Authors: Inmaculada Barbero, Olga Casas, M. Teresa Daussá, Katty Homar, Emi Martinez, Francis Moreno, Eloisa Nonato, Aurora Sanchez, Magda Sanmartin, Rut Terol
Centro Publico Dr. Folch y Camarasa
c/ Ventura Rodríguez, l0
08035 BARCELONA
1.- PRESENTATION OF CENTRO PUBLICO "DR. FOLCH Y CAMARASA POPULATION, PSYCHO PEDAGOGIC INTERVENTION.
Since 1984 the public school "Dr. Folch y Camarasa" of Barcelona has been attending the educational necessities of children with psychological disorders associated with blindness or low vision and/or additional neurologic deficits.
Presently the school receives a population in scholar-age ,whose handicaps and evolutive characteristics can not be cared for by the conventional school system.
In broad outline, we can establish the followiing disabilities in our collective:
a) Psychological diseases: from the altered relational process to the psychosis and autism.
b) Sensorial deficit:
visual .......... blindness or low vision.
auditory....... deafness.
c) Neurological deficit ... cerebral
lesion.
Each one of those difficulties, considered by itself and isolated from each other, would give us a sectored educational plan, but as education professionals we must understand the child globally, looking at him as a child and not as the sum of a diversity of deficits.
Hence, we refer to the children that we care for at our school as multi-deficient blind children.
Yes, added to the blindness the children have other associated disorders like the ones mentioned ahove. The specialist's intervention must contemplate, in addition to the relational processes, the mental process of the children in combination with the alterations derived from every deficit and must globalize the information in order to attend the children like they are in their totality.
From our educational practice with
these multi-deficient blind children we emphasize the following
difficulties:
A - DIFFICULTIES IN COMMUNICATION
The presence of another person is not enough to establish communication with those children. It is necessary for the educator to initiate the affective, emotional and mental elements that will help the children in the understanding of the communication process.
If other associated disorders are also present, the difficulty of developing language into the inter subjectivity frame is greater and to realize the value of communication, it is necessary to establish a good relationship -affective link- with the adult, with the purpose of motivating the child towards the interaction.
Our educational experience with this
collective has guided us to establish a multidisciplinary psychopedagogic
intervention because. as stated before, in those children, the
difficulties of development are not added, but the resulting effects
for every single deficit is multiplied by the other discapacities.
B - DIFFICULTY IN BUILDING THE
MENTAL IMAGE AND IN THE ENVIRONMENTAL PERCEPTION
Often, we observe a serious rebound to touch and/or to explore persons and objects.
The capacity to encode and decode
the information received from the environment is seriously compromised
and the difficulty to differentiate and in differentiating him/her
self from the others induces him/her to an isolation near pseudo
autism.
C - THE IMMOBILITY: DIFFICULTY
WITH SPATIAL RELATIONS
The notion of space. just as the notion of time, is not inborn.
Since their birth, the multi-deficient blind children do not receive all the information from their environment.
Of course adequate and early stimulation will help to compensate for their delayed evolutive process. However if the child with a visual deficit also has a cerebral lesion or deafness, then we are in front of a child with a high risk of becoming psychotic.
The emptiness sensation, which is
a consequence of the fact that the child can not control the enviromment,
can go so far as to give the child a situation of anguish that
the child tends to escape through a mental disconnection.
D - DIFFICULTY USING THE VISUAL
REMAINS
The use of the remaining visual capacity, that the child has is in close relation with understanding the sensory information received and the environment. Therefore, it is in close relation with the neurological process and its greater or lower functioning capacity.
If, moreover the low vision presents a neurological problem we have to treat him/her considering the interaction between the visual process, the functioning of the C.N.S. and the stimulation given by the environment.
That way, the psychopedagogic intervention is structured in three main working ways:
A.- The specific child needs.
B.- The family acceptance.
C.- The relationship with other institutions that can attend our collective.
Each of those items has a unique frame of reference: the opening of the professionals and the school to the realities of the children and the relation with their environment.
This kind of psychopedagogic intervention
in the last ten years and the continuous detection of new educational
needs in our multideficient blind children has taken us to attend
the feeding experience, marked since the first stage in their
life by great diffículties, difficulties manifested in
the school, and that are exposed in this communiqué.
