1. Identifying and Supporting Infants and Toddlers with Multiple Disabilities, including Combined Vision and Hearing Loss
Connections Conference New Orleans, LA - August 25, Barbara Purvis, M.Ed.
Barbara Purvis, M.Ed.

2. Outcomes Increased knowledge of
Risk factors associated with combined vision and hearing loss
Impact of combined vision and hearing loss on early development
Strategies to improve developmental outcomes
National and state resources

3. Early Child Development Basics
Sensory Exploration
Movement
Incidental learning
Hands-on activities
Repetition
Trust & security
Asking questions

4. Learning Needs of Basics for Children with Combined Vision and Hearing Loss
Trusting relationships
Hands-on experiences
Active movement and exploration
Predictable, accessible schedules
Repetition and consistency
Use of residual hearing and sight
High expectations
Communication, communication, communication!

5. Considerations for Learning
Anticipation – what is going to happen to me, where am I going, who is with me Motivation – isolation/withdrawal, lack of interest in environment and people, limited exploration Confirmation – this is how things work, when I do this…this happens, this thing does this action, this facial expression or tone of voice means this Concept Development – objects exist, have names and characteristics, have functions or use

6. Concepts How we connect meaning to objects, events and people
Foundation for literacy and abstract learning
Categories
Concrete
Semi-concrete
Abstract

7. Concept Development: Objects
Objects exist
Objects have permanence
Objects differ
Objects have names or labels
Objects have characteristics
Objects have functions or use
Project SPARKLE, 2006
SKI-HI Institute, Utah State University

8. Concept Development Children need: Hands on experiences
Shared experiences
Thoughtful presentation of experiences that “enable them to develop a gradually expanding view of the world.”
Information, materials, and experiences presented in multimodal formats
Miles, B. & McLetchie, B. (2008). Developing Concepts with Children Who Are Deaf-Blind. Monmouth, OR: The National Consortium on Deaf-Blindness.

9. Concept Development Providers need to: Adopt a holistic approach
Attach language to all experiences
Build on vocabulary already known by child
Use communication appropriate for the child
Remove variables that may cause confusion for the child
Generalize concepts to varied situations
Ensure consistency among team members .

10. Basic Intervention Strategies
When approaching the learner, always let her know you are there
Identify yourself to the learner every time you are with her, even if she has partial sight
Always let the learner know what is going to happen next
Use TOUCH CUES
Use OBJECT CUES

11. Basic Intervention Strategies
Whenever possible, allow the learner the opportunity to make choices in an activity Utilize a tactile cue to let the learner know when you are available for interaction Find a way to always let the learner know when an activity is finished Always let the learner know when you are leaving

12. Strategies for Learning
Greeting/Leaving Rituals Touch Cues Hand Under Hand Active Learning Wait Time Routines Calendar System

13. Greeting and Leaving Rituals
For each person who interacts with child
May be an activity or a unique identifier
Use them EVERY time
Child needs them as well – it’s what people do!

14. What is a Touch Cue?
A TOUCH CUE consists of tactile contact, made in a consistent manner directly on the child’s body, to communicate with her.

15. Role of Touch Cues Alert child that something will follow cue
May reduce startling, challenging behavior
Help focus attention on interaction or event that follows
Develop anticipatory responses
Help children make sense of their day

16. Impact on cognitive & communication skills
Cognitive processing
Message received & understood
Memory of previous event
Association made between two actions
Receptive communication
Remembered & recognized your signal
Responds to cue
May try to assist or engage more fully
Indicates readiness for more!

17. Examples of Touch Cues
Tapping the child’s bottom (in supine) - “I’m going to lift your hips” (for diaper change) Gently pulling up on the child’s upper arms - “Get ready to stand up.” Touching the child’s left elbow - “This is the way I say ‘HI,’ so you know who I am.” Touching the child’s ear- “Time to put your hearing aids on.”

18. Hand-under-Hand
A strategy where the learners’ hands are gently guided from underneath, which allows them to explore and participate as they choose.

