Strategies for Young Children who are Deaf-Blind: A Teachers
Patty Salcedo, M.A.
After my daughter graduated from the Infant-Family
Program of the Foundation for the Junior Blind in Los Angeles
in 1986, I began working there as an early interventionist.
That program serves children (birth to 36 months) with visual
impairments and multiple disabilities. Many of the children
are considered deaf-blind.
In 1989, I began teaching at the Blind Childrens Learning
Center in Orange County. Children who are deaf-blind comprise
a small yet consistent portion of the student population in
the preschool. The Center participated in Dr. Deborah Chens
model demonstration network for infants who were deaf blind
and their families.
In 1995, I began working in the Sacramento County Office of
Educations Infant Development Program, which uses the
transdisciplinary team model. We identified several children
who were deaf blind, most with additional disabilities. The
teachers credentialed in the area of visual or hearing impairments
lead the team for infants who are deaf-blind. Other disciplines
include occupational therapy, physical therapy, and speech
therapy. As the babies began to move, an orientation and mobility
instructors provide consultation.
of Teacher in Visual Impairments
As a teacher credentialed in visual impairments,
my primary role is to identify the childs visual abilities
and the impact of visual impairment on development. With children
who are deaf-blind, my primary role also includes working
closely with the teacher of the deaf and hard of hearing to
develop an integrated intervention program for the child and
family based on learning through touch. An integrated program
requires a true transdisciplinary approach as we share salient
ideas from each of our fields, and seek information from the
field of deaf-blindness. My role also includes articulating
areas of need in other areas, and bringing in the appropriate
team members. Needless to say, my role is to schedule many
As part of the team in both infant and preschool
programs, I develop tactile strategies and adaptations to
meet the needs of children. With infants, our goals include
building a strong child-caregiver relationship, developing
a communication system, and helping the child find methods
for exploring the environment in a meaningful way. We began
by establishing touch routines with family members. Caregivers
would communicate their presence through a touch and then
learn to read infant cues for interaction. We work to build
the babys anticipation for being picked up and held.
Caregivers develop individualized touch and gestures to identify
themselves, (e.g. Daddys beard means "Daddy").
The infants environment is structured so that the baby
can easily encounter objects in close proximity. Objects are
selected based on a variety of tactile characteristics. We
use toys made of wood, plastic, and different textures of
fabric. We incorporate household objects of metal (measuring
spoons), foam (curlers), and nylon (hair brushes).
build concepts by using many tactile variations of the same
object such as a ball, a spoon, or a cup. In this way, the
child learned the characteristics of the object that describe
its function as well as those characteristics that may differ.
For example, a cup may be large, small, heavy, or light. It
may be made of plastic, glass, metal, or ceramic. Yet, all
cups fall within certain size and shape parameters and all
can hold liquids. The child discovers what is different and
what is consistent through exploring many examples of an object.
The child with vision recognizes how a model of an object
(e.g., a plastic fruit) resembles the real object. Children
who are deaf-blind do not have this information. They identify
objects based on shape, size, texture, weight, temperature,
When possible, real objects should be used to teach concepts.
Real objects provide the necessary information with which
the child who is deaf-blind can identify and discriminate
objects, and thus build concepts of the nature and function
As toddlers begin to travel, it is important to store toys
in the same place, not to move furniture "landmarks"
and to allow many opportunities for repetition and practice.
We incorporate touch into daily routines and built learning
activities into these routines.
In preschool, classroom space is divided so
that the children can travel throughout it using touch. Large
open spaces do not provide sufficient information as to location
or expected activity. Students use tactile landmarks to navigate
the classroom, such as cubby storage, the piano, and the tables.
Using a relevant item to label an area helps the children
associate where they were with what occurs there, e.g., a
printed sign identifies the block area with a wooden block
attached to it. The dress-up area is a favorite for many of
the children who are deaf-blind. They enjoy the hats, ties,
hair salon games (curlers and brushes), and jewelry. All of
these objects are used on the body, and seem to feel good
to the children. As with infants, an environment should be
rich in tactile experiences yet organized, because every experience
needs to have meaning to the child who is deaf-blind.
Preschoolers are assigned seats at circle, snack, and lunchtime.
The child who is deaf-blind will get to know the child on
either side over a period of time. Adults can facilitate interactions
by prompting the other children to share objects, pass materials,
and identify themselves verbally and by cue. The other children
are taught how to read the communication of the children who
are deaf-blind by looking at their gestures, facial expressions,
and movements. They are also taught to "wait a little
bit longer" to give the child time to respond. This is
not easy , but very rewarding for all of the children.
