Perkins Activity and Resource Guide: A Handbook for Teachers and Parents of Students with Visual and Multiple Disabilities

By Charlotte Cushman, Kathy Heydt and Monica Allon

We are pleased to release a 3rd edition of this incredible resource!  It contains hundreds of pages of practical suggestions for instructional activities for young children who are visually impaired with multiple disabilities. Each section has been authored by specialists in the subject area. Organized into sections for each instructional domain, and in loose-leaf format for easy pullout of sections, the guide is very user-friendly

• Language: English
• Publisher: eBookIt.com
• Release date: Jun 8, 2021
• ISBN: 9781947954014

Book preview

cover: Perkins Activity and Resource GuidePerkins Activity and Resource Guide, A handbook for teachers and parents of students with visual and multiple disabilities.

© 2021 Perkins School for the Blind. All rights reserved

Every effort has been made to acknowledge commercial products mentioned in this publication whose names are trademarks or registered trademarks.

ISBN 978-1-947954-01-4

Perkins School for the Blind Watertown, Massachusetts

Cover photo: Larry Melander

Principal Authors

Charlotte Cushman holds an M.Ed. in Special Education and an M.L.S in Information and Library Science. She has worked in the field for over 40 years, and has been a classroom teacher at Perkins School for the Blind, and an education consultant for Texas School for the Blind and Visually Impaired, Perkins International, and New England Center for Deafblind Services. She was a Peace Corps Volunteer and has trained teachers and developed curriculum in Africa and Asia. She currently manages Paths to Literacy and the Active Learning Space.

Susan N. Edwards is a certified teacher of the visually impaired (TVI) with an M.Ed. in Educational Evaluations and Consulting from Lesley University, graduate certification in Vision Studies from Boston College, and a B.S. Ed. in Elementary and Special Education from Keene State College. She has worked in the field of visual impairment and multiple disabilities for over thirty-five years. Ms. Edwards is currently the Educational Coordinator in the Early Learning Center / Lower School Program at Perkins School for the Blind. She is a member of the evaluations and admissions team and provides program support in the areas of curriculum and assessment. In addition to her responsibilities at Perkins, Ms. Edwards provides TVI services to students with visual impairments in Boston area public schools.

Monica Allon holds an M.S. in Occupational Therapy from Boston University, Sargent College of Health and Rehabilitation Sciences. She holds a B.A. in Art Education and an Individualized B.A. in Art Therapy from Queens College, City University of New York. Over the course of her 40+ year career, Ms. Allon has worked as an Occupational Therapist at the Perkins School for the Blind. She served as a Clinical Associate of Occupational Therapy at Boston University, as well as providing fieldwork supervision for Occupational Therapy students. Ms. Allon designs, customizes, creates and adapts leisure activities/games and self-care devices for children with multi-sensory impairments. Ms. Allon has been a recipient of the 2007POSB (Principals of Schools for the Blind) Award, receiving the distinction for Outstanding Related Service Provider. Along with a team of parents and educators Ms. Allon helped to establish and currently coordinates the Extended Day Program at the Lower School at Perkins School for the Blind.

Kathy Heydt has provided physical therapy services and taught orientation and mobility to pre-school and elementary school aged children at Perkins School for the Blind for over 25 years. During her time at Perkins, she was also the Assistant Education Direction for the Early Learning Center / Lower School program for 12 years. She has a B.S. in Physical Therapy from Russell Sage College, an M.Ed. in Special Education in the area of Orientation and Mobility from Boston College and a doctorate in Physical Therapy from Simmons University. In addition, Ms. Heydt has worked as adjunct faculty at Boston College and the University of Massachusetts at Boston in the programs for vision professionals. She has presented at a wide variety of workshops and conferences on a national and international level on topics addressing providing services to children who are blind and visually impaired including those with or without additional impairments.

Mary Jane Clark holds a B.S. in Special Education for the Visually Impaired and Elementary Education from Kutztown State College, and an M.Ed. in Special Education from the University of Massachusetts at Boston. She is a certified Orientation and Mobility Specialist and a Perkins Brailler repair technician. Ms. Clark has worked in the field of visual impairment and blindness for more than 30 years. In addition to her position as a teacher of the visually impaired at Perkins School for the Blind, Ms. Clark has participated in international training in the repair of the Perkins Brailler.

