মুখ্য AAESPH Review Sam's Day: A Simulated Observation of a Severely Handicapped Child's Educational Program
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Sam's day: A simulated observation of a severely handicapped child's educational program Michael D. Orlansky This article describes several instructional activities as they might be conducted with a hypothetical severely/profoundly handicapped child. The educational procedures are critically discussed, and suggestions are offered. Teachers, administrators, and teacher educators are encouraged to periodically review and evaluate their programs, and to consider whether or not the instruction is effectively meeting the needs of their severely! profoundly handicapped students. INTRODUCTION The development of instructional programs for severely and profoundly handi capped children has been rapid and intense. As special educators become increas ingly aware that even "the most seriously impaired of all disabled people" have potential for learning and growth (Haring and Smith, 1978), dramatic gains in the application of behavioral technology and systematic instructional procedures have been made. Indeed, the extension of full educational services to the severely and profoundly handicapped may truly be said to signal an exciting "new ideology of human management" (Wolfensberger, 1977). The exigencies of this field, however, allow us little time for self-congratulation. Those who assume responsibility for the education of severely and profoundly handicapped children must be prepared to examine their own programs carefully and critically. Is the program well-balanced? Are the personnel and resources being used to their best advantage? Does the educational setting encourage children to AAESPH Review, 1979,4(3), 251-258 252 AAESPH Review, Fall, 1979 develop skills that are functional and appropriate? Objective evaluation and con structive criticism can greatly assist educators in facing these challenging questions and in finding honest answers to them. Any conscientious evaluation process should thoughtfully consider the per spective of the consumer, that person who directly receives the pr; oduct or service being evaluated. Most severely and profoundly handicapped children have a greatly limited repertoire of communicative behaviors (Tawney, 1977), and are unable to offer verbal evaluations of their programs through conventional means. It is the intent of this article, therefore, to present a critical review of educational services frequently provided to severely/profoundly handicapped children, as one such con sumer might perceive them. This severely handicapped consumer—"Sam"—has been fabricated for the purpose of helping teachers, administrators, teacher educators, and other con cerned professionals in evaluating their current practices and procedures. The following representation of Sam's activities on one particular day is a simulation, based upon observations of more than 40 different educational programs for deafblind and severely/profoundly handicapped children, in various regions of the United States, over the past 5 years. Severely/profoundly handicapped children comprise "an extremely heteroge neous group" (Sontag, Smith, & Sailor, 1977), and Sam is not intended to be a "typical" student. It is hoped, however, that he will encourage readers to critically examine the structure and content of their educational programs, with the goal of providing maximally appropriate, functional curricula for their students. SIMULATION Subject Sam C. is 6 years old. He is considered severely mentally retarded and multihandicapped, due to maternal rubella and perinatal asphyxia. He is ambula tory. He communicates through signs, gestures, and babbling. He is partially toilettrained. At times, he displays self-injurious behaviors, such as arm-biting and head-banging. Sam is also classified as deaf-blind; although his teachers believe that he has some useful vision and hearing, these have not been tested reliably. The institutional psychologist estimates Sam's IQ to be below 30, and his "devel opmental age" to be approximately 18 months. Program Description Sam has recently been placed in an educational program for multihandicapped children in a large state residential institution for the mentally retarded. His class includes five other children, some of whom are functioning on a generally higher level than Sam, and some of whom are functioning on a lower level. The class is staffed by a master teacher and two paraprofessionals. High school volunteers and foster grandparents allow for a one-to-one adult-child ratio much of the time. The educational program operates year-round. Sam's parents live in a distant city and maintain little contact with their son. Sam's classroom is large and well-equipped. There are mats, inclined planes, adaptive seats, and a wide variety of teaching materials. A bathroom is adjacent. Orlansky 253 The teacher has established "work stations," carrel-like areas for individual instruc tion. "Prescriptive teaching clipboards" and "lists of reinforcers" for each child are neatly hung on the walls. SAM'S SCHEDULE 9:00-9:20 Sam arrives, accompanied by a paraprofessional. He hangs up his coat, and is taken to the vision stimulation station. The staff member switches on an illuminated device with a translucent pegboard. Each time Sam places a peg into a hole, he receives a pat on the shoulder. 9:20-9:40 Sam goes to the mat and begins his "gross motor program" by lying on his back. When the paraprofessional makes the "sit" sign, Sam must move from a supine position to an upright seated position within 10 seconds. Each successful comple tion of this task earns Sam a spoonful of vanilla pudding. 9:40-10:00 At the self-help station, the teacher removes Sam's shoes and socks. Sam must put them back on within 1 minute. There are several trials. Sam is rewarded with sugar-coated cereal for achieving the criterion. 10:00-10:20 The six children go to a table for a snack of juice and cookies. One paraprofes sional works with them on remaining seated appropriately, drinking from a cup, and not throwing food. The other teachers take a coffee break in a nearby room. 10:20-10:40 Instruction resumes, as Sam is led to the communication station. The teacher shows him several large pictures of animals, and demonstrates the manual sign for each. Sam receives a spoonful of applesauce for imitating a sign accurately. Today, he imitates "pig" and "tiger," but has difficulty with "giraffe" and "elephant." 10:40-11:00 A fine motor program is implemented. Using a felt-tipped marker and tracing paper, Sam traces several lines consisting solely of the letter "c." A foster grandpa rent gives Sam a banana and commends him for his relatively neat work. 11:00-11:20 The teacher has devised an intervention program to curtail Sam's self-injurious behaviors. A paraprofessional observes him carefully and uses a stopwatch. The verbal cue "Sam, sit!" is given. Each 5-minute period in which Sam does not bite his arm or bang his head earns him a piece of chocolate. 11:20-11:40 In accordance with his toilet-training program, Sam is taken to the bathroom. His pants are removed, and he is placed on the toilet. He must remain there for 10 254 AAESPH Review, Fall, 1979 minutes or until he defecates in the toilet. Upon fulfillment of either criterion, Sam is allowed to gaze at the illuminated pegboard for the remainder of this period. 77:40-72:00 Sam is led to the auditory training station and given 15 small blocks. The teacher stands behind him and bangs a drum. Sam must drop one block into a tin can immediately after each drumbeat. After all the blocks have been placed in the can, Sam is rewarded with a drink of fruit punch. 72:00 Noon Sam has a brief mobility lesson en route to lunch, which is served in a nearby building. He holds a white cane while traveling to the dining hall, although a paraprofessional leads him and another child by the arms. In the afternoon, Sam will have additional programs in the areas of communica tion, motor development, and self-help skills. At 3:00, he will be taken to his dormitory, where there is no formal instruction. DISCUSSION Our brief observation of Sam's program indicates that the staff is making a conscientious attempt to provide intense, systematic, individualized instruction. They try to state performance criteria in precise behavioral terms and to maintain careful records of Sam's progress. The teachers appear to display a sincere concern for their students and spend considerable effort implementing classroom activities. All these features are regarded as positive aspects of Sam's educational program. It should be remembered that, in the recent past, severely/profoundly handicapped children seldom had access to instruction of any kind. Our observation also indicates that this program could be improved in many areas. Given the opportunity to critically discuss Sam's program with the persons responsible for it, I would raise the following issues for their consideration: 1. The Children Are Overprogrammed For virtually the entire school day, Sam is subjected to one "program" after another. Although it is generally accepted that severely handicapped children bene fit from highly structured situations, the teachers here have carried this concern to an extreme, allowing the students virtually no opportunity for exploration of the envi ronment, spontaneous communication, or independent play. The frantic pace of activity is exhausting for child and teacher alike—even an observer may find it fatiguing! The schedule should allow more time for transition between instructional programs and give Sam a certain amount of less-structured time, during which he is not required to perform. Sam might also be allowed occasional "input" into his own educational program by making simple decisions about how he will spend his time. Perhaps he could be presented with objects or pictures symbolizing two or three different activities and could select the one he would like to participate in. 2. There Is No Opportunity for Interaction with Other Children Some teachers of the severely/profoundly handicapped express the feeling that Oriansky 255 these children "cannot take part in group activities" or are "too low-functioning" to interact with other children. Consequently, they administer their educational pro grams entirely on a one-to-one basis, in effect deepening the already considerable isolation of the children. Creative teachers sense the need for children to interact with other human beings, at whatever level they can, and set aside some time each