American Action Fund for Blind Children and Adults
Future Reflections Winter 2017 EARLY CHILDHOOD
by Casey Robertson
From the Editor: Casey Robertson is a teacher of the visually impaired (TVI) in the state of Mississippi and an instructor in the teacher training program at Louisiana Tech University. In 2013 she received the Distinguished Educator of Blind Children Award from the National Organization of Parents of Blind Children (NOPBC). This article is based upon a workshop she presented at the 2016 national convention of the NFB in Orlando, Florida.
I am an itinerant teacher in Mississippi, and I work for the Institute on Blindness at Louisiana Tech, so I have a dual role. I teach teachers of the blind and at the same time I have a caseload of blind students in the public schools. We use the itinerant model in Mississippi. We often travel great distances to work with our students, from county to county and district to district.
In my teaching I work with a wide range of ages and exceptionalities. I have students who are as young as four, and I've taught Braille to a twelfth grader who never was exposed to it before.
One thing that you guys may have noticed with blind children is that sometimes they don't like to touch things, or they don't like to eat certain foods, or they don't like certain noises. Today we're going to talk about why this happens and how we can help those kids get over their fears and anxieties about touching things.
We're speaking here about blind children, but sighted children often have aversions to things, too. This isn't a blindness problem, it's a kid problem! A lot of times behaviors get labeled as blindness related when really they're about being a child.
Why do some of our children not like to touch things? Why do they touch things very lightly? You may have noticed that some kids, blind and sighted, have a very light touch; it's almost as if their arms and their bodies are floppy. Other kids are very forceful when they touch things, and you're constantly saying, "Not so hard! Not so hard!" What can parents do to help?
I bet if we took a survey in this room, everyone could tell us about something sensory that they do not like. Brown paper towels in the bathroom—I cringe if I have to dry my hands with those brown paper towels! Lines in socks—they have to be the same for me. Socks that are exactly the same except that one's thin and one's thicker, I can't do it! If you make me wear them, you might as well send me away to somewhere. My mother's here in the room, and she can probably tell you about more things I don't like.
We all have sensory things that we don't like, things we try to avoid. Most of the time our aversions don't affect us very much, but there are times when we need to address the issue. Today we'll look at what happens when avoidance becomes a problem and talk about ways we can deal with this problem in our kids.
Sensory information comes into the brain by four main pathways—the eyes, the ears, the nose and tongue, and the hands and skin. These are the four main channels that carry information from our environment to our brains so we can perceive it. Normally we process information from all of these channels at the same time; it's called sensory integration. As we touch and listen, all of that information goes into the brain at once. It's a good educational model to have students touch a thing, hear it, and say the name of it over and over. They're getting information into the brain in multiple ways at the same time. I used this multisensory method when I was a general education teacher, before I got into the field of blindness.
When the brain gets all this information at the same time, it has to decide how to respond. There's a very loud noise outside! What do I do? Some kids have trouble sorting out all the information that comes in at once. We need to teach our kids to process information and help them figure out what to do about it.
We can train our kids to respond to things in appropriate ways. Your child may be over-responsive or under-responsive to sensory stimulation. The over-responsive child is the child we call rambunctious. He or she reacts in a high-energy way to stimulation. If you give this child an object to touch, he hits it hard.
Under-responsive children are the kids who are floppy. They don't have good muscle tone—it's called hypotonia. If you ask a child like this to touch something, he just plops his hand on it and lets his hand slide down. It's as though these kids are apprehensive about touching things. They don't get the feel of an object because they touch it so lightly.
The child who is over-responsive to stimulation can easily become overwhelmed by the information coming from any or all of the senses. This oversensitivity to touch is sometimes described as sensory defensiveness. It's called tactile defensiveness when the child is overly sensitive to touch. A child may also be overly sensitive to sound, or auditorily defensive.
