Instructional Strategies for VI Students Under the Developmental Age of 3 - TETN 20440 This video is posted online with the following chapter markers: Chapter 1. Introduction - Chapter 2. Parents are Experts - Chapter 3. Assessment - Chapter 4. Minimize Stress - Chapter 5. Emotional Development - Chapter 6. Child's Interests - Chapter 7. Self-directed Learning - Chapter 8. Appropriate Interactions - Chapter 9. Tactile Sense - Chapter 10. Pacing is Everything - Chapter 11. Predictable Schedules - Chapter 12. Expressive Communication - Chapter 13. Discussion - Chapter 14. Summary & Resources - Instructional Strategies for VI Students Under the Developmental Age of 3 - TETN 20440 Transcript Chapter 1. Introduction Kate Hurst: Our topic today is on instructional strategies for students with visual impairments who are under the developmental age of three. And I want to emphasize that this includes not only very young children who are chronologically birth to three, but it also includes children who may be older chronologically, but functioning developmentally at a lower age level. So without further adieu we're going to move to our prerecorded portion of the broadcast and we'll be stopping periodically to take questions. And I'd love to hear your comments. I know many of you are very engaged in providing direct services to students in this group, and I know that you have a great deal of expertise and I would really love to hear your thoughts, your questions, your ideas, anything you want to share. So please don't be reluctant, share your expertise. [Slide start] Kate Hurst: Instructional Strategies for VI Students Under the Developmental Age of 3. [Slide end] What are the traits of the children? Who are we talking about when we refer to children under the developmental age of 3? Well, first of all infants and toddlers, of course. [Slide start] But also individuals who, despite their chronological age, function developmentally at a lower developmental age socially, emotionally, physically and or cognitively. These are students who have histories of significant physical and cognitive challenges or those with very fragile health and or chronic pain issues. Many of these children have spent extended periods of time in the hospital, have had multiple surgeries and other invasive medical treatments. Some have genetic syndromes or have lost functioning due to meningitis or other disease. Typically these students have very limited communication skills and communicate primarily in non-symbolic ways. [Slide end] They have global developmental delays though they may have acquired higher skills in isolated areas. So for example they may be able to walk and stand independently, but they do not use their hands and arms very well or readily engage with others. These students are often very reluctant learners. Some are very passive, some cannot attend for more than a few seconds; others exhibit behaviors that make instruction very difficult. They typically have limited interest in the world around them and even more limited experiences. They may connect socially and emotionally with only one or two individuals and seldom seek out individuals for interactions. [Slide start] Their understanding of how the world works, the basic concepts for learning are extremely limited. Often these students have limited stamina or retreat into sleep easily when others try to engage them or the environment becomes overly stimulating. [Slide end] These are the students who do not seem to respond to our typical educational practices. The students for whom progress seems at times almost impossible. But if we utilize proven techniques, these students can make progress. And we do have evidenced-based approaches that work with them, if we will only utilize them. As educators and parents, what roles do we play in providing an appropriate education for these students? Well Daniel Kish, an individual with blindness who taught himself and now teaches others to travel using echolocation, says this about the educator's role, [Slide start] 'We are not teaching skills; we are activating neurology.' And I believe this is true of all instruction, but particularly true for students functioning at or below a developmental level of 3 years. Aristotle tells us, 'For the things we have to learn before we can do them, we learn by doing them.' [Slide end] Children at the earliest developmental stages can only learn by doing. This means students at this level have to be moving and interacting of their own volition to develop the neurology to be able to do higher types of learning. If my role is to activate neurology, I need to recognize that our typical educational paradigm for children chronologically and older doesn't work very well for these students. A different approach, one more a kin to instructional strategies typically used with infants and toddlers, is needed. Children at this level of development are not ready to 'sit and learn'. They learn only by 'doing'. As a teacher or paraprofessional, my job becomes facilitating the child's own learning. This is a very different role for most of us and I think many of us are uncertain about how to do it. Fortunately for us, there are research- and evidenced-based practices related to instructing children who are visually impaired and multiply impaired or deafblind and who function at the developmental level of under three years of age. Many of these strategies and approaches also work very well for other students at these developmental levels even if vision and hearing are intact. [Slide start] Three individuals who have made major contributions to our instructional practices for students at this level are Dr. Jan van Dijk of the Netherlands, Dame Lilli Neilsen of Denmark, and Barbara Miles, a former teacher at Perkins and consultant on deafblindness in the United States. [Slide end] There are numerous resources on the internet if you want to learn more about the mes- methods each of these individuals use. There are also many workshops and conferences at regional, state and national venues you may want to take advantage of to learn more about these individual approaches. Though we can't go into detail about the body of their works in such a short period of time today, I would like to discuss how their approaches overlap or respond to similar facts about development, and how their practices can be utilized in our classrooms. Though van Dijk, Nielsen, and Miles differ in some respects, overall their approaches recommend common strategies. Over the next thirty minutes or so I want to share some of these basic strategies they suggest and resources to help implement these strategies. [Slide start] These students learn by their own self-activity. All children under the developmental age of 3 learn by engaging their world, examining and experimenting with the people and things they encounter. They do this by using all of their senses: [Slide end] taste, touch, smell, vision, hearing and proprioception. If you watch very young children, you will see that they are constantly 'doing'. They pick things up, put them in their mouths, bang them, throw them, scratch them. It is through this type of exploration and experimentation that they learn foundational concepts about size, shape, texture, temperature, weight, color, and function. As they watch others interacting with the physical world, they begin to imitate actions on these materials and with people. Gradually they begin to organize this information into categories based on similarities and differences. While they are doing this exploration they also develop more refined fine and gross motor skills that allow them to expand their ability to learn about the world around them. They gain self-confidence and self-identity. They gradually learn to regulate emotions and biobehavioral states as their sensory systems mature. All of this they do by their own self-activity. We do not teach them to do this. When a child has certain foundational concepts in place he begins to be able to attach language to these concepts. Through interactions with others, usually parents and siblings, the child becomes more successful in interacting with others. He becomes ready to share in an activity, gradually becoming confident and interested in completing tasks on his own. When any child reaches this point in development, we can begin to use more typical instructional methods with them. Methods that we see in most school settings. Prior to that point in development, our typical methods don't really work. If we want to help these students, I believe we must change our methods of instruction and view our roles in a somewhat different light. Rather than instructors we become facilitators of the child's natural development. We become the creators of learning environments that are fully accessible to the child and 'good playmates' who can support these children emotionally and socially while they develop a solid self-identity and the confidence to try new things. Through the work of individuals like van Dijk, Nielsen, and Miles we have identified specific strategies that will help these children progress. For many of these students the process will be slow as a result of the multiple challenges of vision or hearing loss, motor issues, and cognitive impairments. But they can make progress if we do our part. So what are these strategies? As a