chapters 1 and 2.final

UnderstandingDeafblindness2C H A P T E RBarbara Miles and Marianne Riggio

IN THIS CHAPTER

22Defining the Population

24A Changing Population

of Children

24Why a Categorical

Definition?

25Challenges Shared by

People Who Are Deafblind

27Importance of Assessment

27Impact of Sensory

Losses on Attachment,Communication, andConcept Development

35Importance of Diagnosis

and Assessment

35Cultural Attitudes

Toward Deafblindness

In this chapter, we will look athow deafblindness is defined,explore the diversity within thepopulation of people whom wecall deafblind, and explore theimpact that this disability has on aperson. Most importantly, we wantto look at the unique nature ofdeafblindness as a disability andthe effect it has on the individual’sability to communicate.

Defining the PopulationFor our purposes, and for legalpurposes, too, the definition ofdeafblindness is primarily an educational one. Here is the definition of deafblindness thatappears in U.S. Federal law governing special education(Individuals with DisabilitiesEducation Act [IDEA]):

The term,“children with deaf-blind-ness,” means children and youth hav-ing auditory and visual impairments,the combination of which creates suchsevere communication and other devel-opmental and learning needs that theycannot be appropriately educated with-out special education and related ser-vices, beyond those that would be pro-vided solely for children with hearingimpairments, visual impairments, orsevere disabilities, to address their edu-cational needs due to these concurrentdisabilities. (PL101-476, 20 USC,Chapter 33, Section 1422[2])

So, a person who is deafblind is one who cannot simply bethought of as a blind person withan additional disability (and there-fore able to function without helpin an environment geared towardhelping people who are blind).A person who is deafblind alsocannot simply be thought of as a person who is deaf and has anadditional disability, but could easily be accommodated in aschool program for children whoare deaf. Even putting personswho are deafblind into the cate-gory of “severely or multiply dis-abled” will not, by itself, do justiceto the nature of their disabilitiesand their needs.Why? That is aquestion that we hope to addressthroughout this chapter.We wantto look at the unique nature ofdeafblindness as a disability andthe effect it has upon an individ-ual’s ability to communicate.

It is important to note herethat throughout this book we will use the term “deafblindness”as a single word. In 1991, theInternational Association for theEducation of the Deafblind (nowknown as Deafblind International)resolved to adopt this spellingrather than use the hyphenatedterm “deaf-blindness” to define thepopulation of infants, children andadults we are talking about here.Although this change may notseem so significant, it demonstrates

22 CHAPTER 2: Understanding Deafblindness

In order to helpA PERSON WHO IS DEAFBLIND COMMUNICATE

TO THE BEST OF HIS OR HER ABILITY, WE

NEED TO UNDERSTAND DEAFBLINDNESS AND

HOW IT AFFECTS COMMUNICATION. FIRST,

WHAT EXACTLY IS DEAFBLINDNESS, AND WHO

IS A DEAFBLIND PERSON?

ONE MIGHT INITIALLY SAY, WITH A LOT OF COMMON

SENSE, THAT A PERSON WHO IS DEAFBLIND IS SOME-

ONE WHO CAN NEITHER SEE NOR HEAR. HOWEVER,

AS ANYONE WHO HAS ENCOUNTERED EITHER DEAF

OR BLIND PERSONS KNOWS, THERE ARE DEGREES OF

DEAFNESS AND DEGREES OF BLINDNESS. THERE ARE

PEOPLE WHO HAVE MORE OR LESS SEVERE VISION

AND/OR HEARING IMPAIRMENTS AND DIFFERENT

KINDS OF HEARING AND VISION LOSSES, AND THERE

ARE MANY KINDS OF VISION AND HEARING IMPAIR-

MENTS. SO, THE QUESTION THEN BECOMES THE FOL-

LOWING:WHAT DEGREE AND KIND OF HEARING AND

VISION IMPAIRMENTS, IN WHAT COMBINATION, CON-

STITUTE WHAT WE WILL TERM “DEAFBLINDNESS”?

CHAPTER 2: Understanding Deafblindness 23

that this is a unique disability, andnot the sum total of a vision and ahearing loss.

We must also take note of thefact that the above U.S. definitionof deafblindness is an extremelybroad one. It includes, for exam-ple, the range of children andyoung adults described in thesebrief case descriptions:

• A three-year-old boy who is totally blind has a moderate-severe hearing loss, apparentlynormal motor and intellectualabilities, is just beginning towalk on his own, but has notyet learned any expressive language.

• A six-year-old with congenitalrubella syndrome who is pro-foundly deaf, partially sighted,and has behavior disordersattributed to an attentiondeficit disorder. Intelligenceestimates are that she is severe-ly developmentally delayed.

• A 16-year-old girl with pro-found deafness, visual impair-ment, and severe cerebral palsyaffecting all four limbs. Herintelligence cannot be accu-rately assessed because of lackof motoric functioning andabsence of any consistentaccessible language input during the course of her life.She has no apparent receptiveor expressive language skills.

• A two-year-old girl who ismedically fragile, born prema-turely and suffering from pre-natal brain hemorrhages, with profound deafness and totalblindness, now cared for in a pediatric nursing home.

• A 20-year-old man who iscongenitally deaf and adventi-tiously blind, with above aver-age intelligence; presently edu-cated for a half-day in a specialsetting for youth who are deaf-blind and for a second half-dayin a mainstream situation in a

The current population of infants, children and adults who are deaf-blind is very diverse, although they all have common challenges causedby this disability.

boys’ preparatory school wherehe attends classes with the helpof a sign language interpreter.He plans to attend college.

These brief descriptions are asmall sampling of the kinds ofindividuals who might rightfullybe included in the category ofthose with deafblindness. From asensory standpoint, the disability of deafblindness can be broadlydivided into four categories:

• Those who are totally deaf andtotally blind

• Those who are totally deaf andvisually impaired

• Those who are hard of hearingand totally blind

• Those who have some use ofresidual hearing and vision

To further understand the individual with deafblindness, wemust consider age of onset; anycorrection (i.e., surgery, lenses,hearing aids etc.); the extent ofadditional physical and cognitivedisabilities; and additional healthimpairments.These are all factorsthat will affect the way we thinkabout a child who is deafblind andthat will help determine specificstrategies we should use forinstruction.Whatever specific sen-sory impairments and additionaldisabilities a child has, each onewho is deafblind will require edu-cation by a teacher who has anappreciation of this unique disabil-ity. She can then build a relation-ship with the individual child thatwill maximize that individual’sconnection with other people andsituations in the environment.

