Students Who Are Deafblind
Presented by
Susie Tiggs
Region XI Education Service Center
Identifying deafblindness
Characteristics
Concept Development
Routines and Calendars
Communication
Technology
Planning and selecting appropriate interventions and strategies
Deaf-blindness means concomitant hearing and visual impairments, the combination of which causes such severe communication and other developmental and educational needs that they cannot be accommodated in special education programs solely for children with deafness or children with blindness.
34 CFR § 300.8(c) (2)
A student with deafblindness is one who
(A) meets the eligibility criteria for auditory impairment specified in subsection (c)(3) of this section and visual impairment specified in subsection (c)(12) of this section;
(B) meets the eligibility criteria for a student with visual impairment and has a suspected hearing loss that cannot be demonstrated conclusively, but a speech/language pathologist indicates there is no speech at an age when speech would normally be expected;
Texas Administrative Code
(§89.1040) (2) Deafblindness
(C) has documented hearing and visual losses that, if considered individually, may not meet the requirements for auditory impairment or visual impairment, but the combination of such losses adversely affects the student’s educational performance; or
(D) has a documented medical diagnosis of a progressive medical condition that will result in concomitant hearing and visual losses that, without special education intervention, will adversely affect the student’s educational performance.
Texas Administrative Code
(§89.1040) (2) Deafblindness
Does the child have enough vision to compensate for his lack of hearing?
Does the child have enough hearing to compensate for his lack of vision?
If the answer is “no” to both questions, then the child is deaf blind.
John McInnes, A Guide to
Identifying and Programming for the Deafblind Infant and Toddler
While the term implies it, very few children with deafblindness are completely deaf and completely blind.
Killoran, J (2007) The national deaf-blind child count: 1998-
2005 in review
Vision Loss
◦ 17% totally blind or light perception only
◦ 24% legally blind
◦ 21% low vision
◦ 17% cortical vision impairment
◦ 21% other
Hearing Loss
◦ 39% severe to profound hearing loss
◦ 13% moderate hearing loss
◦ 14% mild hearing loss
◦ 6% central auditory processing disorder
◦ 28% other
Killoran, J (2007) The national deaf-blind child count: 1998-
2005 in review
More than 90% of children who are deaf blind have one or more additional disabilities, and some may be identified as having multiple disabilities rather than deafblindness
◦ 66% cognitive disabilities
◦ 57% physical disabilities
◦ 38% complex health care needs
◦ 9% behavior challenges
◦ 30% other
Killoran, J (2007) The national deaf-blind child count: 1998-
2005 in review
Race/Ethnicity of Children Who Are Deaf Blind
◦ 56% White
◦ 14% Black
◦ 12% Hispanic and Latino
◦ 3% Asian and Pacific Islander
◦ 2% American Indian and Alaska Native
◦ 13% Other
Killoran, J (2007) The national deaf-blind child count: 1998-
2005 in review
Most Common Causes of Deafblindness in
Children in the United States
◦ Heredity (chromosomal syndromes and disorders)
◦ Prematurity
◦ Prenatal complications
◦ Postnatal complications
◦ CHARGE Syndrome
◦ Microcephaly
◦ Cytomegalovirus
◦ Hydrocephaly
◦ Meningitis
◦ Usher Syndrome
Killoran, J (2007) The national deaf-blind child count: 1998-
2005 in review
Educational Settings - Preschool
◦ 72% PPCD classrooms, separate schools or residential facilities
◦ 20% classrooms with young children who do not have disabilities
◦ 5% home
Killoran, J (2007) The national deaf-blind child count: 1998-
2005 in review
Educational Settings – Ages 6 - 21
◦ 39% separate classrooms
◦ 16% separate public schools
◦ 10% in public or private residential facilities
◦ 8% in separate private schools
◦ 7% in hospitals or at home
◦ 5% in other settings
Only 15% are educated in regular classrooms and resource rooms
Killoran, J (2007) The national deaf-blind child count: 1998-
2005 in review
Puretone
◦ Sound at a precise frequency
Frequency
◦ How fast or slow something vibrates
Hertz
◦ Vibrations per second that make a sound
Decibels
◦ A measurement of loudness
Congenital Hearing Impairments
◦ Typically occur before, at, or shortly after birth but prior to the learning of speech and language
Aquired Hearing Impairments
◦ Occur after speech and language have developed
Conductive Hearing Loss
◦ Occur in the outer & middle ear
Sensorineural Hearing Loss
◦ Loss occurs in the inner ear
Mixed Hearing Loss
Very Mild (15-25 dB loss)
Mild (26-40 dB loss)
Moderate (41-55 dB loss)
Moderately Severe (56-70 dB loss)
Severe (71-90 dB loss)
Profound (90+ dB loss)
http://betterhearing.org/hearing_loss/hearing_loss_simulator/index.cfm
Visual Acuity
◦ sharpness of vision; the visual ability to resolve fine detail (usually measured by a Snellen chart)
Legally Blind
◦ Having 20/200 vision with best correction or a visual field of 20 degrees or less.