way to simplify this large body of information I have distilled the content into 11 strategies. Included in your handout are a number of resources and references you will probably want to explore that explain the research and practice behind each of these. [Slide start] Chapter 2. Parents are Experts Hurst: Strategy 1: Recognize parents as the experts and utilize their expertise. [Slide end] Our first and perhaps the most important strategy is to recognize the importance and expertise of the child's parents or caregivers. Why? Well because we need a thorough understanding of the child's history. It is very important that we understand what has gone on medically, when sensory loss first occurred and why. We also need to learn how the child functions in his or her home environment, the place he or she is most comfortable. Parents can tell us what things the child likes, what things frighten or agitate and how she handles new people and experiences. Parents also need to help us determine priorities for instruction based on needs within the context of family life. Since these students will take longer to learn new skills, we need to make good use of each moment we have with them in the classroom. One tool I recommend to gather information from the parents is Home Talk. [Slide start] This booklet was developed for the National Consortium on Deafblindness for use with parents of children who are deafblind and is available in English and Spanish. [Slide end] This information can easily be adapted to meet the needs of most any child with significant developmental disabilities. Home Talk can be downloaded for free and the web-link to this document is included in the resources section of your handout. When using this booklet with parents, I recommend that the teacher take time to evaluate how much of the booklet each parent is able to complete on his or her own. Some parents may be able to take the booklet and complete it alone easily. Others may need to respond to only a few sections a at a time or complete it with a teacher in face-to-face meetings. Now since I know that time with parents may be difficult to come by for a variety of reasons, this might be something that the child's Division of Blind Services Children's Specialist could help educational staff to work with the parent to complete. The book is divided into four parts. Part 1 focuses on general information about the child's home and family life. Part 2 describes the child's interests, talents, routines, special needs and behaviors. Part 3 asks parents to rate their child's skills in four different areas: People Skills, Problem-solving skills, Exploring the environment, and Discovery and Learning. The fourth part is completed with the child's educational team and helps to determine priorities and goals for the child. Gathering this information will greatly benefit the team in developing appropriate programming for the child. Hurst: I'm going to stop here for a minute and ask you if you would be willing to share either online or by just turning your mics on. How many of you are familiar with the Home Talk or are using other tools to gather information from family members who are responsible for caring for these children that you're working with? Can any of you share with me? Peggy: Hi, Kate, can you hear me? It's Peggy. Hurst: I can, Peggy. Peggy: At the School for the Deaf. I haven't used Home Talk and I'm going to get online and do that, but I did like the new- many of the questions that van Dijk puts out in The Child Guided Assessment now that it's actually in a readable form and you can add some things even if you're not going to use that in all the domains. I know when I sat down with a parent last year when the child- a little bit just turning three, it did help to get her answers on many things, especially the area of calming and soothing and what worked and what didn't. Anyway, just throw that out there because that book that came out before is kind of much more readable and then they developed observation and question sheets. Hurst: Thanks for sharing that, Peggy, and you're right, there is some awfully good information in that book, especially since it's kind of been fixed up a little bit. I think it's very, very nice. Other tools people are using? Audience 1: Kate, here we talked about the Oregon project, and the parent component from the APH functional vision evaluation big binder book. And I just had a question on this. For the Home Talk would it apply to any family member or just for family members with children functioning below the age of three? Hurst: By 'any family member', I'm not exactly sure what you're meaning to include? Audience 1: I'm sorry, if they have a child that's maybe just a couple of years below grade level or chronologically? Or is it just geared towards- because I'm not familiar with Home Talk. Hurst: I think that it is actually- a lot of the questions really can apply to any student. It's a nice tool for a student at almost any level. Now, having said that you might need to kind of go through and adapt some of the questions a bit. But I do think it's very useful. I also think the general questions and the way it's sort of developed is good for kids that even- that don't have visual impairments or deafblindness. I just think that it gives you a nice framework whether you're It is kind of written very deafblind specific, but I don't think it's hard to adapt at all. And again, I think if you're going to adapt it, you know, you may want to sort of type up your own book and just credit it so that you can give it to the parents in print, but even if you're just using it as a guide for yourself in visiting with parents and getting information from them, I think it's a very good tool. Good question. Others? Have you found tools that you're liking or you're using regularly? You mentioned some good ones. I think a lot of the infant toddler kinds of things, like Insight and things, have different information to sort of help guide this piece of gathering information from families. But I do encourage you guys to utilize some technique because you know I think with some of our more typically functioning students it's a little easier to know what's going on with the student than it is with these kiddos. And I think if you don't have the opportunity to get information from the parents, it's going to make your job so much harder with that student and you're going to make so many mistakes. And quite frankly, you're going to sort of put the student through a lot of pressure and stress that they shouldn't have to go through. And my comment about utilizing your DARS Division for Blind Services case worker to help you get this information, I don't know how many of you have a close relationship with your case workers in your regions, but you know they really can- if they have a case open with a family, they can be such a help to you because they can make time to get that information gathered and it gives them a really good way to support the educational process and to become a part of your educational team. And they have a lot of expertise to contribute. And they can offer you as a teacher a lot of support in working with that family. So this is one thing you might want to do. There may be other people within your educational team who can take on the responsibility for doing this, but getting that information from parents is absolutely critical for this population. You're just going to be spinning your wheels for a long time and you can save yourself a lot of grief by just getting with those parents and talking with them. And I'm saying that recognizing all the challenges it is to be able to connect with busy families who have a lot of stuff going on, but I do think for this group we absolutely have to do it. Good stuff. Let me see if we're getting any questions here. Let's see... Okay. A lot of you have not heard about Home Talk. Please do go explore that. It's a great free resource. You'll like it. Okay. Well, let's pick it up and go forward to some of our next strategies. Chapter 3. Assessment [Slide start] Hurst: Strategy 2: Conduct Thorough and On-going Assessment. It is important to conduct a thorough assessment of the student in all areas of development. One of the tools that I especially like is Dr. Nielsen's Functional Scheme assessment though there are other assessment tools such as van Dijk's Child Guided Assessment or Every Move Counts that can be used as well. [Slide end] What I particularly like about the Functional Scheme assessment is that it begins with skills and behaviors typical from birth and groups them in levels of 3 to 6 month increments. It provides information about all areas of development. Not only physical, sensory and cognitive development, but also social and emotional development. One of the things that both Dr. van Dijk and Dr. Nielsen stress is the need to understand and address the child's emotional development. Not many assessment tools help you determine the child's emotional level, but this tool does. Another plus for this assessment tool is that it is meant to be used for regular on-going assessment throughout the year and from year-to-year, providing a clear documentation of the student's progress over time. One of the negatives about this tool is that some of the items are specifically tied to Active Learning equipment which many people