A Changing Populationof ChildrenThe population of children withdeafblindness has widened consid-erably during recent years. In theUnited States, education of chil-dren who are deafblind began inearnest with the education ofLaura Bridgman at Perkins School

for the Blind in 1837. Early pro-grams for children who are deaf-blind were academically based and were usually associated withschools for the blind.They tendedto serve children whose sole dis-ability was deafblindness and wholost their sight or hearing afterbirth, rather than those who wereborn with this disability.The birthof about 5,000 children who weredeafblind due to the rubella epi-demic of 1964-1965 changed thenature of the education of chil-dren who are deafblind.

In 1968, the Federal govern-ment funded 10 regional centersfor deafblind services around theUnited States.They were estab-lished to develop model programsand provide training to meet theneeds of these children who wereborn with congenital rubella syn-drome.This population had, relativeto the current population of chil-dren, a defined set of medical char-acteristics (e.g., heart conditions,glaucoma, cataracts, sensory neuralhearing losses).Although there wasvariation among individual chil-dren, there were many commonali-ties, especially regarding educationalapproaches that were effective.

The widening of the identifieddeafblind population since 1965 hasoccurred principally for two rea-sons.Advances in medical technol-ogy have resulted in saving the livesof children born prematurelyand/or with multiple congenitalanomalies; these children might,before this era, have died in infancy.Also, through improved medicaldiagnostics and advancements inthe study of genetics, we are mak-ing strides in identifying childrenwith low-prevalence genetic disor-ders.This means that many childrenare being served who previouslywould not have been identified ashaving vision and hearing impair-ments. Moreover, since there arenow legislated mandates to serve allchildren with disabilities, there hasbeen more effort to identify such

children and to provide high quali-ty educational services.

Why a CategoricalDefinition?Given that children and youngadults who have combined visionand hearing losses have a widerange of needs, one might wellask,“Why is it useful to think ofall under the one category of deaf-blindness?” Our experience, fromour many years of teaching thewhole range of children includedin this educational term “deaf-blindness” is that it is, in fact, avery useful category for a numberof reasons.

Communication:The Central PriorityWhen we define a child’s disabilityas deafblindness, thereby placingthe primary emphasis upon hissensory impairments, we thenestablish communication as thecentral educational priority.This isso because sight and hearing arethe primary avenues of communi-cation.We explained in the firstchapter why we consider commu-nication skills to be crucial inachieving the optimal quality oflife for any individual.We believethat viewing a student from theperspective of deafblindness helpsan educator to think most clearlyand creatively about how to helphim achieve his best communica-tive potential.

Need for SpecificEducational ExpertiseWe hope to continually improvethe body of knowledge and skillsamong teachers, families, caregivers,and other professionals and para-professionals; we are confident thatthis increased knowledge will helplearners who are deafblind toachieve their maximum potential.In our efforts to do this, it isimportant that we have a strongunderstanding of just who is deaf-blind and what their needs are.



In order to train people toprovide high quality services forthe broad population of childrenand young adults who are deaf-blind, we need to know as muchas possible about children and pro-grams.There needs to be a definedfield of deafblindness.Without away of knowing who children areand where they are, and withouthaving some knowledge about theeducational practices that havebeen effective in educating them,teachers, children and familymembers remain isolated.Theylack information and support necessary to meet the educationalneeds of the individual child forwhom they are responsible.

In most developed countries,there is a trend now towarddecentralization of special educa-tion services. Because of this trend,it has become increasingly difficultfor teachers to collaborate withtheir peers who are teaching chil-dren with similar learning needs.Now, many teachers of childrenwho are deafblind have never seenanother child with this disability,nor have they talked with otherteachers who are facing the samechallenges.We need, therefore, toencourage the development ofcentral resources that can developexpertise, provide support, andconnect educators and familieswho have children who are deaf-blind. Emphasizing the uniquenessof deafblindness as a disability canhelp overcome their isolation. It isvery helpful for teachers of chil-dren with deafblindness to have afamiliarity with other persons whoare deafblind, and with otherteachers who are teaching studentswho are deafblind.

If you are teaching a child whois thought of as being “deafblind,”it will help you greatly in planningfor that child and in envisioninghow to teach her if you can visitand get to know a range of per-sons who are deafblind, such asthose described above. If you haveexperience with this broad range

of persons with deafblindness,either through actual visits orthrough reading case studies (suchas are included in this text), thenyou will have a more effective wayof imagining how to teach thechild who is deafblind and is inyour charge. Comparing her solelywith the severely impaired chil-dren you know will limit yourways of understanding her and ofteaching her. (The same would betrue if she were in a class of chil-dren who were blind or deaf andyou thought of her primarily asblind, or deaf, and taught her fromthat perspective only.) Similarly, ifyou are able to connect with otherteachers who are teaching childrenwith deafblindness, you can shareinformation and observations, andcan thereby become a more effec-tive teacher. Making such a con-nection can depend on thinking of

the child as having deafblindness asa primary disability.

The way we categorize in ourminds affects the way we behave.Saying that a child is deafblindhighlights her sensory impairmentsas primary and implicitly asks us

to think of her alongside otherswith dual sensory impairments(regardless of intelligence level,social status, physical impairments,etc.).Through this process ofheightening our awareness of theimpact of this disability, we hopenot to segregate, but to relate tothe person who is deafblind in away that will enable him or her toparticipate more fully in society.

Challenges Shared byPeople Who Are Deafblind

Isolation: As we have said earlier,the senses of vision and hearing arecalled distance senses.These sensesconnect the person with the worldthat extends beyond his or her per-sonal body space. It is throughthese senses that individuals whohave sight and hearing learn mostconcepts about the world anddevelop social relationships.

A person who is deafblind cannot listen to or read the signlanguage of someone who isspeaking or signing to him at adistance. She cannot passivelyobserve what other people aredoing, overhear conversations, orobserve with clarity the environ-ment around her. Because deaf-blindness severely limits theopportunity for a person to havecontact with people and things inthe environment, all people whoare deafblind, regardless of theircognitive or physical capabilities,are reliant to some extent uponothers to help them access, inter-pret, and organize informationfrom the surrounding world. It isimportant to remember, as wethink about our interactions withindividuals who are deafblind, thatthey are essentially isolated unlessthey are in close proximity, or indirect physical contact, withanother person.

