The Struggle for Existence: Case study of a deaf-blind child
Rumiz Uddin Ahmed
Deputy Director
National Institute for the
Intellectually Disabled (NIID)
SWID Bangladesh
Introduction:
So far I know, the issue of deaf-blindness is not very much dealt with in our country.
But it is time to think about this group of people with multiple disabilities. Most of the
organizations working in the field of disabilities put emphasis on single disability of a
person. No organization is working with this group of people with due importance.
Though any organization is not providing specialized service to the deaf-blind children,
still they live in the society. They have to struggle for existence with the available
opportunity at any organization or society or in the family. The present paper describes
a suspected case of deaf-blindness who is struggling to survive on the beautiful earth
with the support of professionals working for the intellectually disabled persons.
Definition:
Children having more than one kind of disability are called multiple handicapped
children. A study shows only 0.5% of disabled persons have multiple disability (Mayer,
1991). In India 12.3% of disabled persons have multiple disability (Pandey & Advani,
1995). Another study conducted on visual impaired in British Columbia shows visual with
intellectual problem 30.8%, visual with hearing problem 10%, visual with epileptic
problem 7.5%, visual with cerebral palsy problem 6.2.
Deaf-blindness is a kind of multiple handicap. The deaf-blind child is one whose
combination of visual and auditory impairment results in multi-sensory deprivation (Jan,
Freeman & Scott-1977). According to Waterhouse (1972).... deaf-blind are not only
those who are completely devoid of sight and hearing, like Helen Keller for example, but
also the blind with partial hearing, the deaf with a visual defect.
If a child who is deaf-blind has some useable vision and/or hearing, as many do, her or
his world will be enlarged. Many children called deaf-blind have enough vision to be able
to move around in their environments, recognize familiar people, see sign language at
close distances, and perhaps read large print. Others have sufficient hearing to
recognize familiar sounds, understand some speech, or develop speech themselves. The
range of sensory impairments included in the term “deaf-blindness” is great. Deafblindness is often accompanied by additional disabilities. Causes such as maternal
rubella can also affect the heart and the brain. Some genetic syndromes or brain injuries
that cause deaf-blindness may also cause developmental delays and/or physical
disabilities. (Sense International, India).
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Characteristics and needs of the deaf-blind persons:
 Diagnosis of the deaf-blind person is very complicated and sometimes they are
mistakenly diagnosed as intellectually disabled.
 A deaf-blind is person whose world of experience is narrow due to his sensory
limitation.
 The challenge of learning language is perhaps the greatest one that deaf-blind
children face.
 A person who is deaf-blind also faces further the challenge of learning to move
around independently.
 The deaf-blind child may have severe limitation in social and self-care skills.
 Some of them may have problematic behaviors.
 In absence of extra-effort they fail to earn required experience essential for
developing intellectual capacity and age appropriate behavioral competence.
 The most important challenge for parents, caregivers, and teachers is to
communicate meaningfully with the child who is deaf-blind.
 As the child who is deaf-blind becomes comfortable interacting non-verbally with
others, she or he becomes ready to receive some form of symbolic
communication as part of those interactions.
 The deaf-blind people need to be communicated through Touch Cues, Object
Symbols, Sign Language, Gestures, Picture Symbols, Lip Reading, Braille Writing
etc.
 Along with non-verbal and verbal conversations, a child who is deaf-blind needs
a reliable routine of meaningful activities.
 A deaf-blind child also needs a meaningful social and educational opportunity to
develop their abilities and fulfill his/her psycho-social needs.
 Children who are called ‘deaf-blind’ are educationally isolated because
impairments of sight and hearing require thoughtful and unique educational
approaches in order to ensure that children with this disability have the
opportunity to their full potential.
Particulars of the Case:
Name : Wasi Istiaq Hossain
Age
: 18 years
Sex
: Male
Family status
:
Middle class family living in the metropolitan city, both parents, grand parents and one
younger brother are in the family. All are cooperative to each other.
Diagnostic category:
Vision: Congenital total blindness in both eyes (Retinal Dysplesia).
Hearing and speech: Early childhood auditory assessment claims no hearing loss but
in practice the boy responds only to selective familiar verbal request of selective persons
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till to date. He has not yet learned to speak. No abnormality of vocal mechanism has
been detected and quality of auditory perception is not known.
Intellectual capacity: It is difficult to assess the intellectual capacity of the boy
through verbal method because he cannot speak or through performance because he
cannot see. But apparently it seems that his understanding is poor compare to his age.
