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Essay: Equality of opportunity for Deafblind students in Mainstream Secondary Education.

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This essay looks to understand the principles of inclusion for deafblind students attending mainstream secondary education. It should be noted that as the number of deafblind students in mainstream settings is so low (there are currently only two students in Hertfordshire being taught in mainstream secondary schools), there is a significant lack of relevant and up to date research regarding this topic. However, my decision to continue with this review is founded on my desire to share the unique experiences and researched practices I have compiled. I believe they work to create understanding and ensure equality of opportunity for deafblind learners so that they can make progress and achieve.

Deafblindness: A definition and underlying causes

The term deafblind is used to describe a person who has severe visual and hearing impairment. As many individuals who are considered deafblind still retain residual sight and/or hearing, being deafblind does not always equate to a complete loss of hearing and/or sight. There are multiple causes of deafblindness; Complications during pregnancy (for example the mother infected with rubella) and birth, (including premature birth) and genetic conditions such as Usher syndrome.

The expression deafblind first came into use in 1993 as a replacement for ‘Deaf and Blind’. Combining these two words at the time was thought to give more clarity and define deafblindness as a unique disability instead of ‘simply deafness plus blindness’ (Aitken, 2000: p.2). Although it may seem that deafblindness and visual impairment share many of the same characteristics, there are profound differences between the two disabilities. One example, and probably the most important regarding the context of education, is that dual sensory loss for a deafblind student will cause them to process information differently from that of visual impaired student, and therefore strategies for attainment must also be differentiated.

The Terms ‘Dual-sensory impairment’ or ‘Multi-sensory impairment’ can also be used to describe a person with both sight and hearing impairments. Though both terms are generally understood to have the same definition as ‘deafblindness’, Sense UK, a charity that works to support people with complex communication needs, makes the argument that, “…Multi-sensory impairment’ is considered a more appropriate term by some people, since the cause may be related to sensory processing, rather than the functioning of the eyes and ears…’ (Sense UK, 2017)

Whilst using the term Multi-sensory impairment (MSI) might help to define the disability as being independent from singular vision or hearing impairment, in Scotland it is a term more commonly related to deafblindness plus additional impairments. In Wales deafblindness is referred to as ‘Profound Multiple Learning Difficulties’(PMLD) (Aitken, 2000). Because of the lack of consensus amongst professionals as to a clear definition, for clarity I will use the expression deafblind throughout this essay.

Within the label of deafblindness there are differentiated groups formed by the unpinning causes of sensory loss. The Royal National Institute for the Blind (RNIB) identifies two broad categories for this disability:

• Congenital deafblindness A term that describes any child who is born with a sight and hearing impairment or develops sight and hearing loss before they have developed language in their early years.

• Acquired deafblindness A person who loses their sight and hearing after they have developed language in their early years is said to have acquired deafblindness. (RNIB, 2017)

Within the general population, the numbers of deafblind children are very small. In Hertfordshire for example, with a population of 1,176,700, there are currently 25 deafblind children of whom less than ten are in mainstream education and only two in secondary education. (Hodges, 2018)

Although the number of children being identified as having deafblindness is not necessarily increasing, new technologies, such as cochlear implants, are helping students to more freely access mainstream educational opportunities.

Admission into Mainstream Secondary Education: A whole school approach

Once a deafblind child is accepted into a mainstream secondary school, it becomes the school’s responsibility, with support from local authorities and specialist teams, to provide a fully comprehensive educational experience for that child.

‘…Provision for pupils with special educational needs is a matter for the school as a whole. In addition to the governing body, the school’s head teacher, [Special Educational Needs Co-ordinator] SENCO and learning support team, and all other members of staff have important operational responsibilities… Teaching such pupils is therefore a whole-school responsibility, requiring a whole-school response…’ (DfE, 2015: P.13,15)

This whole school response is at the core of supporting children with Special Educational Needs and Disability (SEND) and schools who have shown the highest rates of attainment across all SEND students, show evidence of strong learning support teams alongside a school ethos that reflects the values of diversity and inclusion. Instances of deafblind students in mainstream secondary education, as noted, are extremely rare and require and enormous amount of resources, training, specialist teams, funding and dedicated time. It can be understandably daunting for any school to take on this responsibility and most secondary schools will have little or no previous experience of teaching a deafblind student. Working closely with the specialist Local Education Authority (LEA) is imperative to understanding how best to support the student.

