Georgia Sensory Assistance Project Resources
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Topics related to Deaf-Blindness
Deaf-Blindness and Communication
Assessment of Children who are Deaf-Blind
Cortical/Cerebral Visual Impairment (CVI)
Instructional Strategies for Students who are Deaf-Blind
Learn more about calendar systems:
Lilli Nielsen’s Active Learning
When we hear the term deaf-blind, we often imagine a person who is unable to hear or see anything. This is typically not the case. A range of vision and hearing loss can occur in combination. Functional levels may vary from hard-of-hearing and partially sighted to profoundly deaf and totally blind. Many children who are deaf-blind also have additional physical and intellectual disabilities and complex health needs.
From the Code of Federal Regulations: 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)
For infants and toddlers receiving Part C early intervention services, deaf-blindness is defined as: “Concomitant hearing and vision impairments or delays, the combination of which causes such severe communication and other developmental and intervention needs that specialized early intervention services are needed”.
For the Helen Keller National Center – the term ”individual who is deaf-blind” means any individual – (A) (i) who has a central visual acuity of 20/200 or less in the better eye with corrective lenses, or a field defect such that the peripheral diameter of visual field subtends an angular distance no greater than 20 degrees, or a progressive visual loss having a prognosis leading to one or both these conditions;
(ii) who has a chronic hearing impairment so severe that most speech cannot be understood with optimum amplification, or a progressive hearing loss having a prognosis leading to this condition; and
(iii) for whom the combination of impairments described in clauses (i) and (ii) cause extreme difficulty in attaining independence in daily life activities, achieving psychosocial adjustment, or obtaining a vocation;
(B) who despite the inability to be measured accurately for hearing and vision loss due to cognitive or behavioral constraints, or both, can be determined through functional and performance assessment to have severe hearing and visual disabilities that cause extreme difficulty in attaining independence in daily life activities, achieving psychosocial adjustment, or obtaining vocational objectives.
Communication is the exchange of a message between two people. All young children communicate through their behaviors; but by observing others and witnessing the power of their communicative attempts, children with normal vision and hearing learn to use language to make things happen, get things they want, and get information.
Children who are deaf-blind cannot imitate the communication of others, cannot see the consequences of their own communication behaviors, and often have difficulty developing symbolic communication. In order to help these children develop communication skills, families and teachers must become responsive communication partners who recognize and act on any communicative attempts made by the child. They must set up activities so the child has opportunities to communicate and gets immediate rewards for their communicative attempts. They must provide communication in ways the child can perceive and must expect and wait for the child’s response.
Some children who are deaf-blind may learn to communicate with formal language – speech or sign language, print or braille. Others may use objects, tactile symbols, pictures, or electronic devices to communicate. Some may use gestures, facial expressions and behaviors – but all children communicate. There are many resources available to help professionals and families of children who are deaf-blind assess communication and build responsive environments that teach children the power of communication.
Resources on Communication:
Young adults who are deaf-blind share with their sighted and hearing peers many of the same challenges as they transition from high school into the adult world. These students also have unique needs for services and supports. Deaf-blindness is a very low incidence disability while at the same time being made up of a very heterogeneous group of individuals. Because of this, many transition professionals, teachers, and families have no experience with the capabilities and needs of their young adults who are deaf-blind and are preparing for transition.
I hope you will start with GSAP’s transition document – Deaf-Blindness and Transition from High School and find other articles or websites that can help you navigate the transition waters! One of the important considerations unique to young adults who are deaf-blind is communication. Young adults with deaf-blindness use many different methods of communication. Some use sign language, some need hearing aids or assisted listening devices (FM systems, amplification systems) to understand what is being said. Some prefer to rely on captioning systems like CART, where they read what is said from a screen or laptop. Many young adults who are deaf-blind do not communicate in symbolic ways such as speech, sign language, or text. These young adults may be able to use objects or pictures or augmentative communication devices to make their needs and wishes known, or they may depend on adults who understand their behavior and respond in consistent ways.
Successful transition depends upon our ability to communicate with the young adult in whatever mode they use most effectively. This video shows the communication methods used by young adults who are deaf-blind at teen events sponsored by Deaf-Blind Projects from the southeastern states.
Traditional transition assessments frequently fail to provide helpful information, especially when students have limited communication and conceptual development. Person-Centered Planning is a process which can help the family define and achieve a dream for the future by bringing together a group of supportive people to focus on strengths and interests of the student instead of limitations. In Georgia, the Center for Leadership in Disability at Georgia State can help families develop person centered transition plans. GSAP can also help facilitate Person-Centered Plans for Georgia families.
Learn more about transition for students who have combined vision and hearing loss:
The psychological evaluation of students who are deaf-blind can be a challenging task. School psychologists face a lack of appropriate tests designed for students with vision and hearing loss, the communication barriers presented by students who may have no symbolic language, and because of the low-incidence of the population – a lack of experience working with students who are deaf-blind.
