Attachment development in children with sensory needs



Understanding complex needs

This guide looks at children and young people themselves, the nature of their sensory, physical, learning or medical needs, and how these affect growth and development. We look at attachment issues and sensory integration difficulties.

Contents

Part 1: Attachment development in children with sensory needs

Part 2: Sensory integration

Part 3: Mobility and independence for children and young people with complex needs

Part 4: Further guides

Part 1: Attachment development in children with sensory needs

About this part

This part explores attachment development in children with sensory needs. The guide focuses on what is meant by attachment, development of attachment and how we can support parents and carers of children with sensory needs. This guide is written by Mike Brooks, Chartered Educational Psychologist and the Principal Educational Psychologist for Northamptonshire County Council. He writes here in a personal capacity. This guide is informed by his personal experiences from parenting his son, now aged nineteen, who has profound learning and sensory disabilities, by experience of more than twenty years as an educational psychologist (including roles as a specialist in sensory impairment), and by a range of books and articles on attachment theory and child development.

Contents:

1.1 Questions

1.2 What is meant by attachment?

1.3 When do attachment behaviours appear?

1.4 How do young children without sensory disabilities start to become "attached"?

1.5 How do children with sensory disabilities become "attached"?

1.6 How we can support parents and carers

1.7 Conclusions

1.8 Further reading

1.9 References

1.1. Questions

This article aims to answer the following questions:

• What impact might a vision impairment have on early emotional development?

• In our work with children who have sensory impairments, what additional perspectives can we gain from considering research into attachment issues, and into the development of the infant brain?

1.2. What is meant by attachment?

Building on the foundational work of John Bowlby (eg 1969), an influential study on attachment was published in 1978 by Mary Ainsworth and her associates.

Ainsworth categorised the behaviour of young children, while observing them in a structured setting with their mothers and with an unknown adult. Her team was able to identify three categories of attachment. Subsequent analysis of her original videos has identified a further category, that of "disorganised" behaviour.

Type A

The behaviour of Type A ("anxious/avoidant") infants is characterised by a general avoiding of the mother on her return, such as through looking or turning away and ignoring - perhaps as a "flight" from the mother, including through a withdrawal to some "inner place". The infant does not appear to be distressed during the periods the mother is out of the room.

Type B

Type B ("secure") behaviour is when the infant seeks a reunion on the mother's return, often showing signs of distress during her absence, and maintains the interaction, contact or nearness when the mother is in the room.

Type C

Type C ("insecure/ambivalent") describe those infants who actively seek the attention of their mothers on return, but in an angry, attention-seeking approach, externalising their distress through whining and fretting, showing ambivalence towards their mother.

Type D

The fourth type ("insecure/disorganised") is behaviour which does not seem to show clear routines of behaviour. These are children whose early years may have been characterised by experiencing significant relationship difficulties, whose primary carers have been unpredictable and with frequent episodes of psychological unavailability, such as from substance dependency issues, resulting in periods of 'absence' while being physically present. This can result in the untenable situation where those who should be the source of comfort can also be the source of threat.

1.3. When do attachment behaviours appear?

Children may show their "attachment behaviours" when they feel heightened arousal, including through anxiety or distress.

When the parent or carer shows sensitivity, acceptance, co-operation and availability, then the child can begin to relax and they can move from "attachment behaviours" to "exploratory behaviours". This is clearly seen in those children who are able to move away from their parent, perhaps at a toddler group, while often glancing back. These children are more likely to be able to show successful learning than those children who seem to show less concern as to where their parent might be and can be seen moving through activity to activity.

1.4. How do young children without sensory disabilities start to become "attached"?

A helpful starting point in thinking about the social readiness of young children is to consider the sensory abilities of the new-born infant who has no disabilities. "The Social Baby" (Murray and Andrews, 2005) provides delightful and remarkable sets of photographs which illustrate babies' abilities to show preference for their mother.

Sounds

It can still surprise some people just how early an infant can recognise sounds, including their mother's voice.

Even before birth, there is evidence that an initial startle response lessens with repeated exposure to the sound, as the baby learns to recognise the sound. Given that it is their mother's voice that will be the sound most often heard before birth, it is perhaps not surprising that they can be shown to prefer their mother's voice to other sounds from birth.

Faces

Very young infants also prefer looking at faces than at other visually interesting stimuli.

