Question #6
What are some methods for communicating with infants and toddlers who have both visual and hearing impairments?

Resources

        California Deaf-Blind Services, (1999). Creating a need to communicate. Fact Sheet. [Online]. Available. http://www.sfsu.edu/~cadbs/Eng019t.html

        DB-LINK (1999, July). The National Information Clearinghouse on Children Who are Deaf-Blind. [Online]. Available http://www.tr.wosc.osshe.edu/dblink/comm-bib.htm

        Mcinnes, J. M., Treffry, J. A. (1982). Deaf-blind Infants and Children: A Developmental Guide. Toronto, Ont.: University of Toronto Press

        SKI*HI Institute. (1993). A resource manual for understanding and interacting with infants, toddlers, and preschool age children with deaf-blindness. Logan, U.T.: H.O.P.E., Inc.

        Stremel, K. Schutz, R. (1995). Functional communication in integrated settings for students who are deaf-blind. In N. G. Haring & L. T. Romer (Eds.), Including students with deaf-blindness in typical educational settings. Baltimore, MD: Paul Brookes Pub. Co.
 
 

Synthesis of Information

Communication is the exchange of a message between two or more people. Everyone communicates in many different ways and for many different reasons. Communication can be expressive or receptive. Children who are deaf-blind may never learn to talk. However, they can express themselves to you. They can receive the messages you send, (Stremel, 1995).

A child with deaf-blindness is a unique individual with specific skills and needs. The combination of the vision loss with the hearing loss will affect the way he or she learns to communicate. For example, if a child’s vision is better than his or her hearing, a communication method should be used that depends on vision, such as gestures, signing, or possibly pictures. It is also important to use touch, smell, and taste to teach the child with deaf-blindness more about people, objects, places, actions, and relationships to people and things, (SKI*HI).

Communication with a child with deaf-blindness will mean:

• Responding to the child in a different way than would be expected with a child who can hear and see.
• Being close to the child, rather than trying to communicate from a distance.
• Touching the child to increase his or her understanding.
• Letting the child know that someone is there to communicate with him or her.
• Observing carefully to see all the ways the child is communicating.
• Using adaptations.
• Providing more opportunities for communication.

Depending on the individual child, he or she may need some adaptations to communicate, such as:

• Hearing aids or other sound amplifications, ( i.e.: sitting closer to the source of sound, using toys with sound, etc.).

• Glasses or other visual aids, ( i.e.: magnifying lens, bright colors, contrasting colors, line drawings instead of photographs).

• Tactile or touch adaptations, ( i.e.: toys that vibrate, velcro or other tactile materials attached to on/off switches or personal items).

Receptive communication is the process of receiving and understanding a message. It is difficult to determine how a child who is deaf-blind receives a message. Here are some ways to help a child understand messages. Always keep in mind, it is important that everyone uses the same cues with the child, and always use speech along with cues to describe what is happening.
 

• Environmental Cues – Cues that occur naturally within a routine activity and let the child know what is about to happen.

 
• Putting the child in the car seat to go riding.
• Putting a bib on the child before eating.
• Placing the child in his or her bed prior to sleep.
• Unbuckling the seatbelt prior to taking the child from a wheelchair or from a car seat.
• Placing a spoon with food on the child’s lip.
• Placing the child in a certain position to change his or her diaper.

• Object Cues – These cues involve giving the child an object, which is part of the activity, to touch or hold.

Object Cue                                   Meaning

• spoon                                                 eat
• bottle/cup                                          drink
• pants /diaper                                     change
• washcloth/sponge                                 bath
• stuffed animal/blanket                         bedtime
• keys                                             ride in the car
• swimsuit or swim ring float             swimming

• Touch Cues / Tactile Cues – These involve touching the child in the same way each time to let him or her know what is going to happen.

Some Possible Touch Cues                                       Meaning
Lightly stroke the child’s outer arm in an                        up
upward motion

Lightly tap the child’s bottom                                         down

Stroke the child’s hand from knuckles                             want more
to finger tips

Gently guide the child’s hand to push                                 finished
away the object/food, etc.

