conventions of print/braille and of print/braille intentionality,
alphabetic knowledge, and
environmental factors.
These six components are described in detail in Session 4 of this module, along with examples of each.

B. Recommended practices

To facilitate emergent literacy in young children with disabilities, early interventionists should provide collaborative, family-centered support that is developmentally appropriate and grounded in evidence-based and recommended practices that result in functional outcomes within naturally occurring learning opportunities.

Early interventionists and families need empirically based information to meet the requirements of Part C of the Individuals with Disabilities Education Improvement Act of 2004 (IDEIA, 2004). The individualized family service plan (IFSP) for infants and toddlers with disabilities should include

measurable results or outcomes for infants or toddlers and family, including pre-literacy and language skills, as developmentally appropriate for the child, and the criteria, procedures, and timelines used to determine the degree to which progress toward achieving the results or outcomes is being made and whether modifications or revisions of the results or outcomes or services are necessary. (IDEIA, 2004, Part C, Section 636)

Our current recommended practices are drawn from the empirical literature on early literacy for preschool-aged children and from the literature on children with visual impairments; from the Research and Training Center (RTC) on Early Childhood Development ( led by Carl Dunst to bridge research and practice in early childhood special education; from DEC Recommended Practices: A Comprehensive Guide for Practical Application in Early Intervention/Early Childhood Special Education (Sandall, Hemmeter, Smith, & McLean, 2005); and from our own experiences as researchers and practitioners in the field of early childhood special education and early childhood visual impairment. DEC is the Division for Early Childhood of the Council for Exceptional Children, a professional organization of early interventionists and early childhood special educators.

Although we have included practices derived from literature on preschool-aged children, we do so cautiously and hesitantly. Ideally, research on infants and toddlers and their families should guide our work with infants and toddlers with disabilities. Therefore, when reviewing literature on older children, we have constantly asked, “What would be developmentally appropriate for infants and toddlers with disabilities?” In addition, we urge early interventionists and families to remember that emergent literacy evolves “from an early age from children’s exposure to interactions in the social contexts in which literacy is a component, and in the absence of formal instruction” (Whitehurst & Lonigan, 1998, p. 849).

Virginia, the TVI, was sitting with Darryl at a child-sized table at his home. She wanted to be sure that Darryl was ready for preschool, but she wasn’t sure exactly how to help him. She had never worked with a 2-year-old child before, but she knew that literacy was very important. Virginia reached into her bag and pulled out five braille flash cards, one with each letter in Darryl’s name.

“Darryl,” Virginia began. “These are the letters in your name. We looked at them last week. Let’s see if you remember any of them.”

Darryl squirmed in his seat and began to rock back and forth. Virginia placed the letter D in front of Darryl and put his right hand on the letter.

”Do you remember this letter? It’s a D. That’s the first letter in your name, Darryl. Can you say D?”

While Virginia talks, she rubs Darryl’s finger over the letter from left to right several times. Darryl turns his head away from Virginia and his body rocking increases.

“Say D,” Virginia says more firmly, growing frustrated.

Darryl’s mother is watching from the kitchen, and Virginia is embarrassed that the lesson isn’t going better.

“OK,” says Virginia. “Let’s try another letter. Here’s the A.”

Darryl gets up and feels his way around the table. He bumps into a toy and sits down on the floor to check it out.

“Come on, Darryl,” says Virginia. “It’s time to get to work.”

Virginia wanted to provide Darryl with exposure to braille but didn’t know how to provide developmentally appropriate activities. Darryl quickly grew bored and frustrated with Virginia’s activities. Virginia failed to follow Darryl’s lead and didn’t include his mother in the activities. If Virginia continues to use these methods, Darryl may learn to dislike braille and reading long before he ever reaches school.

Family-centered practices
As noted in Session 4, Trivette and Dunst (2005) identify four essential elements of family-centered practices that should guide early interventionists and early childhood special educators as they provide support to the families of children with disabilities:
sharing responsibility and collaboration
interventionists and caregivers share information
interventionists consider the family’s style in processing information
strengthening family functioning
interventionists strive to enhance caregiver competence and confidence
interventionists facilitate opportunities for families to engage in family life
implementing individualized and flexible practices
interventionists consider each family’s unique situation
interventionists confront their own personal biases
implementing strengths- and assets-based practices
interventionists use families’ and children’s strengths and interests to learn new information and skills

Family-centered support should be provided by members of the early intervention team in a collaborative manner. Collaboration among team members is an important recommended practice. Detailed information about recommended practices for early intervention teams can be found in chapter 6, “Interdisciplinary Models,” of DEC Recommended Practices (Sandall et al., 2005).

Developmentally appropriate child-focused practices
As noted in Session 4, recommended practices for child-focused interventions include
designing safe environments that promote active and interactive engagement;
adapting practices to meet the individual and changing needs of each child; and
systematically promoting children’s learning within and across environments activities, and routines (Wolery, 2005).

These practices are consistent with the outcomes for young children with disabilities currently proposed by the Early Childhood Outcome Center (, 2005):
positive social relationships with others,
engagement in meaningful experiences that allow them to acquire and use knowledge and skills, and
independence in taking appropriate actions to meet their needs.

The practices are also consistent with the philosophy of embedding intervention within daily routines and naturally occurring learning opportunities and with McWilliam’s (2005) introduction to the chapter on interdisciplinary teams in the DEC Recommended Practices guidebook. For children with multiple disabilities who may need assistive technology to facilitate emergent literacy, we recommend the chapter on technology use and applications introduced by Stremel (2005) in the DEC Recommended Practices guidebook.

C. Family literacy, family-centered support, and environmental factors that support emergent literacy

Caregivers play a primary role in exposing children to emergent literacy experiences (McLane & McNamee, 1991; Payne, Whitehurst, & Angell, 1994; Rosenkoetter & Barton, 2002). Both exposure to storybooks and parent teaching of literacy influence literacy development across ages (Sénéchal & LeFevre, 2001). Attachment, caregiver expectations, specialized knowledge and skills, literacy access, and parental literacy are some of the factors affecting the quality of family literacy.

Trusting relationships
Children must have trusting relationships with adults who can model and guide them in emergent literacy experiences (International Reading Association & National Association for the Education of Young Children, 1998). As noted in earlier sessions, attachment is the formation of significant and stable emotional connections with significant persons, such as between mother and infant. The attachment process begins in early infancy as the child bonds with one or more primary caregivers. Infant behaviors such as crying during separation from parents, staying close by parents, expressing joy upon reunion with parents, social referencing or “checking in,” and reacting to strangers suggest that young infants have a unique bond with their caregivers. Early attachment is facilitated by mutual eye gaze and reciprocal interactions, often during feeding. Mothers of newborns, especially those who breastfeed, have hormones and neurotransmitters that encourage attachment physiologically (Schore, 1994). Children who are securely attached are more likely to cooperate with their parents, actively explore their environment, and build stronger relationships with others. These behaviors all contribute to the development of emergent literacy (Dodici, Draper, & Peterson, 2003).

Caregivers’ expectations can influence children’s literacy development (Morrow, 2001). Craig (1996) studied the frequency and nature of parental support for emergent literacy of children with visual impairments. Caregivers of children expected to be print readers provided a more responsive literacy environment (more modeling, sharing, and active exploration of literacy) than did caregivers of children expected to be braille readers. Craig (1996) also found that caregivers of children with visual impairments and multiple disabilities ranked self-help skills as the highest goal; caregivers of children with visual impairments and no additional disabilities ranked literacy as the highest goal.

Specialized knowledge and skills
When children have disabilities, and visual impairments in particular, their caregivers usually need additional skills to assist them in emergent literacy (Miller, 1985). Families of children with visual impairments must know about their child’s visual condition and how it might affect literacy, accessible books and how to obtain them, potential challenges in concept development, and the importance of active engagement and hands-on experiences and of providing exposure to environmental print and other literacy features that are not accessible.

Mara, 22 months of age, has Leber’s congenital amaurosis and receives early intervention services from a TVI once a week. Mara and her mother, Cindy, love the visits from the TVI, Randy. Randy always knows how to make learning exciting. Today he suggested that Cindy collect items from the house to help Mara’s understanding of a story. He brought one of his own story bags to help Cindy understand the concept and how it is important to include real items rather than models or symbols. Randy explained that Mara was not developmentally prepared for representations and that real items enhance sensory feedback and understanding. Cindy had fun collecting the items for the story bag and was excited to read the story with Mara.

Mara enjoyed the story and the story bag. As Cindy finished the story, Mara said “More.” Mara’s word and her enthusiasm made Cindy cry. She told Randy how worried she had been that Mara, due to her visual impairment, would have no interest in books.

Parental literacy
Functional illiteracy is the inability to use reading, writing, and computational skills in daily life. The National Center for Education Statistics (n.d.) reports that in 1992 approximately 40 to 44 million adults in the United States were functionally illiterate. While illiteracy is sometimes associated with low socioeconomic status, individuals from middle or high socioeconomic homes may be illiterate. Adults who are functionally illiterate may be of any race and may live in any region of the country.

When caregivers are unable to read to their children, early interventionists can support alternative ways to share literacy with their children. For example, caregivers can check out books with audiotapes or CDs from the library and listen to the audio while looking at the book with their child. Some caregivers may be able to learn to read simple or repetitive books with assistance from early interventionists. Some parents may be interested in learning to read, and early interventionists can help them locate appropriate adult literacy programs. Early interventionists can also help caregivers locate other adults or older children who can read and write with the child. If families are unable to purchase literacy materials, early interventionists may be able to help them obtain a library card. Early interventionists may also help families who lack financial resources access social service agencies and community organizations that might provide material support.

Braille resources for families
Some caregivers may want to learn braille so they can read and write with their child. The Hadley School for the Blind (; telephone 1-800-323-4238) offers a braille course for families, along with more than 90 other distance education courses related to visual impairments at no cost. The Dots for Families Web site ( is a collaborative project of the University of Arizona College of Education and Outreach Program for the Visually Impaired of the Arizona State Schools for the Deaf and the Blind (Rosenblum & Reed, n.d.). The Web site is designed to increase awareness of literacy opportunities for young children with visual impairments. Just Enough to Know Better (Curran, 1988), published by the National Braille Press, is a braille primer appropriate for caregivers who just want to know enough braille to help their child with visual impairment learn to read. Teachers of children with visual impairments may provide braille instruction for families or provide information about local braille courses for families. Handout B, Resources and Information for Parents About Braille (Swenson & D’Andrea, 2003), provides additional resources for caregivers about learning braille.