Within around three to five weeks, they are able to discriminate between the face of their primary carer (commonly, their mother) and those of others. Within minutes of birth, an alert infant can copy facial expressions, including opening the mouth and protruding the tongue.

One study, using this infant sensitivity to the sight and sounds of the mother, found that those mothers who had been able to interact visually with their babies in the delivery room were, thirty days later, significantly more sensitive to their babies' auditory and visual cues than those who had not had this opportunity (Butterfield et al, 1982).

Looks and smiles

Looks and smiles help the "social brain" to develop.

Research into baby-brain development suggests that the looks and smiles that pass between infant and carer also make a significant contribution to the growth of neuronal networks that comprise the 'social brain' (Schore 1994). During the first year, the infant brain more than doubles in weight, illustrating the importance of these early positive and predominantly visual interactions that help shape and prune the infant neural networks.

1.5. How do children with sensory disabilities become "attached"?

Berry Brazelton (1990) notes that "visual ability in the newborn has powerful adaptive significance, attaching the mother to her baby", while Warren (1994) comments: "There is no question whether the visually impaired infant is at risk of inadequate attachment".

Responding to the unexpected

For parents who have a child who is differently responsive from the infant they had expected to be parenting, such as through a disability, it is obvious to say that they are likely to find these early days, months, years a time of significant stress.

How parents, respond to such a change in circumstance and expectation can significantly impact upon the new-born infant. When parents / carers find themselves out of synchrony with their infants, much distress can follow. The video work of Colwyn Trevarthen showed this very clearly, as he inserted a delay in the video feedback of parental responses to their infants, leading to some very upset babies, who found that their mothers were no longer able to show the signs of attunement to their needs, necessary for healthy psychological and relational development (eg 1979).

As Gerhardt (2004) notes, "human babies are born with the expectation of having stress managed for them" (page 65). However, those infants whose interactive style is difficult to interpret or is different from the experience of the carers, may find that this is an expectation that is not met, or not met reliably.

1.6. How we can support parents and carers

We need to help parents in recognising their infant's communication, and developing the right ways to communicate with the infant.

The US Council for Exceptional Children (2003) notes: "early intervention that is focused on strengthening attachment between infants with visual impairment and their caregivers and family is recommended. Typically, very early intervention for infants with visual impairments and their families is directed to helping caregivers interpret communicative cues of their infants while also helping them use appropriate communication cues that may not be as dependent on intact vision."

It is this emphasis on supporting carers to recognise and celebrate their infant's communication that will be the core of so much of our work.

Eye contact

Pushing for eye contact is not always the best option.

I am reminded of a cautionary experience in my own early parenting of our disabled son and the care that is needed when we do offer advice to parents / carers.

One speech and language therapist was adamant that we should "work on eye contact" between our son and ourselves, instructing us that we should hold him at a distance of around twelve inches from our faces when we talk to him. While we tried this for a while, we also noticed that each time our son was held at a distance from us, he became very distressed, and subsequently, so did we.

We needed to go against this advice very consciously, as we realised that what our son actually needed was to be held very closely to my chest. In this position (where neither of us could see the other's face), he began to relax, I began to feel his movements and he mine. It wasn't eye contact that was required to promote our communication, but an ability to 'resonate' with each other, as we began to feel our way into a mutual understanding.

When eye contact does not work

When a child has not learned to make sense of his/her vision, it is not the best time to insist that eye contact should be the basis of shared communication. Instead, our role is to hold the development of attachment clearly in mind and support the parents in their recognition of their infant's different or more subtle signals for joint attention, such as through leaning towards, rather than pointing to an object.

Helping parents recognise and join those early 'proto-conversations', through talking about those things to which the infant seems to be giving attention, or helping them to be sensitive to the potential difficulties the infant or young child may have in getting the timing right for joining a 'conversation'.

Interpreting infants' reactions

Some parents may need reassuring that their child is interested in them.

The types of attachment outlined above include descriptions of children, insecurely attached, who withdrew from the mother as part of their repertoire of their attachment behaviour.

Some infants with vision impairment may become quiet as they listen for the approach of their carer, rather than smiling or becoming visibly excited as the carer enters the room. These purposeful, adaptive behaviours may be misinterpreted by the parent/carer as a personal rejection or a lack of interest.

