Future Reflections                                                                                                 Special Issue 2004

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Hand-Over-Hand Guidance: What
Lesson Do We Teach?

by Andrea Story

This blind mentor uses a hand-over-hand approach as he demonstrates the use of a slate and stylus.
This blind mentor uses a hand-under-hand approach as he demonstrates the use of a slate and stylus.

Independence is emphasized in much of the literature concerning young children who are blind. In the revised edition of Can’t Your Child See? A Guide for Parents of Visually Impaired Children, it states that “The more they [parents] teach the child to function independently in the first three to four years, the less they will have to do later (Scott, Jan, Freeman, 1985).” But how do you “teach” independence to a one-, two-, or three-year-old child without sight? How do you bring the world to the child, and how do you teach skills such as putting on a jacket without making the child dependent on constant prompts and cues? It has often been observed that many children with visual impairments, especially those with additional impairments, are much more passive than their sighted peers. They seem to think of themselves not as doers, but as people who must wait for assistance or a prompt.

Literature on young children with blindness often mentions the fairy godmother syndrome. The child has little information to make the connections of how and why things are appearing and disappearing within his/her world. There is also the concern of imitation: how do you show a child how to eat with a spoon if he/she can’t see how others are doing it? The solution offered for these concerns has often been a hand-over-hand guide technique. The adult holds the back of the child’s hand, the child is guided to the objects to be explored, and guided through the motions of the activity to be learned.

Some have begun to question and reject this method. Dr. Lilli Nielsen of Denmark noticed that children often pulled away when an adult attempted to direct or guide the child’s hands. Lilli writes, “I changed my approach so that guiding or leading the child’s hand was used infrequently. This resulted in the children seldom withdrawing their hands. On the contrary they became more eager to initiate exploration and examine objects, thus improving their ability to grasp and to use their hands in various ways.” Dr. Lilli Nielsen, Educational Approaches for Visually Impaired Children, SIKON, 1992.

Watching Nielsen play with a child, one can see how touching the inside of the child’s hand with an object elicits a grasp quickly and much more independently on the child’s part than forcibly placing the child’s hand on the same objects. Once the child is motivated by the objects, a sound or a nearby vibration can elicit a reach and grasp. The children she has worked with at her presentations often begin to imitate activities such as strumminga stringed instrument, blowing into a harmonica, or dropping balls into a container. The children’s hands were never guided, and they stayed actively engaged for up to an hour. The children’s parents, teachers, and therapists are often amazed at how much children will do for Lilli. A bigger challenge may be the very passive child who moves very little. It will take these children longer to learn, and small steps should be appreciated when they do occur. As Lilli has said, these children do not have time to waste.

Enthused by Nielsen’s results, many who attend her lectures focus on equipment such as the Little Room™, but continue to guide children’s hands. The children’s reaction is most often to pull their hands away, or passively to allow their hands to be manipulated. It is an issue that I still struggle with, for although I have seen some wonderful results in using alternatives, I still have to sit on my own hands sometimes to stop myself from guiding a child’s hand. Even if I do restrain my own hands, I still have to convince educators, therapists, and parents that there are alternatives. Fortunately, some of the parents I’ve worked with have had success with getting their children to hold their own bottle, finger feed, and eventually spoon feed without guiding/controlling their child’s hands. These successes make me question the standard advice given to parents and others about teaching a child without sight.

Hand-over-hand guidance is recommended in most of the literature (or at least there are photos or videos demonstrating it). For a sighted person, it seems an almost instinctual response to guide the child’s hands. Some children protest the guidance, but eventually come to accept it and wait for their turn to explore. How frustrating to have to wait to explore something yourself! One child that I worked with seemed actually to enjoy the hand-over-hand guidance for finger plays and songs, but was quick to push the adult’s hands away if the activity or object was unfamiliar to her. Other children seem much more affected by the technique and become more passive or defensive to touch. These children do not repeat the skill by themselves after being guided. It should be considered that this technique of guiding a child’s hand has been used too often and too quickly. Often it seems that the sighted person forgets, or is unaware of, the unique perspective of those that are blind. Martha Pamperin wrote about this perspective on the AER listserv recently:

“As I, a blind adult, go about getting myself a cup of coffee, I may (1) search the shelf tactually to locate cup and coffee pot, before (2) pouring the coffee. This preliminary search is normal for me, especially if I am at the home of a friend. It does not, however, look normal to the watching friend. Often as not, the friend concludes that I am not able to pour coffee and does it for me, or watches in amazement as I do it myself. Since a blind person, at the beginning of a task, uses a tactual search to substitute for the visual search made by a sighted person, blind people can look unable when they are actually very able indeed.”

Martha compares the sighted method vs. the tactual method of putting on a jacket:

“While the sighted kindergartner (1) sees the arm hole where his arm needs to go, and (2) puts his arm right in, the blind child will probably (1) aim his arm in the general direction of the arm hole, touch the front or back of the jacket, feel around to find the arm hole, and then (2) put his arm in. It is hard to resist directing the arm into the armhole or moving the jacket… The tactual search and the pause for auditory searching may make us look blind, but—surprise, surprise—we are blind. Consider the beauty of gently searching hands, and the wonderful awareness of the listening posture. Wait, let it be.”

Another educator who is searching for alternatives to controlling hands is Barbara Miles, who presented a workshop entitled “Hands: Tools, Sense Organs, Voice” at the 1997 National Conference on Deaf-blindness. Barbara listed this topic among others in her agenda: “Skillful ways of touching and inviting touch, including alternatives to hand-over-hand techniques.” Barbara showed a video in which she gained the trust of a child described as tactually defensive. Barbara used her hands to “invite” and “comment” on objects and activities rather than directing his activity. Her hands followed the child’s very gently and were slightly under the child’s hands rather than over them, thus allowing the child to know that his tactile attention was shared. From this hand-under-hand position, the teacher could gently invite the child to touch an object or person without controlling. This freedom resulted in dramatically increased hand activity.

Consider the O&M technique of the sighted guide. We are taught that the sighted guide does not hold onto the blind person’s arm and pull—that would take all control away from the one being guided. The guiding must be invited and even then it is understood that the one being guided will have a harder time repeating the route by themselves because the guide-ee is dependent on the guide-er.

Hand-over-hand guidance has been promoted as a catchall solution without many questions as to how it is done, when, and why. The challenge remains in our work with young children to explore this issue of teaching, yet still promote independence.

Ms. Story is a teacher of the visually impaired and a member of AER Division 8, Anchorage, Alaska. This article was originally published in The National Newspatch, November 1997.

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