Three types of family support
Teachers of children with visual impairments (TVIs) can empower families in several different ways.
They may provide informational support regarding appropriate emergent literacy experiences such as actively involving their children in their own literacy activities.
They may provide material support by identifying literacy resources.
TVIs may also provide emotional support, such as listening supportively when parents express successes and challenges related to literacy activities.

D. Facilitating emergent literacy in children with visual impairments

As discussed in Session 4 of this module, children with disabilities may not acquire emergent literacy as effortlessly as many typically developing children do. In particular, visual impairments may affect children’s concept development, motor and movement development, and access to literacy environments in ways that, in turn, affect emergent literacy.

Children with disabilities often do not acquire concepts about the world around them as easily and efficiently as typically developing children. They may not readily grasp cause-and-effect relationships, and they may not be as interested in the world around them—particularly if they cannot see enticing objects, people, and activities. Conceptual knowledge helps children understand the content of stories and conversation and is related to reading comprehension in the second and later grades.

Researchers, clinicians, and theorists throughout the world have documented delays or differences in motor and concept development in children with visual impairments (Brambring, 1994, 2001; Fraiberg, 1977; Hatton, Bailey, Burchinal, & Ferrell, 1997; Sonksen, Levitt, & Kitzinger, 1984; Strickling & Pogrund, 2002; Tröster, Hecker, & Brambring, 1994; Warren & Hatton, 2004). Concept and motor development are linked to emergent literacy because they contribute to exploration and understanding of the world. The cognitive understanding of the world helps children grasp the content and meaning of language and stories—literacy. Therefore, families and early interventionists should take a proactive approach to facilitating development in these domains.

Severe visual impairments may also impede children’s access to literacy experiences. Children with visual impairments may not be aware of the books, magazines, and writing tools in their homes. They may not be tuned in to the literacy activities that their caregivers and family members engage in, such as reading the paper, looking up numbers in phone books, addressing bills, writing checks, reading labels and recipes, etc. Therefore, early interventionists and families must consciously introduce children to, or mediate, direct experiences that will familiarize children with literacy-related items, tools, and activities. Providing access to literacy materials in the appropriate media and to literacy events facilitates knowledge of print/braille and of print/braille intentionality, as well as alphabetic knowledge.

Parents of children with disabilities may be more at risk for depression than the parents of typically developing children. Because caregivers who are depressed are typically not as responsive as caregivers who are not depressed, children with disabilities may have fewer opportunities to engage in early literacy activities. Less responsive caregiving, combined with a lack of awareness of environmental print, may impede the acquisition of emergent literacy skills. Therefore, parental depression and/or less responsive parenting may also contribute to inaccessible literacy environments.

Early interventionists and families should carefully consider children’s unique abilities and the impact they may have on the components of emergent literacy: oral language (listening comprehension and vocabulary development in particular), phonological awareness, concept development, knowledge of the conventions of print/braille and of print/braille intentionality, alphabetic knowledge, and access to literacy rich environments. An awareness of the impact of disabilities on emergent literacy should help professionals and families take a proactive approach to providing individualized activities that will provide the foundation for future literacy.

In addition to implementing strategies for communication and language development, as described in earlier sessions of this module, caregivers and early interventionists should facilitate emergent literacy in children with disabilities by
promoting concept development,
enhancing motor development, and
creating accessible literacy environments.

Promoting concept development
Through watching and seeing things, most children acquire many concepts about the world effortlessly. Even when children use other senses to develop concepts, vision is the unifying sense that integrates information from the other senses. Children with visual impairments may be delayed in developing many concepts about the world (Warren & Hatton, 2003), including concepts about their own bodies and about others’ bodies; object concepts (the understanding that things continue to exist even when they are not providing sensory input); classification (the ability to group objects together on the basis of common features); and conservation (the understanding that certain objects, such as a quantity of liquid, may stay the same even when made to look different).

For example, if a child with a visual impairment has never experienced insects (one of the most common themes in children’s literature) except through the occasional mosquito bite, the child may not understand stories about bugs. If children have repeated opportunities to touch insects or to look at them under a magnifier or closed-circuit television (CCTV), they will better understand stories about bugs. Children can go on “bug hunts” to find out where insects live. There are endless possibilities for very young children to begin to develop concepts about insects.

When facilitating concept development in children with visual impairments, consider using a developmental approach. Infants with visual impairments may not be able to see their caregivers, their own bodies, and their surroundings. The earliest concept-development activities could focus on awareness and enjoyment of early interactions with caregivers and on the infant’s own body and body parts. Infant massage can be used to facilitate attachment and bonding and to help infants develop concepts about their own bodies. Later, they can explore their caregivers’ faces, hands, wrists, etc., to gain awareness that others have similar body parts.

By thinking through daily routines and objects and events that children may not be aware of if they cannot see, caregivers and early interventionists can identify an endless number of concepts that children may need to be introduced to directly. Early on, children should be introduced to other family members and other important people in their lives. If they cannot identify these people visually, special cues can be used to help children build concepts related to particular persons (e.g., unique greetings and touches). Children may also need to be introduced, in a developmentally appropriate manner, to their homes, beginning with cribs and other defined spaces; their neighborhoods; and their communities. The opportunities for developing concepts within naturally occurring excursions into the community are endless; however, the activities for building concepts should always be fun and developmentally appropriate. By carefully attending to children’s interests and their attentional focus, adults can provide information that builds concepts when children are motivated to acquire them.

Families and early interventionists may need to guide children’s exploration of the environment and objects in a responsive and respectful manner so that children learn about the objects and events and their relationship to each other. Without vision, children may be oblivious to the most common features of daily routines, such as furniture, appliances, light switches that turn on lights, and so on. They may also fail to see the commonalities and differences between objects. Therefore, they may need direct experiences with matching objects with salient sensory features and comparing and contrasting objects, shapes, sounds, weights, and textures as they grow older and as these activities become developmentally appropriate.

Children with visual impairments often develop motor skills, especially self-initiated movement, at later ages than do their typically sighted peers (Warren & Hatton, 2003). These delays may limit children’s ability to explore their world and learn about objects and concepts. Children with visual impairments need early experiences to acquire meaning from literacy activities and experiences (Koenig & Holbrook, 2002). Therefore, it is important to recognize that delayed motor skills and limited exploration may affect the type and number of concepts children acquire.

Enhancing motor development
Many children with visual impairments acquire motor skills similarly to their sighted peers. Some children with visual impairments, including those with additional disabilities, may exhibit differences in motor skill development or differences in quality of movement that may indirectly affect literacy development (Strickling & Pogrund, 2002). These differences are attributed to low postural tone, limited early movement experiences, lack of visual motivation for movement, and spatial mapping (Strickling & Pogrund, 2002). A spatial map is a mental representation of the relative position of objects and phenomena in an individual’s environment. Sensorimotor development also seems to occur at a faster rate when there is reciprocity between movement and vision (Barraga & Erin, 2001).

Differences in motor skill development and quality of movement. Children with severe low vision or blindness sometimes display differences in the rate or sequence of motor development (Strickling & Pogrund, 2002), which may affect emergent literacy development. For example, children with visual impairments develop goal-directed movement later than do their sighted peers, affecting their independent access to literacy experiences. Strickling and Pogrund (2002) list and describe the following differences in quality of movement.

Low muscle tone in the trunk. Some children with visual impairments have low muscle tone through the trunk and pelvis manifested by loose movement patterns and difficulty maintaining an erect posture. Low postural tone can cause slouching and clumsiness, which may further limit active explorations and access to literacy experiences.

Decreased balance. Static and dynamic balance is also affected by lack of vision; impaired balance can cause frequent falls and result in reluctance to move. If children use their hands to stabilize their bodies, bilateral coordination, unilateral reaching, and mature grasp patterns may be delayed, making it difficult to reach for and manipulate writing tools and to hold books, thereby impeding emergent literacy development. Ungraded movements and decreased balance can also limit children’s independent mobility and access to rich literacy experiences.

Repetitive head movements. Some children with visual impairments engage in repetitive head movements, such as rocking or swaying. When the head is not aligned with the body or is constantly changing position, balance, bilateral hand coordination, and fine motor manipulation are affected. These motor differences may create challenges during shared storybook readings and other joint literacy experiences. For example, children may lose their place while reading braille or print.

Unstable shoulder girdle. When children have low muscle tone and limited experience in the prone position, the muscles in the shoulder girdle develop slowly, which in turn influences hand and arm mobility and coordination. Bilateral coordination and mobility are essential in many emergent literacy experiences, such as scribbling with a slate and stylus, handling paper and crayons, and turning the pages in a book.

Limited hand rotation. Because of limited visual input, children with visual impairments may not fully rotate their wrists during early exploration of objects. Later, reduced wrist rotation may affect the fine motor skills needed to read and write braille; children may also have difficulty in turning the pages of a book or producing circular scribbles.

Fisting. Limited early body-weight bearing in the prone position and lack of experience in reaching and extending the hands to explore may cause some children with visual impairments to maintain fisting of the hands or to hold their hands up at their shoulders instead of at midline (in the center of the body). Fisting of the hands and failure to manipulate and explore objects with both hands affects development of finger strength and control. If children cannot engage in tactile exploration of objects and textures, they are unprepared for locating and reading braille (Drezek, 1999). Finger dexterity and strength are also needed to efficiently use a braillewriter, a keyboard, an augmentative communication device, explore a book, etc.

Ruben was a 15-month-old with bilateral anophthalmia. His parents wanted him to walk and eagerly awaited their weekly meetings with the orientation and mobility specialist (OMS). LaMont, the OMS, talked with the parents about ways to encourage independent movement, especially crawling, within Ruben’s defined play spaces and during the family’s routines. Ruben’s mother was curious about why LaMont still wanted Ruben to spend so much time crawling. LaMont scheduled a joint home visit with the teacher of children with visual impairments (TVI) so that they could talk with the family about the importance of emergent literacy. The TVI and OMS explained to the family the importance of weight bearing and its influence on later braille reading and writing. The parents began to understand the connection between Ruben’s using his hands to crawl now and using them to be a highly literate adult later.