Visual Field
◦ The ability to see objects in the periphery of ones vision when looking straight ahead.
LP
Light Perception
HM Hand Motion
CF Count Fingers
Partially sighted indicates some type of visual problem, with a need of person to receive special education in some cases
Low vision generally refers to a severe visual impairment, not necessarily limited to distance vision. Low vision applies to all individuals with sight who are unable to read the newspaper at a normal viewing distance, even with the aid of eyeglasses or contact lenses. They use a combination of vision and other senses to learn, although they may require adaptations in lighting or the size of print, and, sometimes, Braille
Legally blind indicates that a person has less than 20/200 vision in the better eye after best correction (contact lenses or glasses), or a field of vision of less than 20 degrees in the better eye
Totally blind students learn via Braille or other non-visual media.
http://www.acbvi.org/albums/vision/index.html
Problems occurring with mild visual impairment
◦ Retinitis Pigmentosa and dim lighting
◦ Visual fatigue
◦ Changing and busy visual environments
Jenny Lace, TSBVI Deafblind
Outreach 2000
Problems occurring with mild hearing impairment
◦ Trouble hearing faint or distant speech
◦ Missing subtle conversational cues
◦ Problems following classroom discussions
◦ Problems hearing word-sound distinctions
Jenny Lace, TSBVI Deafblind
Outreach 2000
Other problems occurring with mild visual and hearing impairments
◦ Speech-to-noise ratio
◦ Busy visual environments
◦ Seating placement
Jenny Lace, TSBVI Deafblind
Outreach 2000
John McInnes, A Guide to
Identifying and Programming for the Deafblind Infant and Toddler
John McInnes, A Guide to
Identifying and Programming for the Deafblind Infant and Toddler
Distorted perception of the world because of lack of non-distorted information from the distance senses (vision and hearing)
Difficulty in communicating or an inability to communicate with people and things in the environment in a meaningful way
Extreme difficulty in establishing and maintaining interpersonal relationships with others
Tactile defensiveness
John McInnes, A Guide to
Identifying and Programming for the Deafblind Infant and Toddler
Self-stimulation behaviors and discipline problems which may result from sensory deprivation, frustration, confusion and fear
Severe medical problems and/or other handicapping conditions which may lead to serious developmental delays
Delays in motor development
Inconsistent use of whatever vision and hearing is present. Sensory integration must be learned
John McInnes, A Guide to
Identifying and Programming for the Deafblind Infant and Toddler
The child cannot benefit from secondary or tertiary learning. He or she must be taught everything first hand.
◦ For typical children, 8% of learning is first hand,
12% is secondary, and 80% is tertiary
John McInnes, A Guide to
Identifying and Programming for the Deafblind Infant and Toddler
The child may not benefit from group instruction, because he or she cannot benefit from watching and learning others.
The child is deprived of many of the most basic extrinsic motivations, such as curiosity.