Contributing Authors

Judith E. Bevans, Mt-BC, holds a B.S. in Music from the University of Rochester, an M.Ed. from Harvard University, and an M.M. in Performance of Early Music from the New England Conservatory of Music. She has worked in the United States and the Middle East, and as a Music Therapist in the Lower School Program at Perkins School for the Blind. Ms. Bevans has published extensively on music education, music therapy, and music braille, and has conducted in-service and university training in the areas of music education and music therapy.

Dennis Lolli was a Regional Director for Perkins International, working with the Europe and Eurasia Region including Russia. He holds a B.A. from St. Anselm College, an M.Ed. in Orientation and Mobility from Boston College, and a CAGS in Educational Administration from Boston State College. He has been a Low Vision Education Consultant at Perkins Outreach Services and is a Certified Orientation and Mobility Specialist. The majority of his work has been with children who are blind with multiple disabilities and deafblind. Mr. Lolli has written a number of articles and has presented on low vision and orientation and mobility at national and international conferences.

Vickie R. Brennan holds a B.A. from the College of Wooster, an M.Ed. in Orientation and Mobility from Boston College, and an M.S. in Vision Rehabilitation from the Pennsylvania College of Optometry. She has worked in the fields of orientation and mobility and low vision for many years. She has also worked as a project administrator of a federal grant providing low vision services to deafblind children in New England, and has provided in-service training regionally, nationally, and internationally.

Flo Peck holds a B.S. in Young Children with Special Needs from Boston University, an M.Ed. in Multihandicapped/Deafblind Education from Boston College, and a postgraduate certificate in Low Vision from the Pennsylvania College of Optometry. Ms. Peck has teaching credentials in the areas of Early Childhood Special Education, Severe Special Needs, and Vision Impairments. She has worked in the field of blind and deafblind education for 36 years. Ms. Peck worked at Perkins School for the Blind as a Teacher of Children with Visual Impairments in the Infant/Toddler Program, a Teacher of Children with Deafblindness in the DeafBlind Program, Low Vision Education Specialist in the Low Vision Clinic, state trainer for both INSITE and VIISA programs, and CVI Mentor. Currently, Ms. Peck is employed as an Early Intervention Vision Specialist and Early Childhood Special Educator in northern California with the Placer County Office of Education – Infant Development Program.

Alex Truesdell is a fierce advocate for high expectations, custom adaptations, and removing doubt from disability. Alex founded and led the Adaptive Design Association in New York City from 2001 to 2019 and founded and led the Assistive Device Center at the Perkins School in Boston from 1987 to 1998. Alex promotes proliferation of adaptive design expertise (imagining and constructing person-specific adaptive devices) and runs hands-on workshops in the US and internationally. Alex holds Masters degrees in teaching the visually impaired and in curriculum development; she is a 2015 MacArthur Fellow, and received an honorary doctorate from Lesley University in 2017.

Project Coordinator

Marianne Riggio holds an M.Ed. in Deafblindness and Multiple Disabilities from Boston College. She is an Educational Consultant for the Hilton/Perkins Program at Perkins School for the Blind, providing technical assistance to U.S. Projects serving infants and preschool children who are visually impaired with additional disabilities and in the education of children with deafblindness. She coordinates projects for children with visual and multiple disabilities in Asia, and is a consultant for deafblind projects in East Africa. She co-authored Remarkable Conversation, Competencies for Teachers of Learners who are Deafblind and Competencies for Paraprofessionals who work with Learners who are Deafblind. Prior to working for the Hilton/Perkins Program, Marianne served in many capacities at the New England Center for Deafblind Services, and as Teaching Coordinator of Multihandicapped and Deafblind services for New Hampshire Educational Services for the Visually Handicapped.

Acknowledgments

We are pleased to offer the field this third edition of the Perkins Activity and Resource Guide. A project of this size could not have been completed without the assistance of a great number of people over the years. We especially wish to thank Larry Melander, who served as the Supervisor of the Lower School Program at Perkins for many years, for his unwavering encouragement and his constant, but gentle, persuasion to publish.

We would also like to thank all of our students, past, present, and future. The challenges of identifying their strengths, reinforcing their skills, and encouraging their independence has been the motivating force behind this book.

Foreword

Many years ago a group of pioneering educators from the Lower School of Perkins School for the Blind were reflecting on how much they had learned through their own experience of working with children who were visually impaired and multiple disabilities. They appreciated how their mentor Larry Melander, who was the supervisor of their program at the time, encouraged them to be creative and practical about how to teach this group of children. Indeed, they were traveling in uncharted territory since many teacher training programs at that time did not focus on the needs of children with more than one disability and there were few resources at their disposal.

