Transcript Students Who Are Deafblind

Presented by
Susie Tiggs
Region XI Education Service Center
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Identifying deafblindness
Characteristics
Concept Development
Routines and Calendars
Communication
Technology
Planning and selecting appropriate
interventions and strategies
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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)
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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
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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: 19982005 in review
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Vision Loss
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17%
24%
21%
17%
21%
totally blind or light perception only
legally blind
low vision
cortical vision impairment
other
Hearing Loss
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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: 19982005 in review
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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
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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: 19982005 in review
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Race/Ethnicity of Children Who Are Deaf Blind
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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: 19982005 in review
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Most Common Causes of Deafblindness in
Children in the United States
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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: 19982005 in review
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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: 19982005 in review
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Educational Settings – Ages 6 - 21
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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: 19982005 in review
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Puretone
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Frequency
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Hertz
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Decibels
◦ Sound at a precise
frequency
◦ How fast or slow
something vibrates
◦ Vibrations per second
that make a sound
◦ A measurement of
loudness
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Congenital Hearing Impairments
◦ Typically occur before, at, or shortly after birth but prior to
the learning of speech and language
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Aquired Hearing Impairments
◦ Occur after speech and language have developed
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Conductive Hearing Loss
◦ Occur in the outer & middle ear
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Sensorineural Hearing Loss
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Mixed Hearing Loss
◦ Loss occurs in the inner ear
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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)
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http://betterhearing.org/hearing_loss/hearing_loss_simulator/index.cfm
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Visual Acuity
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Legally Blind
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Visual Field
◦ sharpness of vision; the visual ability to resolve fine
detail (usually measured by a Snellen chart)
◦ Having 20/200 vision with best correction or a
visual field of 20 degrees or less.
◦ The ability to see objects in the periphery of ones
vision when looking straight ahead.
 LP - Light Perception
 HM - Hand Motion
 CF - Count Fingers
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Partially sighted indicates some type of visual problem, with
a need of person to receive special education in some cases
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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
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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
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Totally blind students learn via Braille or other non-visual
media.
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http://www.acbvi.org/albums/vision/index.html
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Problems occurring with mild visual
impairment
◦ Retinitis Pigmentosa and dim lighting
◦ Visual fatigue
◦ Changing and busy visual environments
Jenny Lace, TSBVI Deafblind
Outreach 2000
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Problems occurring with mild hearing
impairment
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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
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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
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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
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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
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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
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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
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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.
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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?”
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Communication is a primary component of
concept development
Both skills and concepts must be taught
Skill
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Concept
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◦ Ability to physically complete a task
◦ A learned power of doing something competently
◦ A developed aptitude or ability
◦ 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
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Concrete concepts
◦ Relate to an object or something tangible
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Semi-concrete concepts
◦ Relate to actions, colors, positions, or something
that can be demonstrated but not held in one’s
hands
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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
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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
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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
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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
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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
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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
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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
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John McInnes, A Guide to
Identifying and Programming for
the Deafblind Infant and Toddler
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Speech
Sign language
Fingerspelling
Writing
Gestures
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Facial expression
Body movement
Posture
Vocalization
Crying
Tantrums
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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
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Communication skills assessment instrument
Organized into four basic reasons for
communicating
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To
To
To
To
REFUSE things you don’t want
OBTAIN things that you want
engage in SOCIAL interactions
provide or seek INFORMATION
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Level
Level
Level
Level
Level
Level
Level
I: Pre-Intentional Behaviors
II: Intentional Behaviors
III: Unconventional Communication
IV: Conventional Communication
V: Concrete Symbols
VI: Abstract Symbols
VII: Language
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Protest/reject
Make a request
Gain attention
Direct attention
Social interaction
Confirm/deny
Label/comment
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Basic Behaviors
◦ Vocalizations, simple body movements, simple
actions on people or objects
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Conventional Behaviors
◦ Pointing, raise hand/wave, extend hand,
nod/shake head
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Symbolic Behaviors
◦ Object symbols, picture symbols, manual signs,
spoken words, printed letters or words, brailled
letters or words
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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
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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
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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.
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Coactive Movement Sequence
◦ An extension of resonance strategies
◦ The student demonstrates purposeful signals
◦ Sharing of common movement or action
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Coactive Manipulation
◦ Hand-over-hand or hand-under-hand
◦ Should be systematically decrease
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Representational Reference
◦ Prerequisite to the formation of symbols
◦ Mutually understanding a common item (Helen
Keller and “water”)
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Distancing
◦ Ultimately leads to conceptual level of
representation
◦ More symbolic in form
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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?
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Social Interactive
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Communication
◦ Increased turn taking
◦ Increased joint attention
◦ 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
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Cognitive
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Transitioning to symbolic representation
Matching picture to object
Re-sequencing activities at the end of the day
Understanding day, and possibly week, concepts
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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!
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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
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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
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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
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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
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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
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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
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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
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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.
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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.
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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
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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
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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
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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
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TTY
Videophone
Cochlear Implant
Assistive Listening Device
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Deafblind Communicator
Telebraille
Silent Alarm
Electronic Braille Notetakers
Brailtalk
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Eight competency areas are delineated as
follows:
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deafblindness,
personal identity, relationships, and self esteem,
concept development,
communication,
Hearing vision,
orientation and mobility,
environment and materials,
professional issues.
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Develop secure and positive relationships
Promote sense of self
Provide an appropriate environment
Provide extensive experience
Promote use of all available senses
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Provide anticipatory information
Teach functional activities
Be consistent
Provide opportunities for making choices and
problem solving
Make it ROUTINE!
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Building Staff
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General Ed Teacher
Special Ed Teacher
Intervener
Paraprofessional
Interpreter
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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
[email protected]
 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
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Active
touch
Passive touch
 Social
touch
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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
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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

Early intentional

Intentional/early symbolic

Symbolic

Early literacy

Literacy
◦ reflexive
◦ body responses
◦ signals and basic gestures
◦ Strongly intentional communication
◦ Beginning “academics”
◦ Complex communication
Touch cues
Coactive sign
Object cues
object calendar systems
Object symbols
sign
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 Design to Learn
www.designtolearn.org

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