Developmental history:
 The parents detected no abnormality until three months of his age.
 At age three months parents started consulting the physicians for repeated eye
movement of the boy and found out his blindness.
 The boy gained bowel control and walking at the age of around 4 years. He was
very much fearful to walk.
 Attempt made to admit the boy in the schools for the blind children but rejected
due to his multiple disabilities.
 Finally he was admitted in the school for the intellectually disabled children under
SWID Bangladesh at Dhanmondi, Dhaka in 1998 at the age of 10 years, keeping
in mind his deaf-blindness or multiple disability, and till to date he is attending
the same school.
 At present he has got epileptic seizures and sleep disturbances and taking
medicines
Justification of admission:
He was a child with disability and he and his parents needed help in educating and
developing skills. As it has already mentioned that there was no institution which deals
with the deaf-blind or such a multiple disabled children. Though it is a school for the
intellectually disabled, it was thought he could be helped in socialization and other
activities which is essential for psycho-social and cognitive development.
Behavioral status at the time of admission:
 Poor social awareness
 Could not speak
 Unable to differentiate edible from inedible items
 Needed full support in self-care
 Unable to express his toilet or other needs
 Knew close persons
 Poor understanding
 Poor response to his name
 Followed some instructions of familiar persons.
Educational goals:
 Socialization
 Engagement in some activities
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
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



Teaching self-care skills
Development of understanding
Mobility training
Communication skills training
Academic skill training?
Psychological well-being
Teaching techniques:
 Behavior Modification
 Communication through touch, sound cues and spoken language
Activities:
 Play- manipulating toys, jigsaw, Lego, everyday instruments etc.
 Physical activities- free hand exercise, cycling, working on exercise machines
 Group activities- Daily assembly, walking, running in a group, attending in the
class
 Pre-academic activities- drawing, painting, paper work etc.
 Interaction with other children and teachers
 Daily living activities at home and at school- training on toileting activities, bath,
cleaning, taking foods etc.
Present behavioral status:
1. Motor skills- Able to use both hands and feet for walking and other activities
2. Mobility- Can go around in his familiar environment, at home and at schools
3. Auditory skills- Responds to familiar sounds including name
4. Visual skills- Can not see anything even does not responds to flash light
5. Speech skills- Can not speak any meaningful word, only makes some
meaningless sounds
6. Self-care skills- Has bowel control, goes alone to the toilet, does cleaning; eats
alone, cleans hands and faces; takes bath alone
7. Cognitive skills- Identify own things like dress, toys, follows some instructions
8. Social skills- Likes to be with the familiar persons, recognizes parents and other
close persons
9. Academic and work skills- No academic or work skill has developed so far.
10. Recreation- Likes to play with toys, enjoy music, sounds etc.
11. Emotion- Most of the time happy, sometimes shows temper if his need is not
fulfilled or cannot express his needs.
Parental Reaction:
‘The boy has developed through the schooling specially his understanding and he enjoys
school activities and his friends’.
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Remarks:
The boy has received limited services due to lack of expertise in teaching the deaf-blind
persons, still he has got some services from the said special school for the intellectually
disabled persons.
Recommendations:
 Developing awareness among the public and professionals regarding
multiple handicapped people including deaf-blind people.
 Organizing training courses on teaching the multiple handicapped persons
including deaf-blind people.
 Creating provision for educating the multiple handicapped children
especially deaf-blind children in the organizations working with the
disabled.
 Appropriate rehabilitation mechanism in to be developed considering their
limitations.
References:
Jan, J.E., Freeman, R.D. Scott, E.P. (1977). Visual Impairment in Children and
Adolescents. Grune & Stratton, New York
Meyer, L.H (1991). In Exceptional Children, Nanda & ZamanThe Salvation Army, Dhaka
Pandey, R.S & Advani, L (1995). Perspectives in Disability and Rehabilitation. Vikas
Publishing House Pvt. Ltd. New Delhi
Waterhouse, E. J. (1972). Paper presented at the Second Symposium on Planning for
Public Relations and Rehabilitation. Athens, Greece.
Knowing About Deaf-Blindness. Sense International (India), Gujrat
National Institute for the Intellectually Disabled (NIID)
SWID Bangladesh, 4/A Eskaton Garden, Dhaka-1000
Tel: 9356592, 933 4009 Fax: 8319438; E-mail: swidbd@accesstel.net Website:
www.swidbd.com
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