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History and Change in the Education of Children Who Are Deaf-Blind Since the Rubella Epidemic of the 1960s: Influence of Methods Developed in the Netherlands

by Dr. Jan van Dijk on Dec 30, 1997
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The approach to education of individuals who are deaf-blind has changed significantly since the rubella epidemic occurred in the United States and Western Europe in the early 1960s. This article examines how methods developed in the Netherlands influenced later theories and practices, and how those theories have evolved and changed over time (Deaf-Blind Perspectives Winter 1997-98 Volume 5 Issue 2).

Reprint permission, courtesy of Dr. Jan van Dijk, 2001

Dr. J. van Dijk
Instituut voor Doven

in collaboration with

Catherine Nelson
University of Utah

The approach to education of individuals who are deaf-blind has changed significantly since the rubella epidemic occurred in the United States and Western Europe in the early 1960s. Prior to the epidemic, only incidental successes in educating children who are deaf-blind had been reported. In the United States, Samuel Gridley Howe wrote in a detailed manner about his student, Laura Bridgman, and Anne Sullivan reported on the enormous educational progress of Helen Keller. In Norway, Ragnild Kaata, a deaf-blind student, was taught to talk, and in France, Marie Heurtin received wide attention for the level of language she was able to attain. This article examines how methods developed in the Netherlands influenced later theories and practices in the education of these children and how those theories have evolved and changed over time.

What Were the New Ideas?

Traditional deaf-blind programs were mainly geared to children who were thought to have what was considered good educational potential. The curriculum emphasized classroom activities (e.g., development of sensory motor skills such as sorting objects and matching) and above all, the development of communication. This type of program was not appropriate for the “new” population of deaf-blind. Particularly in the rubella population, traditional classroom activities were overpowered by the motor clumsiness of this population. Training of motor skills was a prerequisite to the development of any form of formal communication, be it fingerspelling, speech or signing. As research substantiated these observations, a program was developed with motor development as the central component. This approach was in line with the emphasis remedial education of that time placed on the development of gross and fine motor skills (Kephart, 1960; Bannatyne & Bannatyne, 1973; Bladergroen, 1971).

During the 1965 Kalundborg conference (Denmark), a film called “Motor Development in the Deafblind Education” was shown in which Jan van Dijk from Sint-Michielsgestel showed the beginning steps of deaf-blind education. Two parts of the film attracted wide attention. The young rubella population exhibited considerable delay in both their motor functioning and social skills. The majority of children in this group were withdrawn into their own body activities and therefore paid little attention to other people in their world including the teachers or parents who tried to come in contact with them. This was true both, of the children who were completely or almost blind and those with residual vision. There was, however, one way to successfully attract the children’s attention: joining in their favorite activities (e.g., moving hands in front of their eyes, rocking, jumping or spinning around). This “moving-acting together” as Van Dijk called it, was in sharp contrast to approaches practiced with persons with cognitive disabilities in which these activities were stopped by taking their hands away from their eyes or even strapping them down. The co-active movement approach advocated by Van Dijk caught on because of its approach of “joining in” with the child and following his or her attention and interest. It was truly a child-centered approach that included imitation of the child and giving him or her the lead, so he or she would not become totally dependent on the teacher’s activities. In the coming theories of child development, this approach was to be called “feeling of competence” meaning fostering the feeling in the child that he or she can have an influence on the environment instead of being completely dependent upon it. In co-active activities, the educator literally feels what the child’s intentions are. When moving and acting together the educator is able to perceive the topographically subtle intentive movements the child sends out and may act accordingly.

Attachment Theory

Modern insights into child development have shown how well chosen the ideas of co-active movement were. Currently, a well-researched theory, the Attachment Theory, is gaining wide recognition. It appears that if a child’s intentions, which may be subtly expressed through eyes, physical movements, and changes in breathing, are picked up on by the principal caregiver and responded to accordingly, the child will begin to feel that this is a safe person who can be trusted in times of need. In other words, a bond is established between child and caregiver which will serve as a “safe harbor” for the rest of the child’s life.


This idea of following the child’s lead and responding to his or her intentions has only gained in prominence over the years. The same can be said about another theme of the 1965 film made at Sint-Michielgestel. A scene is portrayed in which one of the finest teachers of the deaf-blind, Mary Jurgens, communicates with a nonspeaking, nonsigning, deaf-blind boy. Co-actively, they are making a doll out of clay. Together they roll a kind of sausage representing the leg of the doll. Then Mary guides the child’s index finger to point to the “sausage”, then to her legs and to his legs, and finally to the missing part of the clay doll. He understands it, and with her help completes the clay doll including its leg. A conversation has taken place through pointing and referring to the situation (missing leg). The teacher has made herself understood by guiding the situation in such a way that the boy had to understand her intent. He added his part in the conversation by putting the leg in the right place. This is exactly what Van Uden, meant by having a conversation with a speechless (and nonsigning) deaf-blind child (1967). His conversational method has always been influential, not only for deaf, but also for children with deaf-blindness. Important features in this method such as turn-taking, mutual gaze or the looking to things together (e.g., child and educator or child and parent), and the use of pointing (deixis) have been found to be essential elements in the development of language, as was demonstrated in research that came out many years later (Ninio & Snow, 1996; Preisler, 1983; Volterra & Erting, 1990).