When we try to teach kids Braille at an early age, we often hear professionals say, "He's so tactile defensive, there's no way he's going to touch Braille right now! We need to wait a year or two." It's true that a lot of blind kids—not all of them!—are tactilely defensive when you start to teach them (if you want to use that term). They do have trouble touching the Braille and reading it, but that's not a reason to put off Braille instruction for a year or two! It's a reason for one of your goals to be helping the child become more receptive to various kinds of tactile stimulation.
Parents often call me in to do an independent assessment. They'll tell me that the school district recommends that their three- or four-year-old do pre-Braille before kindergarten because she's tactilely defensive and doesn't like to touch different textures. The team wants to spend two years working on having the child touch different textures before ever putting Braille under her fingers! There's no reason three- and four-year-olds should not have exposure to Braille, even if they're labeled as tactilely defensive. There are ways we can work through that.
I want to share a story with you about the very first blind student I ever had. I was a general education teacher with a degree in gifted education. After eight or nine years I went into the blindness field. I went to Louisiana Tech, which is one of the top programs in the nation for teachers of blind students. I started my very first job, and when I showed up on my first day the principal said, "I'm going to walk you down to the room where this little girl is." She opened the door to the special ed room and said, "This is the special education teacher, and this is your Bella. We'll talk later." And she closed the door.
There was a little balled-up bundle of a child on the floor. She was six years old. She didn't walk. She didn't talk. She didn't eat solid food. When the principal closed that door I thought, "Oh, my! What do I do!"
So I grabbed my cell phone and called Dr. Ruby Ryles, who is kind of a guru in the blindness education field. I said, "Hello! This kid's not reading Braille! She's not walking, she's not talking, she's not eating. She's pretty much in a fetal position on the floor. You didn't teach me about this! What do I do?"
She said, "You're a teacher. You've got to figure it out." [Laughter]
In the process of teaching this little girl, I had to get past being scared. Then I had to figure out what was going on. Bella was six years old and she weighed twenty-five pounds. When I started working with her she would not touch anything except her bottle and a sippy cup. She crawled around the room, but she didn't want to touch anything except the floor.
She was the only student I had for the first semester. I spent the majority of my time with her each day. It took me half a year to get her up and walking. She could swing. She loved to swing because her parents would put her on a swing to occupy her while they did yard work or things around the house. Swinging was the number one motivator I had to get her to start touching things.
My mom loves to sew. I went to the fabric store and picked out about ten different textures of fabric. Mom and I sewed squares of fabric together and made Bella a blanket that she could carry with her everywhere. It came to school with her, and it went home with her every day. In the beginning she would only touch one square of that blanket, a square that was smooth. She would hold the blanket by that one square. She wouldn't touch the blanket anywhere else or let any other part of it touch her.
Touching that one smooth square was all I needed her to do at first. Bit by bit, as we worked together, she began to touch other squares of the blanket. We had put lots of things on it, from rough burlap to a zipper and buttons—a whole palette of textures. We worked up to two textures that she would touch, then three, until finally she had the whole blanket. It became very much a friend for her.
Bella is an example of a child who was under-responsive. She was floppy, had low muscle tone, and was very reluctant to touch things. The number one thing we can do for the under-responsive kid is to get him up and moving. If Bella's parents gave her something and she didn't like the feel of it, they quit. They tried giving her baby food, and she didn't like it, so they quit giving it to her. If they gave her a cup instead of a bottle, she screamed—so they quit. She just stayed in one part of the house doing nothing. She was under-stimulated, had very weak muscles, and she didn't want to touch anything.
If there's one thing I hope you take away from this presentation, it's that all kids don't like certain things. In most cases, if a sighted child doesn't like to touch certain things, we make him touch those things anyway. But when it's a blind or low-vision kid, we tend to assume their aversion is a blindism—a behavior that's somehow caused by the blindness.
The schools generally don't like to push issues dealing with texture. They know that children tend to act out when you try to get them to touch things they don't like, and that's disruptive in the classroom. So the teacher is likely to stop and not to persevere. The child is labeled tactilely defensive, and everybody assumes there's nothing to be done.
My niece, Emily, is the first blind person I ever knew. We didn't know she was blind until she was five or six months old. She was a sensory kid—not because she's blind, but because she had sensory issues. If you put her feet on grass, she'd climb you like a monkey! She would scream and climb you! We had to take it in small pieces. We'd put her feet on the grass, she'd scream, and we'd give her something she liked as a distraction. We'd do that for a short time, take her away from the grass, and then go back later and try it again. When you introduce something to kids over and over, they become better at handling it.
For my niece it was the same with Wal-Mart and the grocery store. It took a team to go to the store with that one small kid! Before I knew her, I used to see kids acting out in public, and I'd say to myself, "Why can't that parent handle that child?" Emily proved me wrong with everything I ever thought I knew about kids. We'd take her to the store; it would be loud in there. She'd scream, and we'd have to take her out. We had to keep reintroducing her to that experience. At the time I thought it was because she's blind. Well, now she loves to shop!
Regarding tactile defensiveness, let's look at the who, what, and why, and let's look at what not to do. Occupational therapy (OT) is a field that gives professionals a lot of training in this area. Teachers of blind children usually get none. What we know is what we learn through our own research when we're trying to help a particular student. The blindness field teaches a lot about kids who are blind—whether or not they need Braille or mobility training and how to teach them blindness-related skills. We learn hardly anything about kids with multiple exceptionalities. I don't call it multiple disabilities; I call it multiple exceptionalities. To me exceptionality is a friendlier term. It doesn't have the negativity that can be associated with disability. Anyway, I'd like to see much more sharing of ideas between blindness professionals and occupational therapists. Sometimes an occupational therapist feels unable to help a blind child because she or he doesn't have any experience with blindness. The OT will sometimes try to say it's up to the TVI to work with the blind child on sensory issues. But the OT needs to work with the TVI to help the child.
When you work with a child who has a lot of tactile defensiveness, first you need to determine some things the child really likes to touch. Most of these kids like things that are really soft, or some things that are really hard. They don't like things that are in between. In my experience, these kids are more likely to prefer hard things. So find out first what the child likes, and emphasize those things. Give her lots of practice with those things. You want the child to be comfortable, to be less fearful than she was when she came in. This helps you build a trusting relationship. If I see a kid for thirty minutes every day, and all she does when she's with me is touch things she doesn't like, she's not going to like coming to me very much! She's not even going to like the sound of my name when they tell her, "It's time to go see Miss Casey!" So you give the child lots and lots of practice with things she likes, and slowly you introduce things she doesn't like, one at a time.
Some of the things we can use with these kids are Play-Doh and Silly Putty. They're not going to like it at first. But the more you introduce it to them, the more they get to accept it.
With Bella and some of my other kids, I use things they like as a way to introduce them to things they don't like. I found out that Bella loved to play in water. She would pat the water and splash the water. Once she became mobile, we couldn't keep her out of the toilet!
I set up a water and sand table, and I filled it full of water. Into the water I put whatever objects I wanted Bella to touch. In the water she might find a rock—she didn't like hard things.
I knew Bella liked to swing, so I went to the hardware store and got them to cut me a link of chain. It felt like the chain of the swing that she liked to swing on, and I'd put that into the water. We'd work on having her find the rock or the chain link. When she found the thing I asked her to find, her reward was getting to play in the water for a longer time.
Feeding was another area where we did a lot of work. Bella wouldn't eat any solid food whatsoever. She had only been given liquids such as milk and apple juice. She wouldn't even tolerate the textures of pudding or applesauce. For about six months I went home every day with pudding or applesauce spit all over me! It was gross, but we had to keep reintroducing those foods to her.
One of the first things I put in the water was a spoon. Bella had never held a spoon before. First she got to where she would touch it. Then we worked on having her hold the spoon outside of the water.