may not have access to. However, overall it provides a nice profile of the child's current functioning even if these items are skipped or adapted. Whatever tool is used to assess the child, weekly documentation of the child's progress is equally important. This tool supports regular observation and documentation of the child's behavior in both independent play and interactive play. Awareness of emerging skills or lack of progress with skills guides the modification of learning environments and our interactions with the student. Chapter 4. Minimize Stress [Slide start] Hurst: Strategy 3: Keep stress to a minimum. Most of us have heard how important it is to reduce stress for the child to enhance learning. But, how do we keep stress to a minimum? [Slide end] For some children this is easy for other children it is quite difficult. Dr. van Dijk tells us to 'follow the child's lead' by imitating their actions and showing interest in what seems to interest them. Dr. van Dijk uses the terms 'resonance' and 'co-active movement' to describe his approach in the article Educational Curriculum found on his new website. He also shows some video examples of what this looks like. Dr. Nielsen also encourages us to take our lead from what the child shows an interest in and cautions us not to make too many demands of the student at the earliest stages. The child at the developmental age of and younger is not ready to let you take the lead in the activity or ask him to do specific things at your request. She advises us to let the child practice their skills repeatedly at whatever level they are at. As they master a skill, they will move on to tackle a higher level skill quite naturally. Skills that have become so ingrained become a part of who the child is and reduce the amount of stress put on the child to complete the skill. Our role is to make sure the child has many, many opportunities to practice skills with a variety of materials in a variety of situations at the level they're currently functioning. Giving the student plenty of time to make skills part of his or her personality without trying to push skills to the next higher level may seem wrong to many of us. Never-the-less, if we allow the child to work at his or her level of competence, only suggesting and modeling slightly higher level skills as we interact, greater progress can be made. I believe this is because we have reduced the level of stress which allows the student to develop better neurology. [Slide start] Another way to reduce stress is to make things as predictable as possible. This includes the environment, people, and schedules. [Slide end] Have specific places and specific people tied to regular care-giving events. Keep the flow of the day predictable when it comes to major care-giving activities, times of independent play and times of interaction. In other words, create a schedule and follow it. Make care-giving activities into routines. Use consistent language. At the same time we strive for consistency we also need to be flexible in the amount of time each activity takes based on the child's interest and mood. If a child is really enjoying an activity let him extend his time in the activity. If on the other hand he is resisting an activity, wrap it up as quickly as possible before going on to the next regularly scheduled event. Chapter 5. Emotional Development [Slide start] Hurst: Strategy 4: Pay attention to the child's emotional development. [Slide end] Human beings learn over time how to alter their own emotional state. How to manage fear, calm themselves when agitated or over excited, or push themselves to try something new. But we don't come into the world being able to do that. We all have different emotional make-up; some of us are shy and others are out-going. It's important to recognize that these children also come with diverse emotional skills that must be considered when we are interacting with them. If we don't adequately address the emotional development, other skill learning may be impaired. The Functional Scheme assessment by Dr. Nielsen is one of the few tools I know that helps to identify a specific emotional developmental level for a student. By responding appropriately to the student's emotional needs we help him to develop a healthier sense of self and gain confidence to more fully utilize other of his developing skills. Many of our older children exhibit some high level gross and fine motor skills, but overall seem to be make little progress in other developmental areas. When we look at where they are functioning emotionally many are much younger developmentally. If we can bring their emotional development more in line with their other developmental skills, greater progress can be made. We need to consider how the student contacts others. [Slide start] Does she use approaches like that of an infant or can she invite the adult to play in a give and take game? We have to match our response to the student's emotional level. [Slide end] We tend to do this quite naturally with an infant or toddler we may encounter, but we may feel uncomfortable doing this with students especially those who are chronologically older. Dr. Nielsen provides some excellent information on emotional development of these students with visual impairment in her book, Are You Blind?. I would strongly encourage you o get a copy of this book and read through it. Dr. van Dijk also shares valuable information about emotional development in a number of his articles that can be found on his website. By responding to the child's emotional state and limiting our own demands, we can help the student grow in his or her ability to take on new challenges. We have to be careful not to put too much on them too soon. And at the same time we need to treat their accomplishments as no big surprise, commenting on them but not overly praising the student. Hurst: Let's talk about this a little bit. First of all, how many of you are aware of Dr. Van Dijk's website? Have y'all had an experience with that yet? I have to confess that I only recently discovered it and have not explored it as thoroughly as I would like to, but there is some terrific stuff on that website, some links to some great articles of his. He's got a lot of information about his child guided assessments, some nice videos that help sort of explain that. [cough] Excuse me, so I really do want to encourage you to do some looking at that. The other thing I want to mention as I think I said, for the last couple of days I've been in a training with Millie Smith who developed the Sensory Learning Kit and the Symbols and Meanings Kit for APH and she's been doing training with us about both of those kits. And one of the things that Millie talked about in sharing some research is something that researchers and that Millie referred to as coherence. [cough] Excuse me. And what I understood her to be saying and those of you I know there were several of you that were in that training as well. I think what she's talking about is our ability to interpret what we're taking in to our senses, through our senses and having it all have some meaning for us so that there's understanding. And she gave the example of waking up in the middle of the night or being waked up in the middle of the night with some sound and not being able to identify that sound and how your heart kind of rushes a little bit. You can't decide, 'Oh, do I need to get up and see if there's a burglar or see if there's something on fire or whatever.' [cough] But as soon as we're able to sort of figure out what that sound- what caused that sound, a lot of times our pulse rate or our emotions drop immediately and we're able to either get up and deal with it calmly or just go back to sleep. And the reason that we're able to do this is because whether it's real or not in what we've decided it is, we've given our self an explanation that makes us see the world and what's going on as a coherent place. It all makes sense. So for example, the other night I woke up to this sound that I thought was fireworks going off. I was just like in the middle of the night fireworks. I was very startled and I was somewhat concerned because fireworks in the middle of January at 3 in the morning is not a typical thing. And I thought, 'Oh, it could be some kind of explosion or guns going off or whatever.' Well, when I got myself awake enough, I realized it was sleet hitting my window. Then I was fine, I can go back to sleep. And everything was great. When we think about our children who have visual and multiple impairments or deafblindness, they have other disabilities, their whole day is just chock-full of sounds and experiences that make absolutely no sense to them. They have no way to know what it is, know when it's coming, understand what has happened to them, get any kind of explanation at all. And I think that that state of just unknowing, of not having an inner story to tell ourselves, to explain what we're experiencing, is the state that these kids are in most of their day. And that's just wrong. I'm sorry, that's just wrong. And especially when even kids who have very, very significant disabilities, if we're thinking about how to make the day more understandable to them, those very simple things of routine and schedule and using consistent language and having consistent people around, you know, that goes a long way