day specifically for this purpose. Children may be encouraged to touch each other, pass interesting objects around, listen to music together, or play simple circle games. I once observed an exciting group activity with severely handicapped adolescents: a teacher read stories aloud, with animation, while another adult moved from student to student in a semicircle, making physical contact with each listener. The students may not have "understood" the stories in the traditional sense, but their enjoyment and active involvement were unmistakable. Sam's only opportunity for interaction with his classmates is during snack time, and even there it does not appear to be encouraged. Sam and his classmates are also denied any contact with nonhandicapped children. If interaction with nonhandicapped students were provided on a regular basis, it is likely that Sam would acquire many skills in communication, self-help, socialization, and other areas through exposure to the age-appropriate behaviors of his nonhandicapped peers. In addition, nonhandicapped children who have con structive interactions with the severly handicapped will be more likely to develop accepting attitudes toward exceptional individuals (Brown, Branston, HamreNietupski, Johnson, Wilcox, & Gruenewald, 1979). Severely/profoundly handicapped students do not profit from segregation. Sam's teacher should attempt to arrange for nonhandicapped children to participate in the classroom as helpers and friends. Programs which do not attempt to encour age such interaction can hardly be regarded as making progress toward the "nor malization" of their students. 3. The Teachers Are Constantly "on top of" the Children Sam's teacher—perhaps motivated by a concern for accountability and by the many persons who regularly observe her—seeks to occupy all of Sam's school time with structured, purposeful activity. While this goal is commendable, the quest may be futile. At his current level of functioning, Sam should probably not be expected to use all his time constructively. It would be more effective for the teacher to ac complish certain tasks with him at designated times and to allow transitional periods during which Sam is not being directly "taught" or "worked with." A reasonable amount of apparently nonproductive behavior should be tolerated and should not be viewed as an indicator of poor teaching. Virtually all of Sam's instruction is individualized. Recent research evidence, however, strongly suggests that severely/profoundly handicapped individuals are capable of deriving many benefits from group instruction (Favell, Favell & McGimsey, 1978; Orelove, 1978; Storm & Willis, 1978). Implementing some group instruc tional programs would also enable Sam's teacher to make more efficient use of her professional time and training. 4. Activities Are Often Done in Unnatural Ways While the need for teaching self-help skills in school makes some adaptations inevitable, many programs for severely/profoundly handicapped children could do 256 AAESPH Review, Fall, 1979 this in more appropriate and functional situations. For example, dressing and undressing are most naturally taught in the home or dormitory, not in the classroom. Coats should be put on before going outside, when the weather is cold—not taken on and off repeatedly indoors. The "naturalness" of Sam's instruction could be increased through some minor modifications in his schedule. The times just before snacks and meals, for example, would be ideal for instruction in washing and drying the hands and in other self-help skills. Sam's toileting program appears to be administered at a predetermined time, rather than in response to a physiological need he expresses; there is no attempt to develop the many skills other than defecation which are associated with effective toileting. The absence of most staff members from the children's snack activity suggests that not enough direct instruction is given in the important area of eating skills. Perhaps a group activity could be presented immediately after snack time, enabling some staff members to have a brief break then, instead. Communication and cooperation with parents and/or resident personnel is crucial if severely/profoundly handicapped students are to develop meaningful skills. This may often require special efforts, but children will benefit from learning to perform useful activities in as natural a manner and setting as possible. 5. Some Principles of Behavior Management Are Applied Inappropriately Although a detailed discussion of the principles and techniques of behavior management is beyond the scope of this article, the observer of Sam's program might question the excessive use of primary reinforcers (especially food) with this child. Is there any empirical evidence to show that these "reinforcers" actually accelerate desired behaviors or decelerate undesired behaviors? Would Sam per form differently if the primary reinforcers were reduced or eliminated? Are the edible items coupled with verbal or physical reinforcement? The implementation of a program solely to curtail self-injurious behavior is also questionable. Note that the teacher did not substitute any appropriate activity for Sam to occupy himself with. By drawing the child's and the staff member's attention to the undesired behavior, such a program may, in fact, have the effect of increasing Sam's arm-biting and head-banging. Rather than restrict the intervention to a specified 20-minute period, a program should be established to deal with the self-injurious behaviors if and when they arise. The teacher would also find it helpful to collect data on the times when arm-biting and head-banging do occur, and to use these data in making decisions about intervention. 