Future Reflections                                                                                                 Special Issue 2004

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Active Learning and the Blind, Multiply Disabled Child

by Lilli Nielsen, Ph.D.

Dr. Lilli Nielsen
Dr. Lilli Nielsen

A native of Denmark, Dr. Nielsen lectures and conducts workshops worldwide. The following article is an edited version (with permission of the author) of the introduction and the first chapter of her book, Early Learning Step by Step: Children with Vision Impairment And Multiple Disabilities. Following the article is a review of the book and information on how to order it and other materials developed by Dr. Nielsen for use with blind children who have additional disabilities.

A mother said: Do you think that she will ever be able to eat her food herself or be able to walk?

A father said: What else can we do? We are doing a great deal, but are we doing the best?

A teacher said: I have the feeling that I know too little about how children learn. I simply do not know what the next step is.

These statements refer to children who have severe learning difficulties. They represent the uncertainty that many parents and teachers feel while trying to help their child or pupil develop. The child in question may be blind or partially sighted—often it is a child who has one or more disabilities other than the vision impairment.

Achieving a skill is often referred to as reaching a milestone. While growing, children without disabilities become able to sit unsupported, to walk, to babble, to talk, to establish emotional attachments with relatives, and to make friends. They also learn to actively play and participate in the events happening within their surroundings.

Gradually they become able to solve problems and to learn at higher and higher levels. Thus, step-by-step, children develop skills without undue effort. Now and then, a child may achieve some skills either earlier or later than considered within the norm.

However, small deviations from so-called normal development are usual. Some children with vision impairment achieve skills without any great difficulty, while some have mild difficulty, and some have severe learning and educational difficulties.

When a child with vision impairment or other disabilities fails to reach a common milestone, (for example, the ability to eat, to walk, or to talk) parents, other caregivers, and teachers often feel bewildered and uncertain about what to do and what to expect the child to do. Although the reason for this uncertainty may be lack of knowledge about the child’s potential, anxiety concerning the possibility of emotional problems, and anxiety for the child’s future; it may also be due to lack of knowledge concerning the sequences of learning that a child follows while developing a skill.

The purpose of this book is firstly to review certain sequences of learning, thus making it easier for parents and teachers to verify what the next step probably would be, and to discover whether a child is missing any links in any sequences of learning. Secondly, it is to suggest approaches and environmental interventions that may facilitate the child’s learning.

So the suggestions given in this book should be considered partly as means of preventing delays, and partly as remedies to problems caused by delays or the child’s handicap(s).

Chapter One
Considerations on Methods

The Methods of Training and Teaching
In my point of view, the current approaches to training and teaching are developed from the philosophy that since children with disabilities do not commence spontaneously to perform basic skills, they must and can be trained or taught to achieve them. Lessons using this approach are often carried out by guiding the child’s hands, feet, or body to perform the movements necessary for the task in question, or by persuading the child to look or listen. After which the child is supposed to imitate the adult or to do as told. If the child turns away from the task or becomes interested in other things, he is persuaded or forced to continue with the task. It is considered important that the child become accustomed to concentrating on a task. Likewise, it is considered to be confusing for the child if too many objects are presented during a task-training session. These methods of training and teaching are accepted and used traditionally or as a basic requirement all over the world. However, for many of the children with severe learning and educational difficulties, these methods have failed to deliver the expected result. Sometimes these methods have served to prevent further delays but, in too many cases, they have failed to facilitate development. In some cases the child is exposed to the same approach for years in spite of the obvious lack of result. In other cases less and less effort is made to train the child until, finally, the method is abandoned without being replaced by another one.

However, to continue a method knowing that it does not help the child, or to give up entirely, is the same as saying that the child is unable to learn or unable to comprehend anything. In other words, it is assessing the child instead of being critical of the method used. In some cases, the methods of training and teaching have a negative effect in that the child either becomes aggressive or withdraws within himself. In too many cases, the method of training the child involves the hand-over-hand approach. In some cases, this results in the child becoming unwilling, for example, to eat, unless an adult is prompting him to take the spoon or fork or bread. In other cases the child refuses to allow the adult to hold his hand. That is, the child withdraws his hand whenever the teacher/adult tries to guide his hand or even whenever he experiences physical contact with any object.

In some cases, the child is so spastic that no method, for example, with regard to learning to eat, is used at all—the child is simply fed at every meal. It is considered that the child will never be able to learn to eat, wash his hands, undress, or do anything else for his own welfare. So, the decision as to whether or not the child can achieve a skill is often related to the complexity of the child’s handicaps rather than to the fact that almost all children are able to learn. (Only the few children who suffer from a progressive disease are sometimes unable to learn. And who knows when a child is going to die?) Also, training the child in so-called splinter skills seems to have failed in that the child does not experience any connection between his abilities, and so has difficulty in developing self-identity and independence.

In some cases, the child actually does perform a skill in which he has been trained, but most often he only uses this skill when prompted.

By the way, when is a skill a real skill? A skill that is used only when the teacher requires the child to do as he is told or is used only after the adult has been prompting or persuading the child for a while, is a trained skill which probably has not become part of the child’s personality.

It must be difficult, if not impossible, to initiate action using a skill that has not become a part of one’s personality. The method of training and teaching seems to increase the risk that the child will begin to reject or withdraw when approached with tasks, or will behave in an autistic-like or stereotyped way, or will perform the trained skills like a robot. Furthermore, there is the risk that the child becomes unable to initiate performance of any skill unless prompted, encouraged, or asked to do so.

And so the child will, therefore, continue to depend on another person. Also, as part of this method, the adults—that is, parents, caregivers, teachers, and other professionals—are required to see to it that the child performs the skills to which so much time had been given to train him. The following warning can be heard: If you help him instead of requiring him to do it, he will forget to do it, and we will have to start training him in that skill again.

But do these children really have such a poor memory? Do they really have such poor comprehension? They do remember how to withdraw, they do understand the message when prompted, and they do know how to avoid interaction.

Would learning at the developmentally appropriate level have been of more benefit for these children than age-appropriate education or training? Is it accurate to think that a child with disabilities can achieve age-appropriate skills without first having had the opportunity to learn the basic skills that a child without disabilities needs before he commences to perform the complicated activities belonging to higher levels of development?

The Approach of Active Learning
In order to develop new approaches, children without disabilities were observed for the purpose of analyzing the ways in which they achieve basic skills. It was found that infants and toddlers without disabilities learn from doing (this way of learning, incidentally, fitted poorly into the educational methods to which the children with disabilities most often were exposed). Similarly, it was found that until the age of 30 to 36 months the child without disabilities is unwilling to accept being trained or taught.

These are the questions we then asked: What is it that a child without disabilities learns? How does he learn this? Does a child who is blind, spastic, or has severe learning difficulties learn in the same way as the child without disabilities? Would these children also learn if they were allowed to explore and experiment, and to do so in their own way? Could and should anything special be done to facilitate this learning?

During the past 20 years, we have been developing alternative educational solutions for the most common learning problems seen in infants and children with vision impairment without or with other disabilities. These include: achieving head control, being able to sit unsupported, learning to eat, learning to stand and to walk, learning spatial relations, achieving object concept and self-identification, learning to talk, learning to play constructively, and learning to initiate interaction with others.

Although we still have a lot to learn concerning facilitation of learning for these children, we have succeeded in giving them opportunity to learn by introducing the approach of Active Learning. The philosophy behind the approach of Active Learning is that, if given opportunity to learn from his own active exploration and examination, the child will achieve skills that become part of his personality. These skills, then, become natural for him to use in interaction with others and to use for the fulfillment of his own needs. They will gradually make him ready to react relevantly to instructions and education. In other words, he will develop to be as independent as possible.

What is then, in a nutshell, the difference between the common educational method of training and teaching and the approach of Active Learning? From the author’s point of view, the starting point in commencing to train and teach a certain skill seems to be the final skill itself. In contrast, the starting point in Active Learning is letting the child learn the basic steps that lead to mastering the skill in question.

Also, as long as the child is developed to a level younger than the level of three years of age, I consider it impossible to train or teach that child.

The Concept of Learning
Learning is the process that happens in the child’s mind when he has opportunities to perform all the steps necessary for achieving a skill.