The sense of isolation causedby deafblindness creates the great-est barriers in the life of a personwith this disability. It is importantto note that this sense of isolation

Laura Bridgman and Dr. SamuelGridley Howe.

does not occur only in the portionof the deafblind population whohave no usable sight or hearing.For the person who is totallyblind, and has some usable hear-ing, isolation begins as soon as theconversation stops. Or, when sev-eral people converse in a group, hemay not be able to follow therapid shifts in conversation fromperson to person and topic to top-ic.This “missing” of large pieces ofwhat is being said isolates the indi-vidual from the group discussion.Once the person who is deafblindhas lost the flow of a conversation,he is likely to become inhibitedabout participating for fear of say-ing something that is inappropriateor has already been said.

Persons with deafblindnesshave a number of additional char-acteristics in common that, whilethey are not necessarily obvious atfirst glance, reveal themselves asimportant considerations in teach-ing (Robbins, 1983). In additionto the communication difficultyhighlighted above, we discussbelow some experiences and needsgenerally shared by persons whoare deafblind.

Need for Individual Instruction:Either touch or very close prox-imity is required in order to makecontact meaningful for someonewith both vision and hearingimpairments.

Reliance Upon Interpreters:Usually a person who is deafblindneeds to have the distant worldinterpreted for him so he mayhave access to it.This interpreta-tion may happen in a number ofdifferent ways. It may include notonly traditional interpreting ofconversations but also descriptionsof physical surroundings and con-text, as well as simplified descrip-tions of interactions. In any case,a close working relationship withan interpreter is shared by manypeople who are deafblind.Thisinterpreting may be done by a

variety of people, depending uponthe needs of the person and thesituation. Not all people who aredeafblind need a certified inter-preter.This will depend on indi-vidual needs. But all people whoare deafblind routinely need some-one to connect them to people,events and places.

Limited Number and Variety ofExperiences: Not being able tosee and hear narrows one’s world,often so much so that it extendsno further than the fingertips. Ifyou think for a moment abouthow much information youreceive everyday through youreyes and ears, you begin to sensewhat a person who is deafblind ismissing. Multiply this by days,weeks, months, years, and you havean even clearer idea of the volumeof missing information.

Limited Social Experiences:Usually a person who is deafblindcannot communicate with morethan one person at a time.Thismeans their social experiences arevery different from those of hear-ing and sighted people, who areaccustomed to being relatively atease in a group, and who have a

broad experience of social customsand amenities. Lacking these experiences, a person who is deaf-blind, no matter how intelligent,may appear socially awkward orrude, when in fact he simply hasnot had the chance to participatein exchanges of facial expressionsand gestures which are very impor-tant aspects of social interactions.

Multiple Hospitalizations: Themajority of the current populationof children who are deafblind havehad prolonged hospitalizations foroften life-threatening illnesses.These hospitalizations have fre-quently taken great emotional tollon these children and their fami-lies.They may be the source ofanxieties that may seem groundlessto an insensitive observer, but areactually rooted in a great deal ofconcrete experience.

The challenges listed abovegreatly affect the development ofthe whole person. In spite ofthese challenges, people who aredeafblind have unique opportuni-ties for intimacy and depth ofexperience that sighted-hearingpeople may lack. Educators musttake into account these differencesand consider how they may influ-


Many children who are deafblind have additional complex health challenges.


ence interactions with peoplewho are deafblind.

Importance ofAssessmentThe population of infants, childrenand adults who are deafblind isnow very diverse, and this diversitymakes it important to recognize achild as deafblind as early as possible.We need to be certain we are rec-ognizing the significant impact ofthe child’s combined sensory losseson his or her development, and wemust address the needs that thesesensory losses create within thechild’s educational program.

In identifying children as deaf-blind, we are also highlighting the importance of sensory assess-ment as a crucial piece of the edu-cational assessment process. Often,especially in the population ofchildren with significant addition-al, very “visible” disabilities, it iseasy to overlook the need to fullyassess the child’s vision and hear-ing. For, example, when a child hassignificant health and physicalchallenges, people will often say,“His vision and hearing are theleast of his problems.”When achild has severe cognitive delays,the assessment of vision and hear-ing will often become a low pri-ority among people who are notknowledgeable about deafblind-ness. However, knowing as precise-ly as possible how a child receivesinformation, and understandingthe possibilities for treatment (e.g.,assistive listening devices, glasses,corrective surgery) and interven-tion, can significantly expand thechild’s learning possibilities.

Impact of SensoryLosses on Attachment,Communication, andConcept DevelopmentWe have just defined deafblindnessas it relates to a child’s educationalneeds.We also need to thinkabout what deafblindness meansexperientially and how it specifi-

cally affects communication.Whatdoes it feel like to have limited,or no, vision and hearing? Whatdoes this mean in terms of howone learns to communicate?Throughout this book we will continue to talk about deaf-blindness as a unique disability;however, we also need to beknowledgeable about the impactof each sensory loss.

BlindnessIf a child is born totally blind, howwill that limitation affect her con-nection with those around her?The literature estimates that 75%

of most people’s learning comesthrough vision (Smith & Cote,1982).This sounds very dramaticand may seem overstated, but thisstatistic rightfully highlights thegreat importance of a child’s visualconnection with the environ-ment—with objects, people,actions, and relationships.

One of the most comprehen-sive and accessible works done onthe effects of blindness on com-munication is by Selma Fraiberg, apsychiatrist who became interestedin blindness in the 1960s, whenshe met a child who was blind andwho presented unique difficulties.

It is important for teachers to know the educational practices that are effectivein teaching children who are deafblind. Many children, for example, require tactile sign language for optimal understanding.

She has studied blind childrenextensively and her book, Insightsfrom the Blind, provides a sensitiveaccount of the development ofcommunication skills in severalblind children.

Bonding: Dr. Fraiberg carefullyobserved the interactions betweeninfants who were blind and theirmothers, and tried to understandwhat those interactions felt likefrom both points of view—thebaby’s and the mother’s. One ofthe first things she noticed wasthat often an “estrangement ofmother and child began in theearly months” (Fraiberg, p. 60).This seemed to happen becausethe blindness of the baby, for themother,“feels curiously like arebuff if you do not know that thebaby is blind.”A sighted infant’ssmiles provide a great deal of rein-forcement for a new mother, andthey are in turn reinforced for thebaby by the mother’s returnsmiles.When this smile dialogue isinterrupted because a baby cannotsee well, or at all, the mother maybecome depressed, especially ifthere has been no diagnosis of

visual problems (which wouldserve to explain to her the child’slack of smiling). She may with-draw from her infant.

