Article
Teaching Children with Autism and Visual Impairment
This interview with Speech Language Pathologist Linda Hagood examines communication and social challenges for students with visual impairment and autism, as well as for learners who are deafblind.
Transcript
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SPEAKER 1: Hello, and welcome to Perkins eLearning To Go. Each week, our hope is to provide you with an inside look at special education topics, in particular, visual impairment. Through a series of interviews with leaders in the field and a fresh look at our webcast series, we know you will learn something new when you are on the go. Now it’s time to sit back, relax, and let’s hear what this week’s podcast is all about.
VALERIE: Hello, and welcome to Perkins eLearning To Go. This is Valerie. On today’s podcast, I had the opportunity to speak with a very special person. She has over 30 years as a speech pathologist and has spanned states to focus on teaching children with multiple disabilities– including deafblindness, visual impairment, and autism on how to communicate.
We at Perkins eLearning are honored to have her instruct one of our courses, Autism in Visual Impairment, the Better Together Curriculum. And to top all of this off, she is an amazing person and wonderful to speak with. Of course, I am talking about Linda Hagood. I was joined by my colleague, Robin Sitten, for this interview and had a wonderful conversation with Linda.
Thank you, Linda, so much for joining our podcast today.
LINDA HAGOOD: Thank you for having me.
What are some of the challenges in diagnosing and teaching students with visual impairment and autism?
VALERIE: I know you’ve done a lot of work with students who have both autism and visual impairment. Can you talk a little bit about the challenges of diagnosing and teaching this group of students?
LINDA HAGOOD: Sure. I first worked with students who were deafblind due to the rubella epidemic in the late ’60s and the early ’70s. Even though I didn’t know anything about autism at that time, as I look back, I see that many of these students had characteristics of autism.
Later, when I became a speech-language pathologist in the 1980s, the numbers of sighted children with diagnoses of autism began to grow. I found that some of the philosophy and approaches to teaching the deafblind students that I had used with those students with rubella syndrome were also very helpful with sighted children who had autism.
After several years of working with sighted children who had autism, I returned to the school for the blind in Texas as a speech-language pathologist. I found a growing number of visually impaired children were being diagnosed with autism in addition to their primary disability of visual impairment. When the teachers of visual impairment looked for methods to teach these children with autism and visual impairment, they found that most of the teaching approaches for autism were very visually based, including things like concrete calendars and lots of written stories, written instructions. They felt they didn’t know how to address the issues around the children’s autism, and they had very few resources to help.
I wanted to explore the problem further. And from my research and experiences, I developed a curriculum entitled, Better Together, which is still available through Texas School for the Blind and Visually Impaired. I’d found that the relationship-based approaches to teaching autism were far easier to adapt to these students who were blind than the more visual approaches. These approaches, including the Relationship Development Intervention, by Steve and Rachelle Sheely, the SCERTS program, by Barry Prizant, and the Floortime Approach, by Greenspan fit nicely with the van Djik methods that I’d learned when I worked with the kids who had rubella syndrome.
And as to your question about diagnosing, there’s lots of pros and cons to adding an autism eligibility for students who are already eligible as visually impaired. Young children who are blind often demonstrate characteristics of autism. But as they grow and learn language and mobility skills, these traits often fade, and they no longer meet the criteria for autism.
Some children do maintain their autistic traits, however, despite excellent accommodations and instruction related to visual problems. For this reason, it’s important that teachers of the visually impaired be included in the diagnostic process when considering autism as an additional disability. Also, I think, in my opinion, autism diagnoses shouldn’t be made so early with students who have visual impairment, not till the student’s at least age six and has to have intervention services related to their visual impairment and social skills.
VALERIE: I think that, for me, my initial thought, it’s very interesting that the teachers would be prepared to help out a student with a visual impairment but not really know what to do with autism as autism is such a big diagnosis nowadays.
LINDA HAGOOD: Well, what I really found was that the teachers were more prepared than they thought they were from their work with students who were blind. It’s just that the autism methods that are the most popular are highly visual. There’s other autism methods, like the ones I mentioned, that are built on relationships. And the relationship-based approaches really do meet the needs of kids who have autism. So very often, teachers of the blind and visually impaired are doing just the right thing. And that’s really what I wanted to help them understand through the work on the book.
I also wanted to mention that that Better Together book is a course offered by Perkins online through eLearning. And we’ll be teaching it again this summer.