Gently rub between the child’s breastbone                             bath

Gently tap the child’s elbow forward                                     go

Tap both of the child’s lips twice with                                     eat
your fingers

Touch the child’s bottom lip and                                             drink
gently push up

Gently tap at the child’s waistband                                 change diaper

Gently stroke the child’s eyelids                                            bed/sleep
(this may be too intrusive for some children)

Lightly rub or tap the child’s lower shoulder                     bye/termination

Tap firmly twice on the child’s outer wrist                                 no
 
 
 

• Gesture Cues – These cues are body or facial gestures to help the child know what is going to happen.

• Shake an object to get the child to visually attend to it.
• Shake your head "No" when the child is doing something you don’t approve of.
• Open and close your hand when you want something from the child.
• Point to a person or a moving object to get the child to notice what you notice.
• Nod your head "Yes" when child wants something.
• Form a kiss with your mouth when you want to show the child affection.

• Picture Cues – These cues involve using photographs or line drawings of people, locations, objects, feelings or actions to give the child information.

• Manual Sign Cues – These cues involve using hand signals that stand for words. Tactile signing can be used, when the child understands the more simple cues of communication.

Expressive communication involves sending a message to another person to make something happen or stop something that is already happening. Children who are deaf-blind are able to express themselves in many different ways. Parents, teachers and caregivers must be responsive to their varied forms of communication, notice and encourage opportunities for expressive communication,(Stremel). Listed below are various ways a child with deaf-blindness can communicate presently, and also in the future.

• Communication by Recognition – Behaviors indicate an awareness that another person is present.

• Facial expressions

• Contingency Communication – These behaviors may not be intentional, but interpreted by others as communication.

• Vocalizations
• Body movements
• Switch activation

• Instrumental Communication – These behaviors are simple, non-symbolic behaviors directed towards another person, with the intent of causing the other person to act.

• Touch person
• Manipulate person (pulls hand)
• Touch object (touches keys to go for a ride)

• Conventional Communication – This level is still non-symbolic. The child begins to coordinate the use of objects and people.

• Extend objects (extends cup for more milk)
• Simple gestures (waves "hi"/"bye", gestures eat, shakes head yes/no)
• Pointing ( points to door to go outside)
• Two / three choice communication systems ( i.e.: uses eye gaze to look at one of three objects velcroed to a board, touches one of three switches for desired activity, etc.)

• Emerging Symbolic Communication – The behaviors used to communicate at this level become more abstract.

• Complex gestures (adding upon the gestures already acquired)
• Miniature objects ( small objects associated with an activity)
• Pictures and line drawings

• Symbolic Communication – A one-to-one relationship between the symbol and the object, person, or activity. The symbol stands for or refers to the real thing.

• Manual signs ( The Deaf-Blind Manual Alphabet, The Block Alphabet, etc.)
• Non-Speech symbols (Braille, written words)
• Speech (speech words, Tadoma)
• Electronic systems ( augmentative communication devices, computers with digitized speech)

Insights

Through everything I have read regarding communication, the reoccurring philosophy was that everyone communicates in many different ways and for many different reasons. Even though these children with this dual sensory impairment have been saddled with an insurmountable challenge, they can still learn to express themselves and receive messages.

Through communication, these children can make changes in their world, express their wants and needs, and make choices. And, through communication, we as teachers, parents or caregivers can teach a child to play, participate in daily activities, work, interact with others, and learn about their world.

Bibliography

        Huebner, K. M., Prickett, J. G., Welch, T. R., & Joffee, E. (1995). Hand In Hand: Essentials of Communication and Orientation and Mobility for Your Students Who Are Deaf-Blind. N.Y., N.Y.: AFB Press

        Mcinnes, J. M., Treffry, J. A. (1982). Deaf-blind Infants and Children: A Developmental Guide. Toronto, Ont.: University of Toronto Press

        SKI*HI Institute. (1993). A resource manual for understanding and interacting with infants, toddlers, and preschool age children with deaf-blindness. Logan, U.T.: H.O.P.E., Inc.
 

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