Dr. Fraiberg found that mostmothers of babies who were blindneeded to be taught not to lookfor responsiveness and initiative intheir children’s faces, but to lookinstead at their body language,especially at their hands. Shepoints out that this is not naturalfor us because we are so condi-tioned both to look at another’sface for responsiveness and toexpress ourselves through our ownfaces. In fact, for a sighted infant,the eyes are a main way of initiat-ing social exchange.A baby,through her eyes, expresses atten-tion, longing, doubt, boredom,questioning. Fraiberg found thatwhen the mothers of blind babieswere taught to look at their chil-dren’s hands rather than their faces for these signs of attention,excitement, exploration, andanticipation, they were richlyrewarded by discovering that thebabies were, in fact, expressing awide range of feelings and inter-ests—emotions that were not evi-dent on the children’s faces. Oncethe mothers could see this, Dr.Fraiberg discovered, a more satis-fying dialogue could resumebetween infant and parents.“Evengrief [over the diagnosis of blind-ness] could be managed when thebaby brought his own rewards inresponse, in diversity of socialexchange, and in becoming anactive partner in the love relation-ship” (p. 108).When such helpwas not available, and when thedialogue was not well establishedbetween mother and baby,Fraiberg found that there oftenensued social and emotional diffi-culties for the children who wereblind, who were not able bythemselves to discover adequateways of relating socially withoutthe initial experience of adequaterelations with their mothers.

Establishing Object Permanence:For an infant who is blind andwho is only a few months old, anobject does not exist if he is nottouching it. Even toys in thebaby’s crib might as well not existif he doesn’t accidentally put hishand on them or roll over ontothem.The sighted infant learnsabout the existence of objectsapart from himself by learning tosynthesize information from hiseyes, his hands, and his mouth.Theplay that sighted babies do in frontof their faces—at first accidentally,and later intentionally—with theirmouths, their hands, their fingers,and with toys, teaches them thatwhat they see has substantiality.Through repeated experimenta-tion, practiced for hours at a time,they learn that certain movementscreate certain visual results, andthat certain visual stimuli have cer-tain physical feelings associatedwith them. Gradually, through trialand error, they are able to reachfor and grasp something they seewith their eyes.They have cometo trust the information from theireyes that tells them the objectthey are not yet touching has sub-stantiality, and, if reached for, willreward their open hands with tex-ture and weight.They have cometo believe this information sosurely that they trust that even ifthe object is covered with a cloth,or dropped on the floor out ofsight, it still exists.This is what wecall object permanence.

Dr. Fraiberg found that childrenwho were blind had a harder timethan sighted children in establish-ing object permanence.That is,they could not as easily hold theimage of an object in their mindswhen the object was not physicallypresent.The ability to do so is inti-mately related to the ability toname and categorize objects, andthus is clearly tied to language andconceptual development.

Blind children, deprived of thevisual connection with objects to


Children who are deafblind are isolat-ed unless they are in close proximityor in direct physical contact withanother person.


one degree or another, must learnother, less direct ways of commu-nicating with the object-world orlearning about it—trusting its veryexistence apart from their physicalconnection with it. For a childwho is blind and can hear, the earand sound begin to substitute forthe eye and sight. Clapping games,toys that make noise, the hand onfather’s speaking mouth, the acci-dental and later intentional brushagainst a hanging bell—these arethe experiences that teach “ear-hand coordination” and the begin-ning of a sense of object perm-anence. Given enough auditorystimulus in place of visual stimulus(and Fraiberg found that thisprocess could be greatly facilitatedthrough the parents’ sensitive pro-vision of these experiences), thechild who is blind will come totrust that mother’s voice meansthat mother is near, that a bellsound indicates the existence of around metal object, that a lullabysound tells that a favorite wind-upteddy bear is near, even if thehands are not able at once to con-tact these things.

One begins here to get a senseof the monumental task ahead ofthe infant who is both profoundlydeaf and totally blind. Right here,at this most basic juncture ofdevelopment where the baby mustcome to know that objects existapart from him or herself, the babywho is deafblind has a very hardtask that will require much helpand patience. Likewise, his familywill need a great deal of informa-tion and support to build theseearly relationships.

Children who are blind and donot receive help in establishingobject permanence will lag behindin language development becausethe ability to name objects de-pends upon some sense of theirexistence apart from oneself.Withhelp, this naming facility will hap-pen in due course, not far behinda normally sighted child’s ability.

Mobility: Another lag will happentoo, if the child who is blind is nothelped to achieve object perma-nence.This child may be slow todevelop mobility and may there-fore have additional cognitive andcommunicative delays. Movingaround in the world and exploringare ways in which a child comesto know about her world, developscuriosity, and learns about theways in which people and objectsare related to one another. Mobil-ity develops in large part, in asighted infant, as a result of vision.Visual objects are “lures” for thechild—they draw her out into theworld. She learns to crawl byattempting to reach something shecan see but cannot yet touch. Shelearns to walk as her visual worlddraws her upward.As she learnsthese skills, she becomes more of aconversationalist, asking questions,protesting, requesting things. Hercommunication skills develop asshe moves about in the worldmore and more.

The child with sight and hear-ing is motivated to crawl towardthe brightly colored toy across theroom or toward Grandma’soutstretched arms and encour-aging words.Without visuallures, or the sound lures thatemerge with object perma-nence, a child who is blind willnot be motivated to move for-ward. Dr. Fraiberg found that itwas not mobility training per sethat helped children who areblind to learn to crawl and

walk, but it was “educational workin the areas of human attachmentand prehension (reaching andgrasping)” (p. 278). She observedthat an educational program thatprovided training for the parentsin bonding with their childrenand in helping their children learnabout reaching “can confidentlywait for the baby to ‘invent’mobility for himself ” (p. 278).Then, cognitive and communica-tion gains will follow naturally asthe child begins to explore hisworld.

Use of Personal Pronouns, Self-Concept and Time Concept:Dr. Fraiberg observed that chil-dren who are blind experienceddifficulty in one other area ofcommunication development. Sherecounts the story of “Kathie,” avery bright child who was blindand who, in spite of her intelli-gence and rich language environ-ment, experienced delays in herability to use personal pronounsappropriately, in her developmentof a stable self-concept, and in herdevelopment of time concepts (allof which seem to be related).Whereas such stable concepts

MOTHERS OF BABIES

WHO ARE BLIND

NEED TO BE TAUGHT

TO LOOK FOR

RESPONSIVENESS

IN THEIR BABIES’BODY LANGUAGE,

ESPECIALLY

THEIR HANDS.

Mothers of blind infants mustlearn the many ways their chil-dren show signs of attention,excitement, exploration andanticipation.

are usually achieved by most sight-ed children at somewhere aroundthree years of age, Kathie did notachieve them until four years and10 months.According to Fraiberg,the observation of Kathie taughther that “the acquisition of per-sonal pronouns goes beyond prac-tice with grammatical tools. Itgoes beyond the influence of thelanguage environment. [It reflectsthe] extraordinary problems inconstructing a self-image in theabsence of vision” (p. 268).