Early interventionists, caregivers, and families should understand the potential impact of visual impairments on motor development and how motor development affects the development of emergent literacy. Facilitating early movement facilitates emergent literacy. For all children with visual impairments, but especially for those with additional disabilities, professionals must closely monitor motor and movement development. Collaboration among families, TVIs, early interventionists, occupational therapists, physical therapists, and orientation and mobility specialists is necessary to determine children’s needs and family priorities and concerns as well as to plan and implement intervention.

Nagaishi (1993) highlights the importance of developing movement and hand use in children with visual impairments by providing them with ample opportunities to explore using all of their senses. Adapted from Nagaishi, Handout C, Strategies to Enhance Motor/Movement and Development for Literacy (EIVI Training Center, 2005f), recommends the following:
Use shoulder slings to carry infants so they can experience the adult’s movement while positioned comfortably and appropriately.
Give infants opportunities to experience a variety of positions, particularly on the stomach.
Use daily routines such as bath time, diaper changing, playtime, etc., to learn about body parts and their movements.
Enjoy gentle roughhousing such as bouncing, swinging, or rocking (but only when the infant enjoys it).
The living room can be a wonderful obstacle course for older infants. For example, infants can crawl under tables, over pillows, etc.
Auditory and tactile cues help motivate infants with visual impairments raise their heads.
Provide infants with interesting objects of various sensory qualities while describing their characteristics and actions.
Provide infants with large objects to hold with both hands, and smaller objects that make noise when you bang them together. Play a variety of hand games such as pat-a-cake or ring-around-the-rosy.
Allow older infants to move their bodies to retrieve objects at different distances and positions.
Play provides many opportunities for children to develop finger and hand strength, wrist rotation, and isolating the index finger through activities such as playing with Play-Doh (kneading, poking, pulling, etc.).
As children mature, include them in functional activities such as brushing teeth, spoon-feeding, putting away toys, etc.

Regular, organized sensorimotor activities can improve the movement of children with visual impairments and additional disabilities. Strickling and Pogrund (2002) note that motor and cognitive development are influenced by the quality of the sensory messages (visual, auditory, olfactory, gustatory, tactile, vestibular, and proprioceptive) from the body and environment and by the quality of functioning of the central nervous system. The central nervous system assists in the integration and processing of sensory messages. Individuals with visual impairments may have difficulty interpreting sensory feedback due to differences in how sensory information is processed in the central nervous system. The constant and organized sensory input provided in sensorimotor activities prompts the central nervous system to process the input. As the central nervous system processes more sensory messages, it becomes more effective, resulting in more efficient motor output (Strickling & Pogrund, 2002).

The value of outdoor play in nature of young children was confirmed in a 1997 Swedish study led by scientist Patrik Grahn (Vedelsby, 1998). Grahn concluded that children who engage in outdoor play in the natural world have better motor function than do their peers who play in traditional indoor settings. The outdoors provides a sophisticated and unlimited sensory environment of ponds, lakes, streams, rivers, hills, meadows, and woods where children can practice motor skills. Particularly, crawling, climbing, and playing on uneven ground improves balance and the agility and strength of hands, arms, and trunk. See Handout D, Facilitating Motor Skills in Outdoor Settings, for suggestions for facilitating motor development and movement through outdoor exploration and play (Murphy, 2005a). Although the value of motor experiences in nature for children with visual impairments has not been explored, the varied sensory experiences in outdoor settings should enhance both sensory and motor function. Furthermore, nature play provides children with visual impairments concrete, hands-on, multisensory experiences that build concepts for early literacy (Koenig & Farrenkopf, 1997).

Children need to develop fine motor control and strength to be able to write when they are older. There are many fun play activities that can help children develop their fine motor skills (McComiskey, 1996; Wormsley, 1997). Functional tactile skills include locating, exploring, manipulating, recognizing, comparing, and organizing objects (Smith & Levack, 1996). When infants are very small, they can be placed on their stomachs and encouraged to push up on their hands. This will increase hand and upper body strength and may decrease tactile selectivity. Many commercially available toys encourage children to use individual fingers. Popping bubble wrap and attaching clothespins to the edges of containers helps children to increase finger strength. Carrying toys and objects will also increase hand strength. Fine motor development occurs naturally in most daily routines. For example, children increase finger strength and dexterity and hand coordination when they help to zip their coat, put on shoes, put the lid on a container of food, play with Play-Doh, and pick up Cheerios spilled on the floor. Increasing strength and dexterity also increases children’s confidence in their abilities and encourages further fine motor manipulation.

Amelie loves to help her mother, Tamara, with daily chores. She often carries the garbage bag from the kitchen to the front door or puts garbage in the trash can if her mother asks her to. Today Amelie is helping her mother empty the silverware tray of the dishwasher. She transfers the spoons one by one to the silverware drawer. Her mother places a step stool next to the drawer so Amelie can reach it.

As Tamara is preparing a snack for Amelie, she drops some Cheerios on the floor. Tamara immediately encourages Amelie to help. Amelie smiles as she helps Tamara pick up the Cheerios. Pinching the Cheerios with her thumb and index finger, she picks up the Cheerios from the floor and puts them into a small cup. Tamara intentionally gives her a cup with a narrow opening because she knows that it will help Amelie refine her pincer grasp.

Creating accessible literacy environments
The appropriateness, accessibility, and number of literacy resources within environments enhance literacy modeling, caregiver-child interactions, and active exploration. Therefore, environments may need adaptations for children with visual impairments so that they have equal access and opportunities for developing emergent literacy.

In particular, children may need to be directly involved in the daily literacy activities of their family members. Family members may ask children with visual impairments to “help” them
read newspapers, telephone books, and recipes within daily routines;
write thank-you notes, make grocery lists, and pay bills; and
retrieve and replace storybooks, tape players, and braillewriters.

Children should have access to books and writing materials in appropriate media. If there is any possibility that children may be braille readers, families should secure twin vision storybooks with both braille and print; braillewriters and slate-and-styluses should be available for scribbling and for adult modeling of writing.

E. Early literacy for children with visual impairments and additional disabilities

Children with visual impairments and additional disabilities, including those who use alternative and augmentative communication (AAC) systems, should have opportunities to engage in meaningful emergent literacy activities. Koppenhaver and colleagues emphasize three factors in facilitating emergent literacy of children with multiple disabilities:
caregivers who hold high literacy expectations,
access to a variety of communication forms, and
regular shared storybook readings (Koppenhaver, Erickson, Harris, McLellan, Skotko, & Newton, 2001).

Often when children have multiple disabilities, parents do not rank early literacy as a priority and find their time filled with their child’s basic care and physical needs (Marvin, 1994). Early interventionists should help families and caregivers understand that emergent literacy is integrated into daily routines that do not require additional time. For example, natural learning opportunities for facilitating emergent literacy occur during breakfast as a child is presented with two cereal boxes and asked to make a choice. The parent may trace the words with a finger while asking, “Would you like Cheerios or Kix to eat?” The parent’s words and gestures, the visual graphics and pictures on the cereal box, the sound produced as the parent shakes the boxes, and the familiarity of the routine enhance this literacy event. For children with no vision, parents may glue an actual piece of each type of cereal to the cereal box so that children have a tactile cue that can help with the selection. Families and caregivers with lower literacy expectations would also benefit from seeing other children and adults with multiple disabilities engage in literacy activities (Marvin, 1994).

Children with multiple disabilities often have communication delays or speech and language impairments. Limited communication may affect literacy interactions between caregivers and children (Marvin, 1994). For example, children may be unable to answer adults’ questions during storybook reading without appropriate adaptations. Alternative and augmentative communication (AAC) can facilitate the development of communication and emergent literacy. AAC refers to using devices or techniques to facilitate children’s expressive or receptive communication. AAC includes the use of unaided modes of communication such as body language, gestures, sign language, and facial expressions or the use of high- or light-tech devices.

The use of high-tech and light-tech devices can improve the literacy skills of children with severe multiple impairments, including intellectual disabilities (Erickson & Koppenhaver, 1995). High-tech devices include:
adaptive firmware cards (AFCs)—computer cards used to adapt computers to input devices (e.g., switches, Unicorn boards) other than standard keyboards
dedicated communication devices—portable devices that enable children who cannot speak to communicate; usually include speech output, and may be connected to computers
peripheral devices—various devices (e.g., touch screens) used to adapt computers
scanning programs—computer programs that present a series of choices; users select items using single switches
single switches—devices (e.g., buttons or bars) that allow a single contact to indicate input
speech synthesis or speech feedback programs—computer programs that read text aloud
Unicorn Expanded Keyboards—large, pressure-sensitive programmable keyboards that can be fitted with custom overlays
(Erickson & Koppenhaver, 1995)

Light-tech devices described by Erickson and Koppenhaver (1995) include:
communication boards—boards with symbols that children can point to to indicate preferences
loop tapes—continuous audio tapes (as in answering machines) that caregivers can use to record messages on behalf of children who cannot speak
talking switches—tape recorders fitted with single switches and loop tapes; used by children who cannot talk to repeat a message (e.g., “Turn the page”)

Gretchen sat in the adaptive chair that the physical therapist had recommended. A switch was on either side of the chair’s tray. In the middle of the tray was a portable color CCTV. Gretchen’s mother placed a brightly colored book on the XY tray of the CCTV and turned on the screen. Gretchen immediately looked at the CCTV screen. Gretchen’s mother read the first page of the book.

At the end of the first page, she asked Gretchen, “Do you want more? Or are you done?” Gretchen continued looking at the page. After about a minute, Gretchen’s mother repeated the question. Gretchen stretched out her right arm and hit the switch. “More please,” said a little girl’s voice from the switch.

Gretchen’s mother turned the page and made sure the print and picture were visible on the screen. She continued reading one page at a time, asking Gretchen if she was finished or wanted more at the end of each page. After about four pages, Gretchen began hitting the “More please” switch as soon as her mother finished reading. Towards the end of the book, Gretchen began to lose interest. She hit the other switch with her left hand.

“All done,” said the little girl’s voice. Gretchen’s mother turned off the CCTV and said, “OK, we’ll read some more later.”

Session 3, “Communication and Language Interventions,” provides detailed information about alternative and augmentative communication.

Adults who have difficulty in recognizing children’s subtle responses (e.g., eye gaze, changes in facial expression, simple vocalizations) may stop asking questions and lower their expectations of children. Early interventionists can support communication and literacy development by helping families and caregivers to recognize children’s subtle cues so that they will provide contingent responses to their nonverbal behavior during story reading.

Other assistive technology can also increase children’s participation in emergent literacy experiences (Koppenhaver, 2000). For example, some children may require devices to help hold books or special chairs to stabilize their bodies. Simple modifications to common emergent literacy activities, such as attaching a plastic clothespin to the page of a book so that children can turn the pages themselves, can greatly enhance experiences for children with disabilities.

A team approach is always beneficial in identifying the individual needs of children with multiple disabilities and in planning emergent literacy activities. Families and caregivers are important collaborators because they provide specific information about their children that might not be available to professionals. Speech-language pathologists assess children’s communication and literacy needs. Physical and occupational therapists can support children’s position and motor skills that will facilitate emergent literacy experiences. All members of the early intervention team should collaborate to identify children’s current level of functioning and intervention goals and strategies that will promote emergent literacy.

F. Emergent literacy interventions

Developmentally appropriate and evidence-based interventions to promote emergent literacy that are consistent with recommended practices in early childhood special education include
encouraging play to develop concepts and opportunities for communication, language, and emergent literacy;
using routines-based and naturally-occurring learning opportunities;
creating responsive literacy environments;
promoting shared storybook reading, including
dialogic reading,
storybook preview, and
storybook sounds;
facilitating storytelling, including decontextualized language; and
encouraging dialogue/conversation between adults and children and children and peers.


If children cannot see the toys that are around them or what other children are doing, they will not be motivated to actively engage in play. Families and early interventionists can use recommended practices from early childhood special education
(Sandall et al., 2005) and evidence-based strategies from research (Malone & Langone, 1999; Raab, 2003) to take a proactive approach to facilitating play in young children with visual impairments.

A review of the literature from the field of visual impairment suggests that children with visual impairments often exhibit limited play repertoires and types of play. They also have difficulty in initiating and maintaining interactions with typically developing peers.
Erwin (1993) found that young children with visual impairments spend a disproportionate amount of free play time in solitary play or unoccupied, and several researchers have documented a preference of young children with visual impairments for interactions with adults to interactions with peers (Kekelis, 1992; Parsons, 1986; Preisler, 1993; Tait, 1972b). Perhaps because outdoor spaces such as playgrounds and parks tend to have fewer landmarks for orientation, children with visual impairments may have reduced mobility outside and fewer opportunities for higher-level, interactive play (McGaha & Farran, 2001). Additionally, children who are severely visually impaired tend to engage in more stereotypic play do than their sighted peers (Parsons, 1986; Tait, 1972a).

In a study of children in Germany, parents of young children who are blind reportedly engaged in more structured play with their children than do parents of sighted children (Tröster & Brambring,1994). As might be expected, children without vision preferred toys with unique auditory or tactile qualities. Again, children without vision engaged in significantly less interactive play than did children with sight.

Based on a study of three subjects, Skellenger and Hill (1994) found that a shared teacher-child play intervention could increase the play skills of young children who are blind. Skellenger, Rosenblum, and Jager (1997) reported that young children with visual impairments, especially those with severe visual impairments, may play more often with gross-motor toys (e.g., push-em carts, rocking horses) than they do with sound-making toys, pretend-play toys (e.g., dolls, miniature cars), manipulatives (e.g., bristle blocks, beads), or functional toys (e.g., pots and pans).

Symbolic play appears to be delayed in young children with visual impairments (Fraiberg, 1977; Rogers & Puchalski, 1984b), and it diverges increasingly from that of sighted children as they get older (Parsons, 1986; Tröster & Brambring, 1994).

Nevertheless, many emergent literacy interventions can be embedded in children’s play. Play is process oriented, not product oriented. Children learn through the process of playing, not by creating a product or accomplishing a task. Play can be a powerful tool for children to acquire concepts and skills that are important for emergent literacy (McLane & McNamee, 1991; Roskos, Christie, & Richgels, 2003).

When considering strategies for facilitating play that can support communication and emergent literacy, caregivers and early interventionists should consider a developmental approach that is child directed and that is individualized.
During early infancy, simple interactive games, such as “up and down” and “horsey,” that include movements with caregivers and family members can be used to facilitate attachment, share positive affect, and help children learn body and spatial concepts. At the same time, caregivers can wait for children to signal that they want more of the game or that they want to take their turn, thereby facilitating communication and social interactions.
Caregivers should carefully monitor children’s subtle cues to ascertain their attentional focus and then should imitate any action that suggests that the child is interested in an object (sound that results from fingernail scratching on crib) and then should imitate the child’s activity to engage the child in turn taking.
When children are able to grasp rattlers or small toys, caregivers can model actions and help children explore the objects’ features.
Sighted children often see enticing everyday objects such as bowls and spoons and explore them for long periods of time. Children with visual impairments should be directly introduced to objects and toys they may not discover incidentally. Child-directed exploration of toys and objects, with developmentally appropriate descriptions from parents, can help children learn to use all senses to explore new things and to acquire new concepts. Adults can gently model the appropriate use of the object after children have explored the item on their own.
Children can be introduced to toys and activities that build concepts and cognitive skills and that are also fun, such as putting large bells in metal cans and then taking them out again.
As soon as possible, children should be allowed to choose toys or play activities.
Play that involves the whole body is particularly useful for building concepts such as in and out and for fostering pretend play. Laundry baskets can become boats that children climb into and out of; tables can make wonderful pretend forts for children to crawl under.
Children with visual impairments may need structured play opportunities with peers to acquire social skills and to learn cooperative play. Sand and water tables, block building areas, tea sets, and dress-up areas offer enticing opportunities for toddlers to begin to play together.
Pretend props, such as dress-up clothes, phones, purses, and dolls, can be used to encourage early symbolic play.
Children can be encouraged to “act out” the stories presented in books during story time to facilitate pretend play. Props may contribute to more elaborate play.
As mentioned earlier, outdoor play facilitates motor and concept development that will help children to understand the content of stories they read as they get older.
Obstacle courses provide an opportunity for children to learn spatial and positional concepts such as top and bottom, in and out, up and down, around and behind.
Open areas where children with visual impairments can move freely and without fear of accident encourage the gross motor skill development that forms the foundation for the fine motor skills that are required for reading and writing.

Recchia (1997) and Rettig (1994) have provided additional suggestions for facilitating the play of children with visual impairments:
Follow the lead of children, rather than being directive. Children who are allowed to play freely will develop more initiative.
Resist the temptation to constantly present things to children in order to entertain them; allow children to discover play opportunities for themselves to increase active engagement.
Maintain a positive and playful attitude so that children know that play is fun.
Be flexible. Caregivers should allow children to engage with toys in different ways and in different contexts. Guidance and teaching should be balanced with children’s need to explore and create on their own.
Focus on means more than ends. Do not be so preoccupied with the attainment of goals, outcomes, and skills that play becomes a chore.
Because children with visual impairments can feel overwhelmed by the presence of many peers, consider limiting the number of play partners initially.
Consider the sensory qualities of toys for children with visual impairments and the purposes for which they can be used. Functional, “real-world” manipulatives such as doorknobs, keys, and kitchen utensils encourage concept development and can be fun to play with.
Encourage symbolic play, such as with dolls, stuffed animals, and toy cars, through specific feedback about how toys feel and work.
Facilitate young children’s developing sense of self (i.e., autonomy) by encouraging exploration and play with symbolic toys such as dolls.

Literacy-enriched play, an evidence-based intervention, involves making literacy artifacts available in children’s dramatic play settings (Justice & Pullen, 2003). When literacy props and resources are available, children naturally integrate them into their play. Literacy-enriched play facilitates the development of oral language, including listening comprehension, vocabulary, and narrative knowledge, concept development, knowledge of the conventions of print/braille and of print/braille intentionality, and alphabetic knowledge. Adapted from Justice and Pullen (2003), Table 1, also available as Handout E, Literacy-Enriched Play (Murphy, 2005b), provides examples of dramatic play and the literary and pretend props associated with the specific type of play.

Table 1

Note. Adapted from Justice, L.M., & Pullen, P.C. (2003). Promising interventions for
promoting emergent literacy skills: Three evidence-based approaches. Topics in Early Childhood Special Education, 23(3), 93-113.

Social pretend play facilitates the development of oral language, including narrative knowledge (Howes & Wishard, 2004). Young children produce proto-narratives, or short stories that tell about routines and events in their lives. During pretend play, they collaborate with others to develop proto-narratives. Narratives are formed as children discuss storyline, roles, props, etc. Caregivers can support children’s written and oral narrative development by scaffolding and including literacy artifacts in the play setting.

Routines-based and naturally occurring learning opportunities
Dressing, diapering, feeding, resting, playing, and car trips are common routines for infants and toddlers. Often literacy routines are integrated into the context of daily routines. Lawhon and Cobb (2002, p. 113) describe a literacy routine as “the regular use of a variety of techniques to enhance children’s abilities to listen, to observe, to imitate, and to develop their language, reading and writing skills.”

Caregivers can create bedtime routines with storybooks and can discuss the events of the day. During dressing and diapering, caregivers may sing songs that involve play with language, such “Old McDonald Had a Farm.” Caregivers can also make up their own rhymes that bring attention to individual sounds. A car ride is the perfect opportunity to sing songs, tell stories, and have conversations. Children can explore literacy artifacts for reading and writing during play. Peek-a-boo and hide-and-seek are games that help children build decontextualized language by taking the perspective of someone else (Rosenkoetter & Barton, 2002). These games may be appropriate for children with low vision. For children with severe visual impairments or blindness, interactive games can be adapted by using auditory or tactile cues.

Adapted from Roskos, Tabors, and Lenhart (2004), Handout F, Early Literacy Routines (EIVI Training Center, 2005b), suggests additional verbally stimulating activities that can be integrated into everyday experiences. These include, for infants and young toddlers:
imitating infants’ babbling,
talking about things that happen during the day, and
reading aloud.