towards taking a load off of their little psyches. And if they're emotionally okay, that's what they have to be. They have to be in that quiet alert state or generally in that state for the neural pathways to even develop. So that's the thing to me that is just so important for us to think about. These kids will walk into classrooms, think about the noise level in a typical classroom. I mean, you know when I had my classroom and I was in Deaf Ed in a self contained room with only- I think I typically only had eight kids. Many of these classrooms have 20 kids. There's a lot of racket generated by the children, there's a lot of racket generated by the staff. I think we have to think about that environment and I think we have to think about where can we trim some of the clutter? Where can we make- What can we do to make it just a little bit more calm? A little bit more predictable given the realities of children, school buildings, stuff going on? So what do some of you guys think about this? I'd be interested to hear your thoughts. Oh, come on, I know you have them. [laughter] Audience 2: Well, Kate, we were discussing here that- and I wanna tell you I went to the training that coherence and her example about the bump in the night and once we recognize it our stress level, everything goes down, but if we still haven't discovered what it is, we stay in this heightened sense of fear of the unknown. And when she relayed it- like you said- to the classroom, if we're not clear with our student what's going to happen next or what's going on, and something's coming in we don't let them know, it's just amazing that what she said basically was while they're in the stress state they're not learning. Hurst: They aren't, yeah. Audience 2: It's really hard to learn. Hurst: Yeah, yeah. And I just you know, I just think that's so, so very important and I know our educational staff, you know you guys are working so hard to help these kids. And if things like this make such a big difference, you know it's- I think we make our own jobs more difficult by not doing everything we can to, you know, try to make the day understandable for these children. I really do. And it's a tough it's a tough job. I'm not claiming for a moment that it's an easy thing to do, but I do think we can do a better job with that. Other thoughts? Other comments or questions? If you're on our little online chatter, today's meeting thing, the address for Dr. Van Dijk's website is up there. It's also in your handout so don't worry. But just for the sake of making sure you know, it is www dot drjanvandijk and that's jan van dijk dot org. So go there, check it out. There's some really good stuff there. You'll like it. Okay. Let's go forward. Kendra, let's see what's next. Chapter 6. Child's Interests [Slide start] Hurst: Strategy 5: Base instruction on the child's preferences and interests. [Slide end] Though we know that all students are more motivated to learn when they're interested in something, with these students motivation and interest is everything. We must find out what is motivating to them. To do this, we need to ask ourselves these questions: [Slide start] How does the child use all of his or her sensory channels? What attracts his attention or causes him to orient? What actions can the child take on the objects or in the activity? [Slide end] Does she find her part in an activity enjoyable and how do we know that? As educators we must become expert about student preferences and weave these preferences into activities throughout the day. Tools such as the Sensory Learning Kit developed by American Printing House for the Blind can help us identify preferences and interests that will guide us in the selection of materials, the creation of learning environments, and development of interactive games. We can develop lists based on our observations of the child engaged in independent activity and interactions with others. When we are clear about the things that motivate or attract the child's attention and those things that cause a negative response we are ready to create the rich learning environments that will draw him into natural, self-directed learning. Chapter 7. Self-directed Learning [Slide start] Hurst: Strategy 6: Allow for and encourage self-directed learning. [Slide end] Dr. Nielsen places great emphasis on self-directed learning while van Dijk appears to emphasize adult child interactions more. It has been my experience that some children are naturally 'people' types and others are more engaged by objects. Some children will do nothing if an adult is not there to initiate the activity. Other children are happy to explore things in their own environment, but aren't too interested in engaging with others. I believe it is our role to help our students be able to do both things. [Slide start] We do need to create learning environments that target the student's current developmental level and give him many opportunities to experience and explore on his own. In these environments the student has many opportunities to repeat skills until they become automatic. [Slide end] This is where the student gains knowledge about the properties of materials and how the world works. In these environments our student experiences success and failure in completing actions without the pressure of performing for us. He is self-motivated to make things happen, reducing passiveness and learned helplessness. These students should never be without access to interesting things to explore and to play with on their own. We can utilize the perceptualizing equipment that Dr. Nielsen has developed such as the Little Room, the Resonance Board, the HOPSA dress, Position Boards, and the like if those materials can be purchased. But if they're not available, we can still create homemade versions of these materials and environments, until we can purchase the real thing. The most important thing is that we bring the world to the students until they are able to find it on their own. Dr. Nielsen has provided many ideas about materials to use with children at this level in her books, especially in Space and Self and Are You Blind?. Some of these ideas have been excerpted and are available on the TSBVI Active Learning Page of the TSBVI website. Information for where to access this page is also included in your handout. Well-designed learning environments with plenty of accessible materials and time to play in them independently should be a part of each child's day. Dr. Nielsen recommends alternating fine and gross motor activities throughout the day. Our role is to observe and document what the child is doing and what materials catch his attention. Then we can appropriately expand or develop new environments and opportunities to practice these skills during interactive sessions. Chapter 8. Appropriate Interactions [Slide start] Hurst: Strategy 7: Provide appropriate interactions based on the child's level of development. [Slide end] Some of our students, as I mentioned earlier, seem to prefer being left alone and they avoid interactions with others most of the time. One important strategy is providing regular interaction with trusted individuals. Dr. Nielsen suggests 45 minutes each day of one-on-one time with an adult in well-thought activities. Time when the adult and the child can be together without interruption and distractions. For some children these interactions may need to be broken up into small time increments initially. Some children may lack the stamina or the trust to engage with the adult for long periods of time. By providing regular interaction times, the child's ability to stay in the interaction longer should develop. Dr. van Dijk uses resonance activities and co-active movement in the initial stages of engaging a child with deafblindness. The adult engages the child by imitating the child's actions in close proximity to the child. This helps the child to become aware of his or her own actions. Then the adult turns these actions into simple turn-taking games where the child is encouraged to begin to imitate the adult from time to time. Dr. Nielsen takes a slightly different approach. [Slide start] Initially she uses the technique of 'offering'. Like van Dijk she attempts to be in close proximity to the child and simply offers objects to the child without making any demands about how the child utilizes the object. [Slide end] This time allows the child to develop trust and provides the adult with an opportunity to see what interests the child, what might distract him, and what skills are demonstrated by the child. It also allows a bond of trust to develop gradually between the adult and the child. And when that bond of trust is developed, imitation of the child's own actions on objects provides the child the awareness of his or her own actions and leads gradually to the child being able to imitate the adult. Then ritualized turn-taking games are used to further develop interaction skills. Both Dr. van Dijk and Dr. Nielsen then progress to simple routines where the child has small parts to complete, based on what he can already do. Both van Dijk and Nielsen use familiar care-giving activities such as eating, dressing and toileting as a basis for some of the earliest routines. As the child gains confidence and better understanding of the routine process more demands are made on him to complete the