2 - AN APPROACH TO THE FEEDING
ACT.
Feeding means for everybody a fact, first of all social, from which is derived a series of organic implications an in general, developmental. Thus, thinking about the topic we are talking about, we oral-alimentation automatism, mainly characterized by a passivity and even rebound against the food.
Our educational practice has directed us to think about the structures that can be established at the time of presenting the food to the psychotic or autistic child and moreover the blind child.
We consider that the majority of the pupils in our school share aspects in their records that have repercussions in the first relation with the mother: prematureness, labor complications, long stay in the incubator. etc.
The relationship maintained by the child with the person who feeds him/her, will provoke pleasure or displeasure against the feeding process. Therefore, when a multihandicapped child comes to the school the first thing that we consider is the establishment of a strong affective link with the person who is going to attend him/her more directly and that is the person who is going to accompany him/her in his/her feeding process:
-Respecting his own place
-Remarking the situation to the child
-Giving reference points that give him/her security.
The attitude in the children is shown differently depending upon the social experiences lived before they came to our school; if the child has attended another school, who took care of him during the first stages (baby-sitter, grandpa, grandma, etc.).
For those reasons we look for the maximum amount of information in order to tackle the feeding record inside the school frame.
Once oriented to the feeding process, the child's answers are frequently unexpected, regarding to his attitude during the scholar journey as much as the evolution in front of the food and/or his/her situation at the dinning room. Commonly these answers are the expression of somewhat change in his/her environment, i.e., the absents or the arrival of a member to the family or to the class group. Even, some aspects that can go unnoticed to us can trigger off a variation or stagnation in this process.
Common aspects to the majority of our scholar population are:
-Passiveness: if nobody feeds them they don't eat, it seems that they don't have an interest about their nutrition.
-Gluttony-. Opposed to passiveness. There are cases where the children eat without relish. with the only goal of feeling plenty. Regardless of the amount of food they can eat, they barely fatten.
-Anorexia : The child not only refuses to ingest but he has problems to support the smell and the presence of food and the table services near to him.
-Conduct such as:
*to provoke retches and vomit himself when tasting or smelling the food.
*to accumulate food in the mouth without swallow.
*to make bolus with the food.
*to regurgitate the food.
*to swallow without mastication: they don't know to cut with the incisors, matter that had to be taught to them and in the way that they are accepting the feeding process.
-Difficulties to dose their food.
-Refuse to use the table services: some children even don't want to touch it.
-Preference of the food according to the texture and sometimes even by
-Difficulties to ingest liquids.
3 - FEEDING GOALS. METHODOLOGY.
Our first goal at the dinning room activity is that the child, through the relationship created with the adult, becomes to feel pleasure by the food in order to be able to consolidate himself/herself in the search of his/her personal independence.
Starting from this relational goal that we consider basic and fundamental, we have established another one at a general level, which does not pretend to be unique and immovable but a reflex from our school's experience and always bearing in mind the adaptation to an individual level.
Immediately afterwards it can be
appreciated that we divided these goals in four sections or classes,
attending to a more clarifying organization criteria. Thus, the
priority of one or another comes upon the individual characteristics
of each pupil, so there will be cases with priority objectives,
others where the objectives overlap.... etc. taking into account
its sequence.
DINNING ROOM GOALS
1.-Related to feeding itself
-Go gradually through the crushed food to the regular food.
-To eat separately first dish, second dish and the dessert.
-Avoid behaviors like: spit, make bolus, keep the food in the mouth, retches, vomits. sneezes...,
- Not to devour the food.
-Keep the food in the mouth the needed time (swallow).
-Drink water.
-Express correctly, if he/she doesn't like some meal, causing the adult take this in account following his criterion.
-Use the teeth to masticate.
2.-Related to the table habits:
-Keep a right posture.
-Keep sitting during the meal.
-Keep the table clean.
-Raise the arm to put the food in the mouth.
-Use the table services correctly.
-Use the napkin correctly.
-Come alone to eat or in the most autonomous wav.
-Pass from the tactile location of
the food to the trial with the fork to orienting in the dish.
3.-Related to the behavior and attitude (socialization):
- To accept the dinning room situation.
- Anticipate the activity to come.
-Accept the food dish in front.
-Learn to wait.
-Keep the table services in their place.
-Give a continuity to the dinning room activity.
-Make concrete demands related to the situation.
-Make adequate demands related to his/her preferences.
-Tolerate his/her frustration against an order given by the adult related to his/her feeding.
-Accept the individual or group (depending upon the case) in the feeding act.
-Do not disturb the companions around him/her.
-Tolerate the voices and/or noises from other persons/children not in his/her own group.
-Tolerate the changes that can appear at feeding time.
-Avoid distortional behaviors (scream, disturb, take off the shoes, cry, etc.) while eating.
-Avoid stereotypes.
-Share with the adult.
-Participate in the conversation with the appropriate tone.
-Ask for help and accept it.
4.-Related to the mobility in the dinning room/classroom:
-Go alone from the classroom to the dinning room.
-Find his/her chair/table in the dinning room.
-Get the different table services from the counter.
-Put the table services on the table correctly
-Go for the dishes (first, second and dessert) to the kitchen.
-Give back the empty dishes.
-Pick up the other utensils and give them back once finished with the meal.
-Go back from the dinning room to
his/her classroom alone or with the adult support if necessary.
METHODOLOGY:
We start from the educational practice that is not submitted to a unique psychological tendency, due to the plurality of characteristics converging in our pupils.
When we present the feeding work with those children, giving their emotional instability traits, we try to associate them to the activity in order they can adapt to the changes. One of the resources is to advance, anticipate, positioning and depositioning during the journey.
The dinning room activity starts at the first hour in the morning, when the assistant comes into the classroom telling the menu in the most attractive way. In order to present a logical time sequence to the children, before dinning, hygiene habits are included in daily activities, as well as during the journey to the dinning room.
If the child avoids the contact with the reality, he/she is helped to reorient to reality. After the meal, while performing the hygiene habits, the remembrance of the lived situation is reinforced.
The adult's attitude is open, flexible, and communicative, about this activity, in order to help him/her to elaborate this process. When a preschooler starts his/her scholarship a simultaneous work exists with mother and child, thus a new figure is being introduced in reference to what will be his/'her scholar frame. This stage, of flexible duration, will depend upon the child's adaptational pace and his/her new environment.
We establish different options to tackle the subject, that is the reason that the youngest children eat in their classroom because they are more susceptible to the interferences that come with whatever dinning room situation.
The other children go to the dinning room and there they are grouped according to their needs (individual, couple, small group) bearing in mind their emotional development, the rhythm or continuity against the food, the chronological age, partners.... in order to establish the common goals related to the behavior and attitude.
Since we have one adult with one child or one adult with two children, our approach needs a human and technological resource generation ...
The furniture distribution in the dinning room space is arranged by the groups mentioned above.
As a collective, we work and learn from the experience of our success and failure due to the disconcerting surprises that we encounter in their reactions/responses.
The thought and the analysis are
continuous in our psychopedagogic work, in order that the children
live well, to the extent that it is possible, the feeding act.
4 - FINAL REMARKS
The conclusions we can extract after many years of experience with multi-deficient blind children are quit few, but common in the whole of the cases that we have had at our school, although with this we don't pretend to generalize them to the visually impaired. Thus, we can deduce that:
1. Significant changes in the environment of the child affect him in his evolutive process and are manifested in the whole part of the cases with alterations in the dinning room situation.
2. Our children integrate and generalize the learning with difficulty if there is not a minimum coordination between family and school.
3. In order to tackle the feeding area it is basic to previously establish a strong affective link between the child and the reference adult, bearing in mind that the child is a whole.
Therefore all the learning areas
must be tackled globally without forgetting that we are working
with visual deficients to whom we have to present the reality
in an analytic way and always respecting their own pace.
We can conclude saying that as the
child has a good relation with the the world that surrounds him/her
this makes him/her more open and tolerant to possible changes
in the future, he/she is stronger and consequently more mature.
5 - BIBLIOGRAPHY
- LEONHARDT, Mercé. "El bebé ciego" Primera atención. Un enfoque psicopedagógico. Editorial Masson.
- BIBