Children Who Are Deafblind / Multi-Sensory Impaired - Essay Example

 Education “Deafblind children are extremely difficult to assess… so we should not take… any assessment of the children as the full and complete story about what they can see, hear or do” Eyre, 2000:120 Introduction Assessment of children who are deafblind / multi-sensory impaired is challenging because of diversity of population, including varying degree of vision and hearing loss, and the presence of additional disabilities (Aitken, 1995; Goodman & Wittenstain, 2003). These disabilities both affect and interact with each other. So the development in these children cannot be studied and understood separately or simply by adding the effects of individual disabilities (Field et al., 2005; Lewis & Russo, 1998; Amy & McKenzie, 2007, 2009). There is a lot of subjectivity about the disabilities of children associated with a particular condition and the effect of external factors on the response of the children. The assessment of these children must address the complexity of their needs including communication, vision, hearing, cognition and motor abilities with respect to the priorities of each and every child. Such a holistic assessment is fundamental to the quality educational programming for the child (Dote-Kwan & Chen, 1999; Eyre, 2000; QCA, 2009 & 2012). This paper discusses and explores the complexity of needs experienced by the deafblind / multi-sensory impaired children that have a direct impact upon their assessment, teaching and learning on a day-to-day basis. The findings will be supported by recent examples of pupils observed during the course of this study, to lend more credibility and document first-hand experience and evidence of the phenomenon. Lastly, various strategies which would enable the pupils to access and improve their learning will be discussed at length along with a comprehensive reasoning behind the choices made and their effectiveness when implemented. My role in relation to this project was chiefly concerned with observing and working with a pupil. It was important to collaborate with the support staff as they could provide additional information about the pupil. It was very fortunate that my colleagues fully supported this project and wanted to find a way of improving opportunities for better learning of the pupil. The aim of this assessment is to determine the functional vision available for communication and education, and to propose methods of enhancement and compensation to circumvent the visual problems and enhance development for the pupil.  Illustrations of the child involved in the study are as follows: Pupil Age Description of the problems faced Z 9 years Incontineniam Pigmentation Microcephaly and abnormal brain MRI Dystonic/spastic quadriplegia (gastrostomy fed) with kyphoscoliosis and oropharyngeal, spinal brace Seizure disorder Visual impairment Cognitive impairment Pupil Z has been following the Pre-formal Curriculum, which aims at addressing the needs of pupils working at developmental levels well below the National Curriculum standards. Recent results in the National Curriculum Assessment indicate that Pupil Z achieved P-level 2 (i), which implies that she was generally functioning at a very initial developmental level. This means she had begun to respond consistently to familiar people, events and objects (Appendix 1, 2 & 3). Selecting appropriate instrument of assessment “Assessment is the process of evaluating an individual’s learning. It involves generating and collecting evidence of a learner’s (…) knowledge and skills and judging (…) evidence against defined standards” - SQA, 2012:3 Children with deaf-blindness / multi-sensory impairments pose unique challenges to the educators with regard to the implementation of appropriate and adequate assessment to find the best means of accelerating their developmental potential (Haring et al., 1981; Wolf-Schein, 1998). Hence, there is wide range of published assessment documents (instruments), styles (formal, informal or both), and approaches and techniques (observations, performance tests, interviews) that have conventionally been suggested for assessment (Marson & MaCall, 1997; Maltby & Knight, 2000). Literature review postulates that it is difficult for assessment to provide accurate predictions about the potential, or ability of the deafblind / multi-sensory impaired children (Nelson et al., 2001; Remington, 1996). Most of the assessment instruments assume that such children follow the developmental patterns of typical children with no regard to the additional difficulties (learning, physical or medical) which often occur and affect the assessment (Aitken, 1995; Bishop, 2012). According to the current literature, a few assessments have considered the complex needs of children with multiple disabilities and the interaction between cognitive, motor, sensory and/or medical difficulties that they experience (Sacks & Silberman, 1998; Soukup & Feinstein, 2007). Some researchers have failed to detect minor changes in the behaviour of these children due to lack of some small yet essential steps that make part of the assessment and/or lack of consideration of a holistic evaluation of the learners’ unique needs, strengths, and interests (NCDB, 2012; SENSE, 2012; van Dijk, 2012). Researches and practitioners working with children with multi-sensory impairment have generally emphasized that in order to make the assessment of such children more meaningful, suitable assessors, environments and activities are essential, along with the adoption of appropriate communication methods (Bryson, 1993; McNicholas, 2000). McInnes and Treffry (2001) have emphasized upon a need for the assessor to be experienced in working with deafblind / multi-sensory impaired children. Carney (1987), Lipsky (1989) and Turnubull (1990) add that even highly trained professionals (e.g. optometrists, audiologists, etc.) may not necessarily always understand the child’s behaviour, which affirms a need for the professionals to collaborate with the child’s parents and/or teachers as they can provide additional information about the child (Carney 1987; Lipsky, 1989; Turnubull, 1990). McInnes (1999) and Marks (1998) highlight that, assessors’ attitude; not underestimating the learners’ potential may have impact on their choice of the assessment tool. Johnson (1999) asserts that, testing uncooperative children may be very challenging and complicated for the assessors as most test materials rely on the child’s tendency to co-operate with the assessor and understand what is required. So the response of children who have motor-control difficulties, delayed responses, roving eye movements, “absence” seizures or other issues is delayed and this reflects in the result of the assessment. Eyre (2000) states it is advisable for the assessors to conduct informal assessment prior to or in conjunction with the formal assessments so that good testing results for these children can be obtained. The informal assessment may be carried out by the educational staff. This facilitates the collection of information that may then be shared with the professionals to aid them in making an objective assessment of the child abilities (Eyre, 2000). Identifying strengths and limitations of assessment “Our assessment should profile the strengths and abilities of the child, should focus on the positive achievements and, where there are difficulties, should suggest practical and resourceful ways of overcoming these” Eyre, 2000:121 According to available literature, significant research has been conducted over the years to develop diagnostic or treatment orientated clinical assessments which can facilitate the vision specialist in determining a visual acuity and overall development in very young children with multiple disabilities. There is a lack of adequate tests and normative data in this area (Chen, 1999; Keith et al., 1972; Mackie et al., 1995, van Dijk & Nelson, 2001). Even when clinical assessment has been relatively successful, the outcome has not been quite straightforward. Some children, who have significant problems of vision on the test, may sometimes use vision in everyday situations (Erin et al., 1990; Simeonsson & Rosenthal, 2001). Such behaviors include turning to the light pouring through the window but not responding to the light during clinical assessment. Anthony (2000) says that a child’s visual abilities ‘may not be readily transferable to another setting”. He further adds that when the child’s disabilities are so complex that administrating formal diagnostic measures is considered inappropriate and/or invalid, it is advisable to conduct the functional skills assessment (Anthony, 2000: 32). “Functional vision is most often assessed through observation rather than formal testing” - Goodman & Wittenstein, 2003:86 Current research in the field of learning disabilities has begun to address the failures of traditional assessment methodologies and tools which have traditionally proved insufficient for building an accurate picture of the developmental level of children with complex needs (Aitken & Buultjens, 1992; Brown, 2012; Chen, 1999; Eyre, 2000; Goodman & Wittenstein, 2003; etc.). Particularly, the work of Stuart Aitken and Marianna Buultjens is quite influential in this respect (1992). They have brought assessment to the new level of understanding by viewing assessment as something more then the administration of tests and interpretation of findings. “Vision for Doing” model designed by Stuart Aitken and Marianna Buultjens (1992) makes no claims to be a "standardized test" of vision for learners with multiple disabilities but offers breadth of information (e.g. medical conditions) and set of guidelines (e.g. presentation of materials) for educators to make best use of their tools and findings to plan the learner’s curriculum. The selection of items for the assessment of vision (e.g. responses to objects) has expanded to include other senses, learners’ background information, as well as personal preference (e.g. likes). This has added greater level of content to this assessment. This method of assessment offers flexibility which is not quite consistent with the prevailing trends of assessment of standards and accountability within the educational setup. This is also a passive method of assessment in comparison to the clinical assessment and other assessment tools as it provides flexibility of choosing activities, time, places, and recourses which are generally easily obtainable. For me, it was a time consuming method. Three weeks seemed insufficient for the observation of the Pupil Z. Because of the limited time and use of observation as a technique, I have not been able to determine the functional vision available for communication for the Pupil Z, though the limitation led to new questions on meaningful interpretation of collected data through my and the support staff’s observations. Although my colleagues collaborated a lot with me during the assessment, yet there were times when I had problems interpreting the data as an adult since the data came from the observation of a child i.e. the Pupil Z, and also because of the inconsistent responses of the Pupil Z