Those parents, who may also be particularly vulnerable to depression following the birth of their disabled child, may need significant help to see these responses as signs their baby is really very interested in them and help to find non-visual means of cueing their baby to their presence.

1.7. Conclusions

As our knowledge of attachment has grown, so we understand that much of our work on helping children and their families to develop mutually effective social and communication skills has a direct bearing on the emotional health of very young children who have sensory impairments.

Two sides of the same coin

We know that children's views of their own worth is developed through their perceptions of other people's availability. We know that attachment and learning are two sides of the same coin - while a child's attachment needs are unmet, their abilities to and availability for learning is much reduced.

Children with significant sensory impairments are vulnerable to poor attachment and learning outcomes. One thing that is clear is that the ability to be a sensitive communication partner impacts far more widely than on the development of communication alone.

1.8. Further reading

Murray, L & Andrews L, (2005). The Social Baby

The Children's Project, Richmond, UK

Howe, D, Brandon, M, Hinings, D and Schofield, G (1999). Attachment Theory, Child Maltreatment and Family Support.

Palgrave, Hampshire, UK

Geddes, H (2006). Attachment in the Classroom.

Worth Publishing, London

Gerhardt, S (2004). Why Love Matters

Routledge

1.9. References

• Ainsworth, M. D. S., Blehar, M. C., Waters, E. & Wall, S. (1978) Patterns of Attachment: a psychological study of the Strange Situation Hillsdale, NJ: Lawrence Erlbaum

• Bowlby, J. (1969) Attachment & Loss, vol. 1, Attachment Paragon Press

• Brazelton, T. B. & Cramer, B. G. (1990) The Earliest Relationship Parents, Infants, And The Drama Of Early Attachment, Perseus Books Group, Inc

• Butterfield, P., Emde, R., Svejda, M. & Neiman, M. "Silver nitrate and the eyes of the newborn." In R. Emde and R. S. Harmon (eds.). (1982) The Development of Attachment and the Filiative Systems. New York: Plenum Publishing.

• Schore, A. N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc. (cited in, for example, Gerhardt, S. (2004), above)

• Trevarthen, C. (1979) Communication and co-operation in early infancy, in Bullowa, M. (ed.) Before speech: the beginnings of interpersonal communication, Cambridge University Press, (cited in, Howe, D., et alia (1999), above)

• US Council for Exceptional Children, (2003) Proposed Position Statement, Division on Visual Impairments, Council for Exceptional Children - May 10, 2003

• Warren, D. (1994) Blindness & Children: an individual differences approach New York, Cambridge University Press, in, Goodman, S. A. & Wittenstein, S. H. (2003) American Foundation for the Blind.

Part 2: Sensory integration

About this part

This part explores sensory integration. It looks at how our senses work together and what happens when they don't. This part provides some practical advice on sensory integration for professionals who support children with sensory integration difficulties.

This part is written by Gail Deuce. Gail is a qualified teacher of the deaf and has a M.Ed. in multi-sensory impairment. She currently works as a consultant teacher for Sense, a charity that provides advice, information, support and services for deafblind people, their families, carers and the professionals who work with them. Gail has over twenty years experience in the field of special education, working initially in schools for children with severe learning difficulties and then a school for the deaf before moving into peripatetic work focusing on learners who are deafblind.

Contents:

2.1 What are our senses?

2.2 Sensory Integration

2.3 Sensory Integration Dysfunction

2.4 Supporting Learning

2.5 Specialist Input

2.6 References

2.7 Further Reading

2.1. What are our senses?

If you were to ask people to name the human senses it is likely that they would identify the senses of vision, hearing, touch, taste and smell.

But we have two more senses: our sense of balance (vestibular sense); and the sensation from our tendons, joints and muscles that lets us know where each part of our body is and how it is moving (proprioceptive sense).

Balance

Our vestibular (balance) sense has a role in:

• detecting motion

• detecting and responding to gravity

• providing stability during body movement

• locating body parts and organising our body movements

• influencing muscle tone and posture

• facilitating crossing the midline (bilateral coordination)

• motor control, coordination and sequencing

• assisting with auditory and visual perception

• modulating arousal and alertness for attention and calming

(Hefner M and Davenport L (2002): CHARGE Foundation Manual).

Balance difficulties will affect all these areas and will clearly have an effect on the development of gross motor skills and walking.

They will also influence how we are able to use our vision and hearing.