Some kids like soft things, such as a bag full of cotton balls. You can fill a paper bag with cotton balls and put an object with a texture the child doesn't like down in the bag with the cotton balls all around it. Have the child find the object. If she likes soft things, you can hide something hard in a plastic container full of feathers. You can get feathers from an art supply store. You tell the child, "Find the rock," and have him reach into the bag of cotton balls or feathers to find it.
For Bella I got a small swimming pool. Off season you can get them at the dollar store really cheap! Take a blow-up swimming pool and fill it full of dry beans. Let the child get in and play with them. It's going to be messy—if you're a clean freak like I am, you just have to get past it! We swept up beans every afternoon. You can start off soft and move to hard, or start off hard and move to soft, depending on the child. With Bella I moved from beans to rice. You would not think there's much texture difference between a pinto bean and a grain of rice, but for some of these kids the difference is very big. After a couple of weeks we took the rice out, and I filled the pool with uncooked macaroni noodles.
Once Bella got used to the texture in the swimming pool, I put in objects for her to find. She would pick them out. This activity also encouraged movement, which helped improve her muscle tone. Her improved muscle tone encouraged her to explore, and exploring encouraged her language. Once a child has experiences to talk about, she starts to gain language skills.
One of the things that occupational therapists use with some kids is called deep pressure. Deep pressure can be very calming for some children. Wearing Spandex or tight exercise clothes under regular clothing can have a calming effect, but other kids might hate it. It's trial and error until you find out what works best for a particular child.
Some kids are helped by wearing seamless socks and moccasins instead of shoes. The less uncomfortable he is, the more the child will be encouraged to move around.
Some kids love vibrating toys. If the child is scared of the vibration, let her have control over it. The American Printing House for the Blind (APH) sells lots of vibrating toys that are controlled by switches. The child pushes a big button to turn the toy on and pushes the button again to turn it off. Some of these toys may be available through APH quota funds, so talk to your child's teacher of the visually impaired before you purchase anything. An alternative is, again, to go to your local dollar store. You know those little handheld back massagers that vibrate? The dollar store has those. The button lets the child feel that he's in control of his environment. The more control he has, the more he can understand that things aren't just happening to him at random.
You're not going to find an aisle at Wal-Mart that says TOYS FOR BLIND KIDS, but a lot of the toys they sell can easily be adapted or just used out of the box. They have toys that vibrate when you squeeze them, and at the end of the vibrating they make a little musical tone. Those toys are perfect for kids with sensory issues. If you lay the vibrating toy on the floor out of arm's reach, the child can hear it or feel the vibration. That will encourage the child to move to the toy.
The dollar store sells little sand pails like the ones you take to the beach. You can fill the pail halfway with water or sand and put an object at the bottom for the child to find.
You want the child to feel just enough discomfort to work through the process of getting used to something he doesn't like. However, be careful not to go too far too quickly. You don't want the child to be crying hard or acting as though he's in pain. You don't want to scare him. A bit of discomfort is okay, even necessary. But never force the child to touch something! I remember hearing about a little boy who was always forced to hug people. After a while he wouldn't hug anybody! Introduce things gradually, and the child will learn to tolerate them, maybe even like them.
At home you already have built trust with your child, so you can introduce touch in a much less threatening environment than the school can. Your child doesn't have the same level of trust with her classroom teacher or TVI that she has with you. If you start to incorporate these methods at home, it's easier for the teachers at school to do it, too.
Once the child can tolerate touching something, don't stop there. Encourage him to pat the smooth, foamy ball or hold a ball of Play-Doh. Build upon the skills the child has gained. We call this scaffolding. "You touched the Play-Doh today, and I'm so proud of you! Let's see if you can hold it tomorrow." The child might not hold it tomorrow, but introduce it again the next day. Keep working your way up.
With the child who is under-responsive to touch, occupational therapists do what they call heavy work. Heavy work involves activities that encourage the child to move, help the child build muscle tone, and burn off the stressful energy they build about objects and textures. Lack of movement causes the child's muscles to be weak. Sometimes the child's brain doesn't know what to do with sensory input, and the child may have trouble with movement or posture stability.