routine steps on his own. Dr. Nielsen warns us that until the child is at the developmental level of 2 years, he will not be ready for the kind of activities that make demands on him to take a particular step or complete a particular action. It should be noted that progression from the earliest stage to the completion of routines independently is a long and sometimes very slow process. However, by working at the student's readiness level rather than pushing for a higher level of interaction before he is ready, solid progress will be made. Chapter 9. Tactile Sense [Slide start] Hurst: Strategy 8: Develop the tactile sense. [Slide end] One of the main contributions of Barbara Miles has been her insights into the use of the tactile sense, especially with the hands, in children with visual impairments or deafblindness. She points out these children use their hands for many other purposes than typical children, for example as eyes, ears, voices, and emotional regulators. She introduced us to the use of the hand-under-hand technique when interacting with these children and reminds us that children with visual impairments can develop tactual ways of knowing the world to compensate for their lack of vision. Touch can also support understanding the partial information gathered through impaired senses such as vision and hearing. In her article, Talking the Language of the Hands to the Hands, she goes into detail about the importance of touch and the development of tactile skills. I encourage you to read this article if you haven't and implement her suggestions with your students. The ability of individuals with visual impairments to make full use of tactual information is a critical compensatory skill. As educators we must help our student to develop these skills. Putting it simply we need to make sure we are allowing the student time to tactually explore materials used in all activities. Even if the student cannot easily use his hands we need to encourage tactual exploration however he can with his mouth, with his tongue, with feet, or how ever the student accesses his tactual information best. It is important to provide interesting tactile feedback in all the independent and interactive activities the child engages in throughout the day. [Slide start] Miles also encourages the use of tactual modeling to help the child understand the action of others. For example, encouraging the child to experience the adult eating by putting the child's hands on your mouth while taking a bite and chewing [Slide end] or 'watching' with thier hands while you open a container or pat the dog. Providing regular opportunities for a child to share what you are doing through touch is a very important strategy and one not to be overlooked. Chapter 10. Pacing is Everything [Slide start] Hurst: Strategy 9: Pacing is everything. Slow it down, way down. As we interact with our students we have to match the child's pace. As most of you know, many of these students have very delayed responses for a variety of reasons. [Slide end] If we don't give them enough time to respond, we discourage them from trying to respond. Taping your interactions with a child and analyzing it later can really help you to become mindful of your pacing. Learning to slow down is a very difficult thing for most of us, but is a very important strategy for working with these children. We have to learn how to match our pace to the student's pace. We have to be in closer sync with him if we're going to achieve success. Hurst: So thoughts, comments about that? By the way I appreciate- Gwen: I was going to- Hurst: Go ahead. Gwen: Sorry. I was going to state an example of something. My great niece has a different multiple disabilities, so I was visiting her classroom because my niece, the mother, you know wanted me to come and see this. And of course the child was visually impaired too. But anyway this was out of state and I was trying to be as nonchalant as possible because I didn't want to step on toes in the classroom. And it happened to be in the time of a speech lesson, and the speech therapist was working on swallowing and working hard with my great niece. But I'm sitting back and I'm noticing my great niece, I feel was wondering what these white things were coming at her. And they were the gloves on the speech therapist's hands. And so you know, I was watching all this and I knew the speech therapist hadn't picked up on this. And then I just asked her, I said would it be okay that so and so can touch your hands. And she said, 'Oh, sure.' And I firmly believe that my niece saw that, my great niece saw that white kind of coming at her. She was curious about it. And she was trying to reach out to touch the hands and just see what this was. And to me that's an example of us needing to be responsive to our kids' actions for things. And I have always felt that sometimes we don't observe the student's enough with what they're doing. Hurst: Well and that's such a good point Gwen and I think for me you know that's why I like videotaping so much. I mean, no, I'm not terribly thrilled at looking at myself on video. I don't mean that. But I think that that that when you're in the midst of interacting with the child you just can't be watching and interacting and doing everything all at one time. And so setting up a tripod or getting someone else in the room that walks by to use their phone and get some videotape will really help us to think about what are we doing in this? Let's step back and think, I'm the child. Here's this action I'm taking. How about that child's experience it? And I think that's a perfect example. And it makes me think of something else and this came from Millie the other day when she was training with us and she talked about and some of you that were there help me if I lie about this. But it was my understanding that the three best channels for getting tactile information are of course the hands, number one, but she said oral and what she said podal, which means feet. And I don't know that we're very comfortable letting kids really explore stuff with their mouth, you know. I've heard many, many times, 'Oh, that child just wants to mouth everything'. Well, if they don't have good use of their hands or they don't have good use of their feet or can't use their feet because they're in socks and shoes all the time, then the mouth is kind of all that's left to them. And if we're not comfortable letting them do that kind of exploration we're denying access to information for them. And if a child's got decreased vision and decreased hearing, which are your two distance senses, you're kind of missing out on a whole lot on the world. And even if you have some vision and hearing that you can use, you can't necessarily be sure of what you're seeing unless you can lay hands on it or unless you can get it into your mouth. And if we think about a typical child developing, what did the early months do they spend most of their time doing? The bane of every parents' existence, they put everything that comes in contact with them in their mouth. And they're not doing it about just tasting it, they're getting a whole lot of information that verifies to them what they can gain through their sight or their hearing about the object. So that's one of those things that we just have to think more about how we do it, you know? Thoughts and comments? Thanks for some of the postings that we're getting, by the way. Got a lot of regions out there. Come on, guys, don't let me down. Share some of your thoughts. Participant 3: Hello? Hurst: Hi. Participant 3: Well, we have some questions about you haven't really addressed the issue of older students, students that are maybe getting near the end of their time in school that are still functioning at the below two year old level. Some of this stuff I'm seeing more geared toward younger children. And also is easier presented to parents at that level than when they're child is, say, 20, when we're still talking about playing and interacting and all those things that seemed babyish to most people. So I just wondered what where you were going to go with that one. Hurst: That's wonderful and I'm so glad you brought that up because this is a really tricky thing. And that's why I think that, one, it's real important that you have a good handle on the brain research and stuff to be able to explain it to the parents so that they are more open to letting the child do some of those things, especially the older child, because that's it is, it's a hard thing. It's a hard thing for teachers and it's a hard thing for administrators to understand. What is this 18 year old kid doing mouthing things? That should have stopped long ago. And the only thing I know that we can do is, one, be sure we know why have good reason and help them understand why it is so important to this child to be able to have time to do it. The other thing is in creating learning environments where that time to interact with things that way is set up appropriately and they're encouraged to have lots of opportunities to do it in the day. I think it will make some difference because when they get enough information, when they get enough of the neurology built, they won't necessarily have to continue mouthing everything. But if we deny them that, it's not going to stop the mouthing because they'll sneak around to do it whenever they