Balance and vision

Balance problems can make it difficult to:

• maintain a stable visual field

• track moving objects smoothly

• define whether it is oneself or the object that is moving.

A child with balance difficulties may only be able to use their vision effectively when in a secure position. Some children also learn to use their vision to help them stay upright. They will need clear vertical markers to help them achieve this. (Ref: Brown, 2003).

Balance and hearing

Some children may need to move more to enable them to listen. But other children may not be able to listen when concentrating on moving and maintaining their balance. There is also research that suggests there is a link between balance and walking, and the development of language and the ability to process sound - for example, Travis and Thelin (2007).

Proprioception - where am I?

Our proprioceptive sense uses the sensations we receive from our muscles, joints and tendons to provide us with information about our body position, weight or pressure, our physical movements and changes of position in space, how we stretch and so on. It is this sense that allows us to constantly adjust our body position (for example, to stop us falling out of a chair) and use movements to operate on the world around us.

A poorly developed proprioceptive sense can lead to:

• poor core stability

• poor gross motor skills

• poor fine motor skills

• difficulty imitating movements

• bilateral coordination difficulties

• difficulty organising body movements

• difficulty using the body to act on the environment

• a need to stimulate the proprioceptive (and vestibular) sense by increased movement.

2.2. Sensory integration

It is important that we monitor and encourage the development of all of these senses in each individual child.

During each moment of our everyday life we all take in a continual stream of information simultaneously through our different senses. We then process that information and make an appropriate response.

Sensory integration is the process that "puts it all together" and allows us to sort out and use all this information so that we can engage in everyday life with relative ease and perform many actions and skills automatically.

2.3. Sensory Integration Dysfunction (Also known as Sensory Processing Disorder)

For most of us, sensory integration is an automatic process. However, there are a significant number of children who are not able to cope with and understand all the different sensory input they receive, or respond appropriately to these incoming sensations. This directly affects their ability to interact with the world around them. This difficulty is known as Sensory Integration Dysfunction (Anderson and Emmons, 2004).

Anecdotal evidence suggests that as many as 1 in 5 children in school experience difficulties with sensory integration. It is also recognised that these numbers increase in children with damaged neurological systems.

Research

There is no single accepted or commonly used definition of Sensory Integration Dysfunction to be found in literature.

From the 1960s to the 1980s, there was a significant amount of research that focussed on sensory dysfunction and sensory modulation problems (see Bogdashina, 2003). However, it is most prevalent today in the Occupational Therapy (OT) profession and literature, where the foundation was laid down by Jean Ayres. Original definitions considered the proprioceptive, vestibular and tactual senses, but more recent definitions now consider all the senses.

What impacts does Sensory Integration Dysfunction have?

During the process of sensory integration we all need to constantly decide which information to respond to and which to ignore. This can be extremely difficult for children with Sensory Integration Dysfunction. It will affect their ability to successfully use all the information being received simultaneously through their different sensory modalities, or make any appropriate responses.

Children with Sensory Integration Dysfunction may:

• show postural insecurity when sitting or standing

• enjoy strong rhythmic movements

• resist changes to body position

• show delay in fine/gross motor skills and poor head control

• experience difficulty with balance and poor saving reflexes

• have problems regulating arousal levels and fluctuate between being hypo-responsive and hyper-responsive

• attempt to gain information and make sense of the world through repetitive behaviours and actions

• seek behaviours to provide very strong sensory inputs

• develop adaptive behaviours

• have problems organising their movements and actions

• have difficulty engaging in constructive exploration

• only be capable of using certain sensory channels at any one time.

(Bogdashina, 2003; Brown, 2005 Deuce, 2002).

2.4. Supporting learning

What to consider

When working with a child who experiences Sensory Integration Dysfunction it is important to discover:

• what sensory components support or prevent the child's ability to do a task; and

• whether conflicting demands are being placed upon the child.

We also need to consider:

• whether we are working at the child's pace and giving the time needed to allow the child to take in the information, process it, formulate a response and then give the response

• in each learning situation whether a multi-sensory approach or uni-sensory approach is best

• whether there is appropriate therapy input, including a sensory integration programme

• developing strategies to help the child handle sensory overload

• developing strategies to manage fatigue

• what working positions are offered. Adapted furniture may need to be offered, including 'active seating' and

• facilities for safe rest periods.

Practical activities

Some practical activities that might be used to promote the proprioceptive and vestibular senses are:

• experiencing large movements and movement through space

• rolling/ bouncing on a physio ball

• swinging in a blanket/hammock/swing

• hydrotherapy

• rebound therapy

• 'rough and tumble' play

• increasing body awareness

• physiotherapy/ stretches

• massage

• 'Tac Pac' activities

• climbing/crawling over and under large pillows, bean bags, large apparatus, etc.

• firm handling/ hugs

• use of a weighted blanket/ waistcoat

• a secure, small learning environment.

2.5. Specialist input

We can all recognise and acknowledge the impact of sensory integration difficulties on a child's learning and compensate for this. However, only a specialist occupational therapist or physiotherapist with additional expertise in Sensory Integration Dysfunction (sensory processing disorder) can develop a remediation programme.

For some children, home and school-based activities are better than using special rooms with equipment. It might be that, rather than receiving pure sensory integration therapy in a specially designed room with specific equipment, a child may benefit more from the use of a sensory integration approach where the specialist occupational therapist or physiotherapist provides advice about activities that can be undertaken in the home and school environments.

This may include the development of a "sensory diet" that considers how the child is seeking to be "fed" through their different senses and how this can be provided in an acceptable way and at a level that they require.

2.6. References

• Anderson E and Emmons P (2004). Unlocking the Mysteries of Sensory Integration Dysfunction. Arlington, Texas: Future Horizons INC.

• Bogdashina O (2003). Sensory Perceptual issues in Autism and Asperger Syndrome: Different Sensory Experiences Different Perceptual Worlds. London: Jessica Kingsley Publishers.

• Brown D (2005). CHARGE Syndrome Behaviors: Challenges or adaptations? American Journal of Medical Genetics Part A 133(3). Published Online: 21 Jan 2005.

• Deuce G (2002). Sensory Integration Dysfunction in Deafblind Children. Dbi Review July- December

• Hefner M and Davenport L (2002). CHARGE Syndrome management Manual for Parents. CHARGE Foundation, USA.

• Travis L. and Thelin J (2007). Vestibular Function, Balance and Motor Development. 8th International CHARGE Syndrome Conference' Costa Mesa CA

2.7. Further Reading

• Ayres AJ (1979). Sensory integration and the Child. Los Angeles: Western Psychological Services.

• Hefner M and Davenport L (2002). CHARGE Syndrome management Manual for Parents. CHARGE Foundation, USA.

• Koomar J, Kranowitz C and Szlut S (2002). Answers to Questions Teachers Ask About Sensory Integration. Available from .

• Williams MS and Shellenberger S (1994). "How does your engine run?" A Leader's Guide to the Alert programme for Self-regulation.

• Albuquerque: Therapy Works INC. How does your engine run?

Part 3: Mobility and independence for children and young people with complex needs

About this part

In this part, we introduce some themes and models of working for developing mobility and independence in children and young people with complex needs. This guide covers Veronica Sherborne's programme of using movement to develop social, emotional and language skills. This programme looks at ways of including all children in movement education, but also takes a look at the particular needs of deafblind children. Finally, there is a section on wheelchair mobility, which offers hints and tips to friends, family members and support workers on the best way of handling journeys in a wheelchair with children and young people.

Contents

3.1 Movement in children with complex needs

3.2 Sherborne Developmental Movement

3.3 Wheelchair mobility

3.4 References

3.1. Movement in children with complex needs

Children with more complex needs may still be learning to move. In this context we need to review what we mean by independent movement:

"We do not use the term independent to mean someone who can do everything for themselves, but to indicate someone who has taken control of their life and is choosing how that life is led - the most important factor is not the amount of physical tasks a person can perform, but the amount of control they have over their everyday routines. The degree of disability does not determine the amount of independence achieved." (Swain et al, 2004)

"Developmental movement play"

For all children, "during the early years, movement is food for the developing system and the opportunities we provide comprise the diet" (Greenland, 2006). Through the charity JABADAO, Penny Greenland has promoted the concept of Developmental Movement Play, providing developmentally appropriate activities which include:

• floor play, tummy and back play, rolling over and over

• belly crawling and crawling

• pushing, pulling, stretching, hanging, sliding

• spinning, tipping, tilting, falling.

Helping children move

Do we give all our children the opportunity for movement experiences of this kind, including children with a vision impairment, and children who spend much of their day supported in a variety of equipment, such as wheelchairs and standing frames?

Fraiberg commented that "if the developmental principles are not available to the parents or the educator, there is great peril for the baby in finding the route towards mobility" (Fraiberg, 1977).

Children will be ready to go, but with no place to go: their motor impetus will be exercised in a vacuum, maybe through compensatory movements such as rocking. Reaching out to explore and learn through movement recognises the importance of coming alive to yourself, to others and to the world around.

3.2. Sherborne Developmental Movement

This section has been written with the help of Stephen Cullingford-Agnew, specialist in PE and movement. It focuses on working with pupils who have severe and profound multiple learning difficulties and vision impairment.

Benefits of teaching movement

Including all children within physical education lessons has always provided teachers with a challenge. Much of modern-day gymnastics has centred on the work of Rudolph Laban, especially the motion factors into which all movements and expressions can be analysed. Laban himself recognised that four different aspects of how we move do not only distinguish movement. He wrote:

"Movement is a feature of all man's activities...Through the movements of our bodies we can learn to relate the inner-self to the outer world." (Laban 1948)

These additional elements might include:

• communication

• constructing relationships with others

• self-confidence

• self-knowledge

• meeting social and emotional needs.

Laban further developed theories of natural movement within young children. He noted that living within an environment in which these are suppressed may adversely affect self-confidence, and diminish the ability to relate to the environment and to other people. This is especially pertinent to pupils with severe, profound and multiple learning difficulties and pupils who are deafblind or multi-sensory impaired (MSI).

What is Sherborne Movement?

Veronica Sherborne, a student of both Rudolph Laban and Lisa Ullmann, used this movement analysis to construct her theories of developmental movement. These approaches are widely used with children with special educational needs throughout the world.

"Through my experience of teaching and observing human movement, and learning through trial and error, I have come to the conclusion that all children have two basic needs; they need to feel at home in their own bodies, and so gain mastery, and they need to be able to form relationships." (Sherborne, 1990)

The developmental approach was fundamentally built upon basic objectives.

Awareness of self:

• body awareness

• spatial awareness

• confidence in self and a positive self image.

Awareness of others:

• relationships with a partner

• the three elements of relationships in movement

• trust and confidence in self and others.

The movement approach encourages teachers and teaching assistants to use their own bodies as a flexible tool that allows the pupils to crawl under bridges or be rocked on backs etc. It assists pupils to test and develop strength and stability by pushing against a partner. The teacher can assess these qualities of movement, however small, and skills can be developed over a period of time.

It is the realisation that movement can be used to develop relationships and communication - in order to feel a sense of wholeness and not to be concerned only about the movement of separate parts of the body - that sets it apart from other approaches to PE.

Veronica Sherborne's Movement Analysis

This analysis of movement adopted much of the work of Laban, but an emphasis has been placed upon the importance of relationships in movement. These relationships are defined as:

• With-Relationships: the ability to contain, support and use free-flow from a caregiver, or from one caregiver to another. Building a rapport between partners.

• Shared-Relationships: a Shared-Relationship is one in which partners alternately support each other and demonstrates confidence in the partner and in him/herself.

• Against-Relationships: to help the child to focus, channel energy and develop determination. It is important that a child learns to discover and control strength in an appropriate way.

Case study: using Sherborne

I adopted Sherborne Developmental Movement very early in my teaching career, as I had never previously come across an approach that was applicable and accessible for all pupils, including those at the earliest levels of development. The approach builds upon developing self-awareness and an awareness of others.

I worked with a pupil with severe learning difficulties, vision impairment and challenging behaviour for two years. During this period he would shun the contact of others and actively keep his distance, avoiding all types of contact.

After two years of intervention, he put his hands up to be swung. This action developed into further active communications in which he allowed others to be close and allowed him to relax in their presence. The approach not only assisted him to explore further opportunities for communication across the curriculum, it also meant that his life opportunities in adult life, moving into a residential care home, were enhanced.

What can children learn through Sherborne movement?

The benefits of developing shared learning opportunities in movement, including relationships, can be found in the following areas:

• social and emotional skills

• awareness that our feelings vary in intensity

• accept that others have feelings as well as ourselves

• awareness that feelings refer to different things

• we can label and experience feelings using a shared understanding

• understand that all people can feel the same range of emotions

• understand that our actions can affect the feelings of others

• help to distinguish between accidental and deliberate actions

• develop empathy

• develop the skills to wait for what we want

• we take turns and share

• understand and use non-verbal communication as effectively as possible

• respond to emotions in others effectively

• develop skills of negotiation.

It is debatable whether a special educational needs approach is only relevant to children with special educational needs, or has valid applications for all children. It is now beginning to be accepted that inclusive teaching strategies may benefit all children, both in terms of acquisition of skills, and also knowledge and understanding of the world.

Movement needs to be accepted as a vehicle for communication, and is a "conversation" that goes back to the fundamental interactions between people or between a parent/carer and child.

Difficulties in infants who are deafblind

Research has indicated that infants who are deafblind may demonstrate a number of developmental difficulties. These can include:

• decreased reciprocity, joint attention, and mutual enjoyment in interactions - delays in achieving secure attachment

• adoption of a passive-recipient role, eg increased self-stimulatory behaviours (rocking, eye poking, hand flicking)

• fewer "less readable" early signals

• a restricted repertoire of pre-verbal communicative behaviours and functions.

Clearly these characteristics have an impact on the quality of caregiver - infant interactions. (D. Chen, M. Haney, 1995)

Therefore, we need to develop opportunities to develop these skills from a very early age and provide training for parents/carers to become aware of the range of activities that will provide stimulating movement experiences and hopefully assist bonding.

How Sherborne can help

Sherborne Developmental Movement should assist the pupil to:

• feel safe and secure, and compensate for the impact of sensory impairment

• develop abilities to express choice, however basic, and to have this choice recognised through bodily reaction, gestures and vocalisations

• begin to be able to predict and understand the structure of movement sessions.

These fundamental skills are ones that develop in all young children, but will require nurturing for many pupils with vision impairment.

Through resonance, co-active movements, and mutual responsiveness, the basis of a social relationship, attachment, bonding and communication is laid:

"…the child will become a human being; this means a person with a past, present and future." (van Dijk)

The Sherborne Movement Approach is still widely used both in this country and abroad. Its longevity as an approach is its invaluable contribution to the inclusion of all pupils in physical education - movement.

Long term

The pupils often begin to relax, and enjoy the experiences provided - they are often pupils whom teachers and teaching assistants find a challenge to include in movement sessions. This might take years for some pupils to achieve, but if we consider the complexity of what we are asking then every moment along that path is so important in the lives of the pupils we work with and their parents/carers.

Involving other children in delivering Sherborne

When running courses for school staff Stephen very often works with pupils from the school as part of the course structure. This can immediately encourage the staff by demonstrating how their own pupils can enjoy and benefit from Sherborne activities. Similarly, it can be very helpful in terms of inclusion, relationship building and peer-support to involve young people from mainstream schools in lessons with pupils doing Sherborne movement.

The following is an extract written by a 12 year old pupil from a middle school, about their movement classes with children with severe learning difficulties:

"PE with the Whittlesea children was a lot different to a normal PE lesson, because in a usual lesson we don't have to work as hard, but with the Whittlesea kids we were teaching them. We did all different activities: bumpy rides, bridges, trying to push each other over when we were in a strong position and more. I think that Sherborne PE is very good for the children. It's not only good for the Whittlesea kids, it's also good for us."

3.3. Wheelchair mobility

Children and young people who have difficulty seeing, and who also use a wheelchair, can benefit enormously from well thought out journeys. With planning and a few basic safety tips, real meaning and enjoyment can be added to even the simplest trip.

The mobility of a child with vision impairment is no less significant if they use a wheelchair. Careful consideration should be made of the child's experience of movement and journeys. It is positive if children and adults can work towards a level of awareness, understanding and active participation in mobility, regardless of the means of travel.

Safety considerations - "B and B"

• Belts: If a safety lap strap is used, make sure that it is done up and is tight enough.

• Brakes: If a chair is not moving the brakes should be on.

Before you start - considering the journey

A wheelchair journey needs to be more than a person being pushed from one place to another.

• Think ahead. Plan your time, so that the journey contains the right amount of information with enough time to take it all in.

• Some people need very much more time than others. Know the needs of the person you are with.

• Wheelchairs are badly sprung - push with comfort in mind.

• It is best to go quite slowly, most of the time. (There is a time for going quickly but carefully eg sports day.)

