The student may communicate through facial expression, body movement, posture, vocalization, crying, tantrums, etc. These reactions are frequently seen by parents and/or professionals as behaviors that need to be eliminated, when in fact the student is trying to communicate and becomes more and more frustrated when their communication is misunderstood. If, instead, the student's attempt to communicate can be acknowledged and expanded, difficult behaviors may begin to decrease.

Points to Remember:

1. Look at all of the student's behavior as an attempt to communicate.

2. Be sure the student has had medical problems eliminated.

3. Attempt to understand the student's communication effort.

4. Teach the student a more acceptable way to communicate what he has to say, after showing you understand the effort.

Fact sheets from California Deaf-Blind Services are to be used by both families and professionals serving individuals who are deaf-blind. The information applies to students 0-22 years of age. The purpose of the fact sheet is to give general information on a specific topic. More specific information for an individual student can be provided through individualized technical assistance available from CDBS. The fact sheet is a starting point for further information.

What It Is, What Causes It,

Its Effects, and Treatment

What it is:

Otitis media is one of the most common problems for which a child is seen by a physician. It is an inflammation of the middle ear space and is usually accompanied by fluid build-up. This fluid may or may not be infected. This build up of fluid in the middle ear space restricts the movement of the ear drum. If the ear drum does not move freely, a hearing loss occurs. This can be compared to plugging your ear with your finger. The child with otitis media does not always show signs such as fever, irritability, tender ears, reddened ears, etc.

There are three general categories of otitis media: 1. otitis media without effusion (fluid); 2. otitis media with effusion; 3. otitis media with perforation (hole in ear drum).

What causes it:

The eustachian tube is the tube connecting the middle ear and the upper part of the nasal passages. Eustachian tube dysfunction is a significant factor in the development of otitis media. The purpose of the Eustachian tube is to equalize the pressure on both sides of the ear drum and provide ventilation to the middle ear space. When it does not work properly, the air is trapped in the middle ear space. This air is absorbed and fluid results.

Age plays a factor in the development of otitis media. At birth, the eustachian tube is in a horizontal position and it is wider and shorter. During the first few years of life it begins to extend downward allowing for easier drainage. Therefore, otitis media is most common during the first 2 years of life. Inflammation of the nasal end of the eustachian tube may produce swelling, thus impairing its function. Such inflammation may result from viral or bacterial infection (a cold) or chemical irritation (tobacco smoke, chlorinated pool water).

Allergies have also been known to cause otitis media. Some foods that commonly cause allergic reactions in young children include milk, wheat, eggs, corn, yeast, peanuts, soybean, sugar and citrus. Skeletal changes play an important part in the development of otitis media. Children with Down syndrome, cranial base anomalies (cleft palate, atresia, adenoid problems, etc.) and craniofacial syndromes (Treacher-Collins, Crouzon's or CHARGE) have a high incidence of otitis media. Children with upper respiratory problems are also more prone to develop otitis media. Family history, climate, and dietary reasons have also been linked to recurring otitis media.

What the effects are:

Recurring otitis media has been shown to have a direct impact on a child's speech, language, and academic development. If a hearing loss is present due to otitis media, a child will experience difficulties in attending and following both formal communication (classroom instruction), and incidental communication (conversation that is on-going throughout the day).

Amplification is not prescribed for the child with otitis media because in the majority of cases, the child's hearing returns to normal after the otitis media is cleared. However, more severe cases, especially when prolonged or left untreated, may result in a perforated ear drum, scar tissue on the ear drum and even a permanent hearing loss. Other, more serious, complications that could occur include facial nerve paralysis, meningitis, encephalitis or brain abscess.

Children that have a known sensorineural hearing loss may experience a decrease in their usable hearing and in some cases, these children may not be able to wear their hearing aids during an episode of otitis media. The ear must be allowed to breathe and drain. If an earmold or hearing aid is in the ear, increased condensation may occur or the fluid may drain into the hearing aid causing internal damage to the amplifier. Some children may experience such pain that they cannot tolerate the earmold or hearing aid in their ear.

Treatment:

Treatment for otitis media varies according to the severity, the occurrence, and the age of the child. If the otitis media is found to be infectious, antibiotics are usually recommended. Clearance of the liquid is imperative. If the child has a history of recurring otitis media the doctor may choose to perform a myringotomy and place a tympanostomy tube in the ear drum. This is a common procedure in young children which entails the doctor making an incision in the ear drum to drain the fluid. A small tube is then placed in the incision. This tube allows for the air pressure to be equalized on both sides. It also assists in keeping the middle ear space well ventilated.

IF YOU SUSPECT YOUR CHILD MAY BE PRONE TO OTITIS MEDIA, CONSULT YOUR PHYSICIAN, PEDIATRICIAN, OR EAR, NOSE AND THROAT SPECIALIST (ENT). CDBS IS ALWAYS HERE TO ANSWER YOUR QUESTIONS.

Glossary:

effusion - The escape of fluid into the middle ear cavity.

perforation - A hole or tear.

cranial base anomalies - Pertaining to or involving both the braincase and face.

cleft palate - Nonclosure of all or part of the roof of the mouth.

atresia - Absence of the ear canal.

myringotomy - A small cut in the ear drum.

facial paralysis - A paralyzed face muscles.

meningitis - Inflammation of the membranes covering the brain and spinal cord.

encephalitis - Inflammation of the brain.

brain abscess - A collection of puss surrounded by inflamed tissue on the brain.

tympanostomy tube - A small tube that is placed in the ear drum to allow
air to enter the middle ear.

Fact sheets from California Deaf-Blind Services are to be used by both families and professionals serving individuals who are deaf-blind. The information applies to students 0-22 years of age. The purpose of the fact sheet is to give general information on a specific topic. More specific information for an individual student can be provided through individualized technical assistance available from CDBS. The fact sheet is a starting point for further information.

Fact sheets from California Deaf-Blind Services are to be used by both families and professionals serving individuals with dual sensory impairments. The information applies to students 0-22 years of age. The purpose of the fact sheet is to give general information on a specific topic. More specific information for an individual student can be provided through individualized technical assistance available from CDBS. The fact sheet is a starting point for further information.

Children who are deaf-blind but have a significant amount of vision can be assisted in using their vision to the greatest extent possible by adapting the environment and materials, or by teaching them strategies to meet the demands of the environment. Not all adaptations are appropriate for all children. Each child's visual needs are different according to a variety of factors. These include their visual diagnosis, the presence of other disabilities, their visual abilities, and environmental factors. Two factors to keep in mind when considering adaptations for a child are: Student or material/environmental adaptation, necessity, and level of demand on the student.

Student adaptations can be more effective because they are less intrusive and more flexible. This approach is best when the student is capable of generalizing the learned skill to a variety of environments. This is not always the case and the skill that the student has learned may have to be taught in each environment where it would be helpful.

Materials adaptation should be used when the student has difficulty adapting in the way required by the task. Material adaptations take a number of different forms: Lighting, color and contrast, size and format, and changes in workspace. Material adaptations should be made with forethought and only when required by the student. They should be made as minimal as possible while still allowing the student to complete the task effectively.

You do not want to make the student dependent on an adaptation when it is not necessary. In some situations it may be better to make small adaptations at first in order to place higher demands on the student to help them to learn to adapt. Once they have done so the task can be further adapted to increase efficiency. It is also important to remember that when all visual adaptations are ineffective non visual (tactual) adaptations must be considered.

1. Students should be taught techniques in a variety of settings to encourage independence and generalization of the skill.

2. Students benefit from good positioning. The less energy they expend on holding themselves up the more they can put into using their vision. This is a skill that they can be taught to self monitor.

3. Limiting fatigue will help students perform better. Break tasks up into shorter time periods to give their eyes a rest and limit visual fatigue. Extended time may also be necessary for a child to complete a task.

4. Children can and need to be taught to wait for their eyes to adjust to changes in lighting. This is most true if going from outdoors to indoors and visa versa.

5. Children can learn to view in different ways to maximize their residual vision. The most obvious is distance. Getting closer to or farther away from the object or person to be seen may make it easier. Some children tilt their heads to get the visual material at an ideal angle. They may also do this by moving the material.

1. Lighting interacts with many other factors but most importantly with contrast. Lighting can increase or decrease the contrast of visual materials. In a dark environment increased lighting will increase contrast but in a bright environment it will reduce it. Natural light is good but it needs to be controlled due to glare. Light that comes from behind the individual is best as it minimizes glare and does not strike the person directly in the eyes. A lamp with an adjustable level of light is useful for this. Children who have trouble attending to material may benefit from shining light directly on it. This may help attract their attention.

2. As stated before contrast is effected by lighting but it is also effected by the materials them selves. Visual materials should be a different color from the background and backgrounds should be plain not patterned. For example if you want the child to see some red blocks put them against a blue or black background instead of an orange one. For print or pictures they should be as dark as possible on a clean background. A photocopy where the letters are gray and the background is also darker is not ideal for a child who needs good contrast.

3. Pictures need to have good contrast and be simple in format. Cluttered pictures will not be easy for the child to see. Also having many pictures on a page causes the same type of visual clutter.

4. Color can be an effective visual cue. It can be used to organize and classify or bring attention to important visual material.

5. Pictures or print should be spaced well. It is helpful if there is a good amount of space between pictures or words as it makes them stand out better. More space between lines can make tracking easier.