can. They're going to do it. So setting it up with the notion of we're going to let them mouth, but going to do it in a way that is instructional to them, we're going to help them develop those concepts of temperature and texture and weight and things like that to get that into their system. And then we're going to try to get them to learn to use other parts of their body to explore objects and materials. Some of these kids, you know, just have not been able to put that altogether yet. And I don't think we can get them there by saying, 'We're going to stop mouthing'. Now, having said that, I also think that we can be more creative about the types of things that we're using and we're letting them have access to so that it will be a little bit easier for a parent or an administrator to accept. You know, looking at materials that are more age appropriate. I'm sorry, I'm an adult and I mouth quite a few things. I'm using straws a lot, I'm using pens, but I like pencils to chew on too. You know, there's different things. We can work on letting them use work on some of that mouthing stuff with. But I think bottom line is we're going to have to accept that with them if they're visually impaired that and they don't have good hand use and they don't have good use of their feet to be able to do stuff that they're going to have to do a certain amount of it. Now, the other piece is a lot of times we see kids who won't use their hands and I think they use their mouth to do what they won't do with their hands. And I think that we have created that monster in part because we've grabbed hands and we've manipulated them. And I think that a lot of kids have had numerous invasive procedures that involve hands and arms, like for putting in IV's and things like that. And I think that using more hand under hand and getting them used to having interactions touching with their hands in a way that is not fearful to them may help move them forward doing more exploration with their hands, if that's at all possible. And I'm seeing personally with active learning stuff when you start out with some of the scratch boards that Lilli talks about and you put some things up in the little room that are up near the mouth or whatever, you put the little vest on and you have objects on it that it's easy for those hands to get to, they may start out mouthing some things, but you'll also see their hands begin to do stuff at the same time. And once those hands start getting engaged, they'll use those hands more and they will probably decrease the use of mouthing to know what it is that they're experiencing. I don't know. Does that help at all? Other of you have some thoughts to lend to this question? Because it's a good one. It's a hard one. Participant 4: So Kate, let me ask a question in terms of if you have a high student-any student, I guess, and then they're really exploring with the mouthing. If you could elaborate on. But I want them to move to using their hands more. So do you are you saying doing the hand under hand while their mouthing trying to bring the object to your hand and their hands or can you help us some strategies to transition or try to transition that? Hurst: Okay. So they're sort of chunks in my mind and let me try to be clearer about this. One is provide opportunities in structured environments where they can mouth things. For example, even grown you know big kids, big grown kids, can go into Little Room type environments where they're allowed to be on their back, that they have objects that are placed near their face that they can explore with their mouth. But when they're in that environment and they also have objects near their hands, near their feet, touching their body in other places, what I have noticed and those of you who have been involved in active learning environments and Little Rooms and things like that, please chime in if you see it differently. But what I have seen is yes, they will mouth some, but the longer that they're in there and the better access they have to other materials they will also begin to use those hands. You know, it may just be batting, it may be when they're sitting up in a chair or whatever during an independent play time, that there's stuff like on their chest where their hands may often times are typically setting that they may do more with those hands. And part of what I think makes the difference in this is that when they are doing exploration with their own hands, with nobody grabbing them, with nobody pushing it along or moving the materials too quickly, they will they do more with their hands because they're in control of it. They can touch something and if it's icky they can take their hand right off, but what I've seen is if they touch something icky, nine times out of 10 they will keep coming back to it and just kind of checking it out a little more. You know maybe it's only with a fingertip, but in time as they become comfortable with it and know that if they don't want to touch it they can get their hand off of it at any moment, they get a little braver and they get interested to know more about what it is. And if you start out giving them things to touch that you know they're going to be interested and motivated in because you've watched what's attracted their attention, then the chances are even higher that they're going to explore it with their hands and do things with their hands. So that's one thing, just that piece, opportunities to do it and really motivating and interesting things for them to touch, but at the same time not telling them you cannot put it in your mouth because I think they have to do it as well for a time until they get saturated with it and until they can use the hands better. Okay. The other piece of it is if you're using hand under hand in all of your interactions, all of your interactions with that child, even if their little hands are fisted, they're going to get more information about what it is you do and about the things that you handle. And what I have typically experienced is even those kids with those little fisted hands that don't move so well, if I can get the object up near them and get my hands underneath theirs when they trust me this sometimes takes some time if kids have had really bad experiences with hands then I can model stuff and those little hands will try to creep on and touch that object. And that's where that offering things comes in. Again, they're touching it, they're encouraged to use those hands in a way that's not threatening. If they put their mouth on it am I going to stop them or fuss at them? No, I'm not. If that's what they need to do for a time, I'm going to let them do it because that's what they've got to work with. It would be like you telling me I'm sorry, you can't use your eyes and ears because even though those work, because I don't think that that's cool. And I don't mean to be sarcastic about that but we're denying them the only access they have to learn about the world when we do that. Does that answer anybody's question? Participant 4: Yes, for me. Hurst: My original great question poser did that give you anything at all? Twinkle: Sorry. Yes, it did, thank you. Hurst: It did to you Twinkle, but to the person who asked the question first, and I'm sorry I didn't get your name. Participant 3: Oh, okay. I don't know if you're referring to me. I don't know. It answered part of our question and kind of opened up more questions because we were talking about tactile objects versus tactile symbols and when the transition should occur because it seems like parents want to push toward the symbols because there are more there's a book of symbols and things like that, but then it seems like the child doesn't really have understanding of what those symbols are. And we're wondering if there are they're even effective or functional or even- should even be used when children are functioning below three or the three year old level. Hurst: I would say they're not ready for that yet. Yeah, I would say they are not ready. Your goal is certainly that you can get them to the place where things like that can be meaningful. And again this is where we've got to know enough stuff to be able to talk to parents about it. But in terms of where they're functioning, we hav- we can't it would be like saying we're only going to let you interact with a very young child as if they were a 30 year old. You could do it, yeah, you can do it, and they may pick up some things, but a certain amount of what they're going to do, they have to do it the way they do it. We can't jump light years away if we really want to help the child. And I know that some of it, and I have to admit to this myself, I think some of it comes down to a cultural bias we have that if you aren't communicating non symbolically there's no value in that. And the reality is there is value in any kind of communication that you can do and we have to help parents be okay with that. And it's not an easy thing. Again, I understand that. It's not an easy thing. But if you look at the research you can't a tactile symbol is a form of communication and it's a very abstract form of communication. You can't have that really be meaningful to a child until they have the concept of what that experience represents. And for these children, because of their disabilities, their multiple disabilities, they haven't had the opportunity