• Try very hard not to bump into things.

• Avoid going backwards, and give a warning when you have to.

• Let the wheelchair user do as much as they can themselves, eg use the door handle, apply brakes, propel themselves.

• Repeating and reversing a route helps build up the concept of travel, when it is hard to understand.

Starting

• Use the person's name first when you speak to them.

• Say who you are.

• If they have a choice, ask where they would like to go.

• Tell them where you are both going if there is no choice, and ask them to indicate the way if they know it.

• Say when you are starting.

Along the way

• If you can, keep a hand on the wheelchair user's back, they will feel less isolated.

• Try not to let the wheelchair user's feet or chair hold the door open.

• Find suitable landmarks along the way to give the route a sequence and more meaning. Allow the wheelchair user time to feel the landmarks.

• If there are clues as to where you are, give them a name - eg cooking smells 'by the kitchen'.

• Give a commentary with words at the right level, but also know when to be quiet. Take time to listen.

• Before you move to the left or right, say the direction, and reinforce it with a tap on the appropriate shoulder.

• Make direction changes obvious where possible.

• Say 'slope up' or 'slope down' if appropriate.

Finishing

• Say when you have arrived.

• Put the brakes on.

• A verbal recap as soon as you have arrived can help reinforce the sequence and meaning of the journey.

Understanding the experience

If you can, travel in a wheelchair yourself, when under blindfold.

Make sure that the person pushing you ignores you and pushes you badly (but safely) for the first part of your journey. For the second part of your journey, your pusher could follow these guidelines.

3.4. References

Fraiberg, S (1977) Insights from the Blind: Comparative Studies of Blind and Sighted Infants. New York, Basic Books

Swain, J et al (eds) (2004) Disabling Barriers - Enabling Environments. London, Sage

D. Chen, M. Haney (1995) An Early Intervention Model for Infants who are Deafblind Journal of Visual Impairment & Blindness.

Laban, R (1988) Modern Educational Dance. Northcote House Publishers: London.

Laban, R (1980) Mastery of Movement. Northcote House Publishers: London.

Sherborne, V. (1990) Developmental Movement for Children. Cambridge University Press.

van Dijk, Jan, Dr. & Nelson, Catherine (2001) Child-guided Strategies for Assessing Children who are Deafblind or have Multiple Disabilities [CD-ROM] --The Netherlands: AapNootMuis Educainment.

4: Further guides

The full Complex Needs series of guides includes:

• Special Schools and Colleges in the UK

• Functional Vision and Hearing Assessments

• Communication: Complex needs

• Working with complex needs in the classroom

• The Staff team

• Understanding complex needs

In addition, you may also be interested in the following series of guides, all of which are relevant to children, young people and families:

• Supporting Early Years Education series

• Removing barriers to learning series

• Complex needs series

• Further and Higher education series

We also produce a Teaching National Curriculum Subjects guide, and a number of stand-alone guides, on a range of topics. Please contact us to find out what we have available.

All these guides can be found in electronic form at .uk/educationprofessionals For print, braille, large print or audio, please contact the RNIB Children, Young people and Families (CYPF)Team at cypf@.uk

For further information about RNIB

Royal National Institute of Blind People (RNIB), and its associate charity Action for Blind People, provide a range of services to support children with visual impairment, their families and the professionals who work with them.

RNIB Helpline can refer you to specialists for further advice and guidance relating to your situation. RNIB Helpline can also help you by providing information and advice on a range of topics, such as eye health, the latest products, leisure opportunities, benefits advice and emotional support.

Call the Helpline team on 0303 123 9999 or email helpline@.uk

If you would like regular information to help your work with children who have vision impairment, why not subscribe to "Insight", RNIB's magazine for all who live or work with children and young people with VI.

Information Disclaimer

Effective Practice Guides provide general information and ideas for consideration when working with children who have a visual impairment (and complex needs). All information provided is from the personal perspective of the author of each guide and as such, RNIB will not accept liability for any loss or damage or inconvenience arising as a consequence of the use of or the inability to use any information within this guide. Readers who use this guide and rely on any information do so at their own risk. All activities should be done with the full knowledge of the medical condition of the child and with guidance from the QTVI and other professionals involved with the child. RNIB does not represent or warrant that the information accessible via the website, including Effective Practice Guidance, is accurate, complete or up to date.

Guide updated: April 2014

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