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An Educational Curriculum for Deaf-Blind Multi-Handicapped Persons
From Sensory Impairments in Mentally Handicapped People, Edited by David Ellis, 1986. London and Sydney: Croom Helm Publishers.
Reprint permission, courtesy of Dr. Jan van Dijk, 2001
Dr. Jan van Dijk
The Target Population
It is my intention in this contribution to write an outline of a curriculum for severely sensorily deprived children, i.e. deaf-blind children. `Curriculum' means a specific course of study (Webster, New Twentieth Century Dictionary). In order to make this course of study meaningful, I should first try to describe the population which has to be educated by means of it. In my long career in the field of the education of the severely handicapped child I became very aware of the unique status of the child who is deprived of hearing and sight, from birth.
An organism so deprived of the main natural channels of stimulation, responds to such a condition in a very strong way. One can observe how such children try to overcome their loss of vision by pushing on their eyeballs, by staring into the sun or another strong source of light, while moving their hands in front of their eyes. I have explained these stereotyped behaviour patterns as a reaction to sensory loss (van Dijk 1982).
It is noticeable that when these children meet a person, they try to climb on his body and they want to be carried around. When nobody is around it is sometimes observed that a child makes `jumping' movements on a windowsill or similar objects. From the deprivation theory I have developed, this behaviour might be explained in terms of lack of mothering. When given an unknown object it is quite possible that the child hardly explores it, but either uses it as an extension of his/her body (e.g. by moving it in front of his/her eyes) or throws it away. This child is not curious and not aroused by the novelty of the new toy.
In developing a curriculum along gross lines, the type of child on whom I focus is one who is sensorily, emotionally and intellectually deprived of all adequate stimulation.
The aetiology of the children I have in mind is mainly congenital Rubella, but professionals dealing with children who have suffered a multiple sensory loss because of Cytomegalovirus infection (Hanshaw and Dudgeon 1978) or other types of infection in early pre-natal development, may find similar behaviour in these youngsters.
Our Educational Approach
If my deprivation theory is accepted, the educational approach we have employed during the past two decades becomes rather plausible.
An Educational Curriculum
Descriptions of this theory can be found in Tervoort, van de Geest, Hubers, Prins and Snow (1972), Robbins (1977), Cardineaux, Cardineaux and Lowe (1981), Hammer (1982), Hewitt (1982), Coll, Dumoulin and Sourion (1983) and Cardineaux (1983).
A child deprived from birth of his senses of hearing and sight, however partially this might be, tries to make up for his sensory loss and, in order to keep his damaged organism in balance with the environment, exhibits the types of stereotypic behaviour I have described. This balance is very delicate between the child and his environment. When there are minor changes, the child might be already very upset or over-aroused (Berlyne 1960; Hutt and Hutt 1965). This may lead to head banging, biting own lips and fingers, or hours of endless crying.
The first demand of an educational programme is, therefore, that all people in the child's environment try to understand, i.e. try to `read', the child's behaviour. This requires that only people who are familiar with the child's behaviour and who are very sensitive towards his needs will be able to accomplish something positive. When the child bites his fingers one day more than he did the previous one, this behaviour might be interpreted as due to lack of attention given to the child on that particular day. When the child cries for a long time, he might be suffering from his separation from home. When the child pokes his eyes more often than normally, his environment might be too complex for him. By means of his behaviour, however difficult it might be to interpret it, the child signals his needs. The steps the teacher should take depend a great deal on a child's temperament. When the child is over-excited, the teacher might give him a bath where he can relax. When the child is in a state of under-stimulation, the teacher might decide to give him a massage with body cream or carry him around and soothe him.
In the educational atmosphere I describe, the child holds the central position, the teacher `follows' the child and, when the child responds, the teacher is present to answer the child's request. In terms of `learning theory' (Bandura 1969), I am more in favour of a curriculum based on the principles of operant conditioning than on a strict S-R model. In the latter it is always the teacher who wants the child to carry out activities, which often the child does not like. I refer to activities such as matching exercises, pegboards, stringing beads, etc. In responding to the child, we aim to develop in the child the very important feeling of mastery and competence. The child should feel that he is not at the mercy of his environment, but that he is able to control it, to influence it. It has been shown (Stephans and Delys 1973) that the expectation of a child that he can influence his situation leads to more interesting learning. By the same token, if the teacher responds appropriately to the child (response-contingent stimulation, Main 1975), the child will not only show more pleasure in his activities, but will also attach himself to that person (Ainsworth and Bell 1974; Bowlby 1979).
In our ideas on the education of severely sensorily impaired children, development of attachment has become a more and more vital issue. We consider it as the basis for learning. In the process of bonding, vision plays a dominant role, as can be clearly observed in attachment characteristics such as smiling, stretching out the arms when a familiar person approaches the child, and eye contact (Tait 1972; Fraiberg 1975). It is logical to assume that this process develops much more slowly in a completely deafblind child than in the child with residual vision.
Our program of stimulation of attachment can be divided into three steps (see van den Tillaart 1985).
Co-active Movements and Responsiveness
Co-active movement means that the teacher `joins-in' with the activity of the child, e.g. if the child wants to jump, the teacher jumps with him. Daily living activities, especially, give ample opportunity for doing things together (washing the face, brushing teeth, pulling on the socks, etc.). By adequate reaction to the child's co-operation, however minor this can be, an atmosphere of security and confidence will grow. This procedure has been nicely described as our `hands-on' method because often one has to lead the child's hands through all these activities. The child will become more active himself, when the same activity is repeated day after day, in the same situation, by the same person. We call this:
Structuring the Child's Daily Routine
It has proven a fruitful approach when the day of a multiple sensorily impaired child is built around some important activities, such as taking a bath, mealtime, preparing a snack, going to the swimming pool, preparation for going to bed, etc. By structuring these daily living routines, one builds up a `chain of expectancies' (Vygotsky 1983). After such a chain is established (e.g. taking the toothbrush, putting paste on the brush, etc.), one leaves out a vital element (e.g. the cup of water). At that moment it is quite possible that an orienting reflex wilt arise (Berlyne 1960; Mescheriakov 1962). The child will look for the cup, and lead the teacher's hand to the shelf where the cups are kept. Responding to this may establish the bond between child and teacher.
Another important element in the bonding process is that a person who is assigned to the child comes to be recognized by a special characteristic. This can be, for instance, the teacher's ear-ring. When that particular person comes on duty she refers to her body, leading the child's hand over her face, arms and legs, but finally she leads the child to her ear-ring. Immediately after this, they carry out a favourite activity, e.g. jumping on the bed. After this association is established, the ear-ring might be used as an indicator for that particular person. She announces herself by placing the ear-ring in the child's hands. Using this procedure in characterizing special persons, we were able to help the children to differentiate between people. Using a pipe, a particular child got to know his father, a scarf indicated the mother, a small bowl the young sister. These transitional objects are very important in helping the child to overcome separation anxiety, e.g. if he has to live in residence. After the child has associated `scarf with his mother, we use this object in preparation for going home. We have made the following arrangements for this system: every day of the week is indicated by a special box. In the box the `highlight' of that day is indicated by an object. (When there is swimming on Tuesday, the trunks will be in the `Tuesday' box. When the child goes home on Friday, he will find mother's scarf and father's pipe in that box.) The boxes (called memory boxes, see Jurgens 1977) are lined up and, by referring every day to the `Friday' box with the parents' attributes, one is able to maintain the child's memories of his parents during the weekdays. We have found this a very good method of stimulating attachment behaviour. In order to be successful, however, one should take the child's developmental level into consideration. A child who has not reached the level of object and/or personal permanence is not ready yet for this type of work.
When the child has residual vision, as many of the so-called deaf-blind children have, one can use drawings of the favourite persons, or photographs as `objects of reference'. We have found that drawings are often more valuable, because this activity can be carried out together with the child and the characteristic element, e.g. an ear-ring, freckle on the nose, can be emphasized.
Development of Communication
In the educational approach to severely sensorily impaired children described above, the development of a relationship between teacher and child is essential (see also Stillman and Battle 1984); the context in which communication takes place is constructed in the following ways.
By means of structuring the daily activities around `highlights', the child may anticipate the coming events. In this anticipatory situation the child might initiate a signal himself, e.g. if he wants water in the bathtub he might touch the faucet. This touching movement is reinforced by turning on the water. From that moment the teacher accepts the child's signal. At the next bath time the teacher first waits to see whether the child will make the signal again. If the child does not produce the signal, the teacher may initiate it by taking the child's hand.
There are some children who will hardly ever take the initiative for making a signal to satisfy certain needs. In these cases the teacher has to invent a signal and lead the child. The most effective signals are those which are centered around the body. We have found that tapping on the mouth for food is an `easy to learn' signal; so are: tapping on the breast for going out (buttoning the coat); moving both hands vertically down the body (taking off pants); horizontal movements in the mouth (brushing teeth); vertical movements on the child's body (washing).
It is important that for this type of child the gestures are easy to execute. Therefore it is more appropriate to start with the communication gestures within the motoric competence of the individual child. The objection that different gestures are used in each unit, ward or home is not relevant. The number of gestures in the initial stage are so limited that they can easily be learned by the staff. More important is that the child gets the notion that with relatively little effort he is able to signal his basic needs to his environment.
In the development from signal to symbol it is important that the child discovers the similarity between the gesture and what it depicts, e.g. between `hands making a sliding movement' and the activity of playing on the slide. Whether or not the child discovers this similarity is largely dependent on his intelligence.
The basic steps in the development of communication as described above are in line with the levels in the evolution of the human forebrain. In human ontogeny the first signals are manual gestures, which the infant makes to satisfy affective needs. Gestures develop first because neo-cortical components of the pyramidal motor systems that control hand-arm activity, mature first (Lamendella 1977, p. 195).