to have the experiences yet. And so what we have to do is give them the experiences so that then they'll have the concept so that then we can put the label on it and say this thing that you just experienced, this thing that you just held in your hand and that has these certain properties we call, bam, but they don't even have that yet. They haven't had those experiences. They have been the experiences they for the most part have had, have had to do with their body. They don't know things beyond arm's reach. And some of them not even and arm's reach is like three inches. Does that help a little bit? Participant 5: Yes. I think we are on the same wavelength, that we do understand you know the types of symbols do have some use for some students, but for some other ones it is beyond them and at this point then let's remain as the object in this function. And you know, if we all want them to understand more abstract concepts, but unfortunately some of them are not going to be ready as fast as we want them to. So we have to hold on to that. Hurst: And again, it is and I get it. It's hard for parents, one, to hear, but it's hard to kind of understand. And I think that's where our challenges are as professionals is to have good understanding of the why's ourselves so we can kind of help the parents come to better understanding. And I tell you that the Sensory Learning Kit stuff that Millie shared with us, going in and looking at the guide books and stuff that are included in that, I think maybe will give you some additional information that you can share with your parents so that they get it's not that we're not working towards that. And it's not that we're saying your child won't ever do that. What we're saying is we have to start where they are right now and we have to do these things at the level that's where they are right now if we're going to get to that place. And it's not easy. I mean it really isn't. It's not easy to explain to parents or administrators. Sometimes it's not easy to explain to other educators, you know. It's hard, it's really hard. These kids are at a different place. Okay. I'm going to go on just because I don't want us to run out of time. But we'll have time all the time we need at the end, I hope, to have more questions. And I really appreciate the comments and the sharing you guys are doing. Chapter 11. Predictable Schedules [Slide start] Hurst: Strategy 10: Use predicable schedules and routines. [Slide end] Brain research teaches us that actions and activities which become routine require less energy from our brains. We also are more productive when we can go through activities without having to give each step a great deal of thought. The more we can make things predictable and routine for the child, the easier it will be for that child to attend to new information. As we mentioned earlier, predictability also reduces stress. We can cope with many things we do not like if we know when they are coming and that eventually they will end. That is why it is very important to have a daily schedule for your student. There needs to be a routine flow to each day. Now, this doesn't mean that every day is just alike, but there should be a predictable flow in each day. [Slide start] Doing things in a routine way supports learning by building a scaffold so that new information is highlighted. A child familiar with the routine of making powdered drink mix with a particular wooden spoon will likely pay attention if the metal spoon is substituted. [Slide end] He is alerted to the novel part of the activity and can deduce something about the function of both spoons because of the way they are used. He now adds the knowledge that spoons can be made of different materials or have different shapes and sizes. Without the familiar structure of the routine, the student may not focus on this new information. Any routine activity may vary in length from day to day depending on the variety of factors like the child's physical and emotional state, the general flow of the classroom, and unexpected events. So for example, one day the child may enjoy playing in the Little Room for 45 minutes, and the next he may only want to play for 20 minutes. An interaction with an adult may go on for 5 minutes or 30 minutes. We need to be flexible with the amount of time each activity takes while trying to keep the flow of events similar from day to day. Calendar systems help the child know that predictable things are occurring. Children who do not have some anticipation of regular routines may not be ready for a calendar, but they usually benefit from having a symbol to represent each activity coming up. Once there are specific routine activities which occur, associating a symbol with that activity is important. After some time the child can begin to use an anticipation level calendar and may be able to progress over time to a daily calendar. Just a note. Most students under the developmental level of 3, are not ready to move to higher level calendars that reflect more complex time concepts. If you would like to learn more about the use of these calendars, I would encourage you to read Robbie Blaha's book, Calendars for Student with Visual and Multiple Impairments Including Deafblindness. Chapter 12. Expressive Communication [Slide start] Hurst: Strategy 11: Focus on the student's expressive communication. [Slide end] My final strategy is to remind you to focus on the student's expressive communication and to limit your own. First of all we have to recognize that these students are primarily non-symbolic communicators. They communicate predominantly through their behavior. If we are responsive to all of their communication attempts it encourages more communication. Initially this might mean that we respond to fussiness by ending an activity or a giggle as a request to continue the activity. This is another area where information from the parents can be extremely helpful. They know generally what their child wants or needs just from the way he or she behaves. So make sure you understand as much as possible about how the child currently communicates and what it means. [Slide start] These early attempts to communicate can be shaped over time into more symbolic communication forms. But at the earliest stages your focus is on encouraging expressive communication in whatever form the child uses. What Linda Hagood refers to as 'conversations without language.' We also need to remember that if we are doing all the talking, the student isn't. We should limit our communication to moments when she is not actively engaged in self-activity. [Slide end] Children will take pauses in their play to process the expedience and we can interject comments then. Dr. Nielsen suggests we keep our responses low key and avoid remarks like, 'Good boy'. Instead we might describe what we saw the child doing like, 'I saw you open the lid' or 'You're smiling; you like being tickled.' Our responsiveness to the child's communication attempt by making a desired action occur speaks more eloquently than all the words we can use. Chapter 13. Discussion Hurst: So we're going to skip the summary because y'all don't need that. You can look at that on your own because I did want to take a few more minutes for questions about these slides that you saw and add a couple comments and also want to look at some of the resources. And I'll start out by making a comment because I've been in a couple of situations recently where the slide that says focus on the child's expressive communication was questioned. And I want to be clear about what I mean with that. I do not mean you don't speak in front of the child. I do not mean you don't model language. But what I do mean is that we have to put a lot of focus on what the child is doing and how they're communicating. However they're doing it. And for some of these children, especially the more medically involved, we're talking about things like changes in respiration or an eye blink or something like that. I mean, I know that these are the kinds of things that are very, very easy to overlook because they're so dang subtle. Again I'm going to stress the value of videotaping. Videotaping the child interacting with others. Because I think that's where you will be able to pick up on those often time very subtle communication cues. And then we want to respond to them and we need to respond to them in a way that's meaningful to them, which does not mean we don't model language. I'm not saying that. But we have to respond in a way that has meaning to them first and then we model or along with it we pair what is a more targeted, more higher level symbolic communication. So that's a real important thing I want to stress because I've had I saw Barbara Miles recently. She was at a training we did and she questioned that. And I was like, at this developmental level it's not that you're not modeling, but you really have to shut up and pay attention to what that child is doing. And respond to their communication attempts. And again I go back whenever I sort of get stuck I learned this from Lilli, think about the child, the typical child that's at that developmental level. And when we've got a newborn we're not responding to them with long sentences when we sense we're not expecting long sentences from them. We look into those beautiful little faces and if they scrunch their