In his wonderful fact sheet Psychological Evaluation of Children who are Deaf-Blind: An Overview with Recommendations for Practice, Harvey Mar outlines the problems facing psychologists and offers suggestions for making evaluations meaningful. He provides quality indicators which focus on multiple observations of activities that are relevant and meaningful to the student as part of the student’s natural routines. He lists desired outcomes of a psychological evaluation focusing on recommendations that help the educational team and family with strategies, adaptations and supports, and appropriate goals.
In her guide, Assessing Communication and Learning in Young Children Who are Deafblind or Who Have Multiple Disabilities, Charity Rowland, Ph.D outlines an approach to assessment of children who are deaf-blind that includes a team approach, selecting appropriate assessment instruments, and conducting informal observations in multiple settings.
Perkins School for the Blind and their partners have organized information in The Evaluation of Children with Deaf-Blindness: A Parent Mini Guide
The Ohio Center for Deafblind Education, along with Dr. Melinda Wolford, have published “A School Psychologists’ Guide to Deafblindness: Identifying & Supporting Students with Combined Vision-Hearing Loss"
Some resources that can help teams design appropriate, authentic assessments for their students who are deaf-blind include:
Roughly one-third of students on the Georgia Sensory Assistance Project are diagnosed with cortical/cerebral visual impairment (CVI). CVI refers to a brain condition, not an eye condition. The brain has trouble processing the information sent from the eyes. Because the brain, and not the eye is affected, the child’s problem seeing is often not explained by an eye exam and an understanding of the possible impacts of CVI is necessary to properly evaluate and support these children. Children with CVI may have very limited vision or appear to use vision well in certain tasks. They may have additional disabilities and significant cognitive delays, or do grade level academic work. Many students with CVI can show improvement in their visual skills with the proper intervention, so it is important that professionals and families learn as much as they can.
Learn more about CVI:
For many children who are deaf-blind, their hands are a primary learning tool. Children must explore with their hands and use their hands to do tasks to learn about the world around them. Instruction for many children with vision and hearing loss involves adults controlling the child’s hands to demonstrate actions or exploration of objects. But some children resist when an adult tries to show their hands how to do things.
Using a hand-under-hand approach, instead of hand-OVER-hand, has been demonstrated to be a far superior way to encourage children to learn with their hands. Instead of moving the child’s hands through actions, the adult’s hands lightly touch beside the child’s or the child’s hands ride on the adult’s hands and feel what the adult hands are doing. In the hand-under-hand approach, the child and adult explore together, and are interested in the object together. The child is invited to feel, not forced or heavily manipulated.
Learn more about using hand-under-hand techniques:
Calendar systems provide a structured way in which to refer to events in a child’s day. Sometimes called “Anticipation Boxes” or “Object Calendars,” objects, pictures, symbols, or words represent the activities of the child’s day. Calendar systems can be simple anticipation calendars- presenting an object or symbol representing what is coming next and putting it in a “finished box” at the end of the activity. They can be expanded to have objects, symbols or pictures arranged in the order of the events of the day, or even expanded into weekly or monthly calendars. They can use objects, parts of objects, textures, pictures, words in print or in Braille. Calendars provide a way to teach early time concepts, such as before, after, later, and now; as well as more advanced time concepts of days, weeks, hours and minutes.
In addition to supporting communication and concept development, the calendar system provides emotional support to the child in the following ways:
For children with deaf-blindness, routines provide consistent, repeated experiences that allow them to anticipate what is about to happen, communicate in a structured and familiar setting, and actively participate to the greatest extent they can.
According to Millie Smith, a former teacher at the Texas School for the Blind- “A routine is an instructional strategy developed to increase the level of participation in activities for students who require consistency and repetition in order to learn.” Educators use routines to build anticipation and memory and to teach specific skills used in functional daily activities.
A routine should have a clear signal to the student that the activity is starting. The steps of the activity should always occur in the same order, be cued in a consistent way, and take place in the same place. When the routine ends, there must be a clear signal that the activity is finished.
Learn more about Routines:
Based on the work of the late Danish educator Lilli Nielsen, Active Learning is a theory which suggests that children learn best through exploring their environment without adult intervention. Active learning environments encourage and reward exploration by positioning materials in consistent places that are likely to be encountered by the child through random movements. As they consistently find interesting objects and textures through this random movement, children begin to explore to find these materials, and through repeated interactions with the materials begin to explore the objects' moving parts or shapes and textures. Active Learning Materials include the Little Room- a small space with objects and textures suspended from above or on the sides, the Scratching Board- a piece of wood with different textures on it which can be attached to a child's tray or positioned on a wall beside the child, and the Resonance Board- a board on which the child lies and feels vibrations from any minimal movement.
Learn more about Active Learning: