Catherine Nelson University of Utah cathy.nelson@utah

1. Child-guided Assessment and Intervention Strategies for Children who are Deafblind and have Severe Disabilities:The van Dijk Approach Catherine Nelson University of Utah cathy.nelson@utah.edu

2. Assessment Difficulties • Tests that measure prior knowledge are not accurate measures of ability to learn • Sensory and motor disabilities may invalidate or make assessment difficult • Unfamiliar settings, materials, and people may stress the child and lower performance

3. Problems in assessment • Difficulties in communication or social relationship formation may lead to underestimation of child ability • Existing scales may be deficit based and give information on what the child cannot do rather than what he/she can do • Existing scales do not guide intervention

4. Assessment should: • Address interdependent development • Look at the environmental and biological influences on child development • Take into account and accommodate for sensory or motor impairments • Build from a secure base by beginning with what a child can do and is interested in • New experiences should be appropriate to development and build incrementally

5. Assessments should: • Address the underlying processes involved in learning including • state modulation • preferred learning channels • information processing • accommodation of new and existing experiences • memory • problem solving • social interaction

6. Van Dijk Approach • “ A living along with the child: How can I experience with him so I can better understand his meanings, values, and choices” • Dr. Jan van Dijk

7. Van Dijk Approach • I < > you encounter each other in WE • This encounter forms the basis for a conversational dialog which gradually becomes more sophisticated and symbolic as the child and his/her communication and language develop • Turn-taking, evoking signals and distancing are components of each of the strategies

8. General Guidelines • Prior to the Assessment • Talk to parents/caregivers to obtain information on child’s interests, preferences, etc. • Observe child while talking to parents/caregivers • Beginning the Assessment • Assess in an environment that is comfortable and/or familiar to child • Process is guided by the child’s interests • Start by following the child’s interests and movements • Adapt to child’s level, interests, and emotions

9. General Guidelines (cont.) • Establishing a Routine • Imitate what the child does in a turn-taking exchange to “start a conversation” • Use the turn-taking exchange to establish a pleasurable routine • Utilize “start-stop” form to elicit behavior from the child indicating a desire to continue the routine • Promptly reinforce any behavior from child indicating a desire to continue the routine • Pace the steps

10. General Guidelines (cont.) • Modifying a Routine After it’s Established • Add another step (only one sensory modality at a time) to see if child will imitate the step • Insert a “mismatch” to observe the child’s ability to anticipate the routine and discern changes • Assess problem solving by • Delaying your response to the child’s request for continuation of routine • Adding a dilemma that must be solved in order for routine to continue (e.g, a tissue covering a switch) • Discontinue the routine for a short time and then re-engage the child in the routine to see if child remembers and anticipate steps

12. Recognition/Memory Tasks:Hierarchy of Responding • Arousal • Orienting Response • Encode Information • Compare to existing schemes • Inhibit responses to irrelevant stimuli • Habituation/decrement of response • Dishabituation in response to change of stimulus features

13. Arousal and biobehavioral state • Arousal is produced in response to sensory stimulation and the inner needs of the child • In response to unneeded or unwanted stimulation, child may have heightened arousal (agitation) or lowered arousal (sleep) • Children with compromised central nervous systems have differences in state regulation

14. Arousal and biobehavioral state • State assessment may show how well a child copes with stimulation and can be used to determine the impact of the environment on state (Richards & Richards, 1997) • State may be modulated internally or externally

15. Biobehavioral states • Quiet sleep: Generally unresponsive, smooth regular respirations, occasional startles, lack of body activity, facial and eye movements • Active Sleep:(REM) More body activity, irregular respiration, movements of eyes and face, more responsive) • Drowsy: Variable activity, irregular respiration, delayed responsiveness, eyes glazed, heavy lidded look • Quiet Alert: Minimal body activity, regular respiration, bright, shiny face, most attentive to stimuli

16. Biobehavioral States • Active Alert: Much body activity, irregular respirations, facial movements, fussy, sensitive to stimuli, transitional state • Crying/Agitated: Irregular respiration, facial grimace, crying, color changes, variable sensitivity to stimuli

17. Biobehavioral state • What is the individual’s current state? • Is the individual able to control or modulate his/her state? • How much time does the individual spend in an alert state? • What range of state does the individual show and what is the transition pattern between states? • What variables affect the individual’s state?

18. Intervention: Biobehavioral state • Variety awakens • Repetition soothes • Calming stimuli: slow, rhythmic rocking, firm pressure, warmth, quiet regular rhythms, dim lights, cool colors, steady soft voice. • Arousing stimuli: fast irregular movements, bright light and colors, cool temperature, irregular rhythms, varied vocal patterns

19. Orienting Response • Direction of attention that may be seen in focusing of the eyes, attention to sound, and interest in textures or smells. Head, eyes, ears and/or nose directed toward a stimulus • Prepares the organism for organized behavior • Allows maximum information gathering to occur • Tends to occur in alert states of arousal

21. Orienting Response • What factors elicit an orienting response? • How does the individual exhibit an orienting response? • What channels appear to be associated with the orienting response ?

22. Intervention: Orienting response • Highlight important environmental stimuli if individual does not orient • Pair stimulus modes • Attempt to bring individual to higher state if state is too low for orientation • If state is too high and orienting response too intense, make stimuli moderate and predictable • Increase staff interactions • Cue as to what is coming up

23. Learning Channels • How does the individual take in information? • How does the individual react to sound? • How does the individual react to vision? • How does the individual react to touch • Does the individual use more than one sense at a time? • Does the individual engage or disengage in response to particular stimuli?

24. Approach-Withdrawal • What are the individual’s engagement cues? • What are the individual’s disengagement cues? • What appears to motivate the individual? • What does the individual turn away from?

25. Habituation • The active inhibition of not-needed responding to a stimulus that has been interpreted or recognized as neutral or familiar. • When stimulus features change, dishabituation should occur • Habituation is a learning and memory process

26. Habituation and stimulus function • It allows cognitive attention to switch to an incoming stimulus or to a stimulus with signaling or reinforcing value • Functions of stimuli include: • Attention eliciting • signaling • reinforcing

29. Scheme Development • Visual, auditory, tactual stimuli are integrated and associated with experiences • Schemes are developed and each new stimulus and experience is compared with existing schemes as new networks of schemes are built • Synapses are built based on experiences and schemes

31. Learning Sequences • Associate a preceding event with one that follows • Anticipate the next step and activate previously learned schemes • React to mismatch of expectations and adjust behavior accordingly • Learn a new task or routine • Remember the routine after a short break • Accommodate added tasks

33. Memory and Learning • Does the individual habituate to familiar stimuli? • How long, how how many presentation are necessary before response decreases? • Does the individual attend again if stimulus features change? • Are reactions differentiated? • Does the individual react differently to familiar and unfamiliar people?

34. Memory and Learning • Does the individual appear to have object permanence? • Does the the individual associate a preceding event with one that follows? • Does the individual appear to anticipate an upcoming event? • Does the individual react when there is a mismatch with expectations?

35. Memory and Learning • Does the individual demonstrate functional use of objects? • In the individual able to learn a simple routine? • Is the learned routine remembered?

36. Intervention and habituation • If individual is slow to habituate, allow extra time for information processing • Highlight changes in stimulus features • Modify environment to help child tune out extraneous stimuli • Consider symbolic and/or augmentative communication if child dishabituates to small changes in stimuli

37. Intervention: memory and learning • Use discrimination strategies to help child understand and interact with objects and events in the environment in a functional manner • Use characterizing or the building of a repertoire of communicative referents • Establish coherent chains that are repeated over and over • Use clear signals to help child anticipate each part of the routine • Accomplish daily activities in a consistent manner • When an activity is familiar, add a surprise element

38. Intervention: Memory • Use sequential memory strategies • Schedules, calendar systems • Experiences books • Drawing

39. Schedule Systems or Calendar Boxes • Objects or pictures represent activities of the day • Introduce each symbol one at a time, making sure that child has correspondence between symbol and activity • Involve the child in selection and production of the symbol

40. Calendar Boxes, cont. • Choose symbol based on child interest in activity • Choose symbolic level based on child’s development and perceptive abilities • Pair symbols frequently with activity • Arrange symbols in left to right order • Use calendar system as joint focus for conversation

41. Calendar Systems, cont. • Review symbols (and activities) during the day to build memory and reinforce left to right progression • As the child goes to more environments, think portability

44. Experience Books • Assist children to make books based on their actual experiences • Children can collect materials on outings and put them in books • Children and adults can draw together what they have experienced • Adult should label each picture or object

45. Experience Books • Assist children to make books based on their actual experiences • Children can collect materials on outings and put them in books • Children and adults can draw together what they have experienced • Adult should label each picture or object

46. Experience Books, continued • Encourage children to share book with others and review it frequently to build memory of experiences and positive experience with books • Converse with child about the items or pictures in the book-this can be non-symbolic or symbolic

47. Interactions • Does the individual orient to a person? • Does the individual exhibit secure attachment with important individuals in his/her life? • Does the individual engage in turn-taking when he/she begins the interaction? • How many turns are taken before disengagement? • Does the individual add to the turn-taking?

48. Engagement Cues • Looking at caregiver’s face • Movement of arms to caregiver • Turning head to caregiver • Smiling • Smooth movement of arms and legs • Feeding sounds • Raising head

49. Engagement Cues, cont. • Eyes wide and bright • Face bright • Hunger posture • Feeding posture

50. Disengagement Cues • Looking away • Fast breathing • Yawning • Wrinkled forehead • Dull looking face/eyes • Frowning • Increased sucking noises