Texas School for the Blind and Visually Impaired
Outreach Programs
www.tsbvi.edu | 512-454-8631| 1100 W. 45th St. | Austin, TX 78756
2015 Texas Symposium on Deafblindness
Saturday 8:30-10:00 AM Breakout Session
Increasing Self-Regulation
of Children who are Deafblind
Presented by
Catherine Nelson, PhD, Universitsy of Utah
Cathy.nelson@utah.edu
Developed for
Texas School for the Blind & Visually Impaired
Texas Deafblind Outreach
Increasing Self-Regulation of Children who are Deafblind
Presented by Catherine Nelson, PhD
What is self-regulation?
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Process through which individual modulates emotions, moods, cognitive experiences
Implies purpose and goal setting
Involves executive function
Effortful control (voluntarily inhibit, activate or change behavior)
Choose appropriate response based on expectations of others
Self-regulation is internalized when it can be accomplished mostly without assistance
Nicholas and Hartshorne (2009) 4 dimensions: cognition, behavior, emotion, and
physiology
 Integration of dimensions important in meeting dynamic demands
Cognitive Self-Regulation (Kennert, Hartshorne, Wanka, Dix, & Nicholas, 2014)
 Have a goal
 Use working memory to maintain a focus on goal
 Inhibit distracting thoughts or stimulation
 Problem solve how to communicate wants
 Engage in planning to accomplish goals
Activity
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After a day of meeting demands of school, child comes home and throws hearing aids
across the room and has a melt down
Child is playing with toys and is whisked off suddenly to go clothes shopping
Paraprofessional uses hand-over-hand guidance to ensure child is not faced with difficult
tasks
Child flaps hands and rocks back and forth at the conclusion of an exciting activity
Dysregulation
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Regulatory disorders characterized by difficulties in attention, sensory integration, and
emotional and behavioral moderation
Problems in state modulation, arousal, attention, sleeping, eating
May be excesses and temperamental style
Difficulty maintaining attention and emotional behavior
Dysregulation
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Emotion/cognition balance might be disproportional
Difficulties in interpersonal relationships
Problems occur in more in certain genotypes including CHARGE
But if given support and structure, probability of dysregulation is lessened
2015 Texas Symposium on Deafblindness - Increasing Self-Regulation of Children who are Deafblind, Nelson, C.
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Dysregulation and Deafblind
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Behaviors are seen merely as challenging rather than result of sensory losses
Does not hear or see what is expected
May not see/hear strategies others are using
Strategies may be deemed inappropriate
Difficulty integrating sensory information into salient, manageable whole
Health problems
Self-regulation and Vygotsky (1934)
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Self-regulation is process wherein children progress from co-regulating behavior with
adults to independent self-regulation
Need variety of experiences and practice with adults and other children
Scaffolding
Effective environments (Blair & Diamond, 2008; Duckworth & Carlson, 2013)
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Learning is active
Training in executive function woven throughout the day
Social pretend play utilized
Adults guide planning and goal setting
Choices are offered
Activities are enjoyable
Positive support provided at difficult times such as transition
Additional Interventions- Deafblind
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Calendar systems
Predictable Environment
Social stories
Movement before, during, and after activities
Environmental modifications
Eliminate distractions
Motivating situations
Breaks
Control over schedule
2015 Texas Symposium on Deafblindness - Increasing Self-Regulation of Children who are Deafblind, Nelson, C.
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Case study: Jayden
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5 year old male
Full day preschool class for children with VI
Totally blind, severe hearing loss but wore bilateral hearing aids
Could talk in full sentence but almost all was echolalic
Diagnosed with Sensory Integrative Disorder
Jayden TABS (Neisworth, Bagnato, Salvia, & Hunt, 1999).