As the success of their transdisciplinary thinking showed in the progress of their students at school and at home, once again, their mentor encouraged them to publish their work as a resources for teachers who were often without the skills and support that they needed. As a teacher of children with multiple disabilities and sensory loss and a consultant who provided training and support for those teachers out in field who were without the professional resources they needed, I was pleased to join the group to help them to think about the way to organize the wealth of practical information they were developing.

With their eyes always on the teachers who needed ideas for lessons that would provide their students with meaningful learning opportunities, they worked tirelessly writing lesson plans for activities they knew were tried and true. Through this process they also realized that the teachers needed to understand the rationale for these lessons and have conveyed, often quite technical information, in a very user-friendly way to help them to analyze the learning needs of their students and select appropriate activities. Critical pieces of the guide were the informal checklist of developmental sequences that accompanied each chapter that teachers could use in the assessment process to help them think about realistic educational goals and objectives.

The Perkins Activity and Resource Guide, originally published almost 30 years ago, has proven that these teachers truly had their finger on the pulse of the needs of other teachers in the U.S. and around the globe. It has long been a best seller in our field and has been translated into multiple languages. As the world has changed and digital resources make materials more accessible in many ways, it was fitting that this seminal work has been updated and formatted for online access. One of the changes in this updated version is that the checklists have been pulled together into one sub-document that makes them much easier for educators to use in their comprehensive assessment of their students.

I believe that readers of this timeless classic work in our field will continue to use it as both a foundation and a springboard for their teaching of students with multiple disabilities and visual impairment for many years to come.

Marianne Riggio

Contents

Principal Authors

Contributing Authors

Acknowledgments

Foreword

Chapter 1

Teaching Children with Multiple Disabilities: An Overview

Chapter 2

Foundations of Learning: Language, Cognition, and Social Relationships

Chapter 3

Motor Development: Gross and Fine Motor Skills

Chapter 4

Functional Academics

Chapter 5

Vocational Skills for All Ages

Chapter 6

Daily Living Skills

Chapter 7

Independent Living Skills

Chapter 8

Sensory Integration

Chapter 9

Developmental Music

Chapter 10

Orientation and Mobility

Chapter 11

Enhancing the Use of Functional Vision

Chapter 12

Adaptive Technology: Handmade Solutions for Unique Problems

Chapter 13

Techniques for Lifting Students Safely: Body Mechanics and Transfers

Chapter 14

Assistive Devices and Equipment

Glossary

Chapter Acknowledgments

Bibliography

List of Songs Audio

Jacket Song (0.25)

Hello Song (1.34)

I Have a New Hello Song (2.04)

Sing, ‘Good Morning’ (0.48)

Good-bye, Ev’rybody (1.22)

I’m Gonna Pat My Little Old Head (1.16)

Put Your Finger in the Air (2.52)

The Stand Up, Wiggle Song (3.06)

Up and Down (2.48)

Stand Up, Turn Around (0.46)

People (2.26)

Clap Your Hands (2.20)

Jim Along Josie (2.06)

To the Music I (1.40)

Toodala (2.34)

The Wheels on the Bus (1.56)

Open, Shut Them (1.08)

La, La, La (1.18)

The La La Song (0.26)

Mary Wore a Red Dress (0.58)

Jennie Jenkins (2.04)

Did You Ever? (1.30)

Who’s That Tapping at the Window? (1.12)

What Shall We Do? (1.52)

The Drum Is the King (2.20)

Echo Singing (0.36)

Echo Playing (1.16)

Come, Come, Come (1.22)

Wake Me, Shake Me (1.44)

Walk Along, John (3.34)

Rig-a-Jig-Jig (1.26)

Jingle at the Windows (1.58)

Chapter 1

chapter 1

Teaching Children with Multiple Disabilities: An Overview

by Charlotte Cushman

Chapter 1 Contents

Guidelines for Success

Physical Considerations

Teaching Strategies

Who is This Book For?

This book is intended to be used as a resource for a range of professionals, parents, and other caregivers who are working with children with visual and multiple disabilities. Those who might benefit from this book include some of the following:

Teachers who are new to the field

Experienced professionals who would like to share information with others (student teachers, parents, other professionals)

Teachers of the visually impaired who do not have experience working with students with multihandicapping conditions

Teachers of children with multiple disabilities who do not have experience working with students with additional visual disabilities

Physical, occupational, and speech therapists

Consultants in specialized areas

Parents of children with multiple disabilities

Other caregivers (such as residential, respite, or after school workers)

Different parts of this book will be applicable to different students and adults in various situations. as a whole, the book’s intention is to offer general guidelines and resources to assist you in designing the most appropriate program for the students you know.

What Population of Students Does This Book Address?

This book has been written to address the educational needs of school-age children with moderate visual and multiple disabilities. This population encompasses an extremely wide range of needs and abilities, ranging from students who may be able to read and learn braille to others who will need a much more functional lifeskills approach. The combination of multihandicapping conditions is unique to each student: the degree of cognitive, physical, visual, and emotional impairments is different in each individual learner. For example, some nonverbal students may excel in motor skills while some academically oriented children may be held back by their lack of self-esteem. There is not one single type of student with multiple handicaps and visual disabilities.

What is the Educational Philosophy Behind This Book?

We all believe that a functional, child-centered approach to education is the ideal model, toward which we strive. Realistically, however, many teachers and professionals must work within the constraints of a particular school or budget. Many students with visual and multiple disabilities have great difficulty generalizing skills to other settings, and thus any real setting is preferable to a simulated one. While community integration may be the goal, the fact is that most teachers are still working within a more traditional classroom setting where activities may be isolated. Teachers are expected to align all instructional activities with the general curriculum while keeping in mind the importance of a functional, child-centered approach. Not all of the activities included here are functional in and of themselves, but they are important prerequisites to the development of other more functional skills. We have included functional applications in most activities to reinforce critical skills in other settings.

This book presents a wide range of information, designed to address diverse educational needs, but it is not meant to be an all-inclusive document. Each activity should be viewed as a springboard for ideas, rather than as a rigid pedagogical formula. Specific variations will depend upon the physical and educational needs of each individual learner.

Use a Team Approach to Developing an Educational Program

Children with multiple disabilities present such a wide range of needs that no single individual is equipped to address every concern alone. Therefore, a team approach should be used to design and implement a comprehensive program for each student. A team is composed of family members, a variety of professionals, and other caregivers. Each person brings a special expertise to the team, and all team members should work together to provide a consistent and integrated program.

Evaluate Goals

As a child grows and develops, it is necessary to re-evaluate educational priorities. While this is done yearly by the entire team during a student’s annual review, it is important to examine goals in relation to his progress at more frequent intervals. Often the priorities shift as a student gets older. For example, if an adolescent student still requires assistance to get dressed, perhaps the focus of his educational program should shift from academics to daily living skills. It is essential to establish reasonable expectations for each individual student so that he will be appropriately challenged, but will also experience success.

Personal Future’s Planning is the Base for an Educational Program

The goal of all education is to prepare us for the future. We must develop a vision of that future in order to determine how best to move forward. The personal Futures Planning or Person-Centered Planning process is a way to bring together the important people in an individual’s life to discuss dreams and fears of the future, as well as specific strategies of how to get there. This technique places the person at the center of the planning and her likes and dislikes, strengths, and needs provide the guidelines for what that vision will be. The goal is to create a vision for the future that respects an individual’s choices.

Guidelines for Success

Building Independence

One of the primary goals in educating a child is to help her to function as independently as possible in the world. For some students, independence may be achieved with the help of special equipment, such as a wheelchair, an augmentative communication device, or braille materials. For many students with multiple disabilities, however, gaining independence requires enormous energy, creativity, and patience on the part of all those who work with them. It is often easier to do something for a child than to teach her to do it for herself, but this is ultimately a disservice to the child. It is important to structure situations so that the child can be successful. For example, select simple clothing without fasteners so she can dress herself, or place tactile markers on the coat hook so she can find it without assistance. Create opportunities for success!

Be an Advocate for the Child

Because most children with multiple disabilities may not be able to be their own advocates, it is essential that all of those who come into contact with them respect their rights as individuals.

Encourage everyone to be aware of the child’s privacy and avoid discussing her when she is present. Just because she cannot see does not mean that she cannot hear. Similarly, even if she is not verbal, she may still understand what is being said around her.

Allow the child to have the dignity of taking appropriate risks: let her try to do whatever she can for herself, even if it may be slightly inconvenient for others. For example, let her order her own meal at a restaurant and choose her own clothes when getting dressed, if possible.

Help the child choose activities and materials that are appropriate to her chronological age. Even though a child may be functioning at a developmental level well below her actual age, she should still be encouraged to dress and act in a way that is age appropriate. For example, if a teenager loves to listen to music, expose her to popular music rather than just children’s songs.

Teach Skills that are Functional

It often takes a long time for individuals with visual and multiple disabilities to acquire new skills. Therefore, it is best to teach only those skills that are functional. Before introducing a new skill, think about what the value is for the student. Why should she learn this skill? Is it important in and of itself? Does it lead to the development of other important skills? Is it an educational priority? Does it promote independence? Sometimes the answer may be self-evident, for example, teaching a child to use the toilet is clearly a priority in and of itself. Other skills, such as sorting and matching objects, may not be functional at the moment, but may lead to functional goals in the child’s future (e.g., sorting silverware or matching socks). Other skills, however, may be taught simply because everyone always teaches them, but not because they have any true value to a child with multiple disabilities. For example, is it necessary to teach an adolescent to pass a ball or stack blocks or string beads? These skills are often taught in early childhood settings because they are valuable for young children. Reexamine the priorities for older students or for students who are more severely impaired.

As stated previously, the ultimate goal is to teach skills that are functional. While some activities may not appear to be functional in and of themselves, many are prerequisites necessary to the acquisition of later skills. In addition, many school settings do not have the flexibility to teach students in the natural setting, due to lack of staffing or other constraints. We have, therefore, presented many activities that can be taught within a classroom and included functional applications for teaching those skills in natural settings whenever possible.

Teach Skills in the Natural Setting

Not only does it take a long time for many students with visual and multiple disabilities to develop new skills, but it is often difficult for them to generalize known skills to other settings. It is, therefore, preferable to teach functional skills in a natural setting. Do not assume that because you have taught a child one task, she will be able to apply this knowledge to a similar task in a different setting. For example, just because a student learns to put pegs in a pegboard does not mean that she will automatically be able to put cups in a rack or envelopes in mailboxes. Similarly, if a child learns to fasten a snap on a doll, this does not mean that she will be able to snap her own pants, especially because she will have learned to snap in reverse. Teach skills that are functional in the setting in which they occur whenever possible.

Break Tasks Down into Individual Steps

Most students will not be able to acquire a new skill all at once. Therefore, tasks should be broken down into small steps. This process, called task analysis, involves looking at each sequential step in an activity. If a child is learning to brush her teeth, for example, she may begin by simply tolerating having the toothbrush in her mouth. Later, when she is ready, other steps can be added, such as finding the toothpaste, removing the cap, squeezing it onto the brush, etc. It may be helpful to write down all the steps when teaching a new or complex skill to assure you are giving the child opportunities to be successful.

Provide Assistance as Needed

As we have said, an important goal is for the child to become as independent as possible. In order to achieve that goal, she may need adult assistance while she is learning new skills. The following list describes the different levels of intervention.

Independently: No adult intervention necessary.

Verbal prompt: The adult provides verbal directions, reminders, and cuing as necessary.

Modeling: The adult demonstrates the task for the student.

Physical prompt: The adult gently taps or guides the child to perform the task. For example, he or she taps the table when asking the child to place an object on it, or touches the student’s foot when asking her to put her shoe on.

Physical assistance: The adult physically helps the child to perform part of the task, but allows the student to complete the task alone.

Hand-under-Hand: This approach is preferable to hand-over-hand for introducing students to new materials or activities that involve tactile exploration. Many blind children are labeled tactually defensive because they do not like adults to put their hands into wet or unfamiliar substances. Placing your own hands under the child’s will allow her more control and will encourage her to explore at her own pace.

Provide Repeated Opportunities to Practice Skills

Many students will not be able to learn a new skill in a single session, but need repetition in order to master new concepts. Give them the opportunity to practice these skills in structured lessons, as well as in the natural setting during the course of the day. If a student works on coin identification during a math lesson, she should be encouraged to apply this knowledge throughout the day, for example, when counting lunch money or buying a soda. This repetition will help to reinforce new skills, as well as to generalize that knowledge to new situations.

Speak to Students Using Normal Voice and Language

It is important to speak clearly and concisely, using words that students can understand. Speak in a normal tone of voice that is not high-pitched, too loud, or singsong. In general, use words that refer to visual concepts or attributes of color and seeing as you would ordinarily. Phrases such as see you later, or do you see what I mean? are part of normal speech. Similarly, words like watch and look can be used with blind students to refer to their own style of looking. For example, if you ask a student to watch where she is going, she will learn that you mean to pay attention, or if you ask a blind child to look at something, she will learn that you want her to feel it.