What is play-based storytelling?
VALERIE: Oh, nice. So I know– you mentioned play-based storytelling. Can you describe what that is?
LINDA HAGOOD: Well, in my years working with students who are blind or visually impaired, I noticed that many of them have a different mode of play than sighted kids. While typically developing sighted kids tend to play with toys and objects and engage with peers through this shared focus, children who are blind and visually impaired often play first with words, sometimes with the sounds of the words themselves, making up silly rhymes or developing fascinations with topics that they only know through listening and not through hands-on experiences.
To build on this learning style, I developed an intervention that’s called Playing with Words, which is a collaborative approach to play-based storytelling with students who are blind or visually impaired who have additional disabilities, including those who are autistic or deafblind. In these Playing with Words sessions, we focus on the process of story creation rather than the product. We have goals in the areas of social communication, self-determination, self-regulation, and creativity instead of completing a perfectly composed story as maybe the goal. The students usually work in a small group of two to five, with the adult as the scribe, facilitator, and often, the play partner.
I’ve found six essential components of the intervention.
- First, we build on all the students’ strengths and interests. No topics are considered perseverative or off limits.
- Second, peers with stronger social skills are included in the intervention sessions to serve as models and to help to build shared focus and relationships.
- Third, the adult facilitator, or scribe, builds an atmosphere of play, modeling and encouraging social and symbolic dimensions of play, supporting an atmosphere where it’s OK to be silly. Stories are usually fictional, supporting imagination and building on creativity.
- Fourth, the adult role is to be flexible in support of acknowledging, accepting, and expanding on the students’ input. One of the most important responses that an adult can make to any input provided by the students, even the unintentional input, is yes, and also. Fifth, the context for building the stories include predictable routines, and consistent, accessible locations for materials and seating, and adequate space for enactment and story creation.
- Finally, physical enactment, including props and actions, should be included. I’ve had a lot of fun adding this component to the stories in recent months. The students who do best with this approach are at least minimally verbal. And it’s been helpful for me with students at the kindergarten through 12th grade level. I find that this work feeds my own imagination and creativity. And I’m always excited to see how my students engage with me and each other when we acknowledge and accept their sometimes quirky fascinations and help them express themselves in ways that others can understand.
If you’re interested in learning more about this intervention, I’ve been working with colleagues, Charlotte Cushman, Megan Mogan, Kate Hurst, Jay Hiller, and Cyral Miller on a microsite that includes video samples of story creation and lots of tips for implementing Playing with Words. The microsite is almost finished. So if you’re interested, keep looking for this on Paths to Literacy.
VALERIE: I watched a few of the videos that are going up on the Paths to Literacy site, and they are– I love the creativity of these kids. It’s just really amazing to see some of the crazy stories they come up with. But– and they’re funny. And it’s just a delight to watch them.
LINDA HAGOOD: Well, I’m glad you’re liking it. It’s been– it’s just such a delightful project for me to work on. I feel really honored to work with that group of people. And we’ve had– I think we all walked away from every planning session feeling kind of energized by it. So that’s been a great experience for me. And I’m really looking forward to getting that posted and up.
VALERIE: It’s a good refresher for your hard work that you’ve had to see– to have this microsite so you’ll be able to–
LINDA HAGOOD: It pulls a lot–
VALERIE: Linda– I’m sorry. Go ahead.
LINDA HAGOOD: Excuse me. I was just saying, it pulls a lot together for me.
VALERIE: Yeah, it’s like the Linda in the box, [INAUDIBLE] Paths to Literacy.
LINDA HAGOOD: Well, it’s also– the play-based storytelling is also the topic of my dissertation work that I’m doing right now. So this will definitely get finished. I don’t know about the dissertation. We’ll see.
What role does improvisation have in your practice?
ROBIN SITTEN: Linda, I was really interested that you’ve captured sort of the central idea of improv comedy, which is yes, and. And so this idea that in cooperative story building, you always say yes, and I’m going to add something else. And I wondered if you were aware that that’s the central tenet of improv comedy and whether you’ve ever worked with any improv teams in this practice.
LINDA HAGOOD: I was aware of that. And I used the book– there’s a book called Plays Well with Others, by Les McGehee. And he does improv sessions for, like, corporate retreats and things like that. And there are a number of games and activities that I use. And yes, and was– I thought, god, that’s brilliant. That’s the most brilliant thing I’ve ever seen. And I’ve seen it in improv sessions too. But I thought that– if we could only remember one thing about teaching, if it was yes, and, that would be the main tenet of teaching.