It goes without saying that such conversations must have a subject. Children who are deaf or nonverbal with hearing can be very clear about what it is they want to communicate about. They may look towards things, move towards something, or bring an object to a person. Most children who are deaf-blind do not show their intentions so clearly. Therefore in the early Van Dijk theory, the topic of conversation was elicited by making the experience very concrete. If the child participated in an activity he or she enjoyed such as swimming, an object associated with this activity was presented. Through pointing to the object, gesturing, and in some instances talking to the child, the experience was discussed: “you” (pointing); “me” (pointing with the child’s finger and teacher’s body); “swimming” (pointing to the water wings); “you” (pointing); “splash, splash” (co-actively splashing). A model of the swimming pool might be present with chlorinated water in order to depict the situation as vividly as possible. These objects called “objects of reference” were, and are, intended to serve as a concrete aid for engaging in conversation with the child.

Objects of Reference

In his early work with deaf-blind children, Van Dijk and his coworkers stuck the objects of reference to wooden boards and sorted them according to conversation topics. Later the objects were also used to announce the activity (e.g., presenting the entire water wings or a portion to indicate actually going to the swimming pool). The use of the objects of reference for this function is now widely used with people who have all types of significant difficulties in communication. A group of special educators in the U.S. have expanded considerably upon the idea of the objects of reference. On a video tape, Rowland and Schweigert (1996) demonstrated step-by-step how the objects can be used.


From the same basic question of how to come into conversation with the child, grew the idea of calendars. By ordering the days/weeks/months according to their main activity and putting the objects of reference in the time order of the day/week/month, conversation can be enhanced. When the objects of a specific event are arranged in a box, they can serve as a support for the child’s memory of episodes in his or her life. In a true conversation, both partners play an active role. By the nature of his sensory impairments, a child who is deaf-blind must be introduced into a situation which enhances expression, either through touching the objects, pointing to them, or having them arranged in a way that represents what the child has experienced. This gives the child the chance to be an active participant, rather than a person who is simply handed objects and is then compelled to proceed to the activity the objects refer to.


Our Russian colleagues have made us aware of how objects of reference can be included into the development of play in children who are deaf-blind. Since the political barriers were eliminated, western deaf-blind experts have become aware of how much Russian deaf-blind education has to offer. The educational practices described here could be enriched by including play activities in a methodical manner. In the Russian method of deaf-blind education, one starts by depicting the child’s experience through the use of dolls. The child is asked to make compositions that resemble real life. Gradually, the teacher adds her part and together they move gradually away from the concrete reality into the world of fantasy in which accompanying language plays an increasingly important role. It is very important to note that Russian deaf-blind education has a strong social component. Its purpose is to have a group of students participate in the activities, asking one another about the experience his or her playmate has gone through. Eventually, the conversation is put into words, picture books (embossed), or in large print and these products are put on display in a central location, preferably a library so that other students can read the stories of their peers.

Social Relationships

Deaf-blind education in the Netherlands has always had a strong emphasis on the development of social relationships. Conversation, the major principle of working with deaf-blind children, was stressed from the beginning. Social relationships are an integral part of conversations between communication partners. However, in some instances, despite intervention by the teacher or caregiver, the child might be unable to play his or her conversational role. In order to prevent the fragile relationship from going astray, the educator might be forced to prompt the child with an object indicating that he or she wants the child to participate in an activity. This may lead to a one-sided, teacher-oriented approach that may be socially undesirable, but necessary. Sometimes this situation arises because the educator lacks the skill to engage the child in meaningful communication and then overlooks the child’s communicative intents for the sake of her own dominance. The theory itself, however, is not responsible for such poor implementation.

Over the years, we have become very aware that it takes good on-the-job supervision and carefully planned training to develop true conversational skills in educators. Present research should be continued to develop teacher training and corresponding parent programs to address this need.

Questions Remain

While parts of our original theories have evolved over time, it can be stated that a number of principles of deaf-blind education developed in Europe still hold and are even stronger as many have received support from developments in the scientific field of early childhood and early language development. Far from anecdotal are the comments of teachers of the deaf-blind all over the world who have put our ideas into practice: “It really worked!” There are, however, a few points that continue to need evaluation:

  • The role of sign language in deaf-blind education
  • The role of the parents in the decision-making process
  • The role of inclusion.