nose we give it meaning. We give it meaning. And that's what I'm talking about here. We really have to focus in on that and we have to talk about that. The other thing is, and there's a really wonderful thing in the Sensory Learning Kit no, sorry in the Sensory Symbols and Meanings Kit, the Sam's kit, that helps you target language at those early developmental levels. And Millie took us through this yesterday and it is fabulous. And what they've done is they've taken environments that are the typical environments that a young child is going to experience and they've got the most important words and they've done research to come up with these. They weren't just oh, random, I think this would be a good word. And it helps you when you are developing your instructional situation and your interactions with your child, or your student, that you have agreement about which words are the most important words to focus on and that you're going to use the same word. Because these kids may not be able to learn five different ways to say, you know, whatever entree you're having for dinner. There has to be consistently there. And then the other thing is when we are using language, we need to simplify it. You know, think about it. You don't need to use five run on sentences. Use simple word combinations. One and two or three word combinations like you do with an infant or a toddler. So that's one thing. Okay I know we're running [Slide start] close on time. Yeah. So while I'm chatting with you let me go ahead and make sure you have the secret code, which is 120130. That's the code you need to include in your evaluation, your online evaluation if you would like to receive a certificate. We'll keep that up for a minute. Let's see if there's anything else to stress on this. Oh, I think that's good enough for me. Before I hit some of these resources that I think that I want to really make you aware of. [Slide end] Are there questions or comments? Okay let me just point out a couple on your handout if you look at page 6, at the very top of the page is the active learning website, [Slide start] and there are links to a lot of information about materials there. Some of them are under forms, but just kind of look through that whole page. We're going to try to keep adding more and more stuff up there about active learning, including some videos that you may find useful. [Slide end] [Slide start] Then down just a little further on the page is the link for the Home Talk so you can go there and download that and I really want to encourage that. If you have not seen Barbara Miles' webcast on the Perkins' site, where she talks about hands and touch, that is this is a great resource and it's a wonderful thing to share with parents. They can view it from their computer at home and I think it will help them understand a lot, especially when we're talking about the mouthing stuff and touch, that's a really good resource to give them. As well as the article Talking the Language of the Hands to the Hands. I think both of those are really good to share with parents. [Slide end] [Slide start] I am deeply enamored of the Sensory Learning Kit and the Symbols and Meaning Kit and I think it's not absolutely confirmed, but we are leaning towards doing a study group next year on the Sensory Learning Kit and the Symbols and Meaning Kit. So I'm putting that out there right now so that if any of you have end of the year funds to buy stuff you may want to get some of those materials so that you can [Slide end] join in the study group and learn more about what those materials can do for you. Because they're really I liked them when I first saw them, but now that I know what to do with them I'm more enamored of them. I think this pulls so much of this together and really is a great tool. Let me think. I think we're about out of time. We are out of time. So I'm going to stop there. Thank you all so much for being a part of this. I appreciate your comments. And I appreciate the chat that was shared. I got a note that some of my people are having trouble with the Home Talk link. And they put up a different number, which is https colon slash slash [cough] Nationaldb dot org slash library slash page slash 789. And if you have trouble getting to it just email me and I'll make sure I can get you to it or I'll download the file. In fact, what I may just do is download the file and post it up under today's website so that y'all can easily download that file yourself. Because I had a little trouble finding it at first. Okay. Well, thank you again. Participant 6: I'm sorry, Kate, aren't the kits available with federal quota funds? Hurst: I'm not 100 percent sure about the federal quota funds, but let me ask Sue that and ask and then I'll shoot out a note to the ESC's about it. How's that? To share. Participant 7: [inaudible] Hurst: I'm sorry? Participant 7: You are able to purchase them with federal COTA funds. Hurst: Okay so you can get them with federal quota funds. Good. Chapter 14. Summary & Resources [Slide start] Hurst: In summary, children under the developmental age of 3 learn through their own self-activity and are not ready for more traditional instructional approaches. As educators working with these children who are significantly developmentally delayed, we need to use different educational strategies with them. Denying this need for a different educational approach does not serve them. In response to those who are not familiar with or do not understand how to do this, we need to share the evidenced-based practices that we know will work. We need to be able to explain and advocate for programming that meets these children's need. [Slide end] If the child is not making progress using more traditional practices because they are not ready developmentally, we need to try other techniques. By using these practices, our intent is to build foundational skills and concepts that will allow the child to benefit in time from more traditional educational approaches. So some of the strategies we want you to focus on [Slide start] include: Recognizing the parents as experts and utilizing their expertise. Conduct thorough and on-going assessment. Keep stress to a minimum. Pay attention to the child's emotional development. Base instruction around the child's preferences and interests. [Slide end] [Slide start] Allow for and encourage self-directed learning. Provide appropriate interactions based on the child's level of development. Use touch and provide opportunities to develop the tactile senses. Slow it down, pacing is everything. Predictable schedules and routines work. Focus on the child's expressive communication. [Slide end] What follows is a list of references and resources to help you learn more about specific educational practices and resources that are beneficial for students at this developmental level. I would like to highlight just a few of these. [Slide start] To access more information about Dr. Nielsen's Active Learning approach, visit our Active Learning page on the TSBVI website at www dot tsbvi dot edu forward slash outreach forward slash equals 3415. To learn about the use of calendars you may want to review a copy of Robbie Blaha's Calendars for Students with Multiple Impairments Including Deafblindness. This will help you determine which level of calendar system you- that may be appropriate for your student and give you a step-by-step process for using the calendar. I would also encourage you to visit the Communication for Children with Deafblindess or Visual and Multiple Impairments site at http colon forward slash forward slash distance dot tsbvi dot edu forward slash communication forward slash. [Slide end] The section on Interaction will be particularly helpful to you. Design to Learn has many wonderful products to share. Some of these tools, especially the Communication Matrix, the Home Inventory of Problem-solving Skills and the School Inventory of Problem-Solving Skills are very nice resources for assessment with these children. Some of my favorite articles that really help me think about the instructor's role with these children include [Slide start] Peggy Malloy's 'Harmonious Interactions', Stephanie MacFarland's 'Overview of the van Dijk Curriculum Approach' and Barbara Miles' 'Talking the Language of the Hands to the Hands'. [Slide end] And by the way, if you haven't already visited Perkins webcasts, let me recommend starting with Barbara's presentation on hands and touch. Dr. van Dijk now has his very own website, www dot drjanvandijk dot org. On this site you will find a wealth of information about his approach and research. Of course, if you really want to learn about Dr. Nielsen's Active Learning Approach, read any of her books. Three that I have found particularly helpful include [Slide start] Are You Blind?, Space and Self, and Munctional Scheme. [Slide end] [Slide start] Another resource is the Sensory Learning Kit and the Symbols and Meaning Kit from APH developed by Millie Smith. I have also included a number of my favorite articles by Dr. van Dijk. The first is 'Development Through Relationships, Entering the Social World'. [Slide end] [Slide start] And then there are two articles dealing with brain development that I particularly like, one is 'Strategies in Deafblind Education Based on Neurological Principles' and 'Lessons Learned from Neurobiology'. [Slide end]