Designate specific areas of the classroom to store belongings and to do regular activities

We all feel more confident when we are in familiar environments. When a child has poor or absent vision and hearing, this becomes even more important. Establish the child’s place in a classroom by designating a place where possessions from home are stored, specific activities take place, and where favorite materials can be located.  Make sure the child travels to these locations to complete the activity and, when possible, to gather materials.

This will help him feel more confident to explore the environment on his own and to be more self-determined in his choices about activities and interactions. Initially the child may need materials and activities to be nearby, especially if movement and travel is difficult. Extend the distances as the child gains skills and confidence in navigating his or her space.

Support the development of the child’s expressive forms of communication

Babies hear and understand a substantial number of spoken words before they actually begin to speak in meaningful words or phrases.  Children who are deafblind or have visual and multiple impairments are no different, except that they may have greatly reduced exposure to language or understanding of concepts because of their sensory deficit(s). They may also have little or no modeling of expressive communication forms that they can use, since use of speech and print aren’t in their skill set.

From the earliest ages, these children need significant support to develop their expressive communication skills. This begins by tuning into and providing consistent vocabulary for whatever forms their communication takes, beginning with the basic behaviors they exhibit. Parents do this with typically developing babies naturally.  They watch what the baby does with his or her body and guess at what might be going on. “Oh, you are hungry!” “I think that doggy scared you!” “You like bouncing!”

You may not know how to provide similar support to a child who is deafblind or visually and multiply impaired if you are not familiar with alternative communication forms.   Begin to respond by using simple concrete forms of communication (e.g., sharing a real object or mimicking the child’s actions) that let the early communicator know he has been heard. Respond as best you can to what you think is wanted or needed by providing the object or action. (e.g., give him the bottle, take him away from the scary dog, or express happiness and excitement with your movements.) 

If you know more abstract forms of communication, for example, a sign, gesture, or symbol, they can also be paired with what you do. The most important thing, however, is to recognize the movement, behavior, or action as an attempt to express a need or thought and respond without monopolizing the conversation (remember, serve and return). Watch and wait to see if the child has something else to communicate. Conversations without formal language sometimes require more time.

As the child begins to be more adept with various expressive communication forms, the need to pay attention, respond, and then give the child an opportunity to comment is critical. Take the time necessary for the child to share what he is thinking or feeling and supply language that may be missing in his vocabulary. Give names especially to emotions.

As much as possible, allow the child to make choices about activities and the daily schedule

A mark of independence for humans is the ability to make choices about activities and events that occur in our lives. When we don’t feel we have choices, this can become a source of stress. School settings, out of necessity, are often extremely regimented. Meals, recess, physical education in the gym, music in the music room, and therapies must be scheduled to keep things running smoothly for the majority of the children and staff.  However, when a child is in distress, they may not be able to follow the schedule easily on any given day.

It is important to understand that many of these children are delayed in their emotional and social development, despite having many skills that are near normal. They may lack the ability to self-regulate. They may lack the ability to sit in a seat, work with attention for more than a few minutes, and may easily become frustrated when asked to comply with instructions that they lack the confidence to complete. Think of a cranky two-year old in a grocery cart while mom is shopping…we know how challenging this activity can be for both parent and child.

When a distressed child is asked to complete a series of non-preferred activities or tasks, they may become resistant. If pressed to continue the activity, their resistance can escalate especially if it continues for any length of time. Conversely, if a child is enjoying a particular activity, leaving that activity before they are ready may cause problems. Providing choices as much as possible can help the child cope. 

While structure and routine help provide security to the child, flexibility with scheduling and activities can provide relief to a stressed child.  As much as possible, set up systems, such as calendars and choice boards, to allow the child to choose activities and the sequence of activities throughout the day. If the activity is not preferred, let the child schedule a preferred activity immediately following it. If a non-preferred task or activity must be completed, allow the child to complete it with minimal participation and for a shorter period of time before moving on to something new.

On the other hand, when the child wants to continue a preferred activity a little longer, allow that to happen while setting some specific limits. You may need to use tactile markers or other communication supports to track time or number of turns that will continue. This helps the child to emotionally prepare for the end of the activity and may make it easier to transition from the preferred activity. 

Most importantly, if the child is having a really bad day or is in great distress, don’t force the child to complete activities that will only cause behaviors to escalate. Allow the child the opportunity to reject an activity for the moment and let the child do something else. You can always come back to the original activity later.