For toddlers and young preschoolers, Handout F suggests:
exposing them to new words,
sharing books with them,
sharing nursery rhymes, and
providing print/braille-rich environments.

Adapted from Weitzman (1995), Handout G, Making Print/Braille “Talk” to Children (EIVI Training Center, 2005d), provides examples of natural print/braille learning opportunities. To make print in the environment “talk” to young children, caregivers should expose children to print/braille during everyday routines,
for pleasure,
in social interactions,
for communication,
for record keeping, and
for information retrieval.

Alana was a 30-month-old girl with Stage 4 retinopathy of prematurity. Her mother, Jonette, noticed that much of the environmental print at Alana’s childcare center was located high up in the room. For instance, the cutout letters of the alphabet were taped in a line to the wall above a whiteboard, 10 feet from the ground. A poster promoting a picture book about whales was placed over the door. A mobile of different-colored cardboard balloons, each labeled in large letters “red,” “blue,” and so on, hung in the center of the room, high enough so that an adult could walk underneath it. Jonette was concerned because, while the children with normal vision at the center could see the cardboard letters, the poster, and the mobile, Alana probably could not.

Jonette read to Alana every day and had made print/braille resources such as books, crayons, and paper available to her at home. Jonette understood that incidental exposure to print, at daycare as well as at home and outside, is important for children learning to read and write.

Jonette approached Alana’s teacher, Virginia, and explained her concern. “It never occurred to me that Alana might be missing out,” Virginia said. “We’ll have to do something to fix that.”

Virginia and Jonette discussed strategies for rearranging elements of the daycare center. They moved the cut-out letters to beneath the whiteboard so that they were at eye level to the preschoolers. They also had Alana’s TVI make alphabet braille labels. The whale poster was moved to a lower section of the wall near the door, where the children could see it up close. The mobile was moved from the center of the room to a corner where it would be out of the way of adults, and hung low enough that it could be explored by the children. The cardboard balloons were replaced with different real objects, and braille was added.

Virginia enjoyed seeing Alana engage with the mobile and explore the braille letters. She was excited to learn more about Alana’s needs and make more adaptations. Jonette was pleased with the improvements in her daughter’s daycare center. She was sure that the additional daily exposure to braille in the environment would contribute to Alana’s learning to read and write.

Adapted from McComiskey (1996), Table 2, also available in Handout H, Emergent Literacy Skills for Future Braille Readers (EIVI Training Center, 2005c), lists emergent braille skills that should be encouraged during daily routines. It is not essential for young children to achieve all of these skills in order to become successful braille readers and writers. However, these are skills that may make learning to read and write braille easier. Skills should not be taught in isolation in a drill-like manner.

Table 2
Emergent Literacy Skills for Future Braille Readers
Fine motor
Listening and attention
Book and story
Tolerates being touched
Holds objects in each hand
Alerts to sounds
Identifies body parts
Uses books as toys (squeak, pull, etc.)
Enjoys being touched
Uses pincer grasp
Listens to interaction songs
Names body parts
Identifies parts of a book (cover, pages, margin, etc.)
Examines objects by touch
Opens and closes books
Socially sits with adult 5-10 minutes
Identifies objects and actions
Holds book and turns pages
Matches and sorts objects
Turns cardboard pages
Listens to and enjoys rhymes
Names objects and actions
Explores tactile books using pad of fingers
Touches braille in exploration
Uses two hands cooperatively
Participates in finger plays and songs
Shows object permanence concept
Purposefully traces marks in tactile book from start to end
Matches graduations of sandpaper, etc.
Uses appropriate grasp with stylus
Follows 2-step directions
Searches for dropped objects
Participates in object “book” story
Locates tactile “mark” on paper
Makes stylus art with construction paper
Matches sound cans
Shows same and different concept awareness
Daily Twin Vision book lap time
Uses pad of index finger to touch
Turns pages one at a time
Shows interest in short stories about self
Demonstrates number awareness of quantities to 3
Dictates and reads “sentence” book
Traces 3-dimensional outline of shape
Copies patterns with pegs, muffin tins, geo boards, etc.
Shows interest in short stories about others, with participation
Shows more/less, big/small, long/short, wide/narrow concepts with objects
Selects favorite book and stories
Traces 2-dimensional outline of shape
Shows hand strength and flexibility
Shows interest in short stories about others without participation
Plays symbolically
“Touch and Tell” and “Patterns” series completed (APH)
Traces left-to-right continuous line with sticks, glue, etc.
Shows finger strength and dexterity
Uses jargon and imitation on phone
Shows concepts of: above/below, left/right, back/front, up/down, top/bottom, middle/sides (with objects)
Enjoys “On the Way to Literacy” series (APH)
Traces left to right using:
Braille cell with no space
Braille cell with space
Dot 2,3,5,6 with no space
Dot 2,3,5,6 with space
Dot 3,6 with no space
Dot 3,6 with space
Dot 1 with no space
Dot 1 with space

Places individual finger on braille keys
Tells simple even (idea)
Understands positional concepts with marks on page

Uses two hands cooperatively in tracing (place marker and reader hand)
Manages paper into stylus
Makes up simple stories (3 ideas)
Shows rote knowledge of alphabet

Participates in Mangold’s activity sheets and units
“Scribbles” with slate and stylus
Listens to simple story tape
Shows letter/cell awareness using balls, marbles, and braille

Manages paper into/out of brailler with help
Manages tape recorder with help
Says letters of name (rote)

Positions fingers on braille keys appropriately
Manages tape recorder independently
Says names of brailler keys

Manages paper into/out of brailler independently
Attention to task completion (5-20 minutes)
Shows awareness of touch patterns representing word; e.g., name

Operates all keys of brailler appropriately

Directions: Reading and writing braille is achieved by systematic building of skills in many areas of development. This literacy readiness grid enables parents and teachers to identify accomplished skills and target other skills for educational programming.

Using observation and informal assessment, identify which skill in each area a child has accomplished. Highlight the accomplished skill box entirely. Emerging skills are partially filled with highlighter. Nonhighlighted skill boxes are targeted for the child’s educational program. This is a flexible tool. Add or delete boxes for individual children. Remember: FUN IS THE KEY INGREDIENT.
Note. McComiskey, A.V. (1996). The braille readiness skills grid: A guide to building a foundation for literacy. Journal of Visual Impairment & Blindness, 90(3), 190-193. Grid and directions copyright 1996 by American Foundation for the Blind. Reproduced with permission of American Foundation for the Blind.

Responsive literacy environments
Responsive literacy environments provide experiences in which children
observe caregivers modeling literate behaviors,
engage in literacy activities and interactions with caregivers, and
explore literacy actively (Teale & Sulzby, 1986).

Responsive caregivers of children with visual impairments model literacy during daily routines by describing what they are doing, share natural literacy experiences by involving children, and provide opportunities for active exploration of appropriate literacy resources.

Experiences in which children observe caregivers modeling literacy. Observing adults engage in literate behaviors provides literacy-related role models and helps children understand print/braille intentionality.

Children with normal vision have numerous opportunities to observe their parents modeling literate behaviors, such as making grocery lists, reading newspapers, and reading shop-window signs. Children with visual impairments may not see details and therefore may have less of an understanding of the activities. Even if an activity involves sound (e.g., typing on a computer keyboard), children may not be able to see the literacy aspects of the activity (e.g., the letters on the screen).

Caregivers can assist children by talking about their reading (e.g., “I will read the recipe to see what we need to put in the soup.”) and writing activities and by letting children explore materials physically while they talk about what they are doing.

Caregivers can pretend to write on braillewriters so that children hear the keys and feel the bumps that are produced. Ideally, parents will learn braille as soon as possible so they can model braille reading and writing.

Experiences in which children share literacy with caregivers. When children share literacy experiences with adults with whom they have positive relationships, they begin to associate reading and writing activities with enjoyable social interactions (International Reading Association & National Association for the Education of Young Children, 1998; Ortiz, Stowe, & Arnold, 2001; Rosenkoetter & Barton, 2002). Early interventionists can help families learn to share literacy experiences with their children throughout daily routines.

Nguyet sat on the sofa with her daughter, Cam. “I think your favorite show comes on in a few minutes,” said Nguyet. “Let’s check and see.”

Nguyet picked up the newspaper on the coffee table and turned to the TV listings. Cam, who has cerebral palsy, developmental delays, and low vision, was sitting beside her mother supported by pillows, as the physical therapist recommended. Nguyet stretched her right arm around Cam so that the newspaper was held up in front of both of them.

“Here we are,” said Nguyet. She folded the paper back so she could hold it with one hand and pointed to the grid with her other hand. “The Merry Munchkins are on channel six at ten o’clock. It’s almost time.”

It is particularly important to share literacy experiences with children with visual impairments because they experience fewer incidental learning opportunities. Literacy sharing should occur regularly during daily routines. Some caregivers may have specific literacy routines with their children, such as bedtime story sharing, writing grocery lists, or reading the mail. These shared experiences provide caregivers opportunities to scaffold children’s learning.

Maddie and her son Howard, who has low vision, sat at the table that was covered with papers, pencils, pens, markers, and crayons. The different writing utensils were in boxes—one for crayons, one for markers, and so on. The paper was loosely stacked in the middle of the table. Maddie was drawing a picture of a flower. Howard was making dots with a marker all over his paper.

“What color should I make the petals?” Maddie asked. Howard looked up but kept tapping the marker on the paper to make dots. Maddie held out the box of crayons to Howard.

“Pick a color for me,” she said. Howard put down his marker and peered into the box. He reached in, pulled out three crayons, and handed them to his mother.

“These are pretty colors,” Maddie said. “I’ll color the first petal purple, and the next petal red, and then the next petal yellow.”

As Maddie named each color, she filled in another petal on her flower. Howard leaned over and watched his mother fill in each large circle she had drawn for petals. He took his marker and began scribbling on his mother’s flower.

“You’re helping me color my flower,” Maddie said. “Thank you.”

For totally blind toddlers, caregivers may have to provide direct physical contact with literacy tools. Caregivers might say, “Come and sit on my lap while I write a birthday note to Grandmother. You can help me fold the note, put it in the envelope, and attach the stamp. Then we will take it out to the mailbox so the mailman can pick it up. Do you want to raise the flag on the mailbox for me?”

