Wednesday 7 December 2011

Communication and Visual Impairment

I am regularly asked to speak to a group of foster carers, some of whom look after visually impaired children. They always ask me to speak about communication and the child with visual impairment.  This has really challenged me and caused me to think hard about the whole area of visually impaired children who communicate in sometimes different ways from the rest of us. Social isolation is often a serious difficulty for many young people with a visual impairment. One reason for this is their inability to pick up on social cues, such as body language. 80% of learning is provided by the sense of vision and 90% of learning is incidental i.e. not planned. Visually impaired children miss out in both ways. They miss much incidental information in their environment and they miss out on much information because it relies on the sense of vision. But perhaps more significantly they miss out on the many opportunities that present themselves daily to create friendships with their sighted peers.

Communication in a sighted world
Our world is largely a visual world. The television is part of all our lives. Computers and I-Pads are visual media. Statistically communication is mainly visual. Research indicates that as a percentage communication is mainly visual and only a limited amount is verbal. 

a.     55% of person’s communication is non-verbal, i.e. most of our communication uses the medium of vision.
b.     38% of communication is through the inflexion of the voice i.e. the tone in which we speak.
c.      7% only of communication is accounted for in the actual words we use.

At an interview they say it is in the first two minutes of entering a room that a decision is made by an interviewing panel about our suitability for the post. In other words the way we are dressed, body posture, smiling and the general air of confidence. It is all visual. Even before we have had to chance to say anything it seems the die is cast!

Actions speak louder than words
Body language is intrinsic and essential to all our communication. There is both positive and negative body language. Making eye contact shows you are interested and curious. Nodding during a conversation, smiling intermittently, leaning forward are all good signs of a person who is paying attention to you. On the other hand if someone fidgets or taps their feet, looks away or avoids looking at you and crosses their arms when you are chatting, these are all negative signs, indicating lack of interest or attention and can be off-putting.

We use eye contact to build a relationship; we avoid eye contact to avoid a relationship. People sometimes tend to look over to the left when they are trying to be deceitful. But be careful not to read too much into body language.

Paralanguage refers to the non-verbal elements of communication used to modify meaning and convey emotion. Paralanguage may be expressed consciously or unconsciously. It includes the pitch, volume and intonation of speech. Paralanguage accounts for 38% of communication. It is the tone in which you speak. Someone asks you in all innocence, ‘How are you?’ You have had a bad day or you are feeling angry and you reply, ‘Fine!’ yet you drop the pitch of your voice and what you have said in your tone of voice is ‘I am not fine’ even though your words say ‘I am fine’. If you had raised your pitch and said, ‘Fine’ it would have meant the opposite.

How is a child with a visual loss affected by their difficulty? Such a child will fail to see the vast amount of incidental visual information that we all take for granted. It has to be pointed out verbally. It is chiefly the lack of access to information or the distortion of information that impacts on such a child. This can have a cumulative affect on a child’s understanding of basic concepts such as size, shape, proportion and distance. Conceptual development is formed during a child’s interaction with the environment.

What body language does a partially sighted child miss in school?

-       The teacher’s visual cues in the classroom - a finger pointing, crossed arms, raised hands, eyebrows lifted, smiling, frowning, calling
-       Visual cues from other children – in the classroom - laughing, a nod, a hand gesture
-       Visual cues from other children – in the playground – faces, recognising friends, a ball thrown towards them, a running child
-       Misunderstandings can develop as a result of not seeing and acknowledging a friend in the playground or street
-      Smiles, frowns, funny faces ... 
 What can we do to compensate for this?

-       Awareness raising with the teacher and the children
-      With children talk about the precise problems a person will have because they do not see clearly
-       Specific strategies can be trialled
A card shown to the child to represent certain facial teacher expressions
Seating close to teacher but also with the flexibility to turn and see other children
A low vision device to bring distant things closer
A classroom ‘buddy’ to help them see what they are missing

How can we effectively communicate with a person who is visually impaired? Above all we have to emphasise the 7% of verbal communication that we are able to use. Everything including what is going on in the environment, what is being shown on the screen it all has to be verbally described and explained in detail. If you greet a child say who you are, if there is any doubt. Use ordinary language such as ‘see you later’. Make it clear when a conversation has finished. If there is a sudden noise it may help to explain it. Basically everything visual must have a verbal counterpart. The information missed should be filled in. It is important to use the child’s name frequently also and remember to ask them questions. 

Think of all the different kinds of body language used in everyday interactions in school. I have observed drama exercises in the classroom where children were grouped in a circle and had to read the opposite person’s face and react to it. Circle times in primary schools can be frustrating for children who cannot see details or faces well. When a teacher is speaking from the front they should try to modify their behaviour where possible:

-       Approach closer to the visually impaired child without making it too obvious
-       Talk about what they doing – i.e. ‘see how I am smiling’, ‘I am raising my hand’, ‘how do you know I am angry…?’ Talk about feelings and facial expressions
-       Use your tone expressively – vary it to express emotions more than you usually would
-       If the child has a learning support assistant with them they can describe what the teacher is doing

Nor must we forget that a lot of visually impaired people find it difficult to make eye contact, either because they turn their head away to see or because they have poor central vision. Forming social relationships relies heavily upon making eye contact so perhaps this is one reason many visually impaired young people are socially isolated. 

Sometimes i get asked the very confusing question about the child with a visual impairment - 'Does she use sign language'?
I leave you to work that one out...

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