The SEND Code of practice is a statutory guidance on duties, policies and procedures that relate to the wellbeing and legal rights of those with special educational needs. In the revised version of 2015 the code clearly states that,

“Schools should work closely with the local authority and other providers to agree the range of local services and clear arrangements for making appropriate requests. This might include schools commissioning specialist services directly. Such specialist services include…. specialist teachers or support services, including specialist teachers with a mandatory qualification for children with hearing and vision impairment, including multi-sensory impairment, and for those with a physical disability.” (DfE, 2015: Para 6.61,)

Specialist Children’s’ Services, coordinated by the LEA, advise schools on how the National Curriculum can be accessed, drawing on the skills of trained professionals. For example, a team supporting one deafblind student will include an ‘Advisory teacher’ (DfE, 2016) who oversees the support framework and an experienced qualified teacher who has taken the mandatory additional visual impairment qualification, in order to effectively teach Braille and tactile resources. Inside the classroom, an intervenor (i.e. specialist teaching assistant VI) will be the main 1:1 support for a student with deafblindness, to support and develop communication skills, access to learning and modifying materials. This can involve creating specialist resources; i.e. braille, modifying existing resources; i.e. large print or coloured paper, assisting communication; i.e. signing and assisting the pupil through scribing. Other team members may include access to technology professionals and mobility specialists. These teams work to mandatory legal requirements to identify the needs of their individual students usin
g Education, Health and Care Plans. Provision maps may also be u
sed to track progress.

Specialist equipment such as Braillers, Brailliants and Embossers, are usually funded by the LEA according to the students EHCP. statement of need (GDS 2016). An annual review is essential for understanding the effectiveness of the learning support given to that student shown through the progress and attainment reports that year. The meeting is held by the head teacher on behalf of the LEA and any collated advice and information regarding the student received by the school must be circulated at least two weeks before a review meeting. Review and modification must be considered by the parents/guardians of the child; a relevant teacher, i.e. a class teacher or form/year tutor; the SENCO; An LEA representative; any other person who the LEA considers appropriate (notice must be given); any other person deemed appropriate by the head teacher.

Parents are encouraged to contribute their views to the annual review process and to contribute to discussions about new targets for the child’s progress. Especially in the instance of a first review, parents are asked to help by providing written advice. Students are also encouraged to be actively involved in the review process, where possible attending all or part of the review meetings. They are asked to give their views on their progress for the previous year and openly discuss any difficulties they may have encountered.

School experience: Observing existing practice

During my first placement of initial teacher training, I observed on a regular basis, a deafblind Year 7 student, Sarah (anonymised name) during her first term. The school was experienced in teaching visual and hearing-impaired students, but this was the first admission of a deafblind learner in their school. The school itself has a very strong learning support team and due to familiarity with SEND students, it was already well adjusted to provide inclusion strategies for Sarah.

During my initial observations, I positively noted that Sarah has good ownership of her own learning and she was a very willing participant in the classroom, when given the opportunity. I feel that she is empowered by her intervenor, who has supported her since Key Stage 1. I was introduced to the support team and their roles were explained and demonstrated to me in an accessible way. Some advice was given to me concerning communication tactics and I also discussed inclusion with the Art class teacher, who has herself previously received guidance and training for a number of visually impaired students. As I was going to take on the class including Sarah for a number of weeks, my first action was to educate myself about deafblindness and the potential barriers to learning that I wanted to avoid.

This research on pedagogical approaches for deafblind students in mainstream education led me to devise a table of what I understood to be: Key strategies; The application of those strategies; The rational. The strategies focus on reasonable adjustment and inclusion of the pupil, with consideration to utilising specialist support and resources. However, it should be noted that these strategies are intended as a guide and full consideration must be given to the individual student free from assumptions surrounding their disability.

The role of the teacher: Pedagogical strategies and reasonable adjustment

Strategy Application Rationale

Creating a successful environment for learning

Pedagogical approaches informed by:

Hodges, L, 2000

Miller, O, 1997

Pease, L, 1997, 2000

Porter, J, 1997

• Creating a strong sense of stability where students feel they can rely of their surroundings being safe and predictable.

• Using predictable, ‘structured routines’

• Considered classroom layout.

• Seating plan, ‘Physical positioning’ • Students will not anticipate change due to the loss of sensory cues.

• Any change to routine i.e. change in seating plan or group work must be directly expressed to the pupil prior.

• Many deafblind pupils will have preferences founded by their sensory loss. I.e. one pupil may need to sit at the front of the classroom in order to better hear the teacher, another pupil may need to sit closer to a window for improved natural light.

• Particularly noisy or disruptive pupils will create an unstable learning environment for a deafblind pupil, negatively impacting their learning.

Building strong working relationships

Pedagogical approaches informed by:

Hodges, L, 2000

Miller, O, 1997

Pease, L, 1997, 2000

Porter, J, 1997 • Taking the time to meet with the pupil, Advisory teacher, the intervenor, parents, and SENCO to fully appreciate the needs of the pupil.

• Creating emotional security for the student.

• Getting to know the pupil and understanding preferences.

• Understanding pupil motives. • The student should feel comfortable around you and be able to communicate freely, either through the use of specialist equipment an interpreter. The Teacher should understand how to communicate properly and use inclusive language at all times, even when not talking directly to the student.

• Generally speaking deafblind pupils may have fewer satisfactory experiences from which to draw a wider range of interests. It is important to utilize existing areas of interest to motivate pupils to learn through experience.

Delivering teaching programmes and setting curriculum goals

Pedagogical approaches informed by:

Hodges, L, 2000

Miller, O, 1997

Pease, L, 1997,

Porter, J, 1997 • Clear precise instructions that focus on short learning outcomes.

• Ensuring appropriate motivation for pupils.

• Considering pace.

• Repetition

• When presenting information consideration must be given to modified resources

• Modelling outcomes and processes. • Recognising successful outcomes and genuine praise help pupil to feel pleasure from succeeding. This in itself can be one of the best forms of motivation.

• Pupils will take longer to investigate a task and absorb information. i.e. a deafblind pupil completing a brailed word search will need fewer words and longer to complete as they are not able to be simultaneously aware of all the letters at the same time.

• Due to restricted information of the senses, pupils may need more repetition of an activity to maximise attainment.

• if a class is studying a poem then the intervenor must be given the resources to modify well enough in advance to ensure quality and accuracy. A good rule of thumb is at least one week.

• Children with deafblindness are much more likely to have a limited grasp of concept by verbal explanation.

The role of the TA: Access to curriculum

Working alongside a specialist TA to support a deafblind pupil is central to maximising progress and achievement. I have identified 5 areas of specialist support that are essential for a deaf blind student to be able to access curriculum:

Preparing specialist resources: Classroom teachers of deaf blind students may ask for alternative versions of instructional materials or learning resources to be created so that the child may access the same i
nformation at the same time as their peers. For example, in English, the class are reading a book which must be transcribed into braille along
with ‘tactile illustrations’ (Gale, B, 2012).

Assisting the pupil to practice skills: The deafblind student must learn a school curriculum and a tactile curriculum to prepare them for the challenges ahead, so regular practice is necessary.

Supporting and reinforcing instruction: During the lesson, the teacher may ask the intervenor to assist the student during instructional times. For example, they may need to provide verbal descriptions of presentations, demonstrations and videos. They may also need to help reinforce concepts taught during the lesson and be able to recall and reinforce specific instructions given by the teacher. The may also be needed to interpret instructions through the use of specialist sign, and relay information back to the teacher.

Monitoring pupil safety: The intervenor may need to supervise their student during such situations as walking through busy hallways, participating in practical projects and subjects such as P.E where physical movement is necessary. This high level of ‘monitoring’ (Gale, B, 2012). is crucial to allowing the student to participate safely in the classroom activities, whilst learning independently.

Supporting the pupil with social interactions: The intervenor will help the pupil to practice appropriate socials skills. It is common for deafblind students to have a very reduced set of social understanding and must be taught skills such as facing people when talking, using appropriate body language, asking for assistance, joining in and waiting their turn.

As the intervenor will spend the most 1:1 time with the student, they will be able to collate and relay a considerable amount of information regarding student progression and how that student responds to different circumstances and situations around the school. For this reason, I believe the intervenor is one of the most important members of the team for understanding the everyday needs of the learner, however this experience and knowledge can often lead to misunderstanding. Although that person plays an integral role in the classroom he or she is not a teacher, nor are they required to hold Qualified Teacher Status. In fact, their role can be a delicate one to balance. Generally, the student will need to be encouraged to develop their own skills and become progressively more independent. However, for students with deafblindness, there is a danger of them becoming overly reliant on their 1:1 support.