Sensory information is so distorted that it is ineffective as a source of motivation to explore and to interact with people and the environment
The child will not benefit from being left alone for long periods of time with toys.
John McInnes, A Guide to
Identifying and Programming for the Deafblind Infant and Toddler
Building a trusting relationship is the springboard in the education of students who are deafblind (van Dijk, 2001, p. 1). Because of the reliance of a student who is deafblind on others, to safely and meaningfully access the world that surrounds him or her, trust is at the core of all interactions and teaching.
A student must ask of an educator:
◦ “Can I trust you to help me access my world in a way that is clear and complete?”
◦ “Can I trust you to help me move safely between environments?”
◦ “Can I trust you to understand my needs and desires and to respond to me?”
◦ “Can I trust you to teach me the concepts that the other kids know?”
Communication is a primary component of concept development
Both skills and concepts must be taught
Skill
◦ Ability to physically complete a task
◦ A learned power of doing something competently
◦ A developed aptitude or ability
Concept
◦ Something conceived in the mind, a thought or notion
◦ An abstract or generic idea generalized from particular experiences
◦ A mental representation, image, or idea of concrete objects as well as of intangible ideas, such as feelings
“Understanding Deafblindness: Issues, Perspectives, and Strategies,” Alsop, L. Ed, 2002
Concrete concepts
◦ Relate to an object or something tangible
Semi-concrete concepts
◦ Relate to actions, colors, positions, or something that can be demonstrated but not held in one’s hands
Abstract concepts
◦ Relate to concepts which can be defined or described, but which are often left up to the perception of the individual
“Understanding Deafblindness: Issues, Perspectives, and Strategies,” Alsop, L. Ed, 2002
The child learns…
that objects exist that objects have permanence that objects differ from one another to label or name objects to identify the characteristics of the object the function of an object
“Understanding Deafblindness: Issues, Perspectives, and Strategies,” Alsop, L. Ed, 2002
Use activities which are meaningful to the child
Use activities that the child enjoys
Attach language to all efforts to teach skills
Build on language that is known to the child
Use of a total communication approach
Remove variables
Generalize the concepts to a variety of situations
“Understanding Deafblindness: Issues, Perspectives, and Strategies,” Alsop, L. Ed, 2002
Need one-on-one interaction from someone who can intervene or intercede between the child and the environment in such a way as to minimize the effects of multi-sensory deprivation and enable the child to develop maximum control over his or her life at a level appropriate to his or her age
John McInnes, A Guide to
Identifying and Programming for the Deafblind Infant and Toddler
Interaction and learning which is conducted within the framework of natural routines
Constant one-on-one interaction which provides consistent non-distorted information
Communication which will let the child know what is going to happen before it happens, what is happening while it happens, and what has happened after it has happened
John McInnes, A Guide to
Identifying and Programming for the Deafblind Infant and Toddler
Strategies to promote the development of both an expressive and receptive system of communication for the child
Motivation to explore and reach out and try things
Enough support so that the child can be successful in a reasonable amount of time and know that he or she is successful
John McInnes, A Guide to
Identifying and Programming for the Deafblind Infant and Toddler
Skills and techniques to enhance a child specific program which will stress the following:
◦ The development and reward to curiosity
◦ The development of exploratory techniques
◦ Ways to help the child anticipate coming routines
◦ Procedures and activities that require the child to make choices
◦ Skill development in the areas of motor, self-help, orientation and mobility, communication, etc
◦ Strategies to promote the use of residual vision and/or hearing
◦ Techniques to promote sensory integration
John McInnes, A Guide to
Identifying and Programming for the Deafblind Infant and Toddler
Speech
Sign language
Fingerspelling
Writing
Gestures
Facial expression
Body movement
Posture
Vocalization
Crying
Tantrums
Look at ALL of the student’s behavior as an attempt to communicate
Be sure the student has had medical problems eliminated
Attempt to understand the student’s communication effort
Teach the student a more acceptable way to communicate what he has to say, after showing you understand the effort
Communication skills assessment instrument
Organized into four basic reasons for communicating
◦ To REFUSE things you don’t want
◦ To OBTAIN things that you want
◦ To engage in SOCIAL interactions
◦ To provide or seek INFORMATION
Level I: Pre-Intentional Behaviors
Level II: Intentional Behaviors
Level III: Unconventional Communication
Level IV: Conventional Communication
Level V: Concrete Symbols
Level VI: Abstract Symbols
Level VII: Language
Protest/reject
Make a request
Gain attention
Direct attention
Social interaction
Confirm/deny
Label/comment
Basic Behaviors
◦ Vocalizations, simple body movements, simple actions on people or objects
Conventional Behaviors
◦ Pointing, raise hand/wave, extend hand, nod/shake head
Symbolic Behaviors
◦ Object symbols, picture symbols, manual signs, spoken words, printed letters or words, brailled letters or words
Real objects
Parts of objects
Colored photos of identical objects
Colored photos of non-identical objects
Black & white photos of identical objects
Line drawings of identical objects
Line drawing stick and circle figures
Non-identical objects
Formal symbols of language
Van Dijk’s Resonance Technique
◦ The teacher joins the child in movement
◦ The teacher stops the action when her presence is sensed
◦ The child verbally or physically expresses desire to continue
◦ The teacher accepts the cue and resumes the action
Resonance activities encourage the learner to shift selfstimulatory behaviors to behaviors that involve other persons and objects.
The teacher follows (joins in) the learners behavior and begins to lay the foundation for turn-taking interactions.
Rapport and trust are developing.
Coactive Movement Sequence
◦ An extension of resonance strategies
◦ The student demonstrates purposeful signals
◦ Sharing of common movement or action
Coactive Manipulation
◦ Hand-over-hand or hand-under-hand
◦ Should be systematically decrease
Representational Reference
◦ Prerequisite to the formation of symbols
◦ Mutually understanding a common item (Helen
Keller and “water”)
Distancing
◦ Ultimately leads to conceptual level of representation
◦ More symbolic in form
Provide opportunities to communicate
Create communication rich environments
Look at ALL of the student’s behavior as an attempt to communicate
C = communication
A = anticipation
L = learning
E = expanding content, form & use
N = iNteraction
D = dynamic partners
A = availability
R = representational levels
What do the calendar systems in your classrooms look like?
Social Interactive
◦ Increased turn taking
◦ Increased joint attention
Communication
◦ Early vocabulary development
◦ Expanding topics, common forms & common uses
Comment, label, request, reject
◦ Partnership communication
Developing short conversations/giving & receiving info
Early initiations of conversations
Choice-making between activities
Cognitive
◦ Transitioning to symbolic representation
◦ Matching picture to object
◦ Re-sequencing activities at the end of the day
◦ Understanding day, and possibly week, concepts
Develop signals which let child know what to expect
Have the child carry an object to the next activity
Introduce new care providers and teachers to the child, so she knows who she is working with or playing with at all times
Beware of the Fairy Godmother
Syndrome!
Assessment of Deafblind Access to Manual
Language Systems
◦
Strategies for organizing the assessment process
◦
Assessment questions with considerations for adaptations and summary results
ADAMLS created by Robbie Blaha
& Brad Carlson
What is the best space, placement, and distance of communication forms for the child related to his visual fields?
What is the best rate and distance of communication forms for the child related to his acuity?
ADAMLS created by Robbie Blaha
& Brad Carlson
Can the student visually discern movements that give meaning to the signs?
Does lighting affect a student’s ability to visually access information?
Does the visual background affect the child’s comprehension?
ADAMLS created by Robbie Blaha
& Brad Carlson
Can a student follow signed conversations in group settings?
Would the student benefit from supplemental experience work to assist in understanding the concepts behind the signs or spoken word?