During the time from abouttwo-and-a-half to three years,when Dr. Fraiberg was observingKathie with a view toward under-standing these aspects of her lan-guage development, she observedthat Kathie “could not representherself through a doll or a toy....She could not recreate or invent asituation in play. She could notattend to a story or answer ques-tions regarding a story or tell astory herself. She could not spon-taneously report an experience”(p. 256). In other words, she couldnot yet “see herself as an object to others” (p. 260).Vision is animportant aid to a sighted child in developing a self-concept. Suchexperiences as seeing one’s ownhands, seeing one’s image in a mir-

ror, comparing visually one’s ownbody with others’ bodies, all con-tribute to a young child’s conceptof himself.A child who is blindand who does not have theseexperiences will have delays informing this self-image. In fact,some children who are blind whohave not had any help may beextraordinarily late in being ableto accurately use “I” and “you,”and in being able to recount sto-ries of their past experiences. Suchcommunicative delays may looklike autistic behavior, but mayactually have their basis in the lackof visual experience.

Development of AbstractConcepts: Finally, we must men-tion the effect that limited orabsent vision is likely to have uponconceptual development and, as a result, upon communication.Achild who is blind gains knowl-edge of the world through herremaining senses: hearing, touch,taste, smell, and kinesthetic expe-rience. Some objects and ideas areparticularly difficult to experiencethrough these senses alone. How,for example, would one explainwhat a cloud is to a child who isblind? She cannot see it, hear it,touch it, taste it, or smell it.What

about a sunset, a rainbow, stars?The absence of the experience of such things is only really a deficiency when viewed from theunreflective point of view of those of us who are sighted. If weare sighted people communicatingwith persons who are blind, wemust be careful not to assume thattheir experiences match ours inall areas; we must remember, as we speak, to put ourselves in theirshoes.We must not assume thatlack of knowledge of some thingswe take for granted means thatthey are unintelligent or thatcommunication is thereforeimpossible. It may actually be aricher communication if we eachtake the time to make sure we are understanding one another.

The person who is sighted, fromthe point of view of the personwho is blind, may actually be“deficient” in other senses. Sightusually provides a great percent-age of the information that wereceive about the world.Withoutthat focus, or dependence onvision for connection, the othersenses may become sharpened.Jacques Lusseyran, a Frenchmanwho became blind, has describedsome of his experiences ofheightened sensitivity.

As soon as my hands came to life they put me in a world where every-thing was an exchange of pressures.These pressures gathered together inshapes, and each one of the shapes had meaning.As a child I spent hoursleaning against objects and lettingthem lean against me.Any blind per-son can tell you that this gesture, thisexchange, gives him a satisfaction toodeep for words.

Touching the tomatoes in the gar-den, and really touching them, touch-ing the walls of the house, the materi-als of the curtains or a clod of earth issurely seeing them as fully as eyes cansee. But it is more than seeing them, itis tuning in on them and allowing thecurrent they hold to connect with one’s


Children with significant vision loss have more difficulty holding the image of anobject which is not physically present than do children who have vision.


own, like electricity.To put it different-ly, this means an end of living in frontof things and a beginning of livingwith them. Never mind if the wordsounds shocking, for this is love.

You cannot keep your hands fromloving what they have really felt.(Lusseyran, pp. 27-28.)

DeafnessWe have seen at least some of theeffects that blindness by itself islikely to have upon a person’sconnection and communicationwith the world.What about deaf-ness or hearing impairment? Howmight an inability to hear affecthow a person connects with thosearound him or her?

Feelings of Powerlessness inMother: A deaf infant with nor-mal vision will not have the sametrouble developing early bondswith his caregivers as an infantwho is blind because, as we haveseen, the eyes are a main avenuefor these early bonds. Smiles caneasily be exchanged and body lan-guage can communicate affectionand connection when a child ishearing impaired and has intactvision. It can happen, though, thatan early diagnosis or suspicion ofdeafness may instill in the motherof a baby who is deaf feelings ofpowerlessness and/or depressionthat may affect her rapport withher child. Hilde Schlessinger, whohas done significant longitudinalstudies of children who are deafand their caregivers, has found thatthe most typical effect that thesefeelings of powerlessness are likelyto have is to cause the mothers tobecome “over-directive” in theirattempts to communicate withtheir children; that is, their com-munication with their childrenmore resembles a monologue thana dialogue.They take more turnsthan their children, and most ofthese turns are commands, requestsand directive questions.This over-directiveness may have the effecton the infant of causing him to be

less communicative, less sponta-neous, and less socially adept.These inhibitions may affect his later language developmentbecause language skills grow outof active engagement with theworld, and they do not flourishwhen a child is a passive reactor to an overdirective environment.Schlesinger found that whenmothers could be helped to feelless anxious and more powerful,they helped their children whowere deaf to be better, more spon-taneous communicators.

Language Development in aHearing/Speaking Environment:Deafness most significantly affectscommunication in the develop-ment of language. People need tohave language input in order tolearn language.Without accommo-dation, a child who is deaf in ahearing world does not have accessto enough language to significantlyactivate her own innate capacitiesto develop language.The innatecapacities for language seemto be most flexible andactive during the earlyyears of life. If a childdoes not receive lan-guage stimulation whenyoung, she is at particu-lar risk.A child thusdeprived may neverbe able to be fluentin any language.

Hearing personsreceive most oftheir languageinput throughtheir ears. Before

a child can say his first words, hehas heard thousands of words andsentences thousands of times, andhas somehow begun to makesense out of them.A child with-out hearing or with severelyimpaired hearing does not haveaccess to language input unless itis provided to him through specialmeans. Even certain kinds of rela-tively moderate hearing losses thatallow a person to hear at speechlevels can greatly restrict the use-ful linguistic information a childreceives from his environmentbecause many significant soundsare obliterated.

A child who is deaf or severelyhearing impaired and who growsup in a hearing world is at a dis-tinct disadvantage for learning lan-guage. Her eyes must serve as thesole receptors not only of words,but of sentences, intonation pat-terns, and emphasis; they must alsotake over the “antenna-like” func-tion that the ears serve for hearingpeople—scanning the environ-ment on all sides, picking up indi-cations of movements that wouldtell of danger or pique interest(Myklebust, 1960). Obviously, theeyes alone will miss many of thesethings. Lipreading, even at its best,is a very inefficient way to receive

FOR AN INFANT

WHO IS BLIND

AND WHO IS ONLY

A FEW MONTHS OLD,AN OBJECT DOES

NOT EXIST

IF HE IS NOT

TOUCHING IT.