6. A student's workspace can also be changed to assist them in using their vision. An example of this would be to create visual boundaries by putting colored borders on a desk can be effective in focusing a child's attention. Using a tray can have the same effect, it also creates a tactual boundary to reinforce the idea of space. Materials can also be made more accessible by bringing them closer to the student. This can be done by using a reading stand and by adjusting the height of the desk or table.

7. This same concept is also true of the layout of a room. Areas of a classroom should be visually unique. This can be accomplished by using different colored carpet or by arranging the furniture to separate areas/activity centers from each other.

8. Enlarging materials is useful for children who have reduced acuity. This could be enlarging of pictures or print that the child needs to see. However enlarging materials is not necessarily the best adaptation for children with a field loss as they will see less of what has been enlarged instead of more.

Corn, A.L. (1983). Visual Functioning: A theoretical Model for Individuals with Low Vision. Journal of Visual Impairment and Blindness, 77, 373-377.

Hall, A., & Bailey I.L. (1989). A Model for Training Vision Functioning. Journal of Visual Impairment and Blindness, 82,390-396.

Levack, N. (1991 ). Low Vision: A Resource Guide with Adaptations for Students with Visual Impairments. Austin: Texas School for the Blind.

Stratton, J.M. (1990). The Principal of Least Restrictive Materials. Journal of Visual Impairment and Blindness, 84, 3-5.

Fact sheets from California Deaf-Blind Services are to be used by both families and professionals serving individuals who are deaf-blind. The information applies to students 0-22 years of age. The purpose of the fact sheet is to give general information on a specific topic. More specific information for an individual student can be provided through individualized technical assistance available from CDBS. The fact sheet is a starting point for further information.

Supported Education

Traditionally individuals with deaf-blindness have been educated in separate and specialized environments. Recently research and successful experiences have opened the doors to less restrictive educational programs for these students.

Including students with their non-disabled peers in integrated environments provides individuals with disabilities the opportunity to interact with and learn from students with other abilities. Non-disabled peers model appropriate communication and behavior and provide opportunities for social interaction. Shared experiences between peers allows friendships to develop. These friendships often continue to provide support individuals need in future environments.

Supported education is an option chosen by the educational team, including the family as the primary member. The least restrictive environment (LRE) mandate states that the educational placement of an individual must be based on the IEP and located as close as possible to the student's home.

Supported education is the process of providing support, assistance and information to ensure the successful inclusion of students with disabilities within the general education classroom. This support is most generally provided by a team of general education teacher, special education staff, the individual and his/her family and peers. Supported education is not a way to abolish special education, nor a strategy to decrease services to individual students. It is, however, a means to deliver educational services to students with diverse needs within the general education system. It often results in an increase of services to both individuals with disabilities and their non-disabled peers.

Supported education can benefit students with varying disabilities. While recognizing the unique learning needs of individuals, modifications and adaptations can be made to accommodate individuals with dual sensory impairments within a variety of educational settings. However, successful programming requires that the supports and supplemental services required by the IEP are provided and managed appropriately, and all involved work in a collaborative manner. Personnel specially trained in sensory impairments must work in a team approach to provide related services.

Supported education is an option that should be available to every individual with dual sensory impairments. Careful planning and collaborative efforts will ensure the successful inclusion of individuals in their school, community and work environments.

Strategies for developing supported educaton programs are identified in the following chart. For more information, or to obtain technical assistance on this or other topics related to individuals with deaf-blindness, contact California Deaf-Blind Services.



Fact sheets from California Deaf-Blind Services are to be used by both families and professionals serving individuals with dual sensory impairments. The information applies to students 0-22 years of age. The purpose of the fact sheet is to give general information on a specific topic. More specific information for an individual student can be provided through individualized technical assistance available from CDBS. The fact sheet is a starting point for further information.

ADD .......................................Attention Deficit Disorder
APE .......................................Adapted Physical Education
CAC .....................................Community Advisory Committee
CCS ....................................California Children's Service
CDBS ..................................California Deaf-Blind Services
CDE ...............................California Department of Education
CNS ...........................................Central Nervous System
COE .......................................County Office of Education
DIS ..............................Designated Instruction and Services
DD ..........................................Developmentally Disabled
DHH .........................................Deaf and Hard of Hearing
HKNC ....................................Helen Keller National Center
ICSM ................................Individual Critical Skills Model
IEP .................................Individualized Education Program
IFSP . Individual Family Service Plan (implemented by infant programs)
IHE ...................................Institute of Higher Education
IPP ........ Individual Program Plan (implemented by regional center)
ITP .......................................Individual Transition Plan
LD ................................................Learning Disabled
LRE ..................................Least Restrictive Environment
MH ..............................................Multiple Handicaps
OT .............................................Occupational Therapy
PEERS ............ Providing Education to Everyone in Regular Schools
PNS .......................................Peripheral Nervous System
PT .................................................Physical Therapy
SDC ...............................................Special Day Class
SED ......................................Special Education Division
SED ....................................Severe Emotional Disturbance
SELPA ..........................Special Education Local Planning Area
SH ............................................ Severely Handicapped
SLD .........................................Severe Language Disorder
SLD ....................................Specific Learning Disability
TRCCI . Training and Resources for Community and Curriculum Integration
USD .........................................Unified School District
VI................................................ Visually Impaired

