Gloria: A Flexible Approach

Recently I had the opportunity to observe an interesting session of a ten-year-old student with CHARGE Syndrome working at home with her speech and language therapist (SLT) and occupational therapist (OT). The purpose of this blog is to describe aspects of the session that reveal the therapists’ flexible approach to working with this student.  In the field of deaf-blindness, teaching tends to focus, appropriately, on predictability and structure as a foundation for learning.  Here was a case where a gently challenging and fluid orientation was beneficial.

Some additional background information on the student and the session observed:  The student is profoundly deaf with good functional vision. She has also been diagnosed with autism and communicates with sign language. The therapists co-teach the student one-hour a week, and have been working with her for about a year-and-a-half. The sessions were originally held at their office but when they moved them to the student’s home environment they saw more success. The parent’s private insurance covers the cost of the therapy.

When the therapists started the session, they had a basic idea of what they wanted to do: enhance expressive communication skills, develop the concept of categories, and work on the skill of waiting. As the session went on, they started changing the rules a bit or briefly interrupted the flow of the activities. For example, they asked her to place things in a different spot than before although this is not what the student wanted, and they asked her to request what she wanted by using words instead of expecting the activity to continue simply because she stood waiting. They also asked her to comment on one of the items they were showing her, instead of just naming the item; additionally they created a situation where she needed to wait a little longer than usual for something she had requested.

When the student appeared to be frustrated by their behaviors, e.g., getting upset very quickly when things did not happen as she expected or when she did not get what she wanted, the therapists stayed calm, waited, and explained to her what they wanted her to do, and if necessary guided her through self-regulatory techniques such as taking deep, long breaths. After a short period of time the student was able to come out of her distress and continue working. The therapists reported that in the past it had been impossible for the student to come out of her “upset mode,” which usually ended the session.

I believe this approach helped the student move away from her preferred mode of doing things quickly, automatically, and predictably. What she was learning was a generalizable way to manage life by: 1) becoming more adaptable to change, 2) thinking about what she needed to do before acting, 3) communicating using more than behaviors or one word utterances, and 4) being patient when not obtaining immediate results.

Elements that helped make this approach successful with this particular student were:

• combining the expertise of an SLT and OT.  This may have good results for other students who are deaf-blind:  one has the focus on communication, the other on sensory integration and self-regulation. These therapists had a lot of experience working together and changed and expanded their roles during the session seamlessly.
• The student had good functional vision and could communicate using sign language.
• The therapists had a very good sense of who the student was, her strengths and needs; they had a positive relationship with her.
• The therapists had a playful attitude towards the student and were creative in their activities by not only utilizing the dining room table but the whole house as the student’s learning environment.
• The therapists worked in the home, a familiar and comfortable space for the student. They did not have to follow a fixed schedule or sequence of activities in contrast to what might happen at school.
• The parent was present during the session and was able to observe and participate when appropriate.

Conclusion:

After a careful assessment of a student’s functioning, using challenges strategically in a session with a student who is deaf-blind can be helpful.  Using communication, dealing with change and learning to manage frustration are important skills to develop as we guide and support children and youth to integrate with the unpredictable world at large.