to the routinely activities. My conclusions were supported with a lot of discussions with the colleagues. Hence, this method of assessment is not primarily designed for the “experts”, but people who work with or care for children with complex needs. I think that even highly trained and experienced professionals may at times, misinterpret some child behaviors. There is a need to make use of video recording during assessment as it provides the assessor with added flexibility of reviewing the conclusions drawn from the assessment. It is especially recommendable for the observation of such children as the Pupil Z who is not consistent in responses even to the routinely activities. Overall, I think it is a great method of assessment, but needs to be combined with other instruments of assessment to enable the observers to draw more rational conclusions about the child’s abilities. Impact of assessment findings on teaching and day-to-day learning “Until and unless that child has appropriate education you will not know what he or she can do, no matter how often you assess” Wolf-Schein 1998:40 The purpose of assessment was to determine the functional vision of Pupil Z available for communication and education. Based on my reading and reflection on the Pupil Z’s unique needs, I decided to use functional visual assessment model design by Stuart Aitken and Marianna Buultjens (1992). I preferred choosing this method over other methods of assessments because it provides me with added flexibility (e.g. choosing activity to asset), sets of guidelines, background information on eye conditions and other things to consider during assessment, e.g. other senses, pupil preferences, etc. so that I may be able to adopt a holistic approach rather than strictly concentrating on the assessment of vision alone. Other assessment methods have stricter rules and tasks that need to be completed. It was also not possible to disintegrate other assessment methods into very small steps. So if I used them, this would have limited my ability to record the responses or include extra comment box to the findings (ref). This method reaffirmed the inferences I had already drawn by working with the Pupil Z as well as the conclusions drawn by medical researches and other professionals in the pupil files. Our common conclusion was that the complex needs of the Pupil Z have significant impact on her every day performance both in school and the clinical assessments. Pupil Z was found to be inconsistent in her responses to the routinely activities (e.g. greeting activity). Hence, she showed ability to use her vision by visually attending briefly to the stimuli when given support (e.g. verbal encouragement) and plenty of time to respond. Pupil Z showed different and often delayed responses for the same activity. It was difficult to differentiate between her response to the stimulus on the activity and general response to such environmental factors as sound that I was not able to control during the assessment. She needs continuity in multi-sensory approach to the curriculum which she has followed since she came to my school. She needs a holistic communication system that aims at making use of all senses to support her communication, understanding and education. Conclusion This essay began with an overview of complexity of needs experienced by the deaf-blind / multi-sensory impaired children which directly influence their assessment. Other areas discussed included the lack of appropriate assessment tools / nominative data, the impact of assessor’s individualistic abilities on assessment and the assessor’s selection of tool for the child’s assessment. A brief discussion of the chosen assessment method, the strengths and limitations of that method, and finally, the impact of assessment findings on teaching and day-to-day learning of the Pupil Z was also included. On the basis of review of past literature as well as personal observations, it can be clearly stated that, children with multi-sensory impairments have highly complex needs and experiences, owing to various physical and cognitive developmental issues which impact their assessment. Such complexities result in delayed responses in children during assessment, which leads to an underestimation of their abilities on the part of the assessor. My observation confirmed most of the information I found through discussions with the class staff and other medical and assessment records. Through this study, I have been able to highlight two key strategies to use with Pupil Z to help her enhance her communication and development. Although the success of such strategies may be documented, it is continually the practicalities of implementing such approaches, e.g. use of total communication approach and multi-sensory approach which has an influence on the achievement of children. Overall, I feel a strong need to further investigate the issues identified in the course of this observational study. Based on the information obtained from this observation and working with my support staff / studying the literacy (lack of tools and data to assess this particular group), use of the ecological approach to assessment can be recommended for the identification of skills that are needed in specific settings in which the individuals function. References: Anthony, L.T. (2000). Performing a functional low vision assessment, in D’Andrea, F.M. & Farrenkope (eds.), Looking to learn: Promoting literacy for students with low vision. New York: AFB Press. Bryson, E. (1993). Assessment, in Blythman, M. & Diniz, F. 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