ADAMLS created by Robbie Blaha
& Brad Carlson
Is the child's vision such that he would benefit from the technique of coactive signing when learning new signs or speech cues?
Does the child initiate or benefit from (hand) tracking?
ADAMLS created by Robbie Blaha
& Brad Carlson
Does the child initiate or benefit from tactual signing?
Does the student need additional environmental information provided to him?
If a student will benefit from braille, are there
English acquisition issues associated with students who are deaf or hard of hearing that should be addressed?
ADAMLS created by Robbie Blaha
& Brad Carlson
Are there instructional strategies, materials, and tools typically used with students who are deaf or hard of hearing that may present problems for the students with deafblindness?
Are there modifications to standard interpreting arrangements or signed classroom instruction that need to be addressed?
Does the student have skills to advocate for the modifications he needs?
ADAMLS created by Robbie Blaha
& Brad Carlson
Project SALUTE (Successful Adaptations for
Learning to Use Touch Effectively) defines coactive signing as the physical guidance of the child’s hand(s) to facilitate production of a standard manual sign for expressive communication (Project SALUTE, 2002).
Coactive signing involves taking the child’s hands and, in a respectful way, molding the child’s hands through the signs, so that you are helping the child make the signs.
Project SALUTE defines tactile signing as a communication method based on a standard manual sign system in which the receiver’s hand(s) is placed lightly upon the hand(s) of the signer to perceive the signs (Project
SALUTE, 2002).
Tactile signing is used when the person places his or her hands under the child’s hands to express something to the child.
Translates information from one mode or language to another (spoken language to sign language and vice versa)
Works with deaf-blind people of all ages
Is a conduit through which information flows
May have received professional training in an interpreter-training program
Should hold national and/or state certification/licensure and may have a college degree
Abides by a code of ethics
Will work in various environments (e.g., educational, medical, religious, social)
May be paid independently, through an agency or by an employer Is paid commensurate with certification & local standardized fees
Is required to independently maintain certification through professional development
Must remain impartial at all times
Must keep all information confidential
Is expected to keep a "professional" distance
Acts as a conduit (does not "teach" and is not responsible for ensuring that the deafblind individual learns what is being shared)
Always keeps opinions to him/herself
Intercedes between a child and the environment, allowing access to information usually gained through vision and hearing
Primarily works with children and young adults
Facilitates learning and the development of skills (e.g., receptive and expressive communication, interactive behavior)
May or may not have received specific training (however, training or coursework is recommended)
Has varying educational and vocational experiences (some states offer coursework)
Acts in a manner that is governed by the local education agency and federal education laws
Uses the Individual Education Program as a roadmap for learning
Is considered a paraprofessional and works with, but does not replace, the teacher
Works mainly in an educational setting but may also provide assistance in the community
(e.g., daily living skills, medical situations, vocational environments)
Wears "different hats" (e.g., as interpreter, guide, facilitator)
Is allowed and expected to share pertinent information with team members (e.g., parents, teachers, related service providers)
Maintains an educational (teacher-student type) relationship
Is accountable for decision-making to enhance learning
Empowers individual to make his/her own decisions
Provides support that enhances independence (e.g., facilitating communication, providing sighted guidance, and transportation to/from events)
Provides services to deaf-blind youth and adults who are able to make independent decisions
Facilitates interaction between a deaf-blind person and the environment
Is encouraged to receive basic training in the area of deaf-blindness, including communication strategies, sighted-guide techniques, and cultural issues
Has varying educational and vocational experiences
Abides by standards established by the coordinating agency
Provides assistance in various settings, including the home and community
Is usually a volunteer, unless funds have been allocated
Is usually not required to attend further training but is encouraged to improve communication skills and interact with the deaf-blind community
Remains impartial but has more flexibility than an interpreter
Is expected to keep information confidential
Is expected to act in a "professional" manner, but may develop personal relationships
Does not teach but does provide access to the environment to empower the deaf-blind person
May provide feedback/opinions when asked
Magnifiers and Monoculars
CCTV
Braille Writers
Electronic Braille Notetakers
Braille Displays
GPS
http://www.cbsnews.com/stories/2006/06/17/eveningne ws/main1726480.shtml?tag=currentVideoInfo;videoMetaI nfo
TTY
Videophone
Cochlear Implant
Assistive Listening Device
Deafblind Communicator
Telebraille
Silent Alarm
Electronic Braille Notetakers
Brailtalk
Eight competency areas are delineated as follows:
◦ deafblindness,
◦ personal identity, relationships, and self esteem,
◦ concept development,
◦ communication,
◦ Hearing vision,
◦ orientation and mobility,
◦ environment and materials,
◦ professional issues.
