Professional CornerWorking with young children who are visually impaired is a relatively new avenue for me. I have put together a reference sheet regarding teaching self care skills, daily routines, and developmental tips. Although they were designed to be used with children with vision loss, most of the suggestions work well with all young children. The basic information shared here is attributed to the Ski Hi Institute, TASH, Foundation for the Jr. Blind, and Dote-Kwan (1998).
Tips for Teaching Self-Care Skills
There are some general strategies to keep in mind when teaching self-care skills to a young child who is visually impaired. Here are some ideas shared in two booklets, Get Ready, Get Set, Go by Jeanette Schuch and One Step at a Time by TASH.
1. Use common sense. Teach new skills when and where they happen so that the child learns there is a reason tor what he or she is doing.
2. Teach skills within age-appropriate, functional activities with real objects to help the child generalize information.
3. Try doing it yourself blindfolded. What steps do you go through? How do you do it? How would you deal with the difficult steps? Suggest that the parent or caregiver do this. too.
4 This will help you better analyze the behaviors involved in completing a certain task. Write those steps down into a workable sequence.
5. Once the steps have been identified, you can choose to use and then fade physical prompts with backward or forward chaining. In backward chaining, full manipulation of the child is given on all steps until the last one, which the child performs independently. As training progresses, prompts are faded to the next to the last step and so on until the child performs the entire task without help. In forward chaining, fading begins with the First step and then assistance is given on the others. There are pros and cons to either method. Forward chaining should be used if the child already knows some of the steps.
6. Another approach is to use graduated physical guidance. Here is a suggested sequence:
7. Be consistent. Use the same cues, gestures, words, prompts, and procedures.
8. Give both the child and the parents positive feedback and lots of encouragement for their efforts.
9. Do not hurry; be patient. Progress may be slow at first. It's normal to feel some frustration. Think back to when you last learned a difficult task. If you need to take a break or relax, go ahead.
10. Once the child can do a skill, let him or her do it on his or her own even if it takes longer. If your child thinks you will help, he or she will stall long enough for you to do it. The child needs to know that he or she can do things and that his or her parents expect that of him or her.
11. Seize teachable moments! For example, if all of a sudden one day the baby starts to reach for food, stop what you are doing and turn the session into a finger-feeding activity.
12. Some parents feel that they can only work on one specific objective at a time. They become very concerned with small tasks and forget to let the child be a child. During times such as bathing, outside exploring, feeding, washing dishes and playing, many skills can be taught or reinforced without thinking, "I cannot do that now, I am working on another skill this week" or "I do not know all the steps to teach that skill yet." Encourage parents to read normal baby-rearing books that focus on helping them see children progressing differently and the importance of letting the child be a child too, not always in a structured, educational climate. The child likes free time. too.
13. Always look for ways to let the young child with vision impairment help with things that need to be done around the home. This can build the child's confidence and help to increase his or her mobility skills.
14. If one way does not work, try another way until you find one that does!
15. Use of consistent routines is critical. Routines give the child a sense of control and an understanding of what comes next or what will happen. When routines are disrupted with medical exams or family change, the child may be fussy and take a day or two to get back into the routine.
In the curriculum guide Oregon Project, it is suggested that in one home visit demonstrate to the parents how to teach the skill, then have them try it with the child and write out the procedures for them. The parents are then to teach the child using those steps during the week and record what occurred during the week. On your next visit, ask them how it went. Be prepared to write out a new procedure with their input for the following week. This procedure will detail the next step in the skill or will be a revision of the procedure if the step was not acquired.
Taking advantage of the daily routine
Because parents lack the time or energy to spend long hours of intense work and play with the child, most activities must be planned to fit into the routine of the day, or they will not be carried out. In order to effectively incorporate objectives into a routine, the early intervention specialist needs to know when the child wakes, eats, plays, naps, bathes, goes to school, and goes to bed. She or he must know when the child's parents have specific time to work one-on-one with him or her. Most objectives can fit into these appropriate times. Here is an example of a child's daily schedule with the types of objectives that would easily fit into each activity:
Breakfast: eating, sensory, and communication objectives
Bath: hygiene, vision, communication, play, and dressing objectives
Play: cognitive, vision, fine motor, gross motor, and communication objectives
Morning Nap: rest for parent and child
Lunch: feeding, communication, sensory
Play: (see above) independent play time
Afternoon Nap: rest for parent and child
Play with dad, siblings: auditory, gross motor, social, and communication
Supper: eating, communication, and vision
Bedtime: communication, language, and social
Older child: Incorporate activities into the community such as trips to the park, grocery, mall, and grandparents.
The specialist, together with the parent, may also find it helpful to get a profile of the child's behavioral states over the course of a week. This will help decide the times during the day when the child might be most receptive to learning new skills and how much stimulation the child can really handle. If they find that the child is spending a lot of time asleep, drowsy, or fussy, they will need to explore the reasons and find ways to facilitate a better state. For example, if the child is crying, find ways to soothe him or her such as rocking or swaddling. If he or she is drowsy, explore ways to alert him or her such as movements, lively music, or massage.
Ski Hi lnstitute Resources
References and Reading List
Bailey, D., & Wolery, M. (1984). Teaching infants and preschoolers with handicaps. Columbus, OH: Merrill Publishing Co. An excellent resource for ideas on teaching self-care skills can be found in Chapter 16
Chen, D., Friedman, C. T & Calvello, E. (1989). Learning together. Part of PAV Manual. American Printing House for the Blind, P.O. Box 6085, Louisville, K.Y 40206-0085.
Ferrell, K. (1985). Reach out and teach New York, NY:
American Foundation for the Blind. First steps. (1993). Los Angeles, CA: Blind Childrens' Center. Moore, S. (1985).
Beginnings. Louisville, KY: American Printing House for the Blind. Nelsen, L. Technical Assistance Project, Teaching Research, 345 N. Monmouth Ave., Monmouth, OR 97361.
Oregon Project. Jackson County Education Service District, 101 N. Grape St., Medford, OR 97501. Pogrund, R Fazz, D., & Lamport, J. (1992). Early focus. New York, NY: AFB. Scott, J.,& Scott, F. (1985).
Can't your child see? Pro-Ed, 5341 Industrial Oaks Blvd., Austin, TX 78735. Schuch, J. Get ready, get set, go. International Institute for Visually Impaired. 1975 Rutgers Circle, East Lansing, MI 48823. Swallow, R.M., & Huebner, K.M. (1987).
How to thrive not just survive. New York, NY: American Foundation for the Blind.
Becoming a can do kid: Self-help skills is a 12 minute video available from VI Preschool Services 1215 S. 3rd St. Louisville KY 40203 502/636-3207.
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