Use Real Objects

Students with multiple disabilities, particularly those who are blind, may not understand symbolic representations at first. The only resemblance which most representations have to the real thing is their visual similarity. For example, sighted children may find a teddy bear visually appealing or delight in a small plastic cow that looks just like the real thing. We may bring these items to school when we are teaching about animals and are disappointed because the child does not recognize these tiny animals. Think about this from the perspective of a young, inexperienced, blind child who also happens to be developmentally delayed. These items may mean nothing to her because she does not know what a real cow looks, feels, or smells like. Even if she has had the experience of being with a real cow, the plastic toy shares few of its nonvisual attributes. If you take the child to a farm, she can first learn about real items, and later, when she is developmentally ready, real objects may be paired with representations that are visual or tactual.

A Multisensory Approach is Best

It is important that children who are blind or visually impaired learn to utilize the senses that they have to compensate for the loss of visual information. While it is often a good idea to use a multisensory approach when teaching children with sensory impairments, particularly if they are also developmentally delayed, this does not mean we should bombard the child with an abundance of sensory input to compensate for a vision loss. We must be thoughtful about deciding the types of approaches that will best succeed for an individual child. It has been estimated that 75 percent of learning is visual, but clearly, a blind child cannot learn through the visual mode, which is the basis of most standard curricula. Nor is it effective simply to transcribe print text into braille for many children with multiple impairments. Such students benefit most from a direct, hands-on approach that fosters the development of other senses. Tactile experience is crucial to children who are blind, since much of the information that they gain about the world is acquired through touch. Auditory channels are equally important; helping children to interpret and make sense of what they hear is significant to their ability to function in the world. Children who are blind or visually impaired will use hearing to be in touch with the world beyond their personal body space. The senses of taste and smell can help children develop a deeper understanding of their environment. Students with low vision or CVI may benefit from visual cues or modifications in the environment. Consult with the child’s TVI for specific suggestions. Ideally, each of the senses should be incorporated into an integrated teaching approach to encourage the child to explore the world around him.

Take Advantage of the Teachable Moment

It is no secret that we all learn best when we are interested and motivated. Make the most of these moments, which are often completely unplanned, when the student is drawn toward a particular item or idea. For example, a teacher may have prepared a classroom lesson on following directions, and while on the playground an opportunity arises to apply the concepts of the lesson. The student is enjoying swinging and is reluctant to come inside. The same skills can be taught outside by asking the student to stop and go or swing fast and slow. It is important to be flexible and to take advantage of these moments, since a child may ultimately learn more from these spontaneous interludes than from a structured lesson. Likewise, if you are walking along the corridor and the child encounters the water fountain, you can take time to talk with him about how it feels (e.g. the fountain feels cold because there is water inside) and how it works.

Use Motivating Materials and Activities

Whenever possible, try to incorporate materials that are of interest to the student. For example, if a child loves musical instruments but the goal of the lesson is to teach sorting skills, have her sort small jingle bells and shakers. Similarly, in a counting lesson have the student count bracelets if that is what motivates her. Be aware, however, that some students may perseverate on particular topics or materials in an inappropriate manner. Familiar materials or enticers may be phased out or eventually replaced with some students. The educational team will need to decide how to balance the introduction of new topics to broaden a student’s interests, using familiar, motivating materials that can help develop new concepts.

Physical Considerations

Know the Student’s Medical History and Physical Restrictions

Many students with multiple disabilities have extremely complicated medical histories. Before working with a student, it is absolutely imperative to research her medical background and condition. Be sure that you find out the following information:

Does her diagnosis indicate the need for special care?

What are the educational implications of the diagnosis?

What medication is she on? Has the dosage been changed recently? Are there potential side effects to watch for?

Does she have any known allergies?

Does she have a seizure disorder? If so, what are the warning signs? Is there a pattern to the seizures?

Does she have a shunt?

Does she use braces or any prosthetic device?

Does she have any physical or dietary restrictions?

What is the procedure for medical emergencies?

Students should learn to communicate as much of this information as possible. They can carry special cards or wear medical alert bracelets if their condition warrants.

Adapt Materials to Meet the Student’s Physical Needs

Children with multiple disabilities often have difficulty gaining access to the world around them. A lack of vision, motor skills, or cognitive development can greatly affect their ability to explore their environment. With a little imagination, teachers and parents can make simple adaptations to toys, games, and other materials to make them accessible to all children. Textures, for example, can be added to many toys to help a child to identify different parts of the toy or to locate the on/off switch. Similarly, the placement of textures on a child’s chair or bedroom door may help her travel around the house or school more independently. See the Adaptive Technology chapter for more ideas.

Create an Environment that Encourages Optimal Functioning

It is important to structure the physical environment in such a way that students can function at their full potential. Our senses of vision and hearing are often referred to as the organizing senses. They help us bring order to the world that surrounds us. Most children with multiple disabilities cannot organize their surroundings in a meaningful way, and thus are dependent on others to structure the environment so they can feel safe when exploring and acting independently. When setting up a space for these children, consider factors such as acoustics and lighting, as well as physical layout. See the Enhancing the Use of Functional Vision chapter for suggestions for children with low vision.

Many children with multiple impairments have difficulty screening relevant information from the environment, and the noise of a busy room may be over stimulating. While it is important to help students develop coping mechanisms, it is also necessary to minimize auditory distractions so they can focus on the immediate situation. Within a workspace, it is essential to present materials in an organized manner. Use trays, boxes, and dividers to define space and help children organize their work. Both at home and school it is important to organize and adapt the environment in a way that will help the child feel safe and confident. We should consider the visual and auditory attributes as well as the physical layout.

The physical layout of a classroom or living area also has an effect on an individual’s ability to function independently. The environment should be free of unnecessary obstacles or clutter, so the child can move about freely. Materials should be left in consistent, easily accessible locations, so the child can find them independently. See the Orientation and Mobility chapter for further suggestions.

Teaching Strategies

The following principles are meant to provide general guidelines. A behavior specialist should be consulted for specific concerns.

Be Clear and Consistent

Many children with multiple disabilities rely heavily on the predictability of their routines in order to make sense of the world. Although we want them to be flexible and learn to adapt to an ever-changing world, it is also important to provide a routine in which the expectations are clear and consistent. If they are to acquire a sense of responsibility, children should have clear limits and should be aware of the consequences of their actions. The ultimate goal is to teach an individual to monitor her own behavior.

Accentuate the Positive

Be enthusiastic! Your attitude will set the tone for the student. Often, the use of a cheerful, natural voice will positively affect the way that a child approaches a given task. Begin a structured lesson with a familiar activity that the child can do, so she feels successful. If the child starts out with a sense of accomplishment and praise, chances are that she will be motivated to try a new activity.

When we, as teachers and caregivers, are tired and stressed, it is all too easy to focus on what the child is not doing or is doing wrong. It is very important, however, both for the child and the adult, to remember to praise the child for things she does well and not just to reprimand her for her transgressions. For example, if the child is wandering around the room, you might say Good, Emma, you found your chair. Now can you sit down in it, please? In this manner, the child will be praised for what she has done correctly while also being gently reminded of your expectations.

Remember that all Behavior is Communication

We all communicate through our behavior. Reaching out to give someone a hug, stomping out of a room, laughing, and crying are all examples of behaviors that we use to communicate. If a child screams or throws something, some people may label this as a behavior problem. In fact, the child is trying to communicate something to us (boredom, frustration, anger, pain). We must, therefore, begin by looking at what is being communicated and help the child learn to express this in a way that is more socially acceptable. We must interpret the underlying meaning behind the behavior and adjust our response accordingly. For example, many children will act out if they are confused about the intent of an activity. It is, therefore, essential that we reflect on our own communication with the child and more clearly define the outcome and expectations of the activity.

Redirect Students When Necessary

If a student is doing something that is generally considered to be inappropriate, be sure she understands what is expected of her. Model acceptable behavior and praise the student whenever her behavior is socially appropriate. If the negative behavior persists, try to ignore it at first and praise others for their good work. If the child continues to exhibit negative behavior, redirect her to the desired behavior. For example, if it is time to sit down at the table for circle time, but one student refuses to sit with the group, try to redirect her interest. Drawing her attention to the positive often works best; for example, say, Let’s find out what day it is today. Look, Julie, I’ve got your chair waiting right here so that you can help us with the calendar. This type of approach is often more successful than a direct negative comment, such as, Julie, I told you to sit down! Students often feel more in control when they are redirected because they do not perceive your comments to be a direct request.

Reward Desired Behavior

It is very important to let students know when you are pleased with their performance. Be sure to praise them when they have stayed on task and followed directions. Make it clear exactly what behavior you liked, or did not like; for example, say, Ben, I’m glad you remembered to wait quietly at the table when you were finished. That was great! or It’s too bad you didn’t follow directions. Now you won’t be able to earn free time. Remember that it is important to communicate the consequences of a behavior ahead of time whenever possible. Simply saying good job or good boy does not give the student enough information. In addition, when behavior is specifically labeled, it can be a model to other students.

