Gloria: Planning for Transitions
For students who are deaf-blind, transitions are as important as the activities themselves. This may be difficult to understand for those who work with this population and for their friends and family because typically we tend to focus on the activity that we want to do with them and less on how we transition with them in and out of it. One reason for this is that for those us who are not deaf-blind, transitions often appear as happening almost automatically.
But to have some sense and sensitivity of the importance of transitions I would like you to think about the big transitions in your own life. Try to remember how you get anxious, nervous, or even feel out of control when you are overwhelmed by the feelings of uncertainty that comes with change. To cope with these feelings you may follow several strategies to minimize these levels of anxiety. For example, you may study the situation in advance; talk about it with several people before, during and after; intensify your physical activities; take medication; and/or try other things that help you relax.
Because of their more limited ability to control their environment due to their vision and hearing loss, and perhaps other disabilities and conditions, people who are deaf-blind may have the feelings you associate with major life changes with almost all of the transitions in their day. Therefore, if transitions are not managed properly, these individuals can live in a continual state of uncertainty.
Jan van Dijk recently did a training in northern California where he discussed how many people who are deaf-blind live in this constant state of panic. He said that there is evidence to back this claim as we can now measure levels of cortisol in people. Cortisol is “a steroid hormone produced by the adrenal gland that hammers the limbic system and the hippocampus, (which) can negatively affect physical and mental health.” (Belote, 2011) In people who are deaf-blind, these levels of cortisol are found to be highly elevated.
The lives of students who are deaf-blind, then, may be unpredictable and unsettling from the moment they wake up as they go from one activity to the next without enough awareness of what will happen. This if often because caregivers and/or service providers are communicating insufficiently with them while also making the decisions for them. For example, these students may not know if the next activity will involve feeling a spoon in their mouths that indicates eating time, having their bodies submerged in water for bath time, or riding in a car or school bus to go to school. At school, they may not know who will work with them, or when they will do an activity in the classroom or go out for recess, or even what kind of activity they will doing. If the students are older, they may not fully understand where they are going to go when they go out in the community and what to expect when they do.
A few days back I provided technical assistance to an Orientation and Mobility Specialist who was very concerned about one of her student’s behaviors in the community. She explained that this was someone who was deaf and had partial vision, and with whom she could have a conversation through sign language, but when he was under certain conditions he could exhibit extreme behaviors. We discussed, among other observations and strategies, the importance of including in her lesson a time for preparing for the transition into the community, as well as time for discussing the outing afterward. In addition, I suggested allowing the student to make the decision himself as to where he wanted to go, when appropriate. We discussed the importance of talking about they were going, what were the people, places and things they may encounter, the type of transportation they would be using, what they were going to do, and what the possible stressors might be and some of the things the student could do to manage them. The point was that the transitions needed to be part of the lesson, not just the activity itself.
The student discussed above has formal communication skills, and for those who don’t, you will obviously need to use other strategies. Following are a few links that may guide your ideas on how to make transitions clearer for your students:
- How Can I Help My Child Understand What Is About To Happen by MaryAnn Demchak
- Using Cues to Enhance Receptive Communication by MaryAnn Demchak, Charmaine Rickard, & Marty Elquist
- Let Me Check My Calendar by Robbie Blaha, Education Specialist and Kate Moss
- Using a Schedule with Your Child
Belote, Maurice. Research Update: Stress and Children who are Deaf-Blind. http://www.cadbs.org/newsletter/resources-winter-2011/