Structured teaching for individuals with visual impairments

British Journal of Visual Impairment http://jvi.sagepub.com Structured Teaching for individuals with visual impairments Marie Howley and David Preece British Journal of Visual Impairment 2003; 21; 78 DOI: 10.1177/026461960302100207 The online version of this article can be found at: http://jvi.sagepub.com/cgi/content/abstract/21/2/78 Published by: http://www.sagepublications.com Additional services and information for British Journal of Visual Impairment can be found at: Email Alerts: http://jvi.sagepub.com/cgi/alerts Subscriptions: http://jvi.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Downloaded from http://jvi.sagepub.com at UNIV OF BIRMINGHAM on February 28, 2007 © 2003 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution. Structured Teaching for individuals with visual impairments by Marie Howley and David Preece ’Structured Teaching’, as advocated by the TEACCH approach (Treatment and Education of Autistic and related Communication handicapped CHildren) is widely used to promote independence and facilitate teaching and learning for individuals with autistic spectrum disorders (ASD). Key principles underpinning the approach include assessment and individualisation. As a result Structured Teaching is a flexible approach which can be adapted to meet a variety of individual needs, regardless of the age or cognitive ability of the learner. The components of Structured Teaching, physical structure, schedules, work systems and visual structure, combine to provide structure that is tailor-made for the individual. For those with sensory impairments, assessment of preferred sensory modalities enables us to develop a ’multi-sensory approach to Structured Teaching’. This paper reflects upon acknowledged practice of the approach for individuals with ASD and its potential use for those with a visual impairment, with the intention of stimulating further discussion. Introduction The TEACCH approach, developed by Division TEACCH at the University of North Carolina at Chapel Hill, is a widely recognised approach to providing services for individuals with ASD and their families. TEACCH provides services from Icradle to grave’ including diagnostic and assessment strategies, educational interventions and adult services. ’Structured Teaching’ is a major component of the TEACCH approach that has ’evolved as a way of matching educational practices to the different ways that people with ASD understand, think, and learn’ (Mesibov & Howley, 2003). Wing and Gould (1979) identified a triad of impairments in ASD including impairments in social interaction, social communication and imagination. In addition, other characteristics frequently arise including unusual sensory experiences, difficulties with attention and memory and organisational difficulties. As a result, the thinking and learning styles of individuals with ASD frequently differ from the way the majority of people think and learn. It is widely recognised that individuals with ASD require structured approaches to facilitate learning (e.g. DfES, 2001; Mesibov & Howley, 2003, Schopler, Mesibov & Hearsey, 1995). Structured Teaching takes into account the individual needs of those with ASD, providing individualised strategies to facilitate learning and increase independence and self-esteem. Teaching is essentially a visual approach, responding to the preferred learning style of many people with ASD who are frequently ’visual learners’. There is a focus upon developing independent organisational skills through the use of visual structure. Why then is it useful to consider this visual approach in relation to learners who have a visual impairment? Structured The purpose of this paper is to consider how Structured Teaching may be adapted to meet the needs of individuals with visual impairments and is intended to stimulate further discussion. The components of Structured Teaching are outlined, followed by suggestions for how the approach can be adapted for those with a visual impairment. A case study illustrates how the approach has been used with one pupil with learning difficulties and a visual impairment. Principles of Structured Teaching Structured Teaching has been developed to increase independence and to manage behaviour arising from the underlying deficits of ASD. When successful, the approach facilitates teaching and learning by enabling individuals to access information in a meaningful way. These approaches are particularly useful for example in enabling pupils to access the curriculum (Mesibov & Howley, 2003). The principles of inclusion identified in the National Curriculum (DfEE/QCA, 1999) include the need for teachers and schools to set suitable learning challenges, to respond to diverse learning needs and to overcome 78 Downloaded from http://jvi.sagepub.com at UNIV OF BIRMINGHAM on February 28, 2007 © 2003 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution. barriers to learning and assessment. It is within this context that the principles of Structured Teaching are considered in relation to pupils with ASD and the potential adaptability of the approach for pupils with visual impairments. potential Assessment and individualisation Careful assessment of individual strengths and needs underpins the TEACCH approach, including Structured Teaching. This aspect is fundamental to the development of structured approaches that are designed to meet specific, individual needs. The diverse range of individual difference means that structure that is appropriate for one person may not be useful for the next. Assessment therefore includes a consideration of cognitive developmental level, visual cognition and particular strengths and interests in order to develop individually tailored structure to meet specific learning needs. For those with sensory impairments, assessment will establish preferred sensory modalities, and structure can then be developed accordingly. Following assessment, Structured Teaching approaches are designed for the individual including four main components: physical structure, schedules, work systems and additional visual structure. These elements combine to provide individualised structure that facilitates organisational skills, increases meaning and promotes independence. Structured Teaching promotes access to the curriculum and addresses equality of opportunity for pupils with ASD by addressing their particular learning needs and styles. Structured Teaching need not however be exclusive to teaching and working with individuals with ASD. Similar strategies may be helpful to those with other special educational needs and in this case, individuals with visual impairments. Each component of Structured Teaching is briefly described: for further details readers are directed to Schopler and Mesibov (1995), Schopler et al. (1995) and Mesibov and Howley (2003). Adaptations of each element of structure are considered in relation to individuals with a visual impairment. Physical structure Individuals with ASD often cannot ’make sense’ of the physical environment. Classrooms, and other environments, can be chaotic, confusing places for some who may have little understanding of the purposes of space. This leads to an inability to predict what might happen in a given place, resulting in high levels of anxiety. The aim of introducing physical structure is to help pupils to identify the purpose of space so that they can begin to make predictions about what is expected. In a structured classroom, areas may be designated for independent work, group work, play or leisure and so on. For pupils with ASD these areas are visually distinct, e.g. a carpet square indicates where to sit at circle time, furniture or coloured tape indicates boundaries between different areas of the classroom. Physical structure is also considered in order to reduce potential distractions due to sensory overstimulation. Physical structure for individuals with a visual impairment Physical structure for individuals with visual impairments is equally important when considering how to organise the environment. Sobsey and Wolf-Schein (1996) suggest ’modifications of environmental conditions,’ while Pease (2000) suggests ’zoning’ the classroom to help individuals with sensory impairments to associate activities with places and to anticipate activities and events. Hodges (2000) also emphasises the importance of organising the classroom to reduce glufter, emphasise important features of the environment and minimise distractions. Mason (1995) identifies physical features, including seating arrangements and classroom layout, as important aspects when considering the ’working environment’. For individuals with visual impairments this may include careful positioning of furniture to demarcate specific areas of the classroom for specific activities and the use of different textures and tactile information to clarify and highlight important features of their environment. Sensory distraction may also be addressed through physical structure. Schedules . Visual schedules that are individualised and meaningful to the individual can add predictability and organisation to an otherwise chaotic day. Individualised schedules provide access to information that we all need, but in a format that is meaningful to the individual with ASD. Schedules provide information about what will be happening, when and where, thus increasing understanding that the day is made up of discrete events and activities. Individual schedules vary according to developmental and cognitive variability. For example, schedules may provide information about the whole day or part of the day. Some individuals will be provided with one piece of information at a time, before learning to follow a schedule sequence. Individualisation is also evident in the format of the schedule. Schedules may be in - written, symbol, picture or object form, depending 79 Downloaded from http://jvi.sagepub.com at UNIV OF BIRMINGHAM on February 28, 2007 © 2003 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution. upon individual cognitive abilities. Individuals are taught, as a routine, to check their schedules from top to bottom or left to right, and to keep track of where they are in the day. Some may be encouraged to negotiate or construct their own schedules with support and to make everyday choices and decisions. The schedule can be empowering for the individual in that he or she can begin to predict the day’s events and to follow them independently. Schedules can increase flexibility, cooperation and independence. Schedule for individuals with a visual impairment Individuals with a visual impairment need access to the same information as others, including what will happen, when and where. Schedules can be adapted to take into account the visual abilities and limitations of the individual. Schedules can be presented with objects of reference (Ockleford, 1993), through the use of ’calendar boxes’ (Pease, 2000), mini-objects, three-dimensional symbols, tactile symbols and raised outlines (Hendrickson & McLinden, 1996), enlarged pictures and pictograms, enlarged symbols or words or braille. The principles underlying the development of the schedule are the same as for those with ASD, i.e. assessment and individualisation. Work systems the learner to find resources, and to pack away, independently. Individuals with visual matching abilities are taught to follow a sequenced matching system using colour, shape, letter, number or word cards that correspond to individual tasks. A sequenced list provides information about what tasks are to be done, the sequence in which to do them and what to do when finished. For individuals who read, a written work system can be followed. Whatever the work system, the information provided relates to the same key questions. This can then be applied to a