Supporting Learning and Development in Children Who Are Visually Impaired and Have Additional Disabilities
Although children with visual impairments vary widely in their capabilities and needs, in general, vision loss interferes with a child’s ability to obtain information from the surrounding world. When a visual impairment is combined with other disabilities, the child’s ability to obtain information and experiences that are beyond arm’s reach may be further reduced. Without the ability to observe objects and events at even a short distance, children’s understanding and development of concepts about these objects and events may be fragmented and incomplete. Visual impairment, therefore, can have a significant impact on a child’s knowledge of concepts and language.
Helping Your Child Learn About the World
Not being able to see objects can have an additional effect: It can reduce a child’s motivation to move and to explore, and this, in turn, can further limit his or her experiences. For this reason, children who are visually impaired and have additional disabilities need to be helped to explore the environment around them so that they can learn about the world and the way it works. Additional explanations given in a way the child can understand them, repeated explanations and experiences, the chance to touch objects and to have direct, if possible, hands-on, experiences with them, and extra time in which to explore and examine the environment are all important ways in which multiply disabled children can be helped to learn concepts and gain understanding. If you are the parent of a child who is visually impaired and has additional disabilities, there is much you can do to help your child learn.
Because the abilities and needs of children with multiple disabilities vary greatly, and also because every child learns differently, an individual approach to helping a child is essential. How much vision or hearing does the child have? Can he or she move easily and independently? Does the child have a cognitive impairment that may interfere with his or her understanding? The answers to questions such as these determine the most effective way of presenting information to the child. However, there are some principles that you, your family, your child’s teachers, and anyone else who works with your child can use that may be beneficial in helping her learn. Educational professionals who specialize in working with children with visual impairments and other disabilities will typically be familiar with these helpful and important concepts. Keeping these points in mind may help you in helping your child learn as well.
Consistency: When we know what to expect next, we’re more comfortable and more willing to take new risks. The world seems a predictable, orderly, safe, and knowable place. Having consistent routines for your child, such as a morning routine for getting dressed, a routine for eating breakfast, and a routine for shopping in the grocery store, in which the same things happen in the same order, helps your child predict what will happen next. If routines are consistent, then your child will have opportunities to practice the same skills repeatedly. It is through practice that your child may internalize—that is, learn, absorb, and truly understand—new things.
Natural environments: Children often learn best when things occur naturally. It’s not natural to have your child practice saying “hello” to someone by greeting your mother 10 times in a row when she stops by to visit. It will be more reinforcing to your daughter—it will give her the same message again and again—and help her remember what to do if she has a chance instead to greet 10 people she meets throughout the day.
Functional skills: For most children with multiple disabilities, a functional approach helps learning. Functional activities are activities that happen naturally on a daily basis and that your child needs or wants to do. For example, your daughter may be more motivated to learn to take a cup out of a cabinet if she knows that she is getting it to have a cup of juice, rather than taking a block out of a bucket for no reason other then to practice taking things out and putting them in. You may find it helpful to look for what motivates your child and to build on those opportunities. If she enjoys music, you might want to help her learn to operate the CD player by putting tactile markings on it so that she can find the “play” and “stop” buttons. Then you might want to label her CDs so that she can pick out the one she wants to listen to.
Age-appropriate skills: As your child grows older, it may become difficult to find activities that others her age are doing that she can do too. For example, playing board games, soccer, or surfing the Internet are things a typically developing 11-year-old might enjoy. But if your 11-year-old has a visual impairment, cognitive delays, and limited use of her arms and legs, she may not understand these activities. Instead, she might enjoy watching cartoons on television or lying on a vibrating chair or listening to music that a preschooler might typically enjoy. However, it’s important for her social development and acceptance by others that she have activities that interest her that are fitting for her age. Perhaps you can work with her teacher to locate some Internet sites that have music on them and have her use a switch to make the music play, or you might want to show her how to roll dice so that when others are playing board games, she can participate by rolling the dice for each player. Although she may be getting different things from an activity from others her age and might enjoy them differently, the essential point is that she is participating with them.
Teaching a skill across activities and settings: There may be so much for your child to learn that at times you may feel overwhelmed and unsure of where to begin. Rather than expect your daughter to do everything independently now, it might be helpful to pick one or two things to focus on with her and to work on these in many different activities and settings. For example, if greeting people using her augmentative communication device is a skill that you would like her to be able to do, try to make sure she has access to this device throughout the day so that she can greet classmates, the bus driver on your neighborhood route, and people who come into your home or whom she meets in the park. Focusing on a skill that she can use across different activities and with different people in different places is going to give her more practice.
Using vision skills in clusters: If your child has some usable vision, finding ways for her to use her vision meaningfully in activities that motivate her will help her learn to use that sense more effectively. To help her develop her visual skills, you might want to look for times during a routine when focusing in on visual information is useful to her in completing a task. For example, if your daughter enjoys going out with you to get a bagel and juice at a nearby shop, she can use her vision to locate the door of the store, focus on the handle, and then open the door. Once inside, she can scan the bottles in the refrigerated display to locate the one with the green label that has juice in it. After she focuses on the bottle, she can reach for and grasp it, practicing another skill and learning how to coordinate looking and reaching.
Partial participation: Partial participation means taking part in only one or some aspects of an activity. For children with multiple disabilities who may not be able to perform all the parts of an activity, doing only certain parts can help them learn new skills and feel good about themselves. Your daughter might, for instance, open the drawer to get out silverware, but you might be the one who reaches in and pulls out the spoons she needs to help set the table. Or perhaps she might independently carry the spoons to the table, but you would be there to guide her in putting one down next to each plate. She might not be setting the entire table independently, but she is doing part of the work on her own and part of it with your support. Some children with multiple disabilities may always need support in completing tasks such as dressing, eating, toileting, or bathing, but they can learn to do parts of these tasks so that they have a sense of participation and accomplishment.
Wait time and prompts: Pausing and waiting and observing are important concepts to remember when spending time with a child with multiple disabilities. Because a multiply disabled child may need considerable support and extra time to complete a task, many adults find it easier to jump in and do things for a child instead of waiting for the child to do it on her own. That might save time at the moment, but it prevents the child from learning or practicing how to do something and can help a child remain dependent on others rather than participating as fully as possible in everyday life. Your daughter may need your help to do a task, but if she knows you’re always going to do it for her, she may simply wait for you to do it. It’s therefore important to try to balance wait time and prompting—suggesting to her in some way that she ought to do something or respond—in order to help her do the next step. A good rule of thumb is to count to 10 when you’re waiting for your child to do something, such as pick a can off the shelf and put it in the grocery cart, put a quarter in a vending machine, or take her socks off. If she doesn’t do the task, you might want to prompt her verbally at first, perhaps by saying something like “Would you like to try to put that can in our cart?” If that doesn’t work, you might then try a physical prompt, such as touching her hand or another body part like her elbow. If after the physical prompt you don’t get a response, then you might want to help her complete the step in the task using either hand-under-hand or hand-over-hand guidance.