Harmonious Interactions

by National Center on Deaf-Blindness on Nov 10, 2017
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Practice Perspectives - Highlighting Information in Deaf-Blindness Number 1, June 2007

We all need close connections with other people - the good feeling of being with someone who understands you and with whom you can share experiences and emotions. When people interact harmoniously, their attitudes and actions toward one another are comfortable and reassuring. Harmonious interactions are essential for all human beings, including people who are deaf-blind. They form the foundation of our well-being and quality of life.

Intervener interacting with boy

During childhood, particularly during infancy, harmonious interactions with primary caregivers are the basis for healthy social, emotional, and communication development. Children need these experiences to feel safe and gain confidence to try new things and explore the world. Making eye contact, reading facial expressions, and listening and responding to voices are important ways that children with normal hearing and vision interact with caregivers. For children who are deaf--blind, these senses are greatly decreased or absent. As a result, naturally occurring opportunities to interact with others are limited. Many children also have additional disabilities or health problems that create further barriers to interactions.

Dr. Marleen Janssen and her colleagues, researchers in the Netherlands, have studied the specific qualities of interactions that are important for children who are deaf-blind and have developed techniques to teach families and educators how to improve their interactions. They found that when family members and teachers make positive changes in their own attitudes and behaviors, children respond by interacting more positively. It is the adults who are mainly responsible for creating and maintaining harmonious interactions.

Importance of Harmonious Interactions

The studies by the researchers in the Netherlands build upon previous work by experts in the education of children who are deaf-blind.Over the years, many strategies have been developed to help children who are deaf-blind learn, communicate and gain access to other people and to the world around them. Good interactions are an essential part of these strategies, but families and educators often have serious difficulties in their everyday interactions with children who are deaf-blind. When hearing and vision are limited, interactions occur in a world of physical closeness and touch and require skills that do not come naturally to most people. Children who are deaf-blind often use their own unique communication signals, such as movements, muscle tension, postures, and gestures, which may be missed or misunderstood by caregivers.

Difficulty with interactions can cause emotional or behavioral problems. Children may become passive and withdrawn or develop self-abusive or aggressive behaviors. Poor interactions also hinder communication development. Dr. Janssen notes that harmonious interactions are essential for the development of communication and calls interaction, "the vehicle of communication."

Research on Promoting Harmonious Interactions

Man coloring with boy

Dr. Janssen and her colleagues conducted three studies involving a total of 13 children, from age 3 to 19, all of whom had combined hearing and vision loss that had been present since birth. Most communicated with their own unique signals and a few signs, objects, or gestures. The researchers used video analysis and individual and group coaching techniques to help parents and educators learn to: 
  • recognize a child's signals,
  • respond to a child in appropriate ways, and
  • make changes to a child's surroundings that encourage increased interactions.

Using what they learned from these studies and other resources, the researchers developed a system to classify the characteristics of interactions between children and adults. The training techniques developed by the researchers use this classification system and video analysis to (1) recognize problems with interactions, (2) identify specific behavioral and environmental changes that adults can themselves make to address those problems, and (3) evaluate the success of those changes.

Characteristics of Interaction 

  • Initiatives:
    Beginning an interaction or introducing something new during an interaction
  • Confirmations: Clear acknowledgement of the other person's initiative that allows the person to know that he or she has been heard

  • Answers: Responding positively or negatively
  • Turns: Taking a turn and giving the other person a chance to take a turn
  • Attention: Focusing on the other person and what they are doing, or on an object or action
  • Regulation of intensity: Maintaining balance in the tone of an interaction (children often do this by taking extra time to process information, or by turning away)
  • Affective involvement: Mutual sharing of emotions (often done through movement and touch with children who are deaf-blind)
  • Acting independently: Performing activities independently

Here is how one teacher learned to develop harmonious interactions with a student:

Kris was born deaf and with low vision. When he was ten years old, he became totally blind. His teacher was concerned because Kris was becoming withdrawn. She wanted to encourage him to become more involved in activities and improve his sense of well-being. Through the coaching process, the teacher learned to stay open and available to Kris without pushing, to give him plenty of time to start and participate in interactions, and to respond immediately to his signals. She learned to connect with Kris through touch in ways that were comfortable for him and that encouraged him to interact. She responded sensitively when he expressed both positive and negative emotions. Here are some of the ways that Kris and his teacher interacted. 