For children with low vision, parents may have make adaptations to accommodate children’s functional vision. For example, caregivers may provide higher contrast, reduce clutter, adjust size of images or print, minimize glare, change positioning of literacy tools, etc.

Patrick paused while paying bills and observed his daughter Kay sitting across the room, flapping her hands. She’s probably bored, Patrick thought. She doesn’t know what I’m doing over here. “Kay, come here,” he called.

Kay raised her head and turned toward her father.

“Come on,” Patrick encouraged her.

Kay leaned over and pulled herself up on the coffee table. She slowly made her way across the room to her father.

“All right, sweetie,” Patrick said, picking her up and putting her on his lap. “It’s time to pay some bills.”

Patrick wrote out the check for the last bill while Kay played with a pencil on his desk. He then pulled a printing calculator toward him. He punched in the numbers to balance his checkbook, and the calculator clattered as it spun out the roll of paper with the numbers on it. Kay stopped playing with the pencil and stared at the noisy calculator. When her father stopped punching numbers, Kay reached out and hit the keys with her palm. A row of numbers appeared on the display, and the calculator noisily added the numbers to the printout. Kay laughed and patted the calculator again. While Kay amused herself with the calculator, Patrick sealed all the envelopes and pulled out a book of stamps.

“Do you want to help me put stamps on the bills?” Patrick asked.

Kay stopped banging on the calculator, and Patrick handed her a self-adhesive stamp. He guided her hand down and helped her press it on the corner of the envelope.

“Good job!” he said. “You got it just right. Let’s do another one.”

Experiences in which children actively explore literacy. Active exploration of literacy tools (e.g., looking at books, scribbling with crayons or on a braillewriter, opening the mail, etc.) provides children with opportunities to experiment and play with reading and writing (International Reading Association & National Association for the Education of Young Children, 1998; Koenig & Holbrook, 2002; Lawhon & Cobb, 2002; McLane & McNamee, 1991; Miller, 1985; Neuman, 1996; Wormsley, 1997). Children should be encouraged to actively explore reading and writing artifacts independently as long as the activity is safe (e.g., not poking an eye with a pencil or coloring on the walls).

Some children with visual impairments (more commonly, children with severe visual impairments) may engage in less active exploration, which limits their engagement with literacy tools (Jan, Sykanda, & Groenveld, 1990). Children with visual impairments may not have access to literacy materials that are appropriate for their functional vision (e.g., too much clutter, contrast, or glare). Also, literacy tools may not be available in the appropriate literacy medium (e.g., braille).

In addition to having access to a variety of books in appropriate literacy media, children with visual impairments should have easy access to a variety of writing materials. Print-writing materials include pens, pencils, markers, crayons, paint, paper, chalk, and chalkboard, while braille-writing materials include braillewriters and slate-and-styluses. Caregivers should not be concerned about how their children hold writing utensils or what types of marks they make (Koenig & Holbrook, 2002). Children should simply be encouraged to play with writing materials.

Children with visual impairments may enjoy scribbling with crayons on paper over a wire screen or rough sandpaper. Using screen or sandpaper behind the paper causes the wax of the crayon to be felt more easily. Sand may be mixed with paint and used for finger painting. Some children are tactually selective and may not want to touch textured crayon drawings or paint. Children should never be forced to touch something that they do not want to toucearly

If the primary literacy medium has not been determined, which is often the case for infants and toddlers, children should have equal exposure to print- and braille-writing tools. Even children with no light perception will benefit from some early writing experiences because they will need to sign their names in the future, and they will need an awareness of the activities of their sighted siblings and peers.

Jenny’s child care class had a table for coloring with crayons. Jenny’s mother had talked with the teacher about how important it is for Jenny to color even though she couldn’t see, wasn’t talking, and had difficulty with fine motor control. She explained how they put a piece of rough sandpaper behind Jenny’s paper at home so the crayon wax produced a tactile picture when she colored.

Unfortunately, this didn’t work as well at the child care center. With ten children, the teacher couldn’t help Jenny position the sandpaper every time she wanted to color. After some brainstorming, they decided to cover one fourth of the table with sandpaper. Jenny could position her paper anywhere on that section of the table and produce a tactile picture. This method also allowed the other children in the room to create tactile pictures.

Shared storybook reading
Shared storybook reading is evidence based, family centered, child centered, and developmentally appropriate. Shared storybook reading helps children develop oral language (i.e., listening comprehension, vocabulary, and narrative knowledge), phonological awareness, concept development, knowledge of the conventions of print/braille and of print/braille intentionality, and alphabetic knowledge. Shared storybook reading is one of the most important emergent literacy activities (International Reading Association & National Association for the Education of Young Children, 1998).

Literacy acquisition begins not on the first day of kindergarten but at birth. Newborn infants “read” their mothers’ faces, form attachments, and begin forming concepts about the world. Even infants enjoy books—looking at pictures, especially of faces and particularly the faces of other infants, helping turn pages, and mouthing the corners of board books. Daily storybook reading from birth will provide children with repeated, varied, and enjoyable exposure to literacy.

Shared storybook reading provides an opportunity for children to develop a positive attitude about reading while also learning important oral and written language concepts.
Throughout childhood, storybook reading should be viewed as an interaction between children, parents, and books rather than just an opportunity for parents to teach children. When young children are read to frequently, they begin to associate books with positive feelings such as amusement, comfort, and closeness to caregivers (International Reading Association & National Association for the Education of Young Children, 1998). These feelings, reinforced consistently by attentive caregivers who enjoy storybook time as much as their children do, will promote print motivation. Print motivation refers to children’s relative interest in reading and writing activities. Children with high print motivation become avid readers with positive attitudes toward reading and learning.

Young children learn vocabulary from listening to storybooks and their families’ conversations. Mothers tend to use richer and more varied language during shared reading than they do during other daily routines, which facilitate the development of oral language. Reading routines also allow parents to repeat verbal behaviors that stimulate imitations by children (Sénéchal & LeFevre, 2001).

Whether adults are reading to children or children are playing with books independently, appropriate books should be selected. From birth to 6 months, children with typical vision like books with large, simple pictures printed either on stiff cardboard, cloth, or vinyl (for easy cleaning). From 6 to12 months, infants prefer books with family photos as well as photos of other babies or familiar objects. They also prefer books with sturdy pages for touching and tasting, vinyl or plastic pages to play with in the bathtub, or washable pages for cuddling and mouthing. From 12 to 24 months, children like books with pictures of children doing familiar things, books that tell about routines (e.g., hello/good-bye, bedtime), and books about animals. They prefer books with only a few words on each page and with simple rhymes or predictable text. They like sturdy books that they can carry with them. From 24 to 36 months, children expand their interests and begin enjoying books with simple stories; books about counting, letters, shapes, and sizes; and books about favorite literary or TV characters. Handout I, What Young Children Like in Books (BrainWonders, 2001b), outlines the kinds of books (board books, good-night books, storybooks, and so on) that children at different developmental stages enjoy.

Many children, especially those about 3 years of age, have favorite books (Sénéchal & LeFavre, 2001), which they like to have read to them repeatedly, sometimes to the consternation of their parents, who would prefer to read something else for a change. Favorite books provide the comfort of a familiar story and may facilitate learning by building story schemas, or narrative knowledge (Sénéchal & LeFavre, 2001). A basic knowledge of narrative schemas helps children understand new stories that may deviate, in various ways, from familiar ones. Thus favorite books may help children incorporate and appreciate a wider variety of stories. As children age, a decrease in favorite books may reflect an increase in cognitive abilities, because they have already acquired basic story schemas (Sénéchal & LeFavre, 2001).

BrainWonders ( is a collaborative project of Boston University School of Medicine, the Erickson Institute, and Zero to Three that provides parents, caregivers, and pediatric and family clinicians with meaningful information about early brain development and the relationships between babies and their parents and caregivers that support intellectual and social-emotional development. BrainWonders (2001a) suggests reading with children often, but always keeping it fun. This can be achieved by
reading for short periods of time,
having conversations or singing about the story,
including illustrations and story objects,
asking questions,
letting children actively engage with the book (e.g., turning the pages),
following along the print/braille with the fingers as words are read, and
making stories come alive by creating voices for the characters in the story.

Children are also likely to be more attentive and motivated during storybook readings if gestures and body motions are used to help tell the story. Finally, it is very important to relate the story to the child’s experiences. These suggestions by BrainWonders (2001a) are summarized in Handout J, Sharing Books With Babies and Toddlers.

Caregivers should ensure that children have easy access to appropriate books to “read,” comfortable places to read, and encouragement from adults to interact with books. Young children with frequent access to a wide variety of books have stronger vocabulary skills; later, these skills facilitate reading comprehension (Sénéchal & LeFevre, 2001).

Judy, the TVI, had been visiting the Hernandez family for almost a year, since Miguel was 9 months old. Miguel was diagnosed with corneal ulcers that resulted in severely reduced visual fields with poor acuity in both eyes. Judy had developed good rapport with Miguel’s parents and felt that things were going well. Magdalena, Miguel’s mother, welcomed Judy into the home, and they went into the kitchen to talk. After a few minutes of small talk, they moved on to Miguel.

“We give Miguel books, but he just doesn’t seem to like them,” Magdalena told Judy.

“Hmmm,” began Judy. “Could you show me where Miguel’s books are?”

“OK,” said Magdalena, leading the way into the cramped living room of the family’s apartment. She reached over her head and pulled a pile of books off of a display cabinet. “Here they are.”

Judy looked at the books. “These are great books. They’re perfect for Miguel. You know what, though? Miguel might look at the books more if they were down where he could get to them. Can you think of a good place?”

“We could put them down here,” Magdalena said, pointing to the bottom shelf, which held several wooden knickknacks. “But he might tear them up.”

“They might get a little worn. But you do such a good job of watching him that I’m sure you’ll keep an eye on things. I think it’ll be really good for Miguel to be able to get the books any time he wants them.”

Together the women rearranged the bottom shelf to make room for the books. Miguel came over to investigate. He pushed his way under his mother’s arm and tugged on her shirt to ask to nurse. Magdalena settled herself on the floor, and Miguel began to nurse.

“It’s a little dark down here, now that we are sitting on the floor,” Judy said.

Magdalena nodded.

