The Blind, Multiply Disabled Child

The Blind, Multiply Disabled Child

(back) (contents)
(next)
Active Learning and the Blind, Multiply Disabled
Child
by Lilli Nielsen, Ph.D.

From the Editor: In my opinion
Dr. Lilli Nielsen is one of the most important persons in work with the blind
and multiply disabled today. Some people may recognize her name in connection
with the Little Room. (The Little Room play environment designed by Dr. Nielsen
to provide the optimum opportunity for blind youngsters especially those with
additional disabilities to learn by doing for themselves.) A native of Denmark,
Dr. Nielsen lectures worldwide and has conducted a number of seminars in the
United States over the past several years. I attended one of those workshops
about four years ago. It was one of the most informative and productive workshops
I have ever attended which is no faint praise coming from someone who is accustomed
to the quality of workshops conducted as a matter of course by the National
Federation of the Blind.
The following article is an edited version (with
permission of the author) of the introduction and the first chapter of Dr. Nielsen's
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 and multiply handicapped children. Here is what Dr. Nielsen has to say:

Introduction
(Reprinted from: Early Learning Step by Step:
Children with Vision Impairment And Multiple Disabilities, by Lilli Nielsen,
Ph.D.)
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, and they represent the uncertainty that many parents
and teachers are met with 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 having
reached 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 gain friends whom they appreciate. 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
childs potential, anxiety concerning the possibility of emotional problems,
and anxiety for the childs 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 childs 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 childs 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 childs 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 childs 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 childs
personality.
It must be difficult, if not impossible, to
initiate action using a skill that has not become a part of ones 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, care-givers, 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 fulfilment of his own needs, and 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 authors point of view, the starting
point in commencing to train and teach a certain skill seems to be the final
skill itself, whereas 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
childs 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/childs 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, as well as 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 & Instruction 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 adults cooperation and attitude
The adults cooperation and attitude is crucial
in upholding the approach of Active Learning. Environmental intervention means
that the adult establishes environments appropriate for the childs learning,
makes objects available for him, and reacts to his signals or vocalization by
sharing his interests and by interacting with him at the childs 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 Nielsens Publications
Vision Associates
7512 Dr. Phillips Boulevard
#50-316
Orlando, Florida 32819
(407) 352-1200
Dr. Lilli Nielsen has been working with people
with handicaps for 30 years. She presents workshops internationally that are
based on her research on spatial relations in congenitally blind infants. She
is a special education adviser at Refsnaesskolen, National Institute for Blind
and Partially Sighted Children and Youth in Denmark.
Early Learning Step by Step
#LN-EL $33
Parents, teachers, and other folks who care
for handicapped children will learn how all children achieve readiness skills
for learning, i.e., sit, eat, walk, etc. and how environmental intervention
can facilitate learning through Active Learning.
Functional and Instruction Scheme
#LN-FI $22
The first version of this scheme was used in
1976 and revised to include changes based on pedagogical work with 500 children
with vision impairments and on scientific study on spatial relations in congenitally
blind infants. The scheme continues to evolve and can be utilized for educational
planning.
Spatial Relations in Congenitally Blind
Infants
#LN-SR $22
This is Lilli's dissertation on her scientific
study. The study investigated whether a specially designed environment (Little
Room) would facilitate the development of early spatial relations in congenitally
blind infants.
Educational Approaches
#LN-EA $33
This book is a combination of Lilli's essays
and research. It explains how she expanded the educational approaches for children
and infants with vision impairments.
Are You Blind?
#LN-AY $29
This book addresses children who are autistic
and visually impaired. Lilli explains the children as developmentally threatened.
She describes an educational method which, over 20 years, has shown to be of
benefit to the children's emotional, motor, communication, and social development.
Space and Self
#LN-SS $29
This book 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 $16
The ability to grasp is of fundamental importance
for a blind child to get into contact with his/her surroundings and to enhance
the development of other senses. The book gives practical hints on how to adapt
materials and surroundings to stimulate and encourage development in blind children.
The Fiela Curriculum: 750 Learning
Environments
#LN-FC
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. Contains book, Velcro board for
weekly curriculum, and file of 730 cards describing learning environments. Available
in fall, 1998.
Visual Impairment Understanding the
Needs of Young Children
LN-POEL #33
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
and a necessity for parents, teachers, therapists, doctors and all that work
with the children.
(back) (contents)
(next)