The Role of Sign Language

In early educational programming, the development of “private signs” created by a child was encouraged. This might be a simple hand movement to indicate a wish to switch on the fan or a finger movement to express the desire to continue playing the drums. It was stated as early as 1967 by Van Dijk that the private signs that the child developed himself could be expanded to signed Dutch (Van Beek system). He supported the idea of replacing the signs with fingerspelling or even speech using the Tadoma method. Fingerspelling was encouraged because at that time it was felt to be superior to signing. These views have changed dramatically. It is understood now that sign language is a true, and very effective, language for deaf persons and probably for individuals who are deaf-blind. It was decided fairly recently that the use of sign language for deaf-blind children should be considered as a real option. When the child has sufficient vision, signing can be presented visually, and in cases of blindness or decreased visual capacity (e.g., in persons with Usher Syndrome), tactual signing should be offered at a fairly early age since the earlier this language is used, the better the person’s command of sign language will be.

The Role of Parents

In discussions of which language code to use or whether or not to send children to residential settings, the role of parents in some European countries has lagged behind British, Scandinavian or United States counterparts. In these countries, parents have shared in IEP (Individual Education Program) meetings and have had a decisive voice in educational programming for quite some time. In the United States, parents and their young children who are deaf-blind begin receiving assistance and early intervention as soon as the disability is identified. When the children are old enough for preschool, parents have already gained a great deal of knowledge about the needs of their children and have much to offer as educational decisions are made. Although times are rapidly changing in Europe, too little attention has been given to parents who do not want to send their children away and prefer to educate them with necessary help at home and in their neighborhood school.

The Role of Inclusion

Increasingly, parents want their children educated in the regular classroom with nondisabled peers. The idea of including children with the most severe disabilities in regular education classes is a topic of hot debate in the United States. Is it really effective? Can we really require that a regular education teacher develop the skills to successfully interact with, and teach, children with all different types of disabilities? It is too simple to reject the inclusion movement as a nonrealistic dream. There is ample research showing that simply through observation of their nondisabled peers, children with disabilities can learn social, play, and communication skills. In the coming period, this issue should be looked upon seriously and not rejected out of hand. Types of supports needed by children who are deaf-blind to ensure that learning is enhanced in regular classrooms must continue to be researched as to their efficacy and when and how they should be used. Such supports might include the intervenor system as was developed in Canada and technological advances such as augmentative communication devices and devices for individuals with low vision.

In the early days of deaf-blind education in Europe, as well as in the United States, strong emphasis was placed upon the distinction between educable and trainable children. In the Individuals with Disabilities Education Act (IDEA) in the United States, this distinction is no longer mentioned. All children regardless of their mental and/or physical impairments including combined sensory loss must receive adequate services. The system of consultation is widespread in the United States and a deaf-blind consultant assesses the child and contributes to the IEP and subsequent intervention plans regardless of the level of the child’s functioning.

In some European countries, deaf-blind children in institutions for the mentally handicapped receive very inadequate services. Fortunately, it can be said that this is changing rapidly. However, some countries have been slow to admit that the quality of life of children with severe mental disabilities in combination with sensory impairments can be improved significantly with proper intervention. If outcomes for children with such impairments are to improve, government agencies and educational decision makers must be made aware of the right of all persons to the highest possible quality of life and what must be provided in order for them to achieve such a life.


Through the collaboration and sharing of knowledge of many countries, successful methodologies to teach individuals who are deaf-blind have increased rapidly since the time of the Rubella outbreak. This knowledge has successfully been disseminated to many educators around the world. Such collaboration must stay alive as we address new challenges with a low-incidence and ever-changing population who have demonstrated over and over to us that they can learn when given proper intervention.


Bannatyne, M., & Bannatyne A. (1973). Body-image/communication: A psycho-physical development program. Rantoul, IL: Learning Systems Press.

Bladergroen, W.J. (1971). Motor development and learning disorders. In Deaf-Blind Children and their Education: Proceedings of the International Conference on the Education of Deaf-Blind Children at Sint-Michielsgestel (the Netherlands). Aug 25-29, 1968. Rotterdam University Press.

Kephart, N.C. (1960). The slow learner in the classroom. Columbus: C.E. Merrill Books. Ninio A., & Snow C. (1996). Pragmatic development. Boulder, CO. : Westview Press. Preisler, G. (1983). Deaf children in communication: A study of communicative strategies used by deaf children in social interactions. Stockholm, Sweden: University of Stockholm Institute of Psychology.

Rowland C., & Schweigert P. (1996). Tangible symbol systems. [video] Oregon Health Sciences University - Portland Projects. Available from Communication Skill Builders, 555 Academic Ct., San Antonio, TX 78204-2498, (800) 866-4446.

Van Uden, A. (1967). A world of language for deaf children. Amsterdam: Swets & Zeitlinger.

Voltera, V., & Erting, C. (1990). From gesture to language in hearing and deaf children. Berlin: Springer-Verlag.

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