Intervention With Special Populations

Communication Intervention with Individuals with Progressive Disorders

Communication intervention services may be especially important for individuals who have progressive disorders (conditions that worsen over time). As the disorder progresses, the communication needs of the individual will change. In addition to diminishing health, progressive disorders are often associated with the loss of vision, hearing, motor, and cognitive function. Any of these changes will have a marked effect on the individual's communication profile, requiring responsive communication intervention

For example, an individual who once communicated in sign language may no longer be able to form the hand shapes of the signs. In later stages of the disorder, they may be able to express only the most basic needs through gestures to their own body. An individual who once was able to point to a selection on their speech generating device may lose that ability and need another access method. Thus, the team must plan compensatory skills to replace those expected to be lost due to the progressive disorder. This is very challenging because educational and rehabilitation teams are oriented to improving skills. In the case of individuals with progressive disorders, the goals will be to maintain as many skills as possible while teaching new skills that are needed in response to the individual's changing condition.

In addition to the potential need for new means of communication, the individual with a progressive disorder is likely to experience new environments (such as clinics and hospitals) and new communication partners (such as new medical personnel or caregivers). Thus, communication intervention is important to prepare the individual to participate in these new environments and to prepare communication partners to interact with the individual. Decisions specific to intervention methodologies and desired outcomes should be made on an individual basis. 

Communication Intervention with Individuals who are Deafblind

Individuals who are deafblind have combined hearing and vision losses. Few generalizations can be made about deafblindness because there are many possible combinations of these sensory losses, and they can co-occur with additional disabilities. Some key ideas may be useful to consider:

• Most individuals who are deafblind have some functional hearing and/or vision.
• Those who are deafblind require highly individualized programs.
• Individuals who are deafblind communicate in a variety of ways.
• Due to losses in both distance senses (e.g., the ability to perceive things beyond arms’ reach), many who are deafblind will require 1:1 and small group instruction. 

Services and supports should be delivered using a collaborative model. The visual, auditory, and tactile needs; learning styles; and physical capabilities of individuals with deafblindness differ greatly. No single team member can be expected to address all of these factors adequately when planning and implementing instruction. The sharing of expertise from diverse disciplines aids each team member in delivering services.

Appropriate services will address the following aspects of communication: form (such as gestures, object representations, and verbalizations); function (purpose of communication); content (message); and context. The aspect of context includes considerations about the physical environment (setting it up and watching for the individual's responses), the person’s unique characteristics (such as being outgoing), communication partners (and their need for training), well-defined activities and routines, and the process of communication (how the individual  initiates, sustains, and terminates conversations expressed across forms; Bruce, 2002).

Communication services may include aided and/or unaided augmentative communication systems such as object representations, sign language, and speech generating devices. Individuals who are adventitiously deafblind (i.e., born with hearing and sight, but experience impairment later in life) may need support to transition from one form of expressive communication to another. For example, someone who used visual sign language may need to learn tactile sign as vision loss progresses.

The field of deafblindness often applies “child”-guided methodology grounded in the work of Jan van Dijk (most recently known as the van Dijk curricular approach) and expanded by others (see MacFarland, 1995; Nelson, van Dijk, McDonnell, & Thompson, 2002). Knowledge of this approach is essential to providing sensitive and effective services to children and adults who are congenitally deafblind.

In recent years, the definition of literacy has evolved to include prelinguistic learners. This new view of literacy includes everyone (individuals who are deafblind) and means that what we once thought of as communication interventions—including lessons in choice making and those involving the daily schedule—are also literacy lessons.

More Information

Each state has a federally funded deafblind project. Parents may contact the appropriate teacher in their district (preferably a deafblind specialist, teacher consultant of the visually impaired, or teacher of the deaf/hard of hearing) or directly contact their state deafblind project for more information about how to register the child. State deafblind projects provide services to benefit the child who is deafblind and the family.

Resources

Bruce, S. (2002). Impact of a communication intervention model on teachers' practice with children who are congenitally deaf-blind. Journal of Visual Impairment & Blindness, 96(3), 154–168.

MacFarland, S. Z. C. (1995). Teaching strategies of the van Dijk curricular approach. Journal of Visual Impairment & Blindness, 89, 222–228.

Nelson, C., van Dijk, J., McDonnell, A. P., & Thompson, K. (2002). A framework for understanding young children with severe multiple disabilities: The van DIjk approach to assessment. Research & Practice for Persons with Severe Disabilities, 27, 97–111.

Rowland, C. (2013). The communication matrix.

National Consortium on Deafblindness
This is an information clearinghouse of literature on deafblindness operated by individuals who are experts in the field. International resources are included.

Perkins School for the Blind
Note: Webcasts on deafblindness are available.

Helen Keller National Center for Deaf-Blind Youths and Adults
The site addresses services and advocacy for older students and adults.

Return to the National Joint Committee for the Communication Needs of Persons With Severe Disabilities (NJC) topic areas list.