University of Edinburgh

Working with Pupils with a Dual Sensory Impairment or Deaf Pupils with Complex Needs

Presented on Wednesday 26 November 2008

Working with pupils with Dual Sensory Impairment

Introduction. Jane Eyre. Depute Head Teacher, Hazelwood School. Formerly of Carnbooth School for Dual Sensory Impaired Pupils.

1. By the end of this session, participants will:

  1. have an understanding of what is meant by the term 'dual sensory impairment'
  2. have learned about the causes of DSI and how these have changed over the last 20-30 years
  3. have explored some of the difficulties faced by the DSI pupil in learning and development through discussion and case studies
  4. have looked at some of the methods and strategies currently used with DSI pupils
  5. have been introduced to Hazelwood School in Glasgow – a school designed for pupils with sensory impairments and additional support needs

2. What is Dual sensory impairment?

- discuss the term 'deafblindness' – confusing because it does not mean total deafness and total blindness. Very rare to have total sensory loss in both channels. Means some degree of impairment to both of the distance senses. Deafblind community chose the term 'deafblind' to counteract the supposition that it meant blindness, with some hearing loss or deafness, with some visual loss. The term 'deafblindness', they felt, should be seen as a separate impairment.

'Dual sensory impairment'  is perhaps a more accurate description of the impairment. Deaf children learn primarily through sight and use a sighted method of communication (sign) to compensate for their loss of hearing. Blind children use their hearing (spoken language) and their sense of touch (Braille) to compensate for loss of sight. The pupil with DSI is unable to use the compensatory approach effectively, because both channels are impaired. Even when there is only moderate loss in one of the sensory channels, the compounding effects of the dual loss can give rise to complex difficulties. In addition to this, the DSI child may have physical impairment, learning difficulties of a cognitive nature, medical difficulties (seizure activity, gastrostomy-fed, hypopituitarism, diabetes), social and emotional difficulties, autistic behaviours and communication difficulties.

3. Causes of Dual Sensory Impairment.

  1. Congenital
    - Rubella – now greatly reduced due to vaccination, but MMR scare has recently seen rise in numbers of children with measles and mumps
    - Prematurity – now greatest cause of DSI. Improvements in medical technology have increased the survival rates of younger & younger premature babies, but often with damage to eyes, ears & central nervous system.
    - Genetic/congenital syndromes – These have probably always been present, difference is that now we are better at diagnosis. Discuss 'CHARGE Association' & 'FAS' (Foetal Alcohol Syndrome)
  1. Acquired
    - Infection – Meningitis, Toxoplasmosis, etc.
    - Trauma  - post natal, accidental
    - Usher's Syndrome – Retinitis Pigmentosa – children born deaf, lose sight as     
    - Old Age – we all lose sight & hearing eventually!

4. Factors which impede communication in DSI

  • Direct effects of sensory impairments
    - discuss importance of the two major distance senses in learning & development. The infant learns about the world primarily through sight and hearing 
    - bonding, eye-contact with mother while feeding, exchanging smiles, mutual attention to objects, pointing and naming, familiar voices, familiar sounds that give clues to the environment and what is happening in it
    - all of the important developmental milestones that will eventually lead to language & communication are impeded through sensory loss in both channels.
  • Effects of delayed/impaired development
    - in most DSI children there is also some degree of cognitive damage (damage to the brain, central nervous system). This, alongside the dual sensory loss will mean that developmental milestones are reached long after their sighted, hearing peers.
  • Effects of ill health & medication
    - many DSI infants are very ill, (remember causes), require invasive surgical treatments, long periods of hospitalisation where they are separated from parents, and medication.
  • 'Maternal deprivation'
    - not only because of the above, but because the 'mother-infant bonding' process can be so difficult due to the sensory and other difficulties. The 'synchrony' of communication between mother and infant is difficult to achieve.
  • Lack of opportunities to interact
    - all of the above factors severely limit the opportunities for DSI babies and children to interact effectively with adults and with peers. The DSI child does not see or hear the shiny, noisy toy just across the floor, so is not motivated to move towards it, does not see other children playing, so is not motivated to join in. 
  • Lack of information and knowledge about the world
    - experiences are therefore limited. DSI children are 'victims' of adult wishes
    - they can only go where adults pick them up and take them, they can only touch, interact with those objects/toys that are brought into their reach.
  • Poor self-image
    - even when DSI children do master language and begin to communicate, they have had so many misunderstandings and mixed messages in the past that they lack confidence in their ability to communicate effectively (discuss Paul)
  • Impaired communication from other people
    - research has shown that non-impaired communication partners will alter their language when communicating with children with learning difficulties. This results in constant exposure to an impoverished language model.
  • 'Doing for' the child ('learned helplessness').

5. Activity - break into groups of  4/5.

  1. Read the profiles (included below)
  2. Based on the information available, what communication system might the pupils be able to use and what difficulties do you think the pupils may have in terms of accessing this system?
  3. What other factors might impede the communication process?
  4. How might these be overcome?

6. Discussion and video clips

7. Learning & Teaching - many of the methods/strategies used with DSI pupils for the last 30 years or so are now widely used in the field of SEN:

  1. Independence in basic life skills
    – (Mesheryakov) - discuss 'Awakening the Soul' v 'Awakening to Life'. Also Maslow's 'Heirarchy of Skills' - satisfaction of needs (eating, dressing, washing, toileting, etc.) are first to be met, lay the foundations for other, higher order skills

  2. Communication
    – (Nafstad/Rodbroe) - communication , rather than 'language' understanding the child/young person, learning their language before attempting to teach them ours. Total communication approach, using alternative and augmentative forms of communication - movement, gesture, sign, hand-over-hand sign, on-body sign, BSL, objects of reference, object symbols, pictures, picture symbols, Braille, MOON, spoken language, written word.

  3. Movement/Co-active method (Piaget/Vygotsky) 'Thought is internalised action'
    - DSI child has to experience the actual movements involved in a task in order to learn how to do the task by themselves. We can assist by taking them through the series of movements until they are able to execute on their own. (Co-active movement). Vygotsky emphasised the social imperative of communication and outlined how much more a child can do when assisted by a competent partner - 'zone of proximal development'. Discuss the 'blue-print' for communication that all human infants are born with.

  4. Structure & predictability (Van Dijk)
    - assisting the child to anticipate what will happen through the use of signals/cues. Making the world less chaotic, more predictable, understandable. Pace of learning - time needed to process information.

8. Hazelwood School

Merger of 2 schools - Kelvin School (MDVI) and Carnbooth School (DSI). Opened August 2007.

Architect-designed to meet the needs of pupils with sensory impairments and additional support needs. Hazelwood School is about preparing children/young people for life, giving them the skills they will need to have for life beyond school. Design features:

  • Natural light
  • Tactile materials
  • Trailing wall
  • Acoustic environment
  • Storage space
  • Life skills house
  • Outdoor areas