Fact sheets from California Deaf-Blind Services are to be used by both families and professionals serving individuals with dual sensory impairments. The information applies to students 0-22 years of age. The purpose of the fact sheet is to give general information on a specific topic. More specific information for an individual student can be provided through individualized technical assistance available from CDBS. The fact sheet is a starting point for further information.

Individuals with dual sensory impairments may show beginning communication skills in many ways. This communication may take the form of body movement, gestures, facial expressions, vocalizing, use of objects or people, pointing to pictures, or more formal systems. As these skills begin to develop, it may be helpful to create a need for increasing the use of these new communication forms.

1. You may do movements together with the individual which the person really enjoys (e.g., rocking, dancing or stirring batter). You can stop your movement, pause for a few seconds, and see if the individual indicates he wants to continue. He may indicate he wants to continue by his body movement, facial expression, gestures, vocalizing, etc. This is the beginning of communicating needs and wants.

2. As the individual becomes familiar with various routines, you can watch to see if he anticipates each step of the routine. As you do the familiar routine, pause before moving on to the next step of the activity. During the waiting period of a few seconds, watch for movement, body posture, facial expression, gestures, vocalizing, etc., which indicates that the individual wants to complete the activity. (For example, you may assist the individual with dressing and may pause after the socks are placed on his toes. The individual may wiggle his toes to indicate he wants to finish dressing.)

3. Many times a person with dual sensory impairments learns a variety of tasks well which do not require the need to communicate. You can create a need to communicate within the routine/task by "forgetting" to put out all materials he will need for finishing the task (e.g., putting out a can of soup without the pan, putting out the toothpaste without the toothbrush, or placing a desired object just out of reach). The individual will then need to

ask for the missing item in whatever way he can. You should not, however, interrupt his independence by removing materials he is currently using. It is also not recommended to insist he describe what he is doing in order to continue his task (e.g., the teacher removes the child's cookie for each bite until the child says/signs/gestures, "I want the cookie"). If you interrupt by removing materials he already has, the individual may feel punished and may not wish to communicate. If you block his independence by requesting a description of what he is doing, he may stop functioning independently and may always wait to be prompted to continue actions.

4. After the individual expresses his desire to continue these activities, it is very important to let him know that you understood his attempts to communicate. You may say "Oh, you need the toothbrush!" or "You want your socks on?", etc. Your movements as you speak can be an imitation of his movement. Your statements should tell him that you "heard" what he was saying and that you respect his wishes. Be sure that your facial expression, body language, vocalizations, and speech all give a message of positive feelings about his communication.


Fact sheets from California Deaf-Blind Services are to be used by both families and professionals serving individuals with dual sensory impairments. The information applies to students 0-22 years of age. The purpose of the fact sheet is to give general information on a specific topic. More specific information for an individual student can be provided through individualized technical assistance available from CDBS. The fact sheet is a starting point for further information.

Adapted from Deaf-Blindness: A Fact Sheet, Gallaudet University.

Fact sheets from California Deaf-Blind Services are to be used by both families and professionals serving individuals with dual sensory impairments. The information applies to students 0-22 years of age. The purpose of the fact sheet is to give general information on a specific topic. More specific information for an individual student can be provided through individualized technical assistance available from CDBS. The fact sheet is a starting point for further information.

Fact sheets from California Deaf-Blind Services are to be used by both families and professionals serving individuals with dual sensory impairments. The information applies to students 0-22 years of age. The purpose of the fact sheet is to give general information on a specific topic. More specific information for an individual student can be provided through individualized technical assistance available from CDBS. The fact sheet is a starting point for further information.

Adapted from Sternberg-White, S., Chen D., Watts, J., 1992,
Developing Social-Emotional Skills, INSITE, Utah State University, Logan, Utah

Fact sheets from California Deaf-Blind Services are to be used by both families and professionals serving individuals with dual sensory impairments. The information applies to students 0-22 years of age. The purpose of the fact sheet is to give general information on a specific topic. More specific information for an individual student can be provided through individualized technical assistance available from CDBS. The fact sheet is a starting point for further information.