Calendar systems (which will be discussed in the next chapter) are an effective means for a child to learn about natural consequences. It is desirable to plan schedules in a way that favored activities follow those which are less enjoyable. If, for example, a child knows that music time (a preferred activity) follows physical therapy (a nonpreferred activity), he will be more motivated to cooperate during his physical therapy session.

Establish Meaningful Consequences

Choose consequences that will be meaningful to the individual student. Consider a child’s developmental level, her physical abilities, and her interests when deciding upon a consequence. For example, a child who is totally blind may not be motivated by earning a sticker. Similarly, a student who would rather talk to herself than participate in group activities will probably not feel punished if she is removed from the group for negative behavior. Moreover, a child who cannot see may not even realize that she has been pulled away from the group or that her chair has been turned around.

Many students with multiple disabilities need immediate consequences that are directly related to their behavior at the time. For example, if a child misbehaves in swimming on Monday morning, it would not be appropriate to tell her that she will not be able to go on the class field trip on Friday afternoon. First of all, Friday is too far away, and second, the field trip has nothing to do with the pool. A more appropriate consequence may be having to get out of the pool early. It is necessary to analyze meaningful consequences for each learner (for example, getting out of the pool early may actually be desirable for some).

Follow Through with Consequences

Do not threaten students with consequences that you do not plan to enforce. A student will learn quickly if an adult repeatedly says, This is your very last warning, and does nothing when the student persists in the behavior. In addition, it is usually best to deal with any situation yourself, rather than to threaten with a third party who is not present. For example, if a student acts up and the teacher says, Do I need to call your mother and tell her about this? the student is getting the message that the teacher is not able to handle her behavior. Although there may, of course, be times when a parent should be informed of a child’s behavior, telling parents should not replace dealing with the child directly when a conflict occurs.

Summary

This book is meant to be a model to use as a springboard to develop ideas and create activities for your own students. No rigid formula is appropriate for all students, and each student’s individual needs must be the focus of any educational program. Although specific methods and materials may vary, the goal is the same: to teach students functional skills that will enable them to be happy, to have friends, and to be active participants in the flow of everyday life.

Chapter 2

chapter 2

Foundations of Learning: Language, Cognition, and Social Relationships

by Charlotte Cushman

Chapter 2 Contents

Introduction

Social Relationships Are the Foundation of All Learning

Exposure to Language

Conversational Dialogue

Creating a Dynamic Learning Environment

Accessing the Environment

Modes of Communication

Setting Up an Object Communication System

Additional Strategies to Encourage Communication

Suggested Materials

Developmental Screening Checklist:Language, Cognition, and Social Relationships

Additional Resources

Tools for Assessment

Introduction

Vision and hearing play a critical role in the development of our social relationships and in the formation of concepts about the world around us. As a baby watches passively from an infant seat or high chair, he is beginning to put order to objects and events long before he will fully participate in the daily routines of life. During this same period of a child’s life, parents and caregivers respond to the child in ways that make him feel safe and secure. A reaction to a cry, the natural imitation of the child’s often random sounds, and the exchange of looks are examples of the rhythm of interaction that develops an emotional attachment. This bond is the basis of social and communication development.

Day after day, by watching and interacting with parents and caregivers, the child begins to develop memory, understand important concepts, and build social relationships. For the child who is born with a visual impairment and additional disabilities, these opportunities for early bonding and communication experiences are lessened. She cannot exchange eye gaze and may often receive distorted and fragmented information about the world that surrounds her. For example, as a sighted child watches his mother prepare breakfast day after day, he begins to remember that the cereal is stored in a specific cupboard, the milk is kept in the refrigerator, the bowls in another cupboard, and the spoons in the drawer. The concepts of object permanence, sequencing, anticipation, and knowledge of object function are all developing, even though the child may not seem to be involved at all. For the child with a significant visual impairment, however, the experience may be limited to the spoonful of cereal touching his lips. Likewise, the child who is visually impaired may express happiness in a different way than other children (e.g., through hand or leg movements), and these expressions often go unrecognized, diminishing the desire of others to sustain social interaction.

Specialized early intervention services can help families recognize and encourage the development of important social, communication, and cognitive skills. However, even with the most earnest efforts on the part of the family to create meaningful social interactions with their child and to provide him with firsthand experiences of the world that surrounds him, the child who is visually impaired and has