Develop secure and positive relationships
Promote sense of self
Provide an appropriate environment
Provide extensive experience
Promote use of all available senses
Provide anticipatory information
Teach functional activities
Be consistent
Provide opportunities for making choices and problem solving
Make it ROUTINE!
Building Staff o o o
General Ed Teacher
Special Ed Teacher
Intervener o o
Paraprofessional
Interpreter
Itinerant/Specialists
◦ Teacher of the Visually
Impaired
◦ Teacher of the Hearing
Impaired
◦ Orientation and
Mobility Specialist
◦ Speech Therapist
◦ Occupational Therapist
◦ Physical Therapist
“Making the appropriate modifications and adaptations for a child with deafblindness is critical to their educational achievement. If his unique needs are not met, the child, no matter where he is placed, is in the most restrictive environment. He is cut off from any opportunity to learn. Unfortunately, these supports are not always easy or inexpensive to provide.” –Robbie
Blaha
ADAMLS created by Robbie Blaha
& Brad Carlson
Susie Tiggs, M.Ed.
Visual impairment & Deafblind Specialist
Education Service Center Region XI
817-740-7580 stiggs@esc11.net
Touch is a proximal sense
Touch is impossible to eliminate
Touch provides information on one aspect of an object so multiple tactile images have to be synthesized
Vision is a distance sense
Vision can be eliminated
Vision provides immediate, holistic information
Active touch
Social touch
Passive touch
Creates a sense of belonging
Key to social relationships AND learning
Involves sharing a message between two people
◦ Receptive – understanding a message
◦ Expressive – creating and sharing a message
Use of Sensory Channels
◦ Most children will react with more than one sensory channel
◦ If a consistent pattern does not emerge, differentiate observed behaviors involving near and distant tasks.
Koenig and Holbrooke, 1993
Pre-intentional
◦ reflexive
Early intentional
◦ body responses
Intentional/early symbolic
◦ signals and basic gestures
Symbolic
◦ Strongly intentional communication
Early literacy
◦ Beginning “academics”
Literacy
◦ Complex communication
Touch cues
Object cues
Object symbols sign
Coactive sign object calendar systems communication boards
“By conducting a thorough assessment of the child's visual functioning in accessing manual forms of communication, speechreading and cued speech, you can determine the supports that are necessary. This will help you and your team to develop the type of programming which has the most benefit for the child educationally and make that program accessible to him.” –
Robbie Blaha
ADAMLS created by Robbie Blaha
& Brad Carlson
Academic Deafblind
Functioning more as AI
Functioning more as VI
MI
Unfolding
Blaha, R. & Carlson, B. (2007). Assessment of Deafblind Access to
Manual Language Systems (ADAMLS). Monmouth, OR: DB-Link.
Communication Matrix from www.designtolearn.org
Design to Learn
Lace, J. (2000, Summer) Minimal losses…major implications.
See/Hear .
www.tsbvi.edu/Outreach/deafblind/process.htm
. A Process for
Identifying Students Who May Be At-risk for Deafblindness. A manual provided by the TSBVI Deafblind Outreach .
McInnes, J & McInnes, J (1990) A guide to identifyingand programming for the deafblind infant and toddler. Baton Rouge,
LA: Louisiana School for the Deaf and Louisiana School for the
Visually Impaired