The first prerequisite for learning is that the child is able to move and that objects are available within reach (at least as long as the infant or child is not mobile). It is also necessary to have the opportunity to share experiences with others, to imitate others, and to interact with others.

Thus, learning becomes possible if:

• He is given opportunities to learn from the level to which he is developed.

• He can discover, experiment, and explore with many ways of performing an activity and thus learn the most practical way for him to perform a skill successfully.

• He has sufficient time to experiment and the opportunity to repeat an action as many times as necessary in order to store the information gained and to confirm that a specific way of acting gives the same result, and so comprehend the reality of it.

• He has the opportunity to compare his experiences. This allows him to discover similarities and differences, to recognize specific experiences, to associate a new experience with others already stored in the memory, to link experiences with each other, and later on to categorize and generalize experiences.

• He is given the opportunity to establish even development across the levels of the various learning processes, thus avoiding the missing links in one learning process that would have a negative or arresting effect on another learning process.

• He has somebody with whom to share his interest and experiences. This allows him to learn how to initiate interaction.

Infants and children learn within several areas of development simultaneously. Ability achieved in one area influence abilities in other areas, so that the areas are intertwined and experienced by the infant or child as a small entirety. Through self-activity and interaction with others, this entirety should gradually contain more and more detail as the child comprehends and masters the several parts, becomes able to connect these parts, and finally is able to perceive a bigger entirety.

In summary, learning is achieving knowledge by being active.

Conditions for Learning
Three main conditions should be considered while introducing the approach of Active Learning: The infant/child’s level of development, his readiness for learning, and the skills he has already achieved.

When the infant/child has had a good sleep, feels emotionally settled, and has had something to eat and drink, he is ready to discover and recognize responses from his movements or to learn anything that matches his level of development. However, he needs appropriate stimulating surroundings (including toys and other materials) and he needs sufficient time for doing as well as for thinking. Also, at the right time, he needs appropriate interest from his caregivers and teachers if he is to have optimal conditions for learning according to his potential.

The quality of the environment from which the child is given opportunity to learn

The environment that is established for the child should include opportunity for him to utilize already achieved motor ability. It should also arouse his interest and curiosity and give him opportunity to achieve the next level of development.

Also, the child should be provided with many environments that will give him opportunity to learn in all areas, such as gross and fine movements, connection between games and daily living activities, communication, cognition, socialization, and independence. In order to devise appropriate environments from which the child will be able to learn, it is necessary to know as much as possible about what the child already is able to do, and in which directions his interest is headed from time to time.

This knowledge can be obtained through observations of the child and interviews with his caregivers and teachers. Interviews should be conducted through the use of The Functional & Instructional Scheme (Nielsen, 1990) or by use of any other appropriate checklist concerning performance during early childhood.

It may also be useful to use the sequences of learning for sighted children as a guide for the purpose of discovering when the blind child has difficulties, and so be better able to facilitate his learning—maybe by means of environmental intervention.

The adult’s cooperation and attitude is crucial in upholding the approach of Active Learning. Environmental intervention means that the adult establishes environments appropriate for the child’s learning, makes objects available for him, and reacts to his signals or vocalization by sharing his interests and by interacting with him at the child’s level of development. For the purpose of introducing the approach of Active Learning it is necessary for the adult to know in detail the learning sequences which enable any infant and child to achieve skills.

Lilli Nielsen’s Publications

Vision Associates
2109 US Highway 90, West Suite 170 #312
Lake City, Florida 32055
(407) 352-1200
Fax (386) 752-7839
www.visionkits.com

Early Learning—Step by Step
#LN-EL, $35
Parents, teachers, and folks who care for handicapped children will learn how children achieve readiness skills for learning and how environmental intervention can facilitate learning through “active learning.”

The Functional Scheme: Function Skills Assessment
#LN-FS, $70
This assessment is used with learners between birth and 48 months to determine their developmental levels and changes in levels. It is a great addition to the FIELA Curriculum.

Spatial Relations in Congenitally Blind Infants
#LN-SR, $24
This study is Lilli’s dissertation and investigates whether a specially designed environment (Little Room) can facilitate development of early spatial relations in congenitally blind babies.