wide range of activities including individual, paired and group work. Work systems for individuals with a visual impairment As with schedule information, individuals with a visual impairment require access to information that enables them to develop organisational skills and independence. Hodges (2000) suggests that Ipurposeful activity should be available even if the child is working without an adult’; indeed, working independently is an important skill for everyone. Work systems similar to those identified for individuals with ASD may also be helpful in developing such skills for individuals with a visual impairment. Basic ‘left to right’ systems offer an organisational strategy for those with minimal or no vision. Others may use systems requiring Individuals with ASD often face challenges relating independent organisation to the and work materials. Structured Teaching uses the ’work system’ to develop essential organisational skills. In order to organise activities, we all require access to key questions: organisation, including of resources ~ · ~ ~ What have I got to do? How much is there to do? How do I know if I am making progress and when am I finished? What do I do next when the activity is completed? Pupils with ASD may not have access to this information as the answers to these questions are often provided verbally. Individualised work systems can provide information relating to these questions, leading to increased independence in individual, paired and group activities. Work systems vary according to individual needs. A basic work system might involve learning to work from left to right as a routine. Materials or tasks are placed on the learner’s left and he/she is taught to put them in a ’finished’ place on the right. This provides a routine organisational system that enables some sequencing ability through the use of a matching system, using for example tactile symbols, enlarged pictures or braille. Regardless of the form of presentation, the work system provides the individual with information to enable them to develop organisational skills. Visual structure - clarity, organisation and information The final component of Structured Teaching provides additional visual structure relating to how to complete activities and tasks. This information differentiates tasks in order to meet individual learning needs. Three elements of visual structure are considered, depending upon the needs of the individuals. Clarification of task requirements highlights essential elements of a task and essential expectations. For example, clarifying the dimension for sorting is often critical, as often the individual will be unsure of which information is relevant to the task. Highlighting the requirement to sort by shape and not colour may enable the pupil to be successful. Similarly highlighting important information on worksheets will reduce the potential distraction of irrelevant information. 80 Downloaded from http://jvi.sagepub.com at UNIV OF BIRMINGHAM on February 28, 2007 © 2003 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution. and stability of task materials and resources is another element of visual structure. Individuals with ASD often find it difficult to organise their materials. They are also distracted by sensory Organisation disorganisation, leading to frustration, anxiety or passivity. Unstable materials may lead to anxiety and result in behaviour such as throwing materials Organising materials into containers before presenting the task, and fixing materials so that they are stable can enable successful completion to the floor. the individual through assessment and individualisation. The four elements of the approach can be combined to improve the learning environment and to facilitate teaching and learning for individuals with a visual impairment. The following case study illustrates how the four elements of Structured Teaching combined to enable one pupil to learn and to increase her independence. Case study of tasks. Finally, visual instructions can give information about what is required in order to complete a task. Visual instructions may be provided in different forms, depending upon individual needs. A visual ’jig’ or representation showing where to place materials can enable a pupil to organise materials independently. Lists of instructions can be followed to complete a variety of tasks across the curriculum including different subject areas, e.g. instructions for completing a science experiment, or for self-care tasks. Visual instructions are useful in developing flexibility and the ability to make choices, make decisions and solve everyday problems. Additional structure for individuals with a visual impairment Sarah is six years old and attends a specialist unit in a mainstream school. She has learning difficulties and a visual impairment resulting in high myopia (short-sightedness) and difficulties with visual depth perception. Assessments show that Sarah requires enlarged visual information including mini-objects to increase meaning and understanding. She has a number of individual learning targets, including targets to increase her ability to work for up to ten minutes and to follow instructions independently. Structured Teaching helps Sarah to work towards these targets. The structure developed by Sarah’s teacher has been designed to take into account both her learning needs and her visual impairment. Physical structure organised to help Sarah, and other in designated areas. activities pupils, anticipate Furniture is used to demarcate boundaries between specific areas, including a play area, group and individual work areas. The play area has a large mat defining the area and other areas of the school are labeled with textured squares, enabling pupils to locate specific classrooms. Some areas are screened in order to reduce auditory distractions. The classroom is While visual elements may not be helpful for some, additional