6. Many Activities Are Nonfunctional or Outside the Child's Realm of Experi ence Sam is able to imitate the manual signs for "pig" and "tiger" when he sees pictures of these animals, and his teacher models the sign for him. Such mimicking, however, can be considered "communication" only in the loosest sense. The animals have little relevance to Sam's everyday experience, and his imitations have little practical value. Sam would be better served if he could be helped to receive and express information about his own environment and needs: his eating and toileting, the people and objects familiar to him, the activities in which he participates. It might also be pointed out that any school's "communication program" is of doubtful value Orlansky 257 unless the child's parents and/or resident staff members are directly involved with it and communicate with the child consistently. A large part of Sam's time is spent in activities with little or no functional value. The placing of pegs into a lighted board, and the repeated tracing of the letter "c," for example, are skills which have extremely limited value in Sam's daily life— particularly if he is ever to leave the institution in which he now finds himself. Brown, Branston, Hamre-Nietupski, Pumpian, Certo, & Gruenewald (1979) suggest that, in determining skills to be taught, teachers consider the degree to which that skill will enhance the child's ability to function independently. Placing keys into locks or placing coins into vending machines would surely be more useful skills to Sam than placing pegs into lighted boards. Accurate identification of restroom signs and traffic lights would facilitate more independence than accurate tracing of printed letters. CONCLUSION This simulation and discussion have been presented in order to encourage educators of severely and profoundly handicapped children to critically examine their instructional programs. If any or all of the shortcomings observed in "Sam's program" are found in actual educational programs for severely/profoundly handi capped students, they should cause concern among responsible teachers, adminis trators, and teacher educators. Despite considerable expenditure of time, money, and effort, many programs are not helping children like Sam develop the skills and behaviors which will effectively prepare them to function in minimally restrictive environments. Constructive criticism, self-evaluation, and honest discussion of program as sets and liabilities should have a place in all educational programs serving severely/profoundly handicapped children. Only through an on-going process of program improvement and professional growth can we continue to progress toward the goal of providing a truly appropriate education for all our students. REFERENCES Brown, L, Branston, M. B., Hamre-Nietupski, S., Johnson, F., Wilcox, B., & Gruenewald, L. A rationale for comprehensive longitudinal interactions between severely handicapped students and nonhandicapped students and other citizens. AAESPH Review, 1979,4(1), 3-14. Brown, L, Branston, M. B., Hamre-Nietupski, S., Pumpian, I., Certo, N., & Gruenewald, L. A strategy for developing chronological age appropriate and functional curricular content for severely handicapped adolescents and young adults. Journal of Special Education, 1979,73(1), 81-90. Favell, J. E., Favell, J. E., & McGimsey, J. F. Relative effectiveness and efficiency of group vs. individual training of severely retarded persons. American Journal of Mental Deficiency, 1978,03, 104-109. Haring, N. G., & Smith, J. The profoundly handicapped. In N. G. Haring (Ed.), Behavior of exceptional children (2nd ed.). Columbus, Ohio: Charles E. Merrill, 1978. Orelove, F. P. Instructing severely handicapped students in small groups. Paper presented at the fifth annual conference of the American Association for the Education of the Severely/Profoundly Handicapped, Baltimore, October 1978. 258 AAESPH Review, Fall, 1979 Sontag, E., Smith, J., & Sailor, W. The severely and profoundly handicapped: Who are they? Where are we? Journal of Special Education, 1977,11, 5-11. Storm, R. H., & Willis, J. H. Small-group training as an alternative to individual programs for profoundly retarded persons. American Journal of Mental Deficiency, 1978, 83, 283-288. Tawney, J. W. New considerations for the severely and profoundly handicapped. In R. D. Kneedler & S. G. Tarver (Eds.), Changing perspectives in special education. Columbus, Ohio: Charles E. Merrill, 1977. Wolfensberger, W. The principle of normalization. In B. Blatt, D. Biklen, & R. Bogdan (Eds.), An alternative textbook in special education: People, schools and other institutions. Denver: Love Publishing, 1977. Received July 13,1978 Final Acceptance February 2, 1979 Michael D. Orlansky is Assistant Professor, Department of Special Education, University of Virginia, Charlottesville, Virginia 22903.