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The National Information Clearinghouse

On Children Who Are Deaf-Blind

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Helen Keller National Center

Hilton/Perkins Program Perkins School for the Blind
Teaching Research Institute
Revised October 2008

Overview on Deaf-Blindness
By Barbara Miles, M.Ed.

What Is Deaf-Blindness?
It may seem that deaf-blindness refers to a total inability to see or hear. However, in reality
deaf-blindness is a condition in which the combina tion of hear ing and visual losses in children
cause such severe communication and other developmental and educational needs that they cannot be ac com mo dated in spe cial ed u ca tion
programs solely for children with deafness or children with blindness" ( 34 CFR 300.8 ( c ) ( 2 ), 2006)
or multiple disabilities. Children who are called
deaf-blind are singled out educationally because
impairments of sight and hearing require thoughtful and unique educational approaches in order to
ensure that children with this disability have the
opportunity to reach their full potential.

Who Is Deaf-Blind, and What are

the Causes of Deaf-Blindness?
As far as it has been possible to count them, there
are over 10,000 children (ages birth to 22 years) in
the United States who have been clas si fied as
deaf-blind (NCDB, 2008). It has been estimated
that the adult deaf-blind population numbers 3540,000 (Wat son, 1993). The causes of deafblindness are many. Below is a list of many of the
possible etiologies of deaf-blindness.

Major Causes of Deaf-Blindness

Syndromes
t Down

t Trisomy 13

A person who is deaf-blind has a unique experience of the world. For people who can see and
hear, the world extends outward as far as his or her
eyes and ears can reach. For the young child who is
deaf-blind, the world is initially much narrower. If
the child is profoundly deaf and totally blind, his
or her experience of the world extends only as far
as the fingertips can reach. Such children are effectively alone if no one is touch ing them. Their concepts of the world depend upon what or whom
they have had the opportunity to physically contact.

t Usher

If a child who is deaf-blind has some usable vision

and/or hearing, as many do, her or his world will
be enlarged. Many children called deaf-blind have
enough vision to be able to move about in their environments, recognize familiar people, see sign
language at close distances, and perhaps read large
print. Others have sufficient hearing to recognize
familiar sounds, understand some speech, or develop speech themselves. The range of sensory impairments included in the term deaf-blindness is
great.

Congenital Prenatal Dysfunction

Multiple Congenital Anomalies

t CHARGE Association t F e t a l a l c o h o l s y n-

drome
t Hydrocephaly

t Maternal drug abuse

t Microcephaly

Prematurity

t AIDS

t Herpes

t Rubella

t Syphilis

t Toxoplasmosis

Post-natal Causes
t Asphyxia

t Encephalitis

t Head injury/trauma

t Meningitis

t Stroke
Adapted from Etiologies and Characteristics of DeafBlindness Heller & Kennedy,(1994), p. viii, Table 1.

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Some people are deaf-blind from birth. Others may

be born deaf or hard-of-hearing and become blind
or visually impaired later in life; or the reverse may
be the case.
Still others may be adventitiously deaf-blindthat
is, they are born with both sight and hearing but
lose some or all of these senses as a result of accident or illness.
Deaf-blindness is often accompanied by additional
disabilities. Causes such as maternal rubella can
also affect the heart and the brain. Some genetic
syn dromes or brain in ju ries that cause deafblindness may also cause cognitive disabilities
and/or physical disabilities.

What are the Challenges Facing

a Person who is Deaf-Blind?
A person who is deaf-blind must somehow make
sense of the world using the limited information
available to him or her. If the persons sensory disabilities are great, and if people in the environment
have not made an effort to order the world for him
or her in a way that makes it easier to understand,
this challenge may be overwhelming. Behavioral
and emotional difficulties often accompany deafblindness and are the natu ral out comes of the
childs or adults inability to understand and communicate.
People who can see and hear often take for granted
the information that those senses provide. Events
such as the approach of another person, an upcoming meal, the decision to go out, a change in routine
are all signaled by sights and sounds that allow a
person to prepare for them. The child or adult who
misses these cues because of limited sight and/or
hearing may come to experience the world as an
unpredictable, and possibly threatening, place. To
a great extent, persons who are deaf-blind must depend upon the good will and sensitivity of those
around them to make their world safe and understandable.
The challenge of learning to communicate is perhaps the greatest one that children who are deafblind face. It is also the greatest opportunity, since
communication and language hold the power to
make their thoughts, needs, and desires known.
The ability to use words can also open up worlds
beyond the reach of their fingertips through the
use of interpreters, books, and an ever-increasing
array of electronic communication devices. In order to learn language, children who are deaf- blind
must depend upon others to make language accessible to them. Given that ac cessibility, children
who are deaf-blind face the challenges of engaging
in interactions to the best of their abilities and of
availing themselves of the language opportunities
provided for them.

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A person who is deaf-blind also faces, further, the

challenge of learning to move about in the world as
freely and independently as possible. Adult individuals also must eventually find adult living and
work situations that allow them to use their talents
and abilities in the best way possible. Many adults
who are deaf- blind lead in de pend ent or semiindependent lives and have productive work and
enjoyable social lives. The achievement of such
success depends in large part upon the education
they have received since childhood, and particularly upon the communica tion with others that
they have been able to develop.

What are the Particular

Challenges Facing the Family,
Teachers and Caregivers of a
Person who is Deaf-Blind?
Communication
The disability of deaf-blindness presents unique
challenges to families, teachers, and caregivers,
who must make sure that the person who is deafblind has access to the world beyond the limited
reach of his or her eyes, ears, and fingertips. The
people in the environment of children or adults
who are deaf-blind must seek to include
themmoment-by-momentin the flow of life
and in the physical environments that surround
them. If they do not, the child will be isolated and
will not have the opportunity to grow and to learn.
If they do, the child will be afforded the opportunity to develop to his or her fullest potential.
The most important challenge for parents, caregivers, and teachers is to communicate meaningfully
with the child who is deaf-blind. Continual good
communication will help foster his or her healthy
de vel op ment. Com mu ni ca tion in volves much
more than mere language. Good communication
can best be thought of as conversation. Conversations employ body language and gestures, as well
as both signed and spoken words. A conversation
with a child who is deaf-blind can begin with a
partner who simply notices what the child is paying attention to at the moment and finds a way to
let the child know that his or her interest is shared.
This shared interest, once established, can become
a topic around which a conversation can be built.
Mutual conversational topics are typically established between a parent and a sighted or hearing
child by making eye contact and by gestures such
as pointing or nodding, or by exchanges of sounds
and fa cial ex pres sions. Lack ing sig nifi cant
amounts of sight and hearing, children who are
deaf-blind will often need touch in order for them
to be sure that their partner shares their focus of attention. The parent or teacher may, for example,
touch an interesting object along with the child in a
nondirective way. Or, the mother may imitate a
Overview on Deaf-Blindness

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childs movements, allowing the child tactual access to that imitation, if necessary. (This is the tactual equiva lent of the actions of a mother who
instinctively imitates her childs babbling sounds.)
Establishing a mutual interest like this will open
up the possibility for conversational interaction.
Teachers, parents, siblings, and peers can continue
conversations with children who are deaf-blind by
learning to pause after each turn in the interaction
to al low time for response. These chil dren frequently have very slow response times. Respecting
the childs own timing is crucial to establishing
successful interactions. Pausing long enough to allow the child to take another turn in the interaction, then responding to that turn, pausing again,
and so onthis back-and-forth exchange becomes
a conversation. Such conversations, repeated consistently, build relationships and become the eventual basis for language learning.
As the child who is deaf-blind becomes comfortable interacting nonverbally with others, she or he
becomes ready to receive some form of symbolic
communication as part of those interactions. Often
it is help ful to ac com pany the in tro duc tion of
words (spoken or signed) with the use of simple
gestures and/or objects which serve as symbols or
representations for activities. Doing so may help a
child develop the understanding that one thing can
stand for another, and will also enable him or her
to anticipate events.