“I wonder if it is a too dark for Miguel. Maybe you could find a way to get more light over here.”
“I don’t know,” said Magdalena. “It is so crowded all ready.”

“It doesn’t have to be anything big. Maybe you could move the furniture so one of your lamps is closer to the bookshelf,” Judy suggested. “Why don’t you and Ramón think about what might work.”

The next week, when Judy arrived, the armchair and an end table had been rearranged so that soft lighting fell on Miguel’s bookshelf. Magdalena was excited because Miguel had brought her books several times so she could read to him.

During shared storybook reading, parents can facilitate knowledge of the conventions of print/braille by demonstrating how books open, by encouraging children to turn pages, and by pointing to words on the page.

Children who are read to frequently acquire new concepts about the world around them (i.e., schemas). In a transactional process, children who have many schemas are able to enjoy a wider variety of books more easily. Exposure to new books leads to the creation of new schemas. Gaining concepts about the world helps children understand the concepts in books. For instance, baking bread teaches children many concepts. A book about cooking will be enjoyed more if children have previous experiences with the concepts included in the story such as dough, oven, and timer (Rosenkoetter & Barton, 2002).

Shared storybook readings and children with visual impairments
Shared storybook reading with caregivers is also one of the first and most important book experiences children with visual impairments have. Factors that impact shared storybook readings for children with visual impairments include caregiver priorities, access, parental literacy, and caregiver responsiveness.

Caregiver of children with visual impairments may be reluctant to read to their children, either because they are unsure about how to introduce books or because they are overwhelmed with other concerns (e.g., medical issues) that book reading is not a priority (Craig, 1996). Furthermore, in certain cultures shared storybook reading is secondary to other daily routines.

Children who read braille rarely have as many braille books as children with typical sight have standard print books (Swenson, 1999). Braille books may intimidate caregivers because they do not know braille. They may be unaware of sources of braille books and believe braille books and materials cost too much.

Caregivers must provide braille books and model braille reading (Koenig & Holbrook, 2002). Caregivers do not have to be proficient in braille to facilitate emergent braille acquisition in their very young children. Many books are available commercially or at libraries in print-braille versions. Handout K, Sources for Print/Braille Books (EIVI Training Center, 2005e), provides sources of print/braille books.

Print books can also be adapted by adding braille. When braille is added to book, it should be placed in the same location on each page (e.g., the top of the left-hand side). Books appropriate for children can be made using sturdy cardboard and objects, textured fabrics or paper, photographs, clear print, and braille. Objects that go along with a story can be collected in a box or bag and discussed before and during the reading. Tactile symbols can be placed on the cover of books to help children identify favorite books.

Jill, who has minimal light perception due to microphthalmia and colobomas, walked to the bookshelf in the corner of the living room. She trailed the wall as Miss Nancy had taught her, so she wouldn’t run into anything. When she reached the bookshelf, she sat down and started touching the books on the bottom shelf. These were her books. She had gotten several nursery-rhyme books for her second birthday a few months ago. She was looking for her favorite.

The first book had half of a plastic egg taped to the front. No, she didn’t want Humpty Dumpty. The next book was sitting in a bucket. This was it! Her favorite nursery rhyme book, Jack and Jill. She picked up the bucket with the book in it and started back across the room. She could hear her mother in the laundry room folding clothes. She headed toward the sound, so her mother could read to her.

Handout L, Object Books (Smith, Shafer, & Sewell, 2002), includes suggestions for making and adapting books for children with visual impairments. Among other ideas, Smith et al. (2002) recommend that
children participate in the creation of object books,
object books be made from three-ring binders,
the objects included in books come from children’s experiences,
only one object per page be included,
hot glue be used as an adhesive,
because object books typically don’t last long and are meant for tactile learners, appearance is not very important,
one-word braille labels be added to pages, and
objects placed on book covers serve as book titles.

As children develop tactile skills, object books can become increasingly complex. For children with well-developed skills, Smith et al. (2002) suggest
including plastic bags that contain “hidden” objects,
creating collections of related objects (e.g., kitchen utensils), and
creating alphabet and counting books.

Smith et al. (2002) also include a list of items (crayons, toothbrushes, keys, rubber bands, etc.) that can be incorporated into object books, as well as a list of themes caregivers can base object books on (a sensory walk, a trip to a fast-food restaurant, bath time, candies, etc.).

Children with low vision need opportunities to experience different sizes of print and optical devices such as dome magnifiers and closed-circuit televisions (CCTVs). Children should be evaluated by a clinical low vision specialist who will determine the appropriate device or devices based on individual needs and visual functioning. Selecting books with simple, bright illustrations or commercially available books with textures may also be appropriate. Caregivers should also encourage children with low vision to take time to look at the pictures on the pages. Optimum lighting, reduced glare, and appropriate contrast can help children participate fully in shared storybook readings.

Children with normal vision learn knowledge of the conventions of print and print intentionality through incidental experiences during shared storybook reading. Children with severe low vision or children who are blind may not acquire these concepts without some modifications to encourage them to see and feel their parents’ movements with books. Caregivers should encourage children to explore books (discovering that books have covers, fronts and backs, and tops and bottoms). Caregivers should also model reading from top to bottom and from left to right. A child who is learning braille can be encouraged to take a “piggy back ride” on the caregivers’ hands to feel movement of braille reading. It may also be more difficult for children with visual impairments to learn that a story is expressed through print or braille symbols in a book. When a child stops tracing the braille, the caregivers should stop reading as well. Caregivers should also point out and discuss specific words of interest.

Martin, a TVI, sat on the floor with 2-year-old Ming, who has optic nerve hypoplasia and light perception. Ming, tired of the toy she was playing with, dropped it on the floor, and began to fuss.

“What would you like to do now, Ming?” Martin asked.

Ming continued to fuss and began to flap her hands in the air.

“Ming, can you find another toy to play with?” Martin asked. When Ming did not respond, Martin prompted, “Ming, can you find another toy?”

Ming brought her hands down and began to feel and look around. She felt a toy bear and shoved it away. Then her hand landed on a print- braille book with a fuzzy oval on the front. She picked up the book and began waving it in the air. “Book,” she said.

“Yes, that is a book. Would you like to read it with me?” Martin asked. He moved over beside Ming and asked her to hold the book still. Ming crawled into his lap and held the book in front of them.

“OK, here we go,” Martin said. “Oh, no! The book is upside down. That fuzzy caterpillar is supposed to be at the top. Can I help you turn the book around?” Martin and Ming turned the book around together. Martin read the title of the book and the name of the author to Ming, sliding his hands over the braille as he read. Ming ran her fingers over the fuzzy caterpillar and leaned down to squint at the picture of the caterpillar.
“Open the book, please,” Martin said.

Ming opened the book, and Martin began to read a story about a caterpillar. As he read each page, he ran his fingers over the braille and gave Ming time to feel the tactile pictures and look at the visual pictures. Occasionally, Ming would run her fingers over the braille while looking at the pictures. When Ming turned too many pages, Martin kept reading, knowing it was less important to read every page than for Ming to help with reading.

“Ming, this is your favorite page!” Martin said. “Want to hop on my hands and read it with me?”

“Yeah!” Ming said, and smiled.

She placed her hands on top of Martin’s as he read the page. Ming chimed in with a few of the words on the page. On the next page Ming placed her hands on Martin’s and felt the movement as he read to her.

“The end,” Martin said when they finished the story.

Ming closed the book and clapped her hands. “More,” she said, and placed Martin’s hands back on the cover of the book so he could read it to her again.

Encouraging active engagement in storybook reading by asking children to discuss stories; relate stories to their own experiences; and point to and label objects, words, and letters facilitate emergent literacy (Ferrell, 1996; Rosenkoetter & Barton, 2002). One effective form of active engagement in storybook reading is called dialogic reading.

Dialogic reading is a shared-reading technique in which the adult assumes the role of an active listener, and the child learns to become a storyteller. In dialogic reading, the adult reader asks questions, adds information, and prompts the child to increase the sophistication of descriptions of material in the book. The child’s responses are encouraged through praise and repetition (Whitehurst & Lonigan, 1998).

Dialogic reading is particularly suited for children with visual impairments because few adaptations are required. Some of the standard prompts such as open-ended and wh- prompts often center around the pictures. Caregivers may continue to use open-ended and wh- prompts as long as the prompts involve the storyline, tactile illustrations, or accompanying story objects.

Interventionists can train parents and caregivers in dialogic-reading technique through the use of two helpful memory aids: the words PEER and CROWD. Handout M, Dialogic Reading (EIVI Training Center, 2005a), describes the PEER method and lists the CROWD prompts.

The basic method of dialogic reading is summarized by the acronym PEER (Whitehurst, 2004; Whitehurst, Epstein, Angell, Payne, Crone, & Fischel, 1994). PEER stands for:

The PEER interaction is a short exchange in which the adult prompts the child to comment on the book; evaluates the child’s reply by responding in some way; expands the child’s reply by paraphrasing it and elaborating on it; and repeats the expansion through a second prompt, to make certain the child has understood the expansion.

Doug, who is familiar with dialogic reading technique and has been trained in the PEER method, is sharing a book about dogs with his 2-year-old son, Jonas, who has bilateral anophthalmia. Doug and his wife have made story bags for many of Jonas’s books to enhance interaction and communication during shared storybook reading.

Jonas sits in Doug’s lap as Doug reads, “The big furry dog chases the ball in the park.”

Doug prompts his son: “What is the dog doing?”

Jonas says, “Ball!”

Doug evaluates the Jonas’s response by saying, “You’re right!” and giving him a gentle squeeze. Jonas is pleased by his father’s response and wiggles happily.

Doug reaches into the story bag and gets out a ball. He hands it to Jonas as he expands on Jonas’s reply by saying, “The dog is chasing the ball.” Jonas giggles and pats the ball.

Doug then repeats the expansion, this time phrasing it as a new prompt: “That big dog sure knows how to catch a ball. What other games can we play with dogs?”

Jonas says, “Big dog stick.”

Doug notices that Jonas’s responses grow in sophistication when he is prompted using the PEER method.

The acronym CROWD stands for five kinds of prompts that can be used in dialogic reading (Whitehurst, 2004; Whitehurst et al., 1994):

Completion prompts are used mainly with rhyming or repetitive stories. A blank is left at the end of a sentence, which children may fill in. For example, a parent might pause at the end of a nursery rhyme, “Humpty Dumpty sat on a wall, Humpty Dumpty had a great . . .” and allow the child to chime in, “Fall!”

Recall prompts ask children to describe something that happened in a story. Recall prompts can be used in the middle of a story or, if a child has read the book previously, before beginning to read. For example, a parent might ask a child who is familiar with David Kirk’s Little Miss Spider, “Who helped Miss Spider?”

Open-ended prompts help children problem solve and increase their expressive fluency. Open-ended prompts should begin with words such as "why" and "how" or phrases such as "What do you think about . . ." Open-ended questions may be about the storyline, tactile illustrations, pictures, or accompanying objects. For example, a parent might ask, of one of the characters in the book Little Miss Spider, “What do you think about what the sly spider did?”

Wh- prompts are questions that begin with who, what, when, where, why, or how and are used to build vocabulary. Like open-ended prompts, they may refer to storyline, tactile illustrations, pictures, or accompanying objects. For example, a parent might give the child one of the storybook objects and ask, “What’s this?”

Distancing prompts ask children to relate the pictures and storyline to their own experiences. For instance, if a parent and child are sharing a book about trucks, the parent might say, “Remember when we watched those workers fix the road? They were so loud! What kinds of sounds did we hear?” Although distancing prompts are most appropriate for 4- and 5-year-olds, some younger children may benefit from simple distancing prompts that relate to recent experiences and daily routines.

Caregivers who learn the PEER method and CROWD prompts, and make a habit of practicing them with their children, will soon find that they do not have to consciously use the memory aids. Dialogic reading will become second nature as they share books with their children. Parents who participated in dialogic reading training reported enjoying the new technique and said they planned to continue using it (Huebner, 2000). Parents reported enjoying the closeness and positive interactions with their children and appreciated the way dialogic reading facilitated their children’s learning as well as their motivation to learn (Huebner, 2000). At its most basic level, dialogic reading is simply a way to encourage parents and children to talk about books (Whitehurst, 2004). Dialogic reading has been shown, in a variety of circumstances, to produce greater effects on children’s language skills than a similar amount of typical picture book reading, in which children listen passively (Whitehurst & Lonigan, 1998).

Storybook preview is the exploration of the content of a book without consideration of the storyline (McCathren & Allor, 2002). Children are given the opportunity to label or describe the illustrations of interest, ask questions, and make comments to increase narrative knowledge and vocabulary. Caregivers identify and scaffold children’s communicative attempts. For example, a child might point to a picture of a car and say “Vroom, vroom.” The caregiver will model more descriptive language by saying “Yes, that is a car. It looks just like Grandma’s car.” Children with more developed language may connect the content of a story with events in their lives and say, “One time we drove the car to see Aunt Lilly.” Such a comment will provide the caregiver with the opportunity to comment and ask open-ended questions to further develop the child’s vocabulary, narrative knowledge, and listening comprehension.

Storybook preview is also appropriate for children with visual impairments or blindness. Caregivers can discuss the tactile illustrations or story objects. If the book is familiar to the child, the caregiver can facilitate a conversation about the storyline and relate the story to event in the child’s life. If a tactile symbol is added to the cover, it may be easier for the child to remember (if the story has been read previously) and discuss the story.

Storybook sounds is an intervention that focuses on the development of phonological awareness (McCathren & Allor, 2002). During shared storybook reading, caregivers point out rhyming words or initial sounds. If children show an interest in this, caregivers can make up little games to reinforce phonological concepts. The ability to manipulate the sounds and rhythms of language is associated with reading fluency (Snow, Burns & Griffin, 1998).

The following fun and developmentally appropriate activities, also described in Handout N, Phonological Awareness (Murphy, 2005c), help young children build sound awareness for literacy. Phonological awareness is the ability to detect and manipulate the sound structures of oral language.

Emphasize rhyme and alliteration during shared storybook reading. Rhyme is the correspondence in sounds, especially terminal sounds, of words or lines of verse (as with at in cat, flat, and hat). Alliteration refers to the repetition of the same letter or sound, especially consonants, in the stressed or initial syllables of two or more neighboring words (as with h in hat and hold). Provide opportunities for toddlers to repeat rhyming words. Select books that involve rhyming patterns, such as
Brown, M.W., & Hurd, C. (1947). Goodnight moon. New York: HarperCollins
Degan, B. (1983). Jamberry. New York: HarperCollins
Fleming, D. (1991). In the small, small pond. New York: Henry Holt
Kirk, D. (1999). Little miss spider. New York: Scholastic
Martin, B., & Radunsky, V. (1994). The maestro plays. New York: Henry Holt

Engage in word play involving alliteration (e.g., “Peter Piper picked a peck of pickled peppers”) and rhyme (e.g., “The cat wore a hat as he sat on the mat with his friend the gnat”).

Recite or sing Mother Goose rhymes, such as “Jack Sprat” and “This Little Piggy,” and other rhymes that have been passed down through generations. Rhymes that include movement and gestures, such as “Pat-a-Cake” and “The Wheels on the Bus,” are even more captivating to young children.

Read poetry with vivid rhymes.

Sing songs that play with language, such as “Old MacDonald Had a Farm” and “Bingo.” Some toddlers enjoy listening to Raffi’s song “Eat, Eat, Eat Apples and Bananas.” This song repeats the same four words over and over, but changes the vowel sounds (“It, it, it ipples and bininis”).

Play with syllables of words by setting nursery rhymes to music, using different notes for each syllable. Caregivers can model breaking down words by singing the rhymes slow, singing them fast, and clapping out the syllables. Tapping with percussion instruments, such as sand blocks, cymbals, and drums, while singing can also help young children become aware of syllables.

Storytelling and decontextualized language can be used to promote emergent literacy. Children who are told stories, whether fictional ones or ones based on real-life experiences, gain familiarity with decontextualized language. Decontextualized language refers to the expression of ideas and concepts that are removed from the immediate situation or physical context. Children exposed to decontextualized language often become more adept learners in elementary school (Bardige & Segal, 2004). For example, a parent who has just come home from work uses decontextualized language to describe what happened at the office earlier in the day. A fairy tale uses decontextualized language to tell a tale about a boy named Jack, a beanstalk, and a terrible giant. A recounting of the day’s events; a fairy tale—both are forms of storytelling that feature decontextualized language.

Exposure to decontextualized language, whether through storytelling or through storybook reading, helps children learn about things that are not immediately, physically present. Children who use decontextualized language learn to recall events, make predictions, ask and answer questions, and problem-solve (Bardige & Segal, 2004). Table 3, also available as Handout O, Shared Storytelling (Murphy, 2005d), describes a sequences that facilitates two important emerging aspects of narrative development: children’s ability to use decontextualized language and their ability to tell stories with beginnings, middles, and ends. Shared storytelling is a short exchange between a child and a caregiver in which the caregiver tells a story as a way of eliciting a story by the child and prompts the child to continue to build the story. The caregiver may also wait for the child to initiate a story and may scaffold as needed.

The caregiver assumes different roles during shared storytelling, including storyteller, listener/interpreter (listening to and interpreting the child’s story), and facilitator (building the story).

Table 3
Shared Storytelling
Caregiver role
The caregiver tells a simple narrative.
Caregiver: “Once, when I visited a petting zoo, I saw a llama. It came toward me and made a funny sound that sounded like this, Uuuh.”
After telling the story, the caregiver asks, “Has anything like that ever happened to you?”
Caregiver: “Have you ever been to a petting zoo? What animals did you see? What else did you experience?”
Listener/ Interpreter
The child tells a story.
Child: “Pig. I see pig with my mommy. So big!”
The caregiver uses prompts to help the story unfold, such as

paraphrasing, or

asking wh- or open-ended questions.

Caregiver: “You saw a big pig with your mommy?”
Caregiver: “You went on a trip with you mommy and saw a big pig?”
Caregiver: “What did the pig sound like? What else did you see?”
The child builds on the narrative.
Child: “The pig was loud. . . . Uh-oh . . too big. I’m big.”

Other ways to encourage storytelling include
discussing children’s daily experiences after they occur.
thinking out loud as you problem-solve or think about things you need to do.
using pictures or objects to sequence the daily schedule. Review regularly.
encouraging others to share stories with the child (e.g., Grandma, a sibling, or a friend).
modeling who, when, and what questions.
using art materials to support a children’s storytelling (e.g., scribbling, finger painting).
providing children with props to act out stories.
playing show-and-tell games.

In general, parents, caregivers, and early interventionists should provide infants and toddlers with frequent language and listening opportunities. Parents should be encouraged to talk to their children—frequently, and on a wide variety of topics. As soon as they begin to vocalize, children should be encouraged to “converse” about their experiences. Parents should talk about the books they read to their children; and children should be encouraged to talk about the books that are read to them and, later, about the books they read. Parents, caregivers, and early interventionists should listen to children and answer their questions, and encourage vocal play and word play through rhymes, music, and interactive games (Ferrell, 1996; Rosenkoetter & Barton, 2002).

Young children who are exposed to a wide variety of words in meaningful conversation learn new words each day. When adults use a wide variety of colorful, imaginative, and descriptive language, children pick up on the words and learn their meaning in appropriate contexts. Many children, even many very young children, enjoy learning “difficult” and “funny-sounding” multisyllabic words. Parents and caregivers should be encouraged to use new vocabulary and not to restrict their conversation to simple words; remind them that their toddlers are probably already learning the complicated names of dinosaurs and cartoon characters from older siblings and peers. According to Bardige and Segal (2004), children with larger vocabularies as preschoolers become better readers and writers.

Echolalia, the repetition of previously heard language, is common in many children with visual impairments. See Session 3, “Communication and Language Interventions,” for specific strategies that can be used to replace echolalia with more appropriate language.

Children’s oral language, including listening comprehension skills, is promoted through conversation as well as through other verbally stimulating activities such as storytelling and the learning and recitation of nursery rhymes. Handout P, A Parent’s Guide to Emergent Literacy (Pasadena Public Library, n.d.), offers additional strategies for caregivers and interventionist to facilitate emergent literacy of young children through play, communication, and shared storybook readings.

References for Major Points

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