An additional and common problem is that teachers feel unable to take ownership of having a deafblind student in their classroom and disengage from the direct teaching approach. Therefore, it is important for the intervenor to resist providing too much supervision or assistance that might interfere with the pupil’s development of independent skills.

The National Sensory Impairment Partnership (NatSIP) provide excellent guidance to help both schools and specialist teams understand the boundaries of specialist TA support for SEND students. The report, entitled: Effective working with teaching assistants in schools, highlights some of the ways in which classroom teachers can work effectively alongside the intervenor.

• Give TAs copies of any texts, books or resources that will be used well in advance;

• Provide TAs with copies of schemes of work and lesson plans well in advance;

• Keep to planned lesson activities and resources wherever possible, and inform TAs at the earliest opportunity of any proposed changes;

• Set aside time to meet with the TA to plan and discuss lessons;

• Explain the role they want the TA to take during different parts of the lesson;

• Consult the TA about how best to meet the needs of the pupil with VI and involve them in assessment and target setting (remember that over time the TA is likely to develop considerable knowledge of an individual pupil with VI)

• Keep the TA informed of the pupil’s progress

(Boothroyd, E, Cobb, R, Gale, B. 2012: p.15).

These collaborative strategies alongside advisory teaching tactics should enable classroom teacher to feel confident in providing a rich and diverse educational experience for students with deafblindness.

Teaching experience: Applying practices

After shadowing the whole class for a few weeks, I started to become familiar with Sarah’s style of learning and incidentally, I also observed the different factors which impacted on it. I noted she was considerably more active in the morning and her fatigue increases throughout the day; both residual vision and physical energy. This was an important observation as the residual eye fatigue impacted how much visual information she could attain in one school day, and the physical fatigue meant that as the day progressed she became increasingly reliant on her intervenor to assist with written/practical work.

Secondly, my temporary class included two students with ADHD, and two with severe behavioural problems, as well as Sarah. This meant that Sarah operated in a very noisy and chaotic environment if the behaviour was not appropriately managed. Considering one of the main strategies for teaching a student with dual sensory impairment is to have a ‘stability and consistency’ (Hodges, 2000), these continuous interruptions inevitably disrupted her learning. Sarah interprets audio information through the use of a cochlear implant and microphone that must be worn by the teacher at all times. This means that while she may be trying to concentrate on her work, a reprimand from a teacher to another student might interrupt her learning. It’s also important to note that Sarah will have no contextual reference for the disruption and therefore may be more so confused and distracted.

Lastly, I observed Sarah had little to no interaction with her peers; often during group sessions, Sarah worked her intervenor, rather than pairing up with other students. My initial thoughts were that as Sarah was still in a transitional period, moving from key stage 2 to 3 and in a new school setting, that her classroom teachers had not yet had the opportunity to plan group work effectively.

These observations informed my own practice later on. Deafblindness is a complex and vast topic and I recognised there were bigger issues surrounding educational barriers than was possible for me, a trainee teacher, to resolve during an eight-week placement. However, I felt strongly that the three main issues I had identified could be addressed.

Knowing that Sarah’s learning preferences were vital to her education, I sought advice from her intervenor and developed a good working relationship. I made sure to follow the natSIP guidance by providing feedback on Sarah’s progress, so useful discussions could support my planning for the class. Through these discussions, I discovered that Sarah’s fatigue was relatively high during my class, just before lunch. So, I ensured she did the practical part of the lesson first and the theory afterward. Alternative tasks were to hand, should she be too fatigued and unable to continue with the practical. This saw a dramatic improvement in the quality of work she was able to produce independently and I as the teacher was able to focus more attention on teaching her essential art skills, but one skill per lesson.

Secondly, thanks to my own research and the advice of all of the professionals associated with Sarah, I knew I had to demonstrate excellent classroom management and deal quickly and effectively with any disruptions. My whole class ethos was positive reinforcement and crucially, identifying strategies to motivate th
e four students in particular, who were prone to poor behaviour and disrupti

The success of these strategies enabled me to teach in a calm classroom and offer more in-depth support to individuals, including Sarah. The intervenor relayed to me that Sarah stated that Art was one of her favourite subjects because the classroom was so calm and allowed her to actively participate.

Lastly, after I had worked to resolve the first two issues, I felt confident to intervene and address the lack of classroom social interaction, as I saw it. I knew that the next project would involve the students working in pairs. The class teacher was hesitant to have Sarah in a pair, because at the time her limited artistic skills seemed to preclude her ability to fully participate and help create a successful outcome. The class teacher was mindful that another student’s work could be adversely affected and this contributed to her reluctance.

However, I was persistent, clarified my planning ideas with the intervenor and then presented my modified scheme of work to the class teacher – which was accepted, with the proviso that I monitored Sarah’s progress and enjoyment of the lessons. It was fundamental that the paring be given due consideration and that planning for each lesson was reviewed and revised in accordance to Sarah’s needs.

I identified a suitable and empathic peer to be the pair. Prior to the lesson the intervenor and I prepped her by giving communication pointers and explaining that their joint project would involve incorporation of multi-sensory elements. Such features involved using the scent of chocolate oil to represent the ‘colour of chocolate.’

The project was a success and feedback from multiple sources complimented me on my exemplary differentiation. For me, the success was that the perceived barrier to group work was now broken and thereafter, the class teacher and fellow peers understood that Sarah could rise to challenges when appropriate planning was to put into effect.

Continued observation: Thought for future practice

An unexpected finding through my continued observation of Sarah, was that once I had worked to alleviate some of the physical learning barriers, I was able to look more closely at her learning behaviours during my lessons. I began to notice that Sarah was displaying some ‘distinct traits of Autism Spectrum Disorder (ASD)’ (Matson, J.L 2016), but that she had no record of a formal ASD diagnosis. I was prompted to return to my research and investigate the link between dual sensory impairment and ASD and found that,

“…The similarities in the ways that autism and deaf-blindness present in children have been recognized for a long time, as have diagnostic strategies for differentiating between autism

and deafness… While it is possible for children to be both deafblind and be diagnosed with autism, it is much more likely that a child who is deafblind simply appears similar to a child with autism…” (Belote, Maier, 2014: p.1)

The importance of including my findings on this matter is that only after I had eased the practical barriers for Sarah’s inclusion, was I able to see the how deafblindness might have an impact on her fundamental learning behaviours. Upon re-reading Teaching Children who are Deafblind, I came across a quote that summarised my instinct:

‘Children who cannot depend on their distance senses to provide reliable, undistorted and adequate information about their world will learn less effectively. Learning and experience are restricted in quality and quantity…they do not learn incidentally.’ (Hodges, 2000: p. 166)

Incidental learning is the indirect learning that occurs when we observe the world around us. For Sarah that observation is impaired by her deafblindness and so much of the contextual information concerning the world around her, does not exist for Sarah. As the teacher, it is imperative that I am aware of this lack of contextual understanding. For example, if I ask Sarah to clean her paintbrush, I’m must consider how she will measure cleanliness of the brush. For a sighted student, they would be able to see when the paintbrush is clean, whereas Sarah must be taught to feel the brush tip for residual paint.

Furthermore, at the start of this essay I identified two distinct groups of people with deafblindness. Congenital and Acquired. The Definition for congenital deafblindness identifies that early onset deafblindness hinders the development of Language, which is largely expected by even those with no experience of deafblindness. However, the lesser known impact of this delayed language development is impact on ‘development of self-regulation’ (Zivin, 1979). Vygotsky theorized that humans develop a sense of ‘self’ in relation to the surrounding world through use of ‘self-speech’ (Vygotsky, 1987). The deferral of this self-regulatory language results in characteristics similar to that of a child with ASD.

These distinct similarities relating to Verbal and non-verbal communication, can be seen in this chart extracted from a report made by Belote and Maier in 2014.

Features Associated with Autism Spectrum Disorder (ASD) How might this feature be reflected in children with autism spectrum disorder? Why children with deaf- blindness might appear similar:

Delays in verbal and non- verbal communication • Reduced initiation of expressive communication

• Repetitive vocalizations or sounds

• Lack of or delayed response to communicative attempts by other people

• Inability to establish and/or maintain eye contact

• Difficulties reading the body language, facial expressions, gestures, and other non- verbal cues of others

• Heightened attention to objects rather than people (e.g., looking at a light switch on the wall rather than the expression on conversational partner’s face) With little or no access to spoken and/or visual language, children who are deaf-blind will have reduced or sporadic access to language.

They may not understand the consequences of their actions or understand that they can control their environment through symbolic and non- symbolic communication.