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t Signed English

t Pidgin Signed English

t braille writing and

t Tadoma method of

reading
t American Sign

speech reading
t large print writing

Language

and reading

t lip-reading speech

Along with nonverbal and verbal conversations, a

child who is deaf-blind needs a reliable routine of
meaningful activities, and some way or ways that
this routine can be communicated to her or him.
Touch cues, gestures, and use of object symbols are
some typical ways in which to let a child who is
deaf-blind know what is about to happen to her or
him. Each time before the child is picked up, for example, the caregiver may gently lift his or her arms
a bit, and then pause, giving the child time to ready
herself or himself for being handled. Such consistency will help the child to feel secure and to begin
to make the world predictable, thus allowing the
child to develop expectations. Children and adults
who are deaf-blind and are able to use symbolic
communication may also be more reliant on predictable routine than people who are sighted and
hearing. Predictable routine may help to ease the
anxiety which is often caused by the lack of sensory information.

Orientation and Mobility

Think of the many thousands of words and sentences that most children hear before they speak
their own first words. A child who is deaf-blind
needs comparable language stimulation, adjusted
to his or her ability to receive and make sense of it.
Parents, caregivers, and teachers face the challenge
of providing an environment rich in language that
is meaningful and accessible to the child who is
deaf-blind. Only with such a rich language environment will the child have the opportunity to acquire language herself or himself. Those around
the child can create a rich language environment
by continually commenting on the childs own experience using sign language, speech, or whatever
symbol system is accessible to the child. These
comments are best made during conversational interactions. A teacher or a parent may, for example,
use gesture or sign language to name the object
that he or she and the child are both touching, or
name the movement that they share. This naming
of objects and actions, done many, many times,
may begin to give the child who is deaf-blind a
simi lar op por tu nity af forded to the hear ing
childthat of making meaningful connections between words and the things for which they stand.

In addition, the child who is deaf-blind will need

help learning to move about in the world. Without
vision, or with reduced vision, he or she will not
only have difficulty navigating, but may also lack
the motivation to move outward in the first place.
Helping a young child who is deaf-blind learn to
move may begin with thoughtful attention to the
physical space around him or her (crib or other
space) so that whatever movements the child instinctively makes are rewarded with interesting
stimulation that motivates further movement. Orientation and mobility specialists can help parents
and teach ers to con struct safe and mo ti vat ing
spaces for the young child who is deaf-blind. In
many instances children who are deaf-blind may
also have additional physical and health problems
that limit their ability to move about. Parents and
teachers may need to include physical and occupational therapists, vision teachers, health professionals, and orientation and mobility specialists on
the team to plan accessible and motivating spaces
for these children. Older children or adults who
have lost vision can also use help from trained specialists in order to achieve as much confidence and
independence as possible in moving about in their
world.

Principal communication systems for persons who

are deaf-blind are these:

Individualized Education

t touch cues

t gestures

t object symbols

t picture symbols

t sign language

t fingerspelling

Overview on Deaf-Blindness

Education for a child or youth with deaf-blindness

needs to be highly in di vidu al ized; the lim ited
channels available for learning necessitate organizing a program for each child that will address the
childs unique ways of learning and his or her own
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interests. Assessment is crucial at every step of the

way. Sensory deficits can easily mislead even experienced educators into underestimating (or occa sion ally over es ti mat ing) in tel li gence and
constructing inappropriate programs.
Helen Keller said, Blindness separates a person
from things, but deafness separates him from people. This potential isolation is one important reason why it is necessary to engage the services of
per sons fa mil iar with the com bi na tion of both
blindness and deafness when planning an educational program for a child who is deaf-blind. Doing
so will help a child or youth with these disabilities
receive an education which maximizes her or his
potential for learning and for meaningful contact
with her or his environment. The earlier these services can be obtained, the better for the child.

Transition
When a person who is deaf-blind nears the end of
his or her school-based education, transition and
reha bili ta tion help will be re quired to as sist in
planning so that as an adult the individual can find
suitable work and living situations. Because of the
diversity of needs, such services for a person who
is deaf-blind can rarely be provided by a single
person or agency; careful and respectful teamwork
is required among specialists and agencies concerned with such things as housing, vocational and
rehabilitation needs, deafness, blindness, orientation and mo bil ity, medi cal needs, and men tal
health.
The adult who is deaf-blind must be central to the
transition planning. The individuals own goals,
directions, interests, and abilities must guide the
planning at every step of the way. Skilled interpreters, family members and friends who know
the person well can help the adult who is deafblind have the most important voice in planning
his or her own future.

Inclusion in Family
Clearly, the challenges for parents, teachers and
care giv ers of chil dren who are deaf- blind are
many. Not least among them is the challenge of including the child in the flow of family and community life. Since such a child does not necessarily
respond to care in the ways we might expect, parents will be particularly challenged in their efforts
to include her or him. The mother or father of an infant who can see is usually rewarded with smiles
and lively eye contact from the child. The parent of
a child who is deaf-blind must look for more subtle
rewards: small hand or body movements, for instance, may be the childs way of expressing pleasure or connection. Parents may also need to change
their perceptions regarding typical developmental
milestones. They can learn, as many have, to rejoice as fully in the ability of their child who is
deaf-blind to sign a new word, or to feed herself, or
to return a greeting as they do over another childs

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college scholarship or success in basketball or election to class office.

Parents, then, may need to shift expectations and
perceptions in significant ways. They also need to
do the natural grieving that accompanies the birth
of a child who is disabled. Teachers and caregivers
must also make these perceptual shifts. Parents
groups and re sources for teach ers can provide
much-needed support for those who live and work
with children and adults who are deaf-blind. Such
supports will help foster the mutually rewarding
inclusion of children who are deaf-blind into their
families and communities. (See section below for
resources.)

Summary
Though deaf- blindness pres ents many unique
challenges to both those who have visual and hearing im pair ments and to their care giv ers and
friends, these challenges are by no means insurmountable. Many per sons who are deaf-blind
have achieved a quality of life that is excellent. The
persons who are deaf-blind who have high quality
lives have several things in common.
First, they have each, in their own way, come to accept themselves as individuals who have unique experiences of the world, and valuable gifts to share.
This fundamental acceptance of self can occur regardless of the severity of the particular sensory
losses or other challenges that a person has. Second,
they have had educational experiences which have
helped them maximize their abilities to communicate and to function productively. Finally, these
happy, involved persons who are deaf-blind live in
families, communities, or social groups that have an
at ti tude of wel com ing ac cep tance. They have
friends, relatives, and co-workers who value their
presence as individuals with significant contributions to make to the world around them. For these
persons with limited sight and hearing, and for those
near them, deaf-blindness fosters opportunities for
learning and mutual enrichment.
References
The National Consortium on Deaf-Blindness (2008). 2007
National child count of children and youth who are
deaf-blind. Monmouth: Teaching Research Division.
Wolff Heller, K. & Kennedy, C. (1994). Etiologies and
characteristics of deaf-blindness. Monmouth: Teaching
Research Publications.
Watson, D., & Taff-Watson, M. (Eds.), (1993). Second edition. A model service delivery system for persons who
are deaf-blind. Arkansas: University of Arkansas

Barbara Miles is a communication specialist/consultant and

teacher, experienced with all ages and levels of persons who are
deaf-blind. She has taught regional, national and international seminars on communication issues for children who are deaf-blind. Her
articles have been published in the Journal of Vision Impairments
and Blindness, Deafblind Education, and regional newsletters.
Overview on Deaf-Blindness

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What Help is Available for Families, Caregivers and Teachers of Children

and Adults who are Deaf-Blind?
American Association of the Deaf-Blind (AADB)
8630 Fenton Street, Suite 121
Silver Spring, MD 20910-3803
TTY (301) 495-4402, Voice (301) 495-4403
Fax (301) 588-8705
aadb-info@aadb.org
http://www.aadb.org
AADB is a national consumer advocacy organization that promotes better opportunities and services for deaf-blind people.

