Learning & the Blind, Multiply Disabled Children
Lilli Nielsen, Ph.D.
Reprinted from Future Reflections
the Editor: In my opinion Dr. Lilli Nielsen is
one of the most important persons in work with the blind
and multiply disabled today. Some people may recognize
her name in connection with "the Little Room." (The
Little Room is a play environment designed by Dr. Nielsen
to provide the optimum opportunity for blind youngsters,
especially those with additional disabilities, to learn
by doing for themselves.) A native of Denmark, Dr. Nielsen
lectures worldwide and has conducted a number of seminars
in the United States over the past several years. I
attended one of those workshops about four years ago.
It was one of the most informative and productive workshops
I have ever attended, which is no faint praise coming
from someone who is accustomed to the quality of workshops
conducted as a matter of course by the National Federation
of the Blind.
following article is an edited version (with permission
of the author) of the introduction and the first chapter
of Dr. Nielsen's book, Early Learning Step by Step:
Children with Vision Impairment And Multiple Disabilities.
Following the article is a review of the book and information
on how to order it and other materials developed by
Dr. Nielsen for use with blind and multiply handicapped
children. Here is what Dr. Nielsen has to say:
from: Early Learning Step by Step: Children with
Vision Impairment And Multiple Disabilities, by Lilli
mother said: "Do you think that she will ever be able
to eat her food herself or be able to walk?"
father said: "What else can we do? We are doing a great
deal, but are we doing the best?"
teacher said: "I have the feeling that I know too little
about how children learn. I simply do not know what
the next step is."
statements refer to children who have severe learning
difficulties, and they represent the uncertainty that
many parents and teachers are met with while trying
to help their child or pupil develop.
child in question may be blind or partially sightedoften
it is a child who has one or more disabilities other
than the vision impairment.
a skill is often referred to as having reached a milestone.
While growing, children without disabilities become
able to sit unsupported, to walk, to babble, to talk,
to establish emotional attachments with relatives, and
to gain friends whom they appreciate. They also learn
to actively play and participate in the events happening
within their surroundings.
they become able to solve problems and to learn at higher
and higher levels. Thus, step by step, children develop
skills without undue effort.
and then, a child may achieve some skills either earlier
or later than considered within the norm. However, small
deviations from so-called normal development are usual.
Some children with vision impairment achieve skills
without any great difficulty, while some have mild difficulty,
and some have severe learning and educational difficulties.
a child with vision impairment or other disabilities
fails to reach a common milestone, (for example, the
ability to eat, to walk, or to talk) parents, other
caregivers, and teachers often feel bewildered and uncertain
about what to do and what to expect the child to do.
Although the reason for this uncertainty may be lack
of knowledge about the child's potential, anxiety concerning
the possibility of emotional problems, and anxiety for
the child's future; it may also be due to lack of knowledge
concerning the sequences of learning that a child follows
while developing a skill.
purpose of this book is firstly to review certain sequences
of learning, thus making it easier for parents and teachers
to verify what "the next step" probably would be, and
to discover whether a child is missing any links in
any sequences of learning. Secondly, it is to suggest
approaches and environmental interventions that may
facilitate the child's learning.
the suggestions given in this book should be considered
partly as means of preventing delays, and partly as
remedies to problems caused by delays or the child's
The Methods of Training and Teaching
my point of view, the current approaches to training
and teaching are developed from the philosophy that
since children with disabilities do not commence spontaneously
to perform basic skills, they must and can be trained
or taught to achieve them. Lessons using this approach
are often carried out by guiding the child's hands,
feet, or body to perform the movements necessary for
the task in question, or by persuading the child to
look or listen, after which the child is supposed to
imitate the adult or to do as told. If the child turns
away from the task or becomes interested in other things,
he is persuaded or forced to continue with the task.
