Working with children who are deafblind/multi sensory impaired

The following approaches are key in working with children who are deafblind/multi-sensory impaired (MSI):

Build trust

  • A child looking upwards at her handChildren who are deafblind/MSI may only be aware of other people when they are very close to them, so they take time to develop relationships. Work closely enough for children to pick up information about you through smell, touch and warmth, as well as sight and hearing
  • Limit the number of different people working with the child, and use personal identifiers - a particular bracelet, for example, which one adult always wears and shows to the child, and a particular song or gesture they always use in greeting
  • Be alert to very small signals from the child (changes in breathing pattern, for example), and always respond in a way that the child can pick up
  • Never assume that children know who is with them unless you have specifically told them, and never leave children without telling them that you are going

Be consistent

  • Children who are deafblind/MSI receive so little information from the world around them that events need to happen consistently if they are to make sense. Personal identifiers, for example, must be used every time the child and adult meet
  • Use routines - carry out dressing, getting ready for dinner, saying goodbye, in exactly the same way each time, in the same place, with the same person if possible, using the same objects. Only introduce changes when you are sure that the child recognises and understands the routine
  • Keep furniture in the same places and don't leave bags or other clutter lying around. If children trip or bump into things when they try to explore, they will learn not to explore or move independently

Help understanding

  • Tell children what is happening, and going to happen, in a way that they can understand.  Cues, such as an armband for swimming or a particular song, can be used to mark the beginnings and ends of events and to identify activities. Some children will use speech or signing or other communication modes - but all need help to anticipate what will happen next
  • Give access to activities by letting children touch, smell, taste, hold their hands over or under yours, whilst you make a drink, mix the paint, or put the toothpaste on the toothbrush. It takes much longer but gives the child a chance to understand the activity

Take time

  • Using limited residual vision or hearing is tiring and very slow. Using touch for information is incredibly slow compared to sight. Children who are deafblind/MSI will take much longer to receive, process and respond to information - think of half hearing a remark someone has made, then realising what they have said a moment later, or trying to find a torch by touch in a power cut
  • Missing out a stage of a routine because you are running late may stop the child recognising the activity. Making children hurry may mean that they get too little information to make sense of events

Follow the child

  • Give control to the child wherever possible - many children learn that they cannot affect what happens to them, and so give up trying, and hence learning
  • Children who are deafblind or have sensory impairments may respond to signals that sighted hearing adults do not even notice - the draught from an open door, for example. Try to understand children's behaviour and to show them the significance of the information they receive
  • Respond to signals that mean the child wants to finish an activity, or to continue or change it. Give choices wherever possible

Be supportive

  • Working with children who are deafblind/MSI can be stressful. Being a child who is deafblind/MSI is far more stressful. Multi-sensory impairment frequently causes isolation, confusion and fear. Withdrawal or apparent aggression may be reasonable responses to a crowded environment, someone approaching too suddenly or too many changes
  • Using limited sight and hearing, or operating without sight or hearing, is tiring and often frustrating. Children will need frequent breaks. Conventional play activities may well be demanding rather than relaxing - children will need to relax in their own way

First published: Monday 28 May 2012
Updated: Monday 26 June 2017