Helen Keller National Center for Deaf-Blind

Youths and Adults (HKNC)
141 Middle Neck Road
Sands Point, NY 11050-1299
Phone (800) 255-0411 ext. 326, Fax (516) 944-7302
TTY (516) 944-8900 ext. 326
hkncinfo@hknc.org
http://www.hknc.org
HKNC is a national program that provides evaluation, short-term comprehensive vocational rehabilitation training, work experience training and
assistance to deaf-blind clients for job and residential placements.

National Consortium on Deaf-Blindness (NCDB)

Teaching Research Institute
345 N. Monmouth Ave.
Monmouth, OR 97361
Phone (800) 438-9376, Fax (503) 838-8150
TTY (800) 854-7013
info@nationaldb.org
http://www.nationaldb.org
NCDB works collaboratively with families, federal, state and local agencies to provide technical
assistance, information and personnel training.
NCDB brings together the resources of three agencies with long histories of expertise in the field of
deaf-blindness and is home to DB-LINK.

National Family Association for Deaf-Blind

(NFADB)
141 Middle Neck Road
Sands Point, NY 11050
Phone (800) 255-0411, Fax (516) 883-9060
TTY (800) 255-0411
nfadb@aol.com
http://www.nfadb.org

Overview on Deaf-Blindness

NFADB is a national network of families who focus on issues surrounding deaf-blindness. NFADB
advocates for all persons who are deaf-blind, supports national policy to benefit people who are
deaf-blind, and en cour ages the found ing and
strength en ing of fam ily or ga ni za tions in each
state.

Training and Educational Resources Program

Perkins School for the Blind
175 North Beacon Street
Watertown, MA 02472
Phone (617) 972-7519, Fax (617) 923-8076
betsy.mcginnity@perkins.org
http://www.perkins.org/
The Training and Educational Resources Program
provides information, training, and educational
resources to families and professionals throughout
the nation. Emphasis is on families and professionals in volved with chil dren and youth who are
blind, visually impaired, and deafblind, including
those with additional disabilities.

U.S. Department Of Education, Office of Special

Education Federal Deaf-Blind Programs (326C
Grants)
Office of Special Education and Rehabilitation Services
Research to Practice Division
Elementary and Middle School
550 12th Street, SW - PCP-4086
Washington, DC 20202-2600
Attn: Anne Smith, Ed.D., Project Officer
Phone (202) 245-7529, Fax (202) 245-7617
anne.smith@ed.gov
h t t p : / / w w w . e d . g o v / a b o u t / o ffices/list/osers/osep
The Office of Special Education Programs supports
projects to improve and enhance services that are
provided by state and local education agencies to
children and youth who are deaf-blind. This is
done through a program of grant awards that address technical assistance, research, development,
pre-service and in-service training, and parental
involvement activities.

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Please feel free to copy this pub li ca tion

with the ap pro pri ate ci ta tions. For ad di tional cop ies or cop ies in al ter na tive for mats, con tact DB-LINK at NCDB.

This ar ti cle is avail able on the web at

http://www.nationaldb.org/NCDBProducts.php

For additional resources on all aspects of

deaf-blindness, see the Selected Topics section of
the NCDB Website:
http://www.nationaldb.org/ISSelectedTopics.php

NCDB
345 N. Mon mouth Ave
Mon mouth, OR 97361
Voice (800) 438- 9376
TTY: (800) 854- 7013
Fax:
(503) 838-8150
info@nationaldb.org
http:/nationaldb.org

Funded through award #H326T060002 by the U.S. Department of Education, OSERS, OSEP. The opinions and policies expressed by this publication
do not necessarily reflect those of The Teaching Research Institute, or the
U.S. Department of Education.

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Overview on Deaf-Blindness