19. Why use Hand-under-Hand?
Allows hands to be free
Allows hand to be used at the learner’s discretion
Allows hands to be used for: protection, exploration, self-stimulation, performing functional skills
Hand Over Hand as a teaching strategy is often aversive, and may not respect the learner’s preferences.

20. Why use Hand-under-Hand?
Access to ways people use hands Spatial awareness through tactile experience Encourages authentic involvement Stimulates curiosity Preparation for tactile signing

21. Strategies for Using Hand Under Hand
Guide child’s hands from underneath
Invite child to “watch” while partner uses their own hands
Offer an “invitation” to join an interaction
Follow child’s lead to engage in exploring objects
Honor the request, if child pushes partner away
Look for opportunities to build in communication

22. Active Learning Child is the ACTIVE one!
Emphasizes items or activities with sound, tactile elements, movement
Provides security and safety
Encourages movement & exploration
Maximizes engagement & participation
Promotes memory & autonomy
Demonstrates that everyone can learn!

23. Responsive Environments
Encourage discovery and practice
Offer immediate feedback
Provide sense of familiarity and control
Assist in cognitive development
(Object permanence, visual memory, cause/effect, properties such as size, weight, temperature, texture, sound, color…)
Examples
Lilli Nielsen’s “Little Room”
Resonance board
Stay put play spaces
Create your own!

24. Resource: Stay Put Play Spaces

25. Wait Time
Children with combined vision and hearing loss need more time to process information
Amount of wait time depends on child’s physical challenges and communication level
Consider the pace of your interactions
In most cases – SLOW DOWN!
Illinois, Project Reach 2010

26. Wait Time Watch for anticipation of next step
Pause within a familiar routine
Watch for anticipation of next step
Watch for movement, body posture, facial expression, gestures and vocalizing to indicate desire to complete an activity
Illinois, Project Reach 2010

27. What is a “Routine”? Outcome oriented Meaningful Predictable
Beginning and ending
Outcome oriented
Meaningful
Predictable
Sequential or systematic
Repetitious
Family Guided Routines Based Intervention,
Florida State University, 2014

28. Why are routines important?
Predictability
Provide security
Decrease stress
Anticipation
Sense of control

29. What are the steps in a routine?
Initiation
Preparation
Core
Termination

30. How can routines be used to improve communication skills?
Put meaning to actions & provide vocabulary Introduce new vocabulary in advance Expand related vocabulary Teach concepts associated with routines Pair words with next level objects or symbols Use “conversation boxes” Introduce new partners & topics

31. Daily Preschool Schedule using Object Cues
Calendar Systems
Anticipation schedules
Daily schedules
Daily Preschool Schedule using Object Cues

32. Anticipation Schedule
Introduction to calendars
Represents a single activity
Develops understanding that activities can be represented by symbols
Can explain changes in a routine, activity or schedule
Provides sense of security
Introduces concepts of past & future

33. Creating an Anticipation Schedule
Need two distinctive containers
One for “NEXT”
Another for “FINISHED”
Select an object close (in time and space) to activity
Present to child to build association
Post written list of what each object represents
Can be expanded to 2-3 activities

34. Anticipation Schedule Example
“Finished” bucket
Actual object represents activity
Colored electrical tape delineates edges
and draws attention to object

35. Anticipation Schedule Example
Tactile symbol mounted
on lightweight wedge
Finished bucket is attached to side of wheelchair tray
Adapted for limited range of movement

36. Questions Section Four

37. Resources National Center on Deaf-Blindness
Website: nationaldb.org
Phone: (503)
The National Family
Association for Deaf-Blind
Website: NFADB.org
Phone: (800)

38. Resources NCDB Literacy Website http://literacy.nationaldb.org/
Home Talk: A Family Assessment
Washington Sensory Disabilities Services
Deaf-Blind
Video Topics
Perkins School for the Blind
Teaching Resources
Webcasts

39. What should I do if I Suspect combined vision and hearing loss
What should I do if I Suspect combined vision and hearing loss? Want to learn more? Would like help for a child, family or team?
CONTACT
Michael Norman, Project Coordinator
Louisiana Deafblind Project for Children and Youth
LSU University Human Development Center