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Below 1% on total scale Temperament and Regulatory Index
Detached: Below 1%
Hypersensitive: 3%
Underreactive 15%
Dysregulated: 5%
Some items such as stares at lights could not be scored
Jayden
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Could rote count to 20 at home
Sleep difficulties
Very selective in what he would eat
Able to walk independently but almost always waited for assistance
Regulated behaviors: became still, smiled, reached, explored with hands, laughed,
actively participated
Dysregulated behaviors: repetition of phrases, self-stim, resistive behaviors,
Self-abusive behaviors
Function of behaviors
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Obtain continuation of preferred activity, escape from activity, and self stimulation
Occurred when asked to do task he did not like or was difficult, when asked to give up
favored toy and move to another activity, and when asked to walk.
Target Activities
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IEP goal practice (hand over hand sorting and exploration of books)
Large group circle time
O & M practice
2015 Texas Symposium on Deafblindness - Increasing Self-Regulation of Children who are Deafblind, Nelson, C.
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Case Study Design
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Multiple baseline across activities using sequential withdrawal
3 groups of interventions:
Making activity meaningful, enjoyable
Anticipatory strategies
Calming strategies
Case study design
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Baseline
Intervention 1 with all classes of intervention
Intervention 2: Calming removed
Intervention 3: Calming and Anticipatory strategies removed
Measurements
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Percentage of seconds engaged in duration-based behaviors (e.g., crying) and rate of
discrete dysregulated behaviors (e.g., hitting self)
Percentage of seconds actively engaged in activity
Time from onset of behaviors until in related state (90% regulated behaviors for 3
consecutive minutes)
Intervention IEP goals
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Baseline: Worked alone with intervener, doing hand over hand activities Usually refused
to participated, threw materials or pushed chair away. Sometimes allowed hands to be
moved but little active participation
Intervention: Cars for categorization, choice of tactile books, “talking picture frame”,
Perkins Brailler, least to most prompting, assisted to get all materials out and put them
away
Intervention IEP goals
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Anticipatory strategies: bins with items from above activities lined up in order, sometimes
allowed to choose order, 3 minute verbal warning, told to count to 10
Calming strategies: Affirmed emotion he was trying to communicate, allowed to
physically check in with intervener
2015 Texas Symposium on Deafblindness - Increasing Self-Regulation of Children who are Deafblind, Nelson, C.
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Circle Time Activity
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Baseline: Large group format, many children had teaching assistant behind them, noise
coming from behind Jayden. Teacher talked about days of the week, and month, sang
songs, talked about weather. Jayden participated with full hand over hand assistance
from intervener. Frequent bursts of high pitched repeated phrases, pushed chair back,
clutched at intervener
Circle Time Intervention
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Making activity more meaningful: Background noise reduced, position in circle changed.
Activities that involved more movement and dancing added. Children taken outside to
feel and discuss weather. Themes for days of the week, rhythm band instruments and
turn-taking with instruments. Least of most prompting
Circle time intervention
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Anticipatory strategies: Tactile schedule with activities of the morning, verbal cue given 3
minutes before transition and just before it, natural cues of children moving to circle
highlighted, help move own chair over and put it away at end
Calming: Affirming emotions, sensory object to hold, if he clutched intervener, she would
lightly hold his hand
O&M
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Baseline: Required hand-over hand assistance to move anywhere in classroom, practice
outside with cane. Cane had string tied around it and intervener pulled on the string to get
him to walk. He often stopped and rocked back and forth. Grab back of intervener and
tightly hold on
O & M interventions
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Making activity meaningful: String on cane lengthened and tension reduced, assistance
to move close to target, but then asked to walk independently to target, intervener talked
to him from target. Helped to explore and map out classroom and outdoor environment,
option of taking 1 minute breaks
O & M interventions
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Anticipatory: Tactile schedule for AM activities, verbal cue 3 minutes and immediately
before, natural cue of basket with canes highlighted and sensation of nearing outdoors
highlighted
Calming strategies: Affirmation of communications, holding his hand, allowing him to
hold hand of intervener to get close to target
2015 Texas Symposium on Deafblindness - Increasing Self-Regulation of Children who are Deafblind, Nelson, C.
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Statistical Information (Graph slide 1)
A - IEP goal programs
Percentage of seconds in
duration based behavior
Intervention 3
Intervention 1
Baseline
Interv. 1
Intervention 2
Int.
