Developmental Disabilities

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Vision/Hearing

Toddlers and Preschoolers with Visual Impairment

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The ability to use all sensory modalities simultaneously is critical in early development. Equally important is cross-modal transfer, the ability to take information obtained through one sensory modality and apply it to another.

Observation of sensory modes is the first step for families

Watch how your toddler coordinates his efforts to reach, grasp, roll and turn…all the movements that involve more than one action.  Does he talk and throw at the same time?  Does he crawl and then stop and listen or talk?  Does he whine and cry and kick at the same time? 

These are all examples of doing two things at a time, using two or more sensory skills at the same time!  Two at a time is good for children with visual problems..Parents need to offer their child two objects at once it is that simple!   Two at a time helps him choose and use his mental abilities! 

Observing your child is important to do every time you want to help him do something on his own.  Does the child transfer play toys from one hand to the other; does he bang and laugh at the same time on his highchair?  Does he clap and kick at the same time?  Does he call out or cry while he is poking at a toy with his hands and fingers?

How actively do you as a parent have to give him things to do in order for him to play?  How curious is he and how much of the time does he sit and how much of the time is he staring or blinking or cocking his head or making noises?

Will your child crawl under a table and what makes him laugh or cry? Does he chase you when you are crawling? Does he follow commands and open his mouth for food or spit it out or play with food with his fingers? Does he move his hands and feet at the same time?   Does the child raise his hands in the air, wave bye-bye?  Does he use his nose to indicate he is smelling food? 

Does he snuggle when family members pick him up?   Does the strategy of providing as much sensory stimulation as possible make your child happy or does he gets easily irritable and whiney when he is playing with others who offer him toys that make sounds or noises or moves?

If his activities are routine and he plays with certain toys at the same time each day or hour or minute, does he look for the toys or whine to be picked up?  Does he want to be picked up all the time, some of the time or none of the time? 

When activities or routines include the senses of smell, taste,hearing, and touch (for example, during diapering, the infant is encouraged to smell the difference between fresh cloth and disposable diapers) does your child seem interested and attend to or wait for me for the same activity, or does he  push or turn his head away? 

Although evidence from parent’s reports suggest that sensory interaction and play is enjoyable to infants with visual differences, many visually impaired children are most responsive to two or more activities at the same time and really enjoy action and body movements more if they handle two toys at a time, even if they drop one and want someone to pick up the other toy!  It is a game for the whole family, adults, parents and siblings.

It seems personality and temperament greatly influence different reactions in different children, but all avenues must be explored every day to provide motivation and opportunity for your child’s unique type of vision loss, so he learns and responds at a normal rate of development.   

Attachment and being picked up through infancy and childhood are natural adult responses by parents and family when a child experiences vision loss.  Parents must avoid this habit once the carrying stage of infancy is past and the early toddler stage has begun….one year of age!   Pick up when you need to and hold hands as much as possible for fine muscle control and a sense of independence.   The child with vision loss needs to learn that toys and people and places and things are permanent in their lives and will not disappear, so it is vital that good communication starts in the first year of life, allowing the child to trust, to be inquisitive, and to play a kind of permanent hide and seek game. 

All family members must tell a child where they are and what they are doing, including exiting and entering rooms and describing everything in between. Describe obstacles and keep track of the safety of where objects are placed.  Adults are the speechmakers and communicators all day every day, requiring cooperation and helpfulness from siblings as well as the child with vision loss. 

Normal seeking behaviors and the ability of locating people places and things must be taught in the second year of life.  Praise and thorough training of family members makes life a fun experience out of hide and seek, instead of a fearful one.  Walking and talking and running and playing can all be part of this learning experience! 

The child must learn that objects and people in their lives are permanent no matter if they can see or find them- they are there!  The  knowledge that an object or person exists when the object or person is not in sensory contact with an individual is a huge learning experience that even sighted children find hard to accept and harder to believe.  For an infant with vision this means that a toy played with yesterday is searched for again tomorrow.

The infant with good visual abilities is able to make this connection easier than the infant with visual impairment because of the immediate feedback and verification provided by vision. Substituting sound or tactual qualities for objects does not provide sufficient information, so parents and family members of infants with visual impairments must constantly create situations in which play objects are arranged, found and rewarded, in an effort to compensate for the anticipated learning delay.  

Mobiles, large playpens, wrist rattles, toys with short strings aid in keeping toys nearby and retrieving them when they are pushed out of reach in the infant years.  Then the game changes and the child and family need an upgrade to toddler push toys and things that move and create structures and shapes that are easily identified, such as a baseball bat, a tennis racket, a talking telephone and a large vision  talking computer.   Adults must insure that all children in the house put away clothes, utensils, push and pull toys, wagon and other larger items in the exact same location each day. 

Small muscle motor skills take more time to develop and do not occur in isolation but are interrelated with all aspects of development. Many infants with visual impairment do not receive sufficient opportunities in the stomach (*prone) position and, consequently, miss the experience of weight bearing on the hands and subsequent refinement of grasping.

If the child’s grasp and object relations do not become refined, self-feeding by age 18 months is the average, instead of eight to twelve months.   Holding hands and play circle games in one way to strengthen hand function and finger control.  Walking and running and holding hands are excellent games and do remind parents not to be picking up and carrying the child.

Start brushing teeth by age one at the latest and encourage other fine motor hand tasks that can be introduced into family life style, such as stirring and mixing, cleaning and scrubbing. 

Remember that the muscles in the mouth must be exercised through the introduction of new textures, speech happens later and is dependent on questioning instead of alert self-questioning and asking why and where and when.

I hope this is helpful and I will wait to engage you in any other way I possibly can.   

http://www.turben.com/article/69/395/Encouraging-Movement-in-the-Visually-Impaired-Infant

http://www.blindchildrenscenter.org/pubs.html

www.onestepahead.com/

http://www.ehow.com/way_5374215_child-care-activities-blind-babies.html

http://www.wonderbaby.org/search-topics/development.html

http://www.modernmom.com/article/activities-for-blind-babies

Ask Dr. Susan