  • Initiatives: Kris would sometimes initiate interactions by reaching out to take his teacher’s hand or by giving her an object or making a gesture. One of the ways the teacher initiated interactions was to place her hands under Kris’s hands to communicate that she was listening.
  • Confirmations: When the teacher gave Kris a tactile symbol, he might show her that he noticed that she had done this by touching the symbol. The teacher would then touch the symbol again, along with Kris, to confirm his response.
  • Attention: During activities, Kris would show that his attention was focused on his teacher by placing his hands on top of his teacher’s hands to follow her movements. The teacher focused attention on Kris by turning toward Kris and making her hands available to him.

Over time, Kris’s interactions became more frequent and positive. He began to share his emotions with his teacher. He would take her hand to lead her to his favorite activities. He also began to more frequently use objects and gestures for communication without prompting.

Woman signing with girl

Like Kris, all children need harmonious interactions with the people who are close to them in order to learn and thrive, but interacting effectively with children who are deaf-­blind requires specific knowledge and skills.

Dr. Janssen’s research led to the development of a practical training program. Because each child is unique, the training is individualized, but it follows a specific process that includes assessment of the child, diagnosis of the problem (the interaction difficulties), use of individual or team coaching to solve the problem, and evaluation. Video analysis is an essential part of this process. It gives parents and educators valuable insights into their interactions with children who are deaf-­blind. The following CD-­ROM about the program is available:

Contact: Understanding of Specific Interaction Characteristics to Build Up Reciprocal Interaction with Congenital Deafblind Persons (Product #VD­2003, Vision Associates, Web: [Dr. Jan van Dijk materials]).

Texas School for the Blind and Visually Impaired has also developed an interaction training program for educators who work with children who are deaf­blind that is based on Dr. Janssen’s research and other resources. For more information about this program, go to;

Research Suggests That: 

  • Harmonious interactions provide the foundation for learning and communication.
  • Teachers and parents can improve the quality of interactions with children who are deaf-blind by learning new skills.
  • Video analysis is a powerful tool in the interaction training process.
  • When parents and teachers change their own attitudes and behavior, children use more positive interaction behaviors in response.


Janssen, M. J., Riksen­Walraven, J. M., & van Dijk, J. P. M. (2002). Enhancing the quality of interaction between deaf-blind children and their educators. Journal of Developmental and Physical Disabilities, 14(1), 87–109.

Janssen, M. J., Riksen­Walraven, J. M., & van Dijk, J. P. M. (2003). Toward a diagnostic intervention model for fostering harmonious interactions between deaf-­blind children and their educators. Journal of Visual Impairment and Blindness, 97(4), 197–214.

Janssen, M. J., Riksen­Walraven, J. M., & van Dijk, J. P. M. (2003). Contact: Effects of an intervention program to foster harmonious interactions between deaf-­blind children and their educators. Journal of Visual Impairment and Blindness, 97(4), 215–229.

Janssen, M. J., Riksen­Walraven, J. M., & van Dijk, J. P. M. (2004). Enhancing the interactive competence of deaf-blind children: Do intervention effects endure? Journal of Developmental and Physical Disabilities, 16(1), 73–94.

Janssen, M. J., Riksen­Walraven, J. M., & van Dijk, J. P. M. (2006). Applying the diagnostic intervention model for fostering harmonious interactions between deaf-­blind children and their educators: A case study. Journal of Visual Impairment and Blindness, 100(2), 91–105.

For additional resources and information, go to; (select Harmonious Interactions).

This publication was based on research by Marleen J. Janssen, J. Marianne Riksen­Walraven, Jan P. M. van Dijk, and Bernadette van den Tillaart. It was prepared  by Peggy Malloy, National Consortium on Deaf­-Blindness (NCDB), in collaboration with Marleen Janssen, Univer­ sity of Groningen and Viataal,Sint-­Michielsgestel, the Netherlands, and Craig Axelrod, Texas School for the Blind and Visually Impaired. Design and layout by Betsy Martin-Richardson, NCDB.

The purpose of NCDB Practice Perspectives is to expand and broaden the use of current information resources by developing easily understandable products with accessible formats.

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