2
Interv. 3
Interv. 3
Rate of discrete
behaviors per minute
C – Orientation and mobility
Percentage of seconds in
duration based behavior
Intervention 2
Rate of discrete
behaviors per minute
Baseline
Discrete Behavior
Intervention 1
Rate of discrete
behaviors per minute
Baseline
B – Circle Time
Percentage of seconds in
duration based behavior
Duration Behavior
Session Number
Figure 1. Jayden. Left ordinate represents the percentage of seconds that the child engaged in duration-based
dysregulated behavior. Right ordinate represents the rate of discrete dysregulated behaviors per minute.
Figure 1, Graph showing three activities monitored (IEP Goal Programs, Circle Time, and Orientation and Mobility) the two lines
graphed represent duration of behavior and rate of descrete behavior. The three activities all showed a decrease in rate of
descrete behavior and duration of behavior as condition moved from baseline measure to intervention 1, intervention 2, and then
on to intervention 3.
Statistical Information (Graph slide 2)
C – Orientation and mobility
Percentage of seconds
activity engaged
B – Circle Time
Percentage of seconds
activity engaged
A – IEP goal programs
Percentage of seconds
activity engaged
Active Engagement
Session Number
Figure 2. Jayden. Left ordinate represents the percentage of activity seconds that the child was actively engaged in the activity.
Figure 2, Graph showing three activities monitored (IEP Goal Programs, Circle Time, and Orientation and Mobility) the line
graphed represents the amount of seconds the student demonstrated active engagement. The three activities all showed an
increase in amount of time active engagement was demonstrated from baseline measure to intervention 1, intervention 2, and
then on to intervention 3.
C – Orientation and
Mobility
Minutes to regulated state
B – Circle time
Minutes to regulated state
A – IEP goal programs
Minutes to regulated state
Statistical Information (Graph slide 3)
Time to Regulation
Baseline
Baseline
Baseline
Intervention 1
Interv. 2
Intervention 1
Intervention 3
Intervention 2
Interv. 3
Interv. 1 Int. 2 Intervention 3
Session Number
Figure 3. Jayden. Left ordinate represents number of minutes from onset of dysregulated
behavior until three consecutive minutes of 90% regulated behaviors.
Figure 3, Graph showing three activities monitored (IEP Goal Programs, Circle Time, and Orientation and Mobility) the line
graphed represents the amount of seconds required before the student demonstrated regulation of his behavior. The three
activities all showed a general trend that decreased in amount of time needed until student was able to demonstrate regulating
behavior from baseline measure to intervention 1, intervention 2, and then on to intervention 3.
2015 Texas Symposium on Deafblindness - Increasing Self-Regulation of Children who are Deafblind, Nelson, C.
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What we learned
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Package of interventions was successful in decreasing behaviors and increasing active
participation
Significantly decreased time from onset of behaviors until regulated, calm state
Marked decrease when activities were made more meaningful, environment met sensory
needs, choices offered and hand-over hand manipulation was decreased.
What we learned
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Strategy of counting to 10 increased independent self-regulation and time could be faded
Importance of integration of dimensions of self-regulation
Calming strategies were more important in group activity but were successfully faded
What we learned
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Anticipatory strategies could be faded once ingrained but needed again if anything
changed. Highlighting natural cues important to fading anticipatory strategies.
Strong correlation between active participation and time to regulation
Implications for practice
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Need for personnel preparation and in-service training,
High quality intervener and other para-professional training
Para-professionals not charged with curricular design
2015 Texas Symposium on Deafblindness - Increasing Self-Regulation of Children who are Deafblind, Nelson, C.
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Texas School for the Blind & Visually Impaired
Outreach Programs
Figure 4, TSBVI logo.
Figure 5, IDEAs that Work logo and OSEP disclaimer.
2015 Texas Symposium on Deafblindness - Increasing Self-Regulation of Children who are Deafblind, Nelson, C.
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