A child who is deafmust be continually

exposed to languagein a form that is

accessible to her.

language. Estimates are that anintelligent speech-reader, withgood visual access to the speaker’sface, and with good contextualclues, understands with certaintyonly about 30-40% of the wordsspoken to her. Given this fact, onecan begin to imagine the limita-tions that a person who is deafmust live with when spoken lan-guage is her only method of com-munication. If visual impairmentand/or any other impairments areadded to the deafness, the com-municative isolation becomes profound indeed!

Consider, too, the fact thatmuch of what hearing peoplelearn in life is “overheard.” (Earsare like antennae, in many ways.)In a household, at school, at astore, in a theater—in all of theseplaces and others, a hearing childoverhears hundreds and hundredsof exchanges between adults,between other children, betweenadults and children. People aroundhim discuss all manner of things,exchange information, strugglealoud with decision making,resolve emotional difficulties, andengage in social amenities.All ofthis the hearing child absorbs andmakes some sense of; some ofthese exchanges he later uses asmodels for his own behavior andcommunicative exchanges.This“overheard” experience is a crucialpart of his socialization and animportant source of his informa-tion about the world.

What about the child who is profoundly deaf in a hearing/speaking environment? The simplefact is that virtually all of theseforms of incidental learning areunavailable to him.The com-muncation he receives is only thatwhich is directed exclusivelytoward him, and even that he mayreceive with difficulty.Think for aminute about what this mightmean in terms of the development of his communicative competence.Not only is the information hepossesses about the world likely to

be far narrower in scope than thatof a hearing child, but, perhapsmore importantly, his models forhow to interact socially, how toresolve difficulties, and how tocooperate in decision making willbe either severely restricted ornonexistent unless special provi-sions are made.

Language Development in aSigning Environment: We havebeen speaking about the deaf childin a hearing/speaking environ-ment.The same difficulties do notexist in the same way for the deafchild in a signing environment.If you can imagine a deaf childwhose parents and siblings routine-ly use sign language as a medium

of communication, you can envi-sion all of the normal social inter-actions occurring in a way inwhich the deaf child can accessthem. He can visually “overhear”his parents discussing things, forexample,or struggling with a deci-sion, or exchanging information.And he can learn a great deal fromthese exchanges, all of which helphim engage in similar exchangeshimself at a later date.With visualaccess to language, he becomespart of a social network in whichhe can participate as an equalmember.

Research shows that childrenwho are deaf and have deaf par-ents, and who are raised in anenvironment where sign language



is the primary medium of commu-nication, do not have troublelearning language in the ways thatchildren who are deaf and havenonsigning parents do. In fact, chil-dren who are deaf and who areexposed to sign language frombirth “babble” with their hands(experiment with the hand shapesused to form the signs of sign lan-guage) at the same age their hear-ing peers babble with their voices(or, in some cases, earlier).Theyalso produce their first recognizablesigned words at the same age ashearing counterparts produce spo-ken words.They also make two-and three-word sentences earlierthan peers who are hearing (Caselliand Volterra, 1994). Children who

are deaf and have signing parentswho are deaf also tend to fare better socially later on, probablybecause of their increased self-esteem, ease with communication,and the availability of appropriaterole models for them.

Feelings of Isolation: Envisioningthese very different scenarios—thedeaf child in a hearing/speakingenvironment, and the deaf child ina signing environment—makes usrealize the truth of this statementmade by Hilde Schlesinger:

Profound childhood deafness is morethan a medical diagnosis: it is a culturalphenomenon in which social, emotional,

linguistic, and intellectual patterns andproblems are inextricably bound togeth-er. (Schlesinger & Meadow, 1972, p. 1)

To think of deafness only as animpediment to learning languageis to think far too narrowly.Deafness, especially when it existslargely or wholly within a hear-ing/speaking cultural environ-ment, has much wider and moreprofound implications. It isolatesto a far greater degree than maybe evident at first glance. In fact, asa single disability, it is deceptivelyinvisible.A deaf person may bequietly present with a group ofhearing/speaking persons, may be visually alert and appear to befunctioning normally, and yet maybe profoundly isolated. It is a challenge for hearing people tounderstand and empathize withthe extent and quality of that iso-lation, and further, to understandtheir own complicity in that isola-tion.A person with a physical

disability, or one who is blind,may immediately invite creativeresponses to their isolation. Deaf-ness is not so obvious; it does notpresent itself as being a difficultyin the same way, and so it is likelyto be ignored.What is more, itdemands of us that we learn tocommunicate in a whole new way.It presents us with this challengeof learning to speak with ourhands and faces and bodies, as wellas with our voices.

Helen Keller, commentingabout the comparative effects ofher deafness and blindness, spokeof deafness as being the more diffi-cult of the disabilities:

I am just as deaf as I am blind.Theproblems of deafness are deeper andmore complex, if not more important,than those of blindness. Deafness is a much worse misfortune. For it meansthe loss of the most vital stimulus—the sound of the voice that brings lan-guage, sets thoughts astir and keeps usin the intellectual company of man....If I could live again I should domuch more than I have for the deaf.I have found deafness to be a muchgreater handicap than blindness (froma letter to Dr. J. Kerr Love, March 31,1910, reprinted in the souvenir pro-gram commemorating Helen Keller’svisit to Queensland Adult Deaf andDumb Mission in 1948). (Ackerman,1990, pp. 191-2)

DeafblindnessWhat, now, of deafblindness? What does it mean to be likeHelen Keller, and to be missingsignificant amounts of both hear-ing and vision? It is safe to assume,at the outset, that deafblindness

Opportunities for experiential learning are criticalin order for children who are deafblind to learnconcepts about the world around them.

includes all of the difficulties of both deafness and blindness.However, when both distancesenses are absent, or greatly limit-ed, the difficulties are not simplydoubled, they create a unique disability unto itself.

Isolation: Since vision and hear-ing are our two distance senses,the absence of one places a greatemphasis on the remaining dis-tance sense.A blind person nor-mally compensates with acutehearing; a deaf person is oftenextraordinarily visually alert andgains access to language, whenpossible, through her eyes.