Without access to incidental learning, children must be taught the most basic non- verbal communication,

such as facial features (e.g., interpreting a happy or sad face), gestures (e.g., waving the hand towards you to signal “come here”, shaking the head side-to-side to communicate “no”), etc.

(Belote, Maier, 2014: p.5).

With minimal literature being produced on effective learning theories for students with deafblindness, utilising information like this could prove useful to teachers who are working to create pedagogical approaches for deafblind pupils. It is also worth noting that by focusing on the learning behaviour of each individual student, we ensure that the student is ‘seen’ before the disability.


The heart of the essay has focussed mainly upon observation of practices reviewed in mainstream secondary schools. I can determine that my finding has lead me to identify the 3 main areas for consideration.

Firstly, I believe that my research shows that schools have to work effectively with specialist teams in order to provide fully comprehensive educational experiences for pupils with deaf blindness. Successfully and continued collaboration is at the core for maximising potential and raising achievement levels.

Secondly, this communication must resonate across all aspects of the student’s life I mainstream settings. Any assumptions ma
de regarding student’s abilities, or lack of, cannot be tolerated. Proper investigation an
d consideration must be made concerning each individual student’s needs. When time is spent collating information and building strong working relationships, school should be better able to provide ‘tailor made’ educational experiences that ensure equality of opportunity for Deafblind students in Mainstream Secondary school settings.

Lastly, I conclude that although this is still a very under developed topic, I predict that more and more mainstreams schools will start come into gradual but increased contact with deafblind learners. Currently there are just under 8 pupils in mainstream primary’s school who will likely go on to mainstream secondary schools, a total of 6 more that the county’s current admission. But are the LEA and schools ready for that? Now is the time for more detailed research to be compiled so that schools can be more readily prepared with relevant and up-to-date pedagogical approaches and strategies for inclusion. If we, as educational practitioners, educational institutions, and specialist teams are to ensure the sustained equality of opportunity for Deafblind students, then continued studies in this area are key to supporting every deafblind pupil achieve the most from their educational experience.

Reference List

Aitken, S (2000). Teaching Children Who are Deafblind: Contact Communication and Learning. London: David Fulton Publishers.

Belote, M, Maier, J (2014). Why Deaf-Blindness and Autism Can Look So Much Alike. California Deafblind Services. 19 (2), 1,5.

Boothroyd, E, Cobb, R, Gale, B. (2012). Effective Working with Teaching Assistants in Schools. Raising the Achievement of Pupils with A Visual Impairment. 1 (5), 15.

Department for Education (DfE) (2016). Specification for Mandatory Qualifications For specialist teachers of deafblind children and young people. Available: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file. Last accessed 31/12/2017.

Department for Education (DfE), Department for Health (DfH). (2015). Special educational needs and disability code of practice: 0 to 25 years .Available: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/398815/SEND_Code_of_Practice_January_2015.pdf . Last accessed 31/12/2017.

GDS. (2016). Children with special educational needs and disabilities (SEND). Available: https://www.gov.uk/children-with-special-educational-needs/extra-SEN-help Last accessed 31/11/2017.

Hodges, L, lead practitioner MSI-Deafblindness (school of education) 2018

Hodges, L (2000). Teaching Children Who are Deafblind: Contact Communication and Learning. London: David Fulton Publishers. P. 166, 168

Matson, J.L (2016). Handbook of Assessment and Diagnosis of Autism Spectrum Disorder. Switzerland: Springer Science & Business Media. P.209, 403

Miller, O, Pease, L, Porter, J. (1997). Curriculum Access for Deafblind Children. Department of Education Resources. 1 (3), 20.

Pease, L (2000). Teaching Children Who are Deafblind: Contact Communication and Learning. London: David Fulton Publishers.

Royal National Institute of Blind People (RNIB). (2017). Dual sensory loss. Available: http://www.rnib.org.uk/eye-health/sight-loss-and-other-conditions/dual-sensory-loss. Last accessed 20/12/2071.

Sense UK. (2017). What is deafblindness?. Available: https://www.sense.org.uk/get-support/information-and-advice/conditions/deafblindness/ . Last accessed 31/12/2017.

Vygotsky, L.S (1987). The Collected Works of L.S. Vygotsky: New York: Springer Science & Business Media. P. 53, 93

Zivin, G (1979). The Development of Self-Regulation Through Private Speech. the University of Michigan: John Wiley & Sons. P. 247

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