An older child can help raise and lower the flag at school. She can carry items from one class to the next. I've heard a lot of parents say, "My child should not have to carry his Brailler. The aide should carry the Brailler for him." However, carrying a Brailler is a good example of a heavy workload activity. I'm not talking about carrying it a long distance, from one building to another. But moving it from one part of the classroom to another part, that's fine!
Sometimes the brain knows what the child wants to do, but it can't relay that desire to the muscles. For instance, a blind child wants to ride a bike. Because he has never seen anyone ride a bike, he may not understand what to do with the pedals. You have to physically show him what to do with his body.
A couple of weeks ago we had a BELL Academy in our state. We taught the kids to do the Cha-cha Slide. If you're not familiar with this dance, the music gives directions such as "Step to the right" and "Hop forward" and "Turn around." We thought this would be a great way to begin teaching cardinal directions. Once we did it for a day or two, we could say, "Step to the east," "Step to the west," or "Hop to the north." But these kids, who had never seen anyone dance, looked uncoordinated. We found we had to move their feet to the right or left. We also let them feel our legs as we went through the movements to help them train their brains to do the actions of the dance.
One of the things that works well with kids who have sensory issues is pushing a toy shopping cart. All of the push toys that they sell for sighted kids work the same way for blind kids. Nowadays they make the wheels very slick, so for some kids I put Velcro on the wheels. The Velcro makes the cart less likely to slide out from under the child, and that bit of resistance also helps build muscle tone. Pushing a laundry basket around on the floor is also good for toddlers and preschoolers. Kids can also push toy vacuum cleaners along the carpet.
We don't have snow in Mississippi except about once every couple of years. It's freakish enough that we shut down everything when we see a snowflake! Our kids don't have experience with shoveling snow. But if you live in a place where snow happens, let your child have a toy shovel so she can dig in the snow that's out there.
You can buy a pack of exercise bands really cheap at a sports store. Have your child put the band on his arms and pull his hands apart. He can feel that the band is floppy when his hands are together and that it gets tight as he pulls his hands away from each other. If you have an open-minded teacher at school, you can hook an exercise band around the bottom of your child's chair. He can push it like a gas pedal while he's doing his work.
Jumping or bouncing on a trampoline or an old mattress helps with movement and balance. Sitting in a beanbag chair is also a great activity.
I've never been in a school that had many supplies, so if I can make something rather than buy it, I'll make it. You don't have to go out and buy Play-Doh, you can make your own. You can find recipes on the Internet. You can buy something called therapy putty, which is a bit more resistant than Play-Doh. It's very good for kids to work with, and you can buy it on Amazon for about twelve dollars.
You can also buy sensory blankets, but they're very expensive! Some are weighted, and some are textured. As I said, my mom made one for Bella. You might be able to contract with someone to make you one. Maybe one of our affiliates would like to start making them as a fundraiser. We could sell them at convention. To make a weighted blanket, put small weights in before you sew it all together. Just use small weights; you don't want to go too heavy! And I want to mention that you must never leave a child under a weighted blanket for too long. Once she goes to sleep, take the weighted blanket off of her. Some kids get lung fatigue, so they shouldn't sleep under anything heavy. Just use the blanket to help the child get to sleep, and then remove it.
One thing I want to emphasize before we stop today—it's really important to start exposing a child to different sensory experiences when he's very young, as a baby and toddler. In those early years sensory issues have not become entrenched, and it's much easier to deal with them. If your child has sensory issues when he starts school, he may well end up being diagnosed as having additional disabilities such as autism. I'm sure if I'd been blind when I started kindergarten, I would have been labeled as having other disabilities, too, because of the sensory issues I had at that time. Having sensory issues isn't necessarily a disability; it's just something that needs to be worked through. You may not be able to work through all of the issues before your child enters school, but you can get a good head start.