A person who is deafblind haslimited opportunities to compen-sate. Increasing emphasis falls uponthe near senses, especially touch,and upon whatever remains ofvision and/or hearing.The worldof the person who is deafblindshrinks. For many it does not gobeyond the reach of the fingertips.For others it extends only slightlyfarther than that. Robert Smithdas,a man who is deafblind, said:

For a deafblind person, the world liter-ally shrinks in size and scope, andwhatever knowledge is obtained mustcome through the secondary senses oftaste, touch, and smell, and the exerciseof personal curiosity and initiative.Consequently, a deafblind personmatures more slowly than is considerednormally acceptable, and the individualwill be prone to greater frustrations inexpressing wants and needs.

Blindness takes an individualaway from things, and deafness takeshim away from people…. Deaf-blindness creates unique problems ofcommunication, mobility, and orienta-tion peculiarly its own. (Robbins,1983, p.3-3)

A person who is deafblind isisolated both from people andfrom things. Lewis Hoskins, anoth-er man who is deafblind, describedthis feeling of isolation like this:

I can only talk with one person at atime, and only if that person is within

my reach. If I am in a crowded room,and no one is within three feet of me,I might as well be in a closet. It isvery easy for me to misunderstand, socommunication is often very slow.(Robbins, 1983, p.3-3)

That isolation becomes evenmore profound if the people who are physically near to theperson who is deafblind are notequipped—either emotionally ortechnically—to communicate withhim. Suppose the person who isdeafblind reaches out to touch, butthe one whom he touches knowsno sign language, or is frightenedof blindness, or is too pitying to beable to converse? In any of these,or a number of other imaginedinstances, the person who is deaf-blind may touch with his fingers,but not be able to communicate inany significant way. So, the hurdlesare enormous.

Isolation imposed by lack ofvision and hearing presents itsmost formidable challenges whenboth of these senses are absentfrom birth. Bonding with themother or early caregivers formsthe basis for all further gains incommunication.Without vision orhearing, such bonding is very diffi-

cult, although certainly not impos-sible to achieve. In addition, as wesaw in our discussion of blindness,the achievement both of a sense ofobject permanence and of a stableself-concept or body image is veryhard for the child with blindness;with the additional absence ofhearing, or impairment of hearing,the task becomes monumental.

People who are deafblind, wholost one or both of their distancesenses after they had already bond-ed with their mother and attaineda stable self-concept, generally faremuch better than those who mustbe helped through these stageswith only their senses of touch,taste and smell to compensate.Thebaby born both deaf and blind hasan experience of the world that isso qualitatively different from ourown that the bridging of the gapbetween us and this child presentsa rare challenge.

Presence of AdditionalDisabilities: Another very signifi-cant reason why we cannot thinkof deafblindness as simply the sumof deafness and blindness is thatwhen a person is missing bothhearing and vision, it is highlylikely, though not necessarily the


Children who are deafblind and have additional disabilities challenge us todevelop creative strategies for developing meaningful communication.


case, that there will be additionalmedical and neurological involve-ment that will affect his or heroverall developmental growth.This becomes more true asadvances in medicine result inthe saving of lives of childrenborn with multiple congeni-tal anomalies and with raregenetic syndromes. In suchcases, the challenge to com-municate with these childrenis intensified: Caregivers andeducators must be able toimagine the experience of onewho not only cannot see orhear, but who may be also limitedphysically (as, for instance, in cere-bral palsy), mentally (as in braininjury of various kinds), medically(as with the infant who has mal-functioning organ systems andrequires significant hospitaliza-tions), and/or emotionally (as theresult of any or all of these otherdifficulties). Only by being able toimagine their experience can wecommunicate effectively with thesechildren and help them communi-cate with us.

The presence of additional dis-abilities in a child who is deafblindcreates challenges to our ability toassess children and to be creativein developing a system of commu-nication that will meet his needs.Usually, a single, standard methodof communication will not meetthe needs of children who aredeafblind and have additional dis-abilities. Such children challengeus to learn as much as we canabout the avenues through whicha child can receive information.We need to know how well achild can process information andhow he expresses his thoughts.Wemust turn this understanding into creative strategies for developingmeaningful ways to communicate.

Importance of Diagnosisand AssessmentOur discussion of diagnosis andassessment will occupy a chapter

all its own. For now, we need onlysay that we need to have as clearan idea as possible of what a childhears and what she sees.Thisessential information will enableus to imagine with as much accu-racy as possible her experience ofthe world, so that we may therebyconnect with her and help her toconnect with the world aroundher.The importance of theseassessments is often underestimat-ed, especially when a child withmultiple disabilities is concerned.Indeed, the use of clinical assess-ment, combined with specializedfunctional assessment, is essentialin the process of enabling the stu-dent with deafblindness to joinfamilies, friends and environment.

The issue of clinical assessmentof hearing and vision in many cas-es becomes quite emotional.Thefamilies of children who haveundergone more invasive medicaltreatment during the first year oflife than most of us will experi-ence in a lifetime are often reluc-tant to submit their child to yetanother procedure—one that isoften viewed as unnecessary, alsoone that will often result in more

“bad news” or another label!Thanks to the advances in

medical technology, we are nowable to much more objectivelyevaluate children’s vision and hearing than we werebefore.This can be achievedthrough such tests as VisualEvoked Potential (VEP),Auditory BrainstemResponse (ABR), and ota-coustic emissions.Althoughresults of these tests shouldnot be considered definitive,

they do provide valuablepieces of information that

are essential to the total assess-ment process. Functional assess-ments should always be a part ofour ongoing relationships withchildren.

Medical assessment is also avery important component of thediagnosis and assessment process.Many medical treatments exist thatcan result in a dramatic improve-ment in seeing and hearing.Thesecan range from the prescription ofmedication to remove middle earfluid to the surgical treatment ofglaucoma. Because so many chil-dren who are deafblind have othermultiple disabilities in addition tovision and hearing impairments,we must take every opportunity toensure that we are maximizing theuse of every avenue for learningand preserving whatever residualsenses exist.

Cultural AttitudesToward DeafblindnessCommunication, as we have said, isa two-way process. Difficulties thatpeople who are deafblind experi-ence in connecting with the worldlie not only with their own givenlimitations, but also in the world,or worlds, to which they are tryingto relate. For most hearing andsighted people, deafblindness is anunimaginable condition, if onlybecause of their lack of experiencewith people who cannot see orhear. It is, moreover, a frightening

Helen Keller

condition because most of usdepend so much on our vision andhearing.Trying to imagine beingwithout one or the other can produce anxiety.We may not bewholly aware of such anxiety; itmay manifest itself subtly.We maybecome silent as we pass a blindperson on the street or in a hall-way.We may stare curiously andfurtively at a group of deaf personsconversing in sign language.Wemay feel helpless in the presenceof someone who can neither seenor hear. Becoming aware of ourown anxieties may help us over-come them, or at any rate willkeep us from becoming victims of our anxieties.We may be ableto make contact with a personwho is deafblind, even as we beginto contact our own fears of isola-tion, or perhaps because we havecontacted these fears and cantherefore empathize.