Circle time provides another opportunity for interaction.
Real objects associated with the learning themes are provided,
such as articles of clothing, household objects, outdoor objects,
and toys. An experience box can be used to re-tell the story
of activities that the class had enjoyed together. Themes
are selected with the use of objects and peer interactions
in mind. Rhythm and movement activities are popular, and are
often conducted with partners. Traditional circle time activities,
such as identifying the weather, allows the child who is deaf-blind
to go outside and experience it directlyespecially fun
when it is raining. A calendar box represents the days of
the week because class activities vary by day. Circle time
activities are kept short, and not every child is expected
to engage in each activity.
Some of the children enjoy music. We use instruments that
are highly resonant and provide strong feedback. Favorites
include drums (the larger the better), a dulcimer, and the
piano. The dulcimer is held across the lap, providing more
input to the childs body when strummed. The piano is
placed perpendicular to the wall, allowing the child to feel
vibration through the back of the instrument. The children
enjoy different rhythms, produced by clapping, foot stamping,
or with rhythm sticks. Some children enjoy music and fine
motor activities on a platform, such as Lilli Nielsens
resonance board as this increases feedback to the child.
Object books are developed for both toddlers and preschoolers.
An experience can be recalled through the use of associated
objects. A party or picnic might include a paper hat and napkin,
balloon, or plastic utensil. The experience book (or box)
is used in conjunction with the childs communication
Many of the children are potential braille readers. The children
are exposed to braille incidentally, rather than engaging
in formal braille instruction. Braille appears around the
room as print does for the sighted preschool child, only within
the reach of small hands. Many of the children find braille
labels interesting to touch. The playhouse contains a braille
menu, the classroom areas are labeled with braille signs,
the library corner contains print/braille books, the writing
area offers a Perkins braillewriter, and each childs
cubby features his or her name in print and braille. The children
are prepared for formal braille training by engaging in wrist
and hand strengthening activities such as wringing sponges,
washing and pinning up doll clothes, cutting paper, opening
containers, and pinching play dough. The children need to
learn to discriminate and understand patterns, so they engage
in play and naming activities focusing on concepts such as
rough, smooth, beginning, ending, top, bottom, same, and different.
Orientation and mobility (O&M) training becomes more important
in preschool. The children spend much time trailing in the
classroom, identifying features and mapping their environment.
O&M instructors work directly with students and consult
with families and staff. Classroom areas are demarcated by
the position of storage units. Tabletop activities are adapted
to establish boundaries of personal space using trays or placemats,
and materials are in close proximity and in easily identifiable
Children who are deaf-blind require much exposure
and repetition with activities. We introduce objects using
the technique of offering (touching childs hand and
waiting for an attempt to grasp), or by hand-over-hand joint
movements. This is followed by an opportunity for the child
to engage in the activity independently. The hand-under-hand
technique allows the child more independence while providing
guidance, or "navigation" around a person or object.
A child with motor difficulties, such as cerebral palsy, might
require more stability. A seating position should be developed,
which allows the most independent hand use. Materials may
be adapted to be heavier, larger, or with enhanced handles,
to promote more successful grasp.
Working as a team to develop learning activities
strategies is challenging. Touch cues need to have meaning
for the child. This meaning has to be developed and takes
time for the child to learn. With limited hearing or vision,
a child does not learn meaning incidentally. Agreeing on the
most meaningful, efficient, and easy to use strategies is
often an obstacle for a team. A large team brings many backgrounds
and opinions to the table. Once consensus is reached, everyone
needs to teach others involved with the child to use the strategies
consistently. Families need to be able to voice whether they
can realistically incorporate strategies (or risk a label
of "not following through." )
Consistency is vital to making a learning activity successful.
Everyone needs to know, and commit to using, the same touch
strategies. Everyone needs to greet the child in the same
way, use the same routines, and the same names and labels,
cues and signs. "Everyone" includes all educational
staff as well as the childs caregivers and classmates.
Opinions differ as to when sign language should be introduced,
or how meaningful a touch cue is to the child. Questions arise
as to the timing, position, and repetition of touch cues.
Working with young children involves facilitating language
development. As teachers and interventionists, we need to
know the small steps in typical language development and then
make adaptations for the child who is deaf-blind. This is
not always easy. The children require clear, concrete messages,
much opportunity for repetition, meaningful and satisfying
activities, and ample time to learn. With sufficient support,
children who are deaf-blind can learn about the people, objects,
and places in their environment through their sense of touch.