Use of Drawings
The development of these signals can be stimulated by drawings in the case of residual vision. Some visually deprived children seek visual stimulation continuously. To watch the drawing activity can be a rewarding experience. Making a drawing of an activity for which the child already has a sign, often helps the child to memorize the sign better. It has been found that even for severely intellectually retarded sensorily impaired children (< IQ 50) these drawings can be schematized, e.g. for indicating an eating situation one does not need to draw a plate, sandwich and cup, but only a circle for a plate, or a rectangle indicating a sandwich. This is an important step, because if the child understands these schematized drawings, they can he used to explain more complex situations, such as the number of events which take place on a particular day (see Leygraaf 1985). For a totally blind child a number of schematized objects can serve the same purpose (see Jansen 1985). With the introduction of schematized pictures we come very close to Bliss symbols (Bliss 1965) and Rebus Reading and Premack symbols (Clark and Woodcock 1976). However in our system the picture and its schematization (until it becomes a pictogramme) is a process which is led by the child. For example a picture of a slice of bread meaning breakfast, is reduced by the child to
What was initially a drawing of a complete deer, to represent `going to feed the deer', ended in just characterizing the most striking part: the antlers
Picture language is often conceptually simpler than signs (Murphy, Steele, Gulligan, Ycow and Spare 1977; Lancioni 1983) with which many children have difficulty, because of severe motor problems; we have called this `dyspraxia' (van Dijk 1982; van Uden 1983). The pictures do not have to replace the signs, but can be used together with them. We have evidence that pictures support the recall of the signs. For some children also, a particular colour of the drawing can be helpful, as can adding the written word to it. We do not know to which stimulus a child responds, but the impression is that the different representations (sign, picture, written word) have different origins and course of development (see also Stillman, Chapter 15, this volume). By the same token we add the spoken word as well in case the child has useful residual hearing. In some instances even vibro-tactile stimulation, the so-called Tadoma-method, can be added. We consider the information coming from the different sources to he additive, i.e. the information coming from different sources is processed independently from each other (Morton 1969). The ideas, wishes and needs the child expresses during interaction are `written' down in a special book, in which the day of the week on which the conversation took place, might have a particular colour. This entry is an extremely important source for the child as a reference book allowing past and present experiences to be linked together. For a completely deaf-blind child, books in which the schematized objects are fixed can have the same purpose.
To facilitate the use of gestures by the child, emphasis should he placed on imitation, especially of body movements. This process originates in the so called resonance phenomenon. This is that `sub-consciously' the child joins in
380 An Educational Curriculum
with the movements the teacher initiates, such as tapping on the table, clapping hands, opening and closing of the mouth, etc. Sometimes one has to lead the child's hands in order to get any response at all. This stage leads to the use of co-active movements, an important step in the education of this type of child (van Dijk 1966).
The attention of the child is directed towards the movements the teacher makes. Very often this can be done by the teacher imitating the spontaneous (including stereotyped) movements of the child. Suppose a child likes to swing his body from left to right. When the child initiates this, the teacher stands or sits in front of the child and imitates what the child is doing. If teacher and child also hold each other, a fine interactive play might be elicited. The teacher joins in with the child and the child with the teacher. They can jump, swing, roll on the floor, pull each other, etc., all co-actively. The teacher's responsiveness gives the child a feeling of security. After this is established, both can venture into more complex situations. In our programme we have chosen `circuit-training'. A number of interesting objects are placed in a fixed order in a special room, such as slide, swing and trampoline. Both child and teacher move along these objects and experience the pleasure of sliding down, sitting on the swing, jumping on the trampoline. By carrying out such a training programme everyday, the child might remember the sequence of the movements. When this occurs, he will anticipate the next activity. This is a very good situation for eliciting signs from the child (Mescheriakov 1962; Ward 1981; Hammer 1982).
Imitation can be stimulated, too, by using pictures and dolls. Certain body positions can be drawn or shown by means of a doll. This has proved to be a useful procedure even for very low-functioning children (Lancioni, Smeets and Oliva 1984). This approach helps the child to become more aware of his body, and to learn how to use his hands and legs and how to manipulate objects. Needless to say, this is of enormous importance also for training of self-help skills. Together with the development of communication and physical activities, we consider this training essential in the curriculum for these children (see also McInnes and Treffry 1982).
Behaviourists have shown us how good results can be obtained in this area through careful task analysis and step-by-step procedures (Mahoney and Mahoney 1973; Finny 1981; Singer and Yarnall 1981; Walsh 1981; McInnes and Treffry 1982).
The basis of a successful programme, however, is rooted in the motivation of the child. Then he has the feeling that he is capable of coping with the world around him, despite his multiple handicaps. We think that the curriculum sketched here gives the multiply sensorily impaired child the best chances to become such a person.
An Educational Curriculum 381
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