Educational Approaches
#LN-EA, $33
This is a combination of Lilli’s essays and research explaining how she expanded the educational approaches for children and infants with vision impairments.

Are You Blind?
#LN-AY, $35
Addresses children who are autistic and visually impaired. Lilli explains these children are developmentally threatened. Described is an educational method which benefits children’s emotional, motor, communication, and social development.

Space and Self
#LN-SS, $35
Lilli discusses the use of the Little Room to enhance development of sensory integration, object conceptualization, self-identification, and early spatial relations in children with visual impairments.

The Comprehending Hand
#LN-CH, $18
The ability to grasp is fundamentally important to blind children to get into contact with their surroundings and enhance development of all senses. Gives practical hints on how to adapt materials and surroundings to stimulate and encourage development in blind children.

FIELA Instructional Manual
#LNMAN, $50
This guide is for parents, professionals, and staff responsible for establishing optimal learning conditions for children at the developmental levels of 1 to 42 months. See Web site for information about the complete FIELA Curriculum kit.

Visual Impairment—Understanding the Needs of Young Children
#LN-POEL, $33
Dr. J. van der Poel wrote this as a guide to assist in the interdisciplinary partnership to promote early development in children with visual impairments. The information is important for educational planning.

Early Learning--Step By Step
A Review

by Lis Grundy

Anyone who has attended a Lilli Nielsen lecture will know, from watching her mimic the antics of toddlers, that she has a great insight into the learning processes of the “normal child.” This, coupled with an extraordinary empathy for the needs of visually impaired children, forms the basis of her book: Early Learning—Step by Step.

In it she explores the concept of Active Learning and how, by examining and exploring the world about them, children are able to acquire new skills that are meaningful to them and will therefore be used by them to fulfill their own needs and also their interactions with others. Children learn by “selecting.” This is precisely what I see them doing when they are learning to grasp, to experiment with balance games, to play sequence games, and so on.  Children can only select if they have something to select from—something to compare.

To all those who have read Lilli’s books this may all sound rather familiar but, as the title suggests, this one heralds a welcome progression of her work with the Little Room by suggesting how environmental intervention can be used in the world beyond.

She begins by looking at normal motor development before and after birth. She then goes on to relate this to those children with a visual impairment and/or multiple disabilities and suggests how missed developmental stages hinder the child’s progression and therefore further development.

Lilli gives many suggestions on how to encourage a child to explore and to move and therefore to experience those lost stages that are the prerequisites for progress toward the next skill. For those children with little signs of mobility she describes how kinematics, or unintentional movements, can be harnessed to produce those that are intentional and therefore meaningful. And for those children who are more able she suggests ways of encouraging independent sitting, crawling, walking, and dressing.

It is interesting that nowhere in the book does Lilli explore the use of high tech equipment. Instead, she constantly introduces the tools which are her stock in trade—ordinary spoons, cups, plates, brushes, buckets, etc.—all of which can facilitate learning whilst enabling a visually impaired child to make sense of the world in which they live.

This is particularly so with feeding and Lilli devotes two chapters to this topic— “Learning How To Chew” and “Learning How To Eat.” Again she suggests activities for a great range of abilities—including marbles in the mouth for the more able pupil, definitely not for the faint-hearted tutor!

In the chapter that is given over to “Toys & Materials,” Lilli describes specific pieces of equipment that were developed in unison with the Active Learning Approach. These include the Essef Board, the Support Bench, and the Net Hammock ‘Poten’ all of which were designed to encourage movement. Throughout the book there is a great deal of useful material that describes their functions and ways of using them.

To conclude, rather than examining toys and methods in detail, Lilli looks at learning to play constructively as she outlines the developmental steps and looks at the significance of the sequence of learning required to manipulate toys and to play games.

This book stands alone as a source of information and suggestions for those who are new to caring for, and to teaching, those children with multiple disabilities and/or a vision impairment. It would, however, be enhanced by having first read Lilli’s other work. For those who are already in the field this is the practical book that follows the theory.

Reprinted from the July 1994 Information Exchange, a publication of the Royal National Institute for the Blind (RNIB), England.

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