It is considered important that the child become accustomed
to concentrating on a task. Likewise, it is considered
to be confusing for the child if too many objects are
presented during a task-training session.
methods of training and teaching are accepted and used
traditionally or as a basic requirement all over the
world. However, for many of the children with severe
learning and educational difficulties, these methods
have failed to deliver the expected result. Sometimes
these methods have served to prevent further delays
but, in too many cases, they have failed to facilitate
development. In some cases the child is exposed to the
same approach for years in spite of the obvious lack
of result. In other cases less and less effort is made
to train the child until, finally, the method is abandoned
without being replaced by another one.
to continue a method knowing that it does not help the
child, or to give up entirely, is the same as saying
that the child is unable to learn or unable to comprehend
anything. In other words, it is assessing the child
instead of being critical of the method used.
some cases, the methods of training and teaching have
a negative effect in that the child either becomes aggressive
or withdraws within himself.
too many cases, the method of training the child involves
the hand-over-hand approach. In
some cases, this results in the child becoming unwilling,
for example to eat, unless an adult is prompting him
to take the spoon or fork or bread. In other cases the
child refuses to allow the adult to hold his handthat
is, the child withdraws his hand whenever the teacher/adult
tries to guide his hand or even whenever he experiences
physical contact with any object.
some cases, the child is so spastic that no method,
for example, with regard to learning to eat, is used
at allthe child is simply fed at every meal. It
is considered that the child will never be able to learn
to eat, wash his hands, undress, or do anything else
for his own welfare. So, the decision as to whether
or not the child can achieve a skill is often related
to the complexity of the child's handicaps, rather than
to the fact that almost all children are able to learn.
Only the few children who suffer from a progressive
disease are sometimes unable to learn. And who knows
when a child is going to die? Also, training the child
in so-called splinter skills seems to have failed in
that the child does not experience any connection between
his abilities, and so has difficulty in developing self-identity
some cases, the child actually does perform a skill
in which he has been trained, but most often he only
uses this skill when prompted.
the way, when is a skill a real skill? A skill that
is used only when the teacher requires the child to
do as he is told or is used only after the adult has
been prompting or persuading the child for a while,
is a trained skill which probably has not become part
of the child's personality.
must be difficult, if not impossible, to initiate action
using a skill that has not become a part of one's personality.
The method of training and teaching seems to increase
the risk that the child will begin to reject or withdraw
when approached with tasks, or will behave in an autistic-like
or stereotyped way, or will perform the trained skills
like a robot. Furthermore, there is the risk that the
child becomes unable to initiate performance of any
skill unless prompted, encouraged, or asked to do so.
And so the child will, therefore, continue to depend
on another person. Also, as part of this method, the
adultsthat is, parents, caregivers, teachers,
and other professionalsare required to see to
it that the child performs the skills to which so much
time had been given to train him. The following warning
can be heard: "If you help him instead of requiring
him to do it, he will forget to do it, and we will have
to start training him in that skill again."
do these children really have such a poor memory? Do
they really have such poor comprehension? They do remember
how to withdraw, they do understand the message when
prompted, and they do know how to avoid interaction.
learning at the developmentally appropriate level have
been of more benefit for these children than age-appropriate
education or training? Is it accurate to think that
a child with disabilities can achieve age-appropriate
skills without first having had the opportunity to learn
the basic skills that a child without disabilities needs
before he commences to perform the complicated activities
belonging to higher levels of development?
Approach of Active Learning
In order to develop new approaches, children without
disabilities were observed for the purpose of analyzing
the ways in which they achieve basic skills. It was
found that infants and toddlers without disabilities
learn from doing (this way of learning, incidentally,
fitted poorly into the educational methods to which
the children with disabilities most often were exposed).
Similarly, it was found that until the age of 30 to
36 months the child without disabilities is unwilling
to accept being trained or taught.
are the questions we then asked: What is it that a child
without disabilities learns? How does he learn this?
Does a child who is blind, spastic, or has severe learning
difficulties learn in the same way as the child without
disabilities? Would these children also learn if they
were allowed to explore and experiment, and to do so
in their own way? Could and should anything special
be done to facilitate this learning?
the past 20 years, we have been developing alternative
educational solutions for the most common learning problems
seen in infants and children with vision impairment
without or with other disabilities. These include: achieving
head control, being able to sit unsupported, learning
to eat, learning to stand and to walk, learning spatial
relations, achieving object concept and self-identification,
learning to talk, learning to play constructively, and
learning to initiate interaction with others.
we still have a lot to learn concerning facilitation
of learning for these children, we have succeeded in
giving them opportunity to learn by introducing the
approach of Active Learning.
philosophy behind the approach of Active Learning is
that, if given opportunity to learn from his own active
exploration and examination, the child will achieve
skills that become part of his personality. These skills,
then, become natural for him to use in interaction with
others and to use for the fulfillment of his own needs,
and will gradually make him ready to react relevantly
to instructions and education. In other words, he will
develop to be as independent as possible.
is then, in a nutshell, the difference between the common
educational method of training and teaching and the
approach of Active Learning?
the author's point of view, the starting point in commencing
to train and teach a certain skill seems to be the final
skill itself, whereas the starting point in Active Learning
is letting the child learn the basic steps that lead
to mastering the skill in question.
as long as the child is developed to a level younger
than the level of three years of age, I consider it
impossible to train or teach that child.