And when I started working on my dissertation, my advisor said, so what’s the main idea you’d want people to go away with? And I said, yes, and–
ROBIN SITTEN: Nice.
LINDA HAGOOD: He was a little puzzled.
[LAUGHTER]
But I think it is. It’s the most important thing we can do when we’re teaching kids. We all learn best when what we give is acknowledged and expanded. Instead of no, but, having a yes, and.
ROBIN SITTEN: Right, right. That’s neat. I really appreciated what you said about giving them the opportunity to pretend. So not just to move their bodies in free space, which is such a great opportunity for a child with a sensory disability or more than one sensory disability, to just be able to move freely through space but to also pretend.
You know, it’s one of those incidental learning moments where kids play and maybe they don’t realize– and I’ve seen you do this with kids where you kind– that narrative storytelling of, like, I’m pretending that this car is going to drive fast over this bridge. Here I go driving fast. And then, you know, usually the kid interacts in some way. And then you sort of pick up that story which, particularly for a child with sensory disabilities, is maybe not picking up on what they– that co-play can go on for too long, because they don’t realize what pretending is until they’ve had the chance to practice it.
LINDA HAGOOD: Yeah, I do. I do think that’s right. And I think as adults, we need to be able to play too.
ROBIN SITTEN: Yes.
LINDA HAGOOD: That’s the best part that I think comes out of this is adults need to give themselves permission to have fun and to play and to pretend. And it’s amazing to me when I’ve worked with teaching other teachers how to do this play-based storytelling or some of the yoga stories, how kind of relieved they are sometimes that it’s OK to play and that they don’t need to come in with a perfectly made script– that this child is going to bring them something. And if they pay attention to what the child brings them, they can build play scenarios around it. And for many of us it brings us back to play.
Some adults don’t know how to play. And they can learn it too with their students through this activity.
How did you become involved in doing this type of work?
VALERIE: So how did you become involved in this work? You touched on it a little bit a little bit earlier. But how did you become involved doing this type of work?
LINDA HAGOOD: Well, my first jobs in special education were with some of the very early infant-parent programs in the Houston-Galveston area. I wasn’t a speech pathologist yet then. But I learned a lot from speech-language pathologists and others about how language and communication developed in young children
Then I moved to Austin, where I worked as a house parent at a deafblind program at Texas School for the Blind. And the children in that program fascinated me. I learned a lot about van Dijk’s methods for using a developmental model for teaching communication, moving from nonsymbolic, nonintentional communication to signed or spoken words.
These two experiences led me to return to graduate school at the University of Texas, where I was trained to as a speech-language pathologist. I’ve always been grateful for the foundation that these first two jobs gave me in preverbal communication. The lessons I learned there about the importance of relationships, engagement, and hands-on experience have served me well in many different settings.
Over the years, I’ve worked as a speech-language pathologist, teacher, and consultant in many different jobs, in public schools, private speech clinics, regional support centers, and at two different schools for the blind, first in Texas and later in Washington. I’ve always been most interested in teaching students who have multiple disabilities, including autism, deafblindness, and intellectual disabilities.
Although a lot of new and excellent ideas have come along, that foundation of normal development that I learned in those early jobs with infants and deafblind students have really stayed with me.
VALERIE: You mentioned you spent a lot of time in Texas and lived in Austin. And now you’re living in Washington state. What brought you to Washington?
LINDA HAGOOD: Well, Austin will always feel like home to me even though I’ve been in the Northwest for about 10 years now. I came first to Oregon and now to Washington after a few trips that led me to fall in love with the geography, the climate, and the progressive politics in the Northwest.
Another variable was my daughter, who was attending college in the Northwest, and I really missed her. I didn’t want to stay in Texas without her. I worried about her. And I wanted to be closer. So I worked first in public schools and a private speech clinic here and in the Northwest and have been working at Washington School for the Blind for the past four years.
It’s been really interesting to see the differences in the philosophies and student populations between the Texas and Washington schools. The students at Washington here are more academic, and the school’s outreach department provides mostly direct service. In contrast, Texas school serves a lot more students with intellectual disabilities, autism, and limited language and communication skills. The outreach department at Texas does not provide direct service, focusing instead on consultation training and systems change for school districts and service centers throughout the state, while the outreach department in the Washington school provides mostly direct service through offering teachers to districts that need them and supporting them there.
How are you using Zoom to work remotely with students?
VALERIE: And we were talking before– you mentioned you’re able to do both in person, as well as using Zoom to do a teleconference with a student, which just makes more students more accessible, especially those who might live in remote locations that you could reach where you may not have been able to before.
LINDA HAGOOD: Right. That’s been an interesting tool for the school for the blind in Washington. I think they’re using Zoom in many different classes, some of them, like– I think, in some ways, it’s easier to teach something like a content area class online. And it might be just my teaching style. I’m very touchy-feely. And I’m very hands on. And it’s kind of hard sometimes for me to do everything with words. And so every now and then, I have to go down there and get a fix on actually interacting face-to-face with kids. I think they all got hugged to death this week when I was down there.
How do you use yoga with your students?
VALERIE: So let’s talk about yoga. I heard you use yoga when working with your students.
LINDA HAGOOD: Yes, I do. I started getting interested in using yoga a number of years ago with my students when I took the course that’s offered by a yogini named Shakta Khalsa. She trained me as a children’s yoga instructor, but she claimed to know nothing about special education or disabilities. Now she has added segments on autism and attention deficit disorder to her classes. You can find her courses and material also on her website, called childrensyoga.com.
I really liked her brand of yoga. It was an adapted kundalini yoga. It focuses on relationship building, self-regulation, uses a lot of sound and music and creativity. And these seemed to be real consistent with what our kids with autism really needed.
Yoga is really rich in teaching opportunities. And it can support learning in a lot of different areas, things like improving movement, patterns, and spatial concepts, social interactions, emotional regulation, and language and literacy skills. It’s a perfect activity for collaborating with other professionals, like occupational and physical therapists, orientation and mobility specialists, teachers, and speech-language pathologists, who can all work together to embed skills from their areas into yoga classes for kids.
Yoga helps to build connections and self-regulation through touch and movement. And it’s an activity that gives the teacher permission to respectfully touch and move with the student in a coactive way. One thing I really love about yoga is that it helps the teachers, as well as the students, to become more mindful of their own emotional state. I find that I benefit as much as they do from a yoga activity.
I’ve had a great time developing some yoga stories, in which some visually impaired students have their first experiences with using their bodies to pretend to be various animals, trees in a forest, or mountains. Sometimes we learn the positions first and then blend them together to create stories. For other kids, the ones who aren’t so crazy about the movement, the story creation comes first. And then they begin to accept the movement. Even if you don’t have a time or a place to teach a whole yoga class, some of the calming activities, poses, or meditations can be slipped into the daily schedule for self-regulation.
I’ve recently had some good responses to students performing meditations before stressful transitions. And some of my students have started to cocreate their own meditations. You can see some samples of this work on the Paths to Literacy site. And many descriptions of yoga activities and adaptations are described in the Better Together book, available through TSBVI.
Kassy Maloney, who’s an orientation and mobility specialist, has written a book about teaching yoga to students with visual impairment that’s also available through TSB. Her work is more focused on movement and spatial concepts. But she also embeds the use of symbols in print and braille into the routines.
Another good thing about yoga is that it’s an activity that has become really popular here. And the students can often attend classes with their parents or their family members when they get home. They feel comfortable with yoga. So I have a great time with that. It’s one of the activities that’s hard for me to do online though because I can’t get my cameras right. If I could get my cameras right and have enough support on the other end, I think I could do it. But it just doesn’t feel the same to be online doing yoga as it does to be in the same room and to be physically connected to the kids.
VALERIE: Because part of it’s the energy you have between you and the people you’re doing the yoga with. It’s the energy in the room.
LINDA HAGOOD: Absolutely. I think you’ll see some nice examples of doing some yoga on the Paths to Literacy site. Some of the yoga stories and meditations are included in that microsite on Playing with Words that will be posted too.
VALERIE: I could see the yoga, especially if they’re comfortable with doing yoga. Like, you mentioned them going out with their parents to do it. It must be great for developing their social skills as well.
LINDA HAGOOD: Yes. We used to include parents. When they’d come for parents day at Texas school, we’d include the kids. One of my favorite examples of a kid who learned to love yoga was a young woman named Katie. We had Shakta Khalsa herself come to the school for the blind to help do some consultation. And she sat with us. And Katie, in her southern way, said, Shakta Khalsa, I want to tell you, this is blind Texas yoga. I always remember it.