These fears regarding deaf-blindness appear not only amongsighted and hearing people; theyappear also, and often moreintensely, among the very groupsone might expect would be mostwelcoming to people who aredeafblind—sighted deaf peopleand hearing blind people.AsRobert Smithdas says,“For most

blind people, deafness is the worstthing that could happen; and fordeaf people, blindness is equallyfrightening” (Robbins, 1983,p.3-3).As a result, a person who is deafblind among peers who aredeaf or blind may find herself justas isolated as if she were amongsighted and hearing people.Thisisolation, particularly among peoplewho are blind, may be due notonly to fears of deafblindness, butalso to the simple fact that a com-mon language mode is absent.Aperson who is deafblind whodepends upon manual communi-cation will not be able to under-stand the speech of a blind person,and vice-versa.

Many other overt and subtlecultural attitudes may come intoplay where people who are deaf-

blind are concerned. Over theworld, people of various religionsand ethnic groups have a widevariety of beliefs and attitudes concerning blindness and deafness,ranging from thinking of thesehandicaps as punishments for sinsin past lives, to viewing them assigns of special recognition byGod or gods, to feeling extremepity or compassion for those whocannot see or hear.We will relatemore easily to people who aredeafblind if we can become awareof our own attitudes.

We might do well, as we exam-ine our attitudes, to look not onlyat our culture as a whole, but tolook also at the attitudes that areprevalent in our immediate groupof friends and family. How do our friends feel about disabilities?Will I be ridiculed, or admired, orignored if I choose to relate equal-ly to a person who is deafblind? If I bring home a friend who isdeafblind, what will be my family’sreaction? How do I know? Howam I influenced, even subtly, by the anticipation or imagination of such reactions?

And, finally, we will also dowell to remember that cultural attitudes, including our own, arealways changing, even if sometimesslowly.We each play a part, throughour actions and speech, in facilitat-ing that change. Our own opennessto persons with deafblindness, insmall or large ways, will help influ-ence society as a whole to be morereceptive to those who cannot seeor hear, and will thereby help thembecome less isolated.This opennesswill also help us all learn moreabout each others’ unique experi-ence of the world.

This chapter has presented anoverview of the unique disabilityof deafblindness.Although thosewho have this disability are eachvery different, each is also linked ininnumerable ways to the others;each has, to some extent, experi-enced overwhelming isolation.


As society as a whole becomes more receptive to those who cannot see or hear,we will all learn more about one another’s unique experience of the world.

REMEMBER THAT

CULTURAL ATTITUDES

ARE ALWAYS

CHANGING, EVEN IF

SOMETIMES SLOWLY.WE EACH PLAY A

PART IN FACILITATING

THAT CHANGE.


Ackerman, D. (1990). A natural history of the senses.New York, NY: Random House.

Caselli, M.C., & Volterra,V. (1994). From communi-cation to language in hearing and deaf children.Volterra,V. & Erting, C.J. (Eds.). From gesture to language in hearing and deaf children. (pp. 263-277).Washington, DC: Gallaudet University Press.

Fraiberg, S. (1977). Insights from the blind. New York,NY: Basic Books.

Individuals with Disabilities Education Act of 1990(IDEA), PL101-476. (October 30, 1990).Title 20,USC 1400 et seq.: U.S. Statutes at Large, 104, 1103-1151.

Lusseyran, J. (1987). And there was light. New York,NY: Parabola Books.

Myklebust, H. (1960). Psychology of deafness: Sensorydeprivation, learning, and adjustment. New York, NY:Grune and Stratton.

Riggio, M. (1992).A changing population of chil-dren and youth with deafblindness:A changing roleof the deaf-blind specialist/teacher (ReactionPaper). Hilton/Perkins Program (Ed.). Proceedings of the national conference on deaf-blindness: Deaf-blindservices in the 90s (pp.20-26).Watertown, MA:Perkins School for the Blind.

Schlesinger, H.S., & Meadow, K.P. (1972). Sound andsign: Childhood deafness and mental health. Berkeley,CA: University of California Press.

Smith,A.J., & Cote, K.S. (1982). Look at me:Aresource manual for the development of residual vision in multiply impaired children. Philadelphia, PA:Pennsylvania College of Optometry Press.

REFERENCES

Davidson, I., & Simmons, J.N. (Eds.). (1992). Theearly development of blind children:A book of readings.Ontario, Canada:The Ontario Institute for Studiesin Education.

Edwards, L., Goehl, K., & Gordon, L. (1994).Profiles: Individuals with deaf-blindness. Terre Haute,IN: Indiana Deaf-Blind Services Project.

Freeman, P. (1985). The deaf-blind baby:A programmeof care. London, England:William HeinemannMedical Books.

Huebner, K.M., Prickett, J.G.,Welch,T.R., &Joffee,E. (Eds.). (1995). Hand in hand: Essentials of communication and orientation and mobility for your students who are deaf-blind. New York, NY:AFB Press.

McInnes, J.M., & Treffry, J.A. (1984). Deaf-blindinfants and children:A developmental guide. Toronto,Canada: University of Toronto Press.

Miles, B. (1995). Overview on deaf-blindness.Monmouth, OR:Western Oregon University,Teaching Research Division, DB-LINK.

Reiman. J.W., & Johnson, P.A. (Eds.). (1992).Proceedings of the national symposium on children andyouth who are deaf-blind. Monmouth, OR:WesternOregon State College,Teaching Research Division.

Robbins, N. (Ed.). (1983). Deaf-blind education:Developing individually appropriate communication andlanguage environments. Watertown, MA: PerkinsSchool for the Blind.

Sauerburger, D. (1993). Independence without sight orsound: Suggestions for practitioners working with deaf-blind adults. New York, NY:American Foundationfor the Blind.

Smithdas, R. (Ed.). (1995). Outstanding deaf-blind persons. New York, NY: Helen Keller NationalCenter for Deaf-Blind Youths and Adults.

Simmons, J.N., & Davidson, I. (1992). Determinantsof development: Conceptualizing young blind children.Toronto, Canada: Canadian Council of the Blind.

Within Reach: Getting to know people who aredeaf/blind [Video]. (1987).Available from WesternOregon State College,Teaching Research Division,Monmouth, Oregon.

ADDITIONAL READINGS AND RESOURCES

chapters 1 and 2.final

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