structuring can still increase understanding and meaning. Clarification and organisation of task materials and resources is as important for individuals with visual impairments as for those with ASD. Sobsey and Wolf-Schein (1996) advocate ’modification of tasks’ to make use of other senses, including enlarging materials, providing bolder outlines and using tactile information, and Hodges (2000) suggests that presentation of tasks should ’make the most of the child’s sensory abilities’. This might include clarifying important features and highlighting relevant information through tactile information, organisation of materials to prevent sensory distraction and to enhance independence and additional, individualised instructions to enable independence. Combining elements of Structured Teaching for individuals with a visual impairment use of structured approaches is already recognised for individuals with a visual impairment. is suggested here that Structured Teaching may The enhance the use of individual elements of structure, as the approach offers a strategy for developing a comprehensive structured approach, tailor-made for It Schedule - Sarah has a part-day schedule, comprising up to three mini-objects that she follows in a top to bottom sequence. Each object is presented in a box to help her to locate it. To help her distinguish her schedule, Sarah is given an enlarged name card with her photograph, which she matches to a corresponding card at the top of her schedule. She has been taught to check her schedule as a routine, empowering her to find information about what is happening by herself. In addition, Sarah has learnt that when two objects are in the same box, she has a choice, thus further developing autonomy. Once Sarah is confident with her schedule objects, the teacher intends coupling them with enlarged pictures or raised-line symbols as a step towards developing her schedule. 81 Downloaded from http://jvi.sagepub.com at UNIV OF BIRMINGHAM on February 28, 2007 © 2003 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution. - Work system Sarah has a left to right organisational system with a ’finished’ box on the floor to her right. Up to four tasks are placed on a table to her left and Sarah has learnt to find her work from this place as a routine. Initially she struggled with finding the ’finished’ box and could not place finished work into the box. This became frustrating for her and sometimes resulted in self-injurious behaviour. Therefore, Sarah’s teacher provided a chute on Sarah’s right that she could then push finished work along. She found this easier to use independently and enjoyed pushing completed tasks along the chute into the ’finished’ box. Figure 2: A left to right sorting task This level of organisation allows Sarah to concentrate upon the concepts of tasks, rather than becoming distracted by disorganised materials. Similar levels of organisation are used for a variety of tasks in order for Sarah to work towards her target of working independently for ten minutes. In addition, similar organisation of materials enables Sarah to complete other activities. For example, when washing and brushing her teeth, the materials she requires are arranged in a top to bottom ’list’ on Sarah’s left. This organisation means Sarah can find each item needed to complete the sequence of the task independently. At this stage the organisation of the items she needs provides Sarah with her ’instructions’. Later, enlarged pictures or raised-line symbols may be coupled with the objects to introduce picture or symbol instructions. Figure 1: Sarah’s left to right work system Conclusion Sarah uses this system to complete some work independently and during paired and small group activities. For example, during art lessons, all the materials she needs are placed on her left and a ’finished’ box is placed on the floor on her right, together with her ’finished’ chute. developed to consolidate what she has learnt during taught sessions. These tasks are linked to curriculum areas and individual targets and include tasks to develop literacy and numeracy, fine motor and eye-hand co-ordination and play skills. Materials are organised in containers for Sarah to complete, working from top to bottom or left to right. This routine provides Sarah with a strategy for finding materials and helps her to organise tasks without Elements of structure already exist in many classrooms for children with visual impairments. Combining these individual elements into a cohesive Structured Teaching approach may enhance teaching and learning and facilitate independence. Structured Teaching has been devised for individuals with ASD and by necessity has a strong visual component. However, this need not deter us from using the approach for those with visual impairments; indeed it is essential to consider how to adapt the visual elements for those who have ASD and a visual impairment. The flexibility of the approach, underpinned by key principles of assessment and individualisation, means that the approach can, and should, be tailored to meet individual needs. A ‘multi-sensory approach to Structured Teaching’ enables us to begin to think innovatively about how to adapt the approach for those with sensory impairments. overwhelmed by disorganised materials. Moveable items are fixed to prevent them from rolling or falling. For example, a two-way shape sorting activity is presented in a tray with the shapes for sorting on the left and the tray divided into two sections. One shape is fixed into each section of the tray to clarify the criteria for sorting. This discussion has reflected upon an approach devised for individuals with ASD and its potential use for those with visual impairments. It is hoped that this will stimulate further discussion and research in order to evaluate the potential effectiveness of the approach in this context. 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