What makes a good peer partner in these interactions?
ROBIN SITTEN: And Linda, when you’re looking for these stronger peers to work in these cooperative– you know, to serve as models, what kinds of qualities are you looking for for those kids to contribute to this opportunity? What makes a good stronger peer?
LINDA HAGOOD: Well, usually, somebody who has a sense of humor, who is empathetic, who is open to making friends who have more challenges than them, but not a teacher-type. Some students will come in and say, oh, this is a student with autism. I can tell them how to behave. And we don’t want that.
And sometimes it takes a little bit of work with the peers to make them understand that. But I find that any number of types of peers can actually fit into this model. And some of the kids who are highly academic really enjoy a chance to relax and play with their words instead of thinking so seriously about it. So I think everybody learns from the play-based storytelling.
But you don’t want the type who wants to take over and teach the other child. And mostly I find the kids are very much accepting of other students and they expect the student with autism to contribute in the story, whereas adults are the ones who have the harder time with accepting some of the quirkiness of the student with autism. And those fascinations and topics that the students seem to get stuck on aren’t as much of a problem. The younger the group, the more flexible the peers are. The older kids are harder, although I’ve had good luck with high schoolers lately too.
How do you use touch or hands-on experience in your practice?
ROBIN SITTEN: Another thing I wanted to pick up on– Linda, you talked about how, you know, everybody got hugged that day, and hands on– and certainly the van Dijk method is very hands on. And I feel like we’re in a place in our society where the physical touch is being harder to– what do I want to say? It’s more difficult in an educational situation to give that hands on. Do you find–
LINDA HAGOOD: Absolutely.
ROBIN SITTEN: Do you find resistance?
LINDA HAGOOD: It’s a big issue in schools. Teachers are afraid to touch kids. But when we have kids who are– have a lot of sensory impairment, to learn everything through words just doesn’t cut it sometimes. What they need– and it was very interesting– I did a workshop.
I’ll try to describe this. A student that I have, named Katrina, wrote a story called “The Forest Meditation.” And I brought a video of she and I doing this forest meditation. And the way this worked was we were walking through a forest. She wrote this. We were walking into a forest, and we sat back-to-back. I was the tree, and she was leaning against me.
So I wanted all the people in the workshop to sit back-to-back with each other, to do this along with the video. And what she did was she sat against the tree, and she listened to the wind. She felt the moss under her fingertips. And she breathed, she listened, she felt. And the back-to-back part was really an essential component of this, that we could feel each other being calm together and that she was relying on me to support her.
But the teachers who were in the workshop, very many of them said, oh, can we sit on the chair like this? And they put the back of the chairs together. But the chair is a boundary–
ROBIN SITTEN: A barrier, yeah.
LINDA HAGOOD: –a barrier to you coregulating with that student. And if we’re moving from coregulation to self-regulation, you have to be able to feel the emotion and the level of intensity that the other person is feeling. And so it was hard to get them out of their chairs, back-to-back. But some of them just didn’t want to sit on the floor, and I understood that. But you can still turn your chair sideways and be back-to-back.
But it was interesting to me how uncomfortable we are with touching one another. And I see the reasons for that. And I know it’s a hard time, and people feel vulnerable.
But I think for our kids who have blindness or deafblindness, it’s really important that they be able to feed off of you and that you be able to relax with them. What I found in that particular meditation was I was relaxing as Katrina, the student who wrote the meditation, was relaxing with me. We were both more relaxed in the end.
So I think that that’s why I do like yoga as a place where you have permission to touch. And when I go to yoga classes, I don’t like somebody coming up and adjusting my body without asking me. So I absolutely suggest that if you’re going to do that, you ask permission. But there’s a reason for the touch– is to achieve the right position or to coregulate with the adults. And it’s nice to have a place where that’s OK.
VALERIE: Well, Linda, thank you so much. I really appreciate your time today. I know you’re a busy lady so for taking out some time, I really appreciate it.
LINDA HAGOOD: Thank you very much for asking me. I’m flattered and honored.
SPEAKER 2: Perkins eLearning To Go is a production of Perkins eLearning, at Perkins School for the Blind. Perkins eLearning partners with school districts and agencies to provide customized training for educators of students with visual impairments and additional disabilities.
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