Teaching Orientation and Mobility Skills to Students with Autism and Vision Impairment in Public Schools: A Data-Based Study

Lana (pseudonym) was 12 years old and attended elementary school in a self-contained classroom and was included 50% in the general education classroom. She is congenitally blind due to cortical vision impairment and nystagmus. An ophthalmological examination conducted in 2001 indicated that Lana has nystagmus since birth, probably Leber’s Congenital Amaurosis, and is legally blind. A subsequent functional vision evaluation reported limited use of vision. Based on her medical history and a Full and Individual Evaluation (FIE) conducted by a Licensed Specialist in School Psychologist (LSSP), Lana met the criteria for autism. Additionally, her language assessment included informal data and a Functional Communication Profile - Revised (Kleiman, 2003). The assessment concluded that Lana had a severe receptive language impairment, profound expressive language impairment, and profound impairment in pragmatic/social language. Her assessment scores for intellectual functioning fell into the delayed range on all areas of the Developmental Profile-3 (DP-3) (Alpern, 2007), and in the low range on the Vineland II Parent-Caregiver Rating scale and The Teacher Rating Scale (Sparrow, Cicchetti, & Balla, 2005). On the Adaptive Behavior Scale (Lambert, Nihira, & Leland, 1993) Lana obtained a standard score of less than 50 which falls into the delayed range. She also displayed challenging behaviours including eye poking, self-stimulatory behaviour (stamping feet, flapping hands), hugging, and running away. Her annual O&M goals focused on using correct two point touch cane technique in the school setting, and to find curbs and stop prior to stepping into streets. The teacher and O&M specialist indicated that Lana required training in independent travel with accompanying school personnel to and from her classroom to an outside gymnasium using her folding cane.

Andrew (pseudonym) was a 19 year old male student diagnosed with autism. He was non-verbal and functionally blind due to self-inflicted traumatic injury to the eyes. He attended a self-contained classroom where he spent 100% of his day. Andrew lived at a residential facility near the high school. According to an ophthalmological eye report in 2008, his eye condition included a retinal detachment, glaucoma, and hyphemia in the right eye, and a retinal detachment, and traumatic cataract in the left eye. Andrew was diagnosed with autism and intellectual disability by an educational agency in 1996 and the test scores were not provided. His O&M lessons took place in the hall outside his classroom. Andrew displayed such challenging behaviours as self-injury (hitting his temples with his fist), screaming, striking the floor with his cane, masturbating, and spitting. His overall IEP goals for the year were to increase functional communication, improve social skills, and reduce self-injurious behaviour. He had recently received a communication board which he was learning to use. His special education teacher’s goal for O&M was to learn the way to use a folding cane. However, he was not receiving O&M training at the time of assessment.

Lana’s self-contained classroom included a special education teacher, a paraprofessional, and six students with disabilities with varying functioning levels. The physical arrangements of the classroom consisted of learning centres with tables for group activities and individual pupil desks. The gymnasium was located 200 feet from Lana’s school building. Lana was required to walk 80 feet to double doors leading outside her school building then walk another 120 feet from the doors along a sidewalk to the gymnasium.

Andrew’s self-contained classroom included a special education teacher, three paraprofessionals, and three other students with severe and multiple disabilities. The physical arrangement of the setting included multiple rooms namely a main classroom with a kitchenette and laundry facilities, bathroom, supply room, and an activity room (e.g., bed, swing, tables for crafts, sofa, and chairs). A 67 foot corridor outside Andrew’s classroom was the training environment.

The certified O&M specialist (COMS), classroom teacher, and the paraprofessional selected the training route for Lana based on her functional needs and prior O&M instruction. For Andrew, the classroom teacher decided the training route based on the student’s needs as he never received formal O&M training prior to this study.

Five different toys were used (clapper, noise putty, play dough, pair of magnets, and rubber bracelet) to assess the student’s toy preference suggested by the special education teacher. Initially, all the toys were given to Lana to engage with for two minutes before withdrawing all of them to begin the test. The tests were conducted for three days and on each day three trials/sessions occurred. During the test all the toys were arranged on a table in front of the student. She was then asked to pick the toy she wanted to play with and then allowed her to play with it for two minutes. Using the same procedure, the rest of the toys was presented and the procedure was repeated until all the toys were picked. Lana chose the noise putty as the most preferred item followed by a pair of magnets.

Four different items were used (i.e., rattle, music, body lotion, and teddy bear) as had been suggested by the special education teacher to assess the student’s order of toy preference. The same procedure was used for Andrew as for Lana. Based on the preference assessment, Andrew’s preferred items were the rattle and lotion. The lotion was included in the items because it was more age-appropriate for Andrew than the other items.

A COMS greeted Lana inside her classroom and communicated the purpose of the training. Lana retrieved her cane and appropriate clothing to travel outside. The COMS and Lana exited the classroom into the corridor at the starting point of the training program (i.e., wall beside the classroom door). The COMS then instructed Lana “I want you to walk to the gymnasium five times by yourself using your cane. This is our first trip. Let’s go.” When Lana started her route to the gymnasium, the COMS provided verbal prompts such as “use your cane” “stay on the sidewalk” and “stay to your right/left” when needed. If Lana was not using her cane techniques correctly, then the COMS provided physical and verbal prompts. When Lana was travelling the route and using the cane appropriately, the COMS provided verbal praise (e.g., “good job, Lana”). Whenever she reached the destination she received reinforcement (i.e., hugs, tickles, noise putty) and then allowed to play for one minute. After the completion of five trials, the session was terminated and Lana engaged in her classroom activities.

A COMS greeted Andrew inside his classroom and communicated the purpose of the training. The COMS instructed Andrew to get his cane and his bottle of lotion (i.e., his reinforcer according to the preference assessment). If he did not comply with the request, the COMS gave the folding cane and the lotion to him. The COMS guided Andrew to the starting point of the training route (at the end of his classroom hallway). The COMS instructed him to “square off to the door (put your back to the door), hold your cane in front of you, and now I will show you how to move your cane from side to side. Now let’s go to the end of the hall.” When Andrew started his route down the hallway, the COMS provided verbal prompts such as “move your cane from side-to-side” as needed. If he did not comply then the COMS provided hand-under-hand prompting to assist him when moving his cane. When Andrew completed each route, the COMS provided reinforcers (i.e., lotion for one minute and ‘high-fives’). After the completion of five trials, the session was terminated and Andrew engaged in his classroom activities. On some occasions, less than five trials were conducted and the session was terminated when he had exhibited challenging behaviours (e.g., hitting himself, screaming, striking the floor with his cane).