Concept of Learning
is the process that happens in the child's mind when
he has opportunities to perform all the steps necessary
for achieving a skill.
first prerequisite for learning is that the child is
able to move and that objects are available within reach
(at least as long as the infant or child is not mobile).
It is also necessary to have the opportunity to share
experiences with others, to imitate others, and to interact
learning becomes possible if:
He is given opportunities to learn from the level to
which he is developed.
He can discover, experiment, and explore with many ways
of performing an activity and thus learn the most practical
way for him to perform a skill successfully.
He has sufficient time to experiment and the opportunity
to repeat an action as many times as necessary in order
to store the information gained and to confirm that
a specific way of acting gives the same result, and
so comprehend the reality of it.
He has the opportunity to compare his experiences. This
allows him to discover similarities and differences,
to recognize specific experiences, to associate a new
experience with others already stored in the memory,
to link experiences with each other, and later on to
categorize and generalize experiences.
He is given the opportunity to establish even development
across the levels of the various learning processes,
thus avoiding the missing links in one learning process
that would have a negative or arresting effect on another
He has somebody with whom to share his interest and
experiences. This allows him to learn how to initiate
and children learn within several areas of development
simultaneously. Ability achieved in one area influence
abilities in other areas, so that the areas are intertwined
and experienced by the infant or child as a small entirety.
Through self-activity and interaction with others, this
entirety should gradually contain more and more detail
as the child comprehends and masters the several parts,
becomes able to connect these parts, and finally is
able to perceive a bigger entirety.
summary, learning is achieving knowledge by being active.
main conditions should be considered while introducing
the approach of Active Learning.
infant/child's level of development, his readiness for
learning, and the skills he has already achieved.
the infant/child has had a good sleep, feels emotionally
settled, and has had something to eat and drink, he
is ready to discover and recognize responses from his
movements or to learn anything that matches his level
of development. However, he needs appropriate stimulating
surroundings (including toys and other materials) and
he needs sufficient time for doing as well as for thinking.
Also, at the right time, he needs appropriate interest
from his caregivers and teachers if he is to have optimal
conditions for learning according to his potential.
Quality of the Environment from Which the Child Is Given
Opportunity to Learn
environment that is established for the child should
include opportunity for him to utilize already achieved
motor ability. It should also arouse his interest and
curiosity, as well as give him opportunity to achieve
the next level of development.
the child should be provided with many environments
that will give him opportunity to learn in all areas,
such as gross and fine movements, connection between
games and daily living activities, communication, cognition,
socialization, and independence.
order to devise appropriate environments from which
the child will be able to learn, it is necessary to
know as much as possible about what the child already
is able to do, and in which directions his interest
is headed from time to time.
knowledge can be obtained through observations of the
child and interviews with his caregivers and teachers.
Interviews should be conducted through the use of the
Functional & Instruction Scheme (Nielsen, 1990) or by
use of any other appropriate checklist concerning performance
during early childhood.
may also be useful to use the sequences of learning
for sighted children as a guide for the purpose of discovering
when the blind child has difficulties, and so be better
able to facilitate his learningmaybe by means
of environmental intervention.
Adult's Cooperation and Attitude
adult's cooperation and attitude is crucial in upholding
the approach of Active Learning. Environmental intervention
means that the adult establishes environments appropriate
for the child's learning, makes objects available for
him, and reacts to his signals or vocalization by sharing
his interests and by interacting with him at the child's
level of development. For the purpose of introducing
the approach of Active Learning it is necessary for
the adult to know in detail the learning sequences which
enable any infant and child to achieve skills.
information on ordering Early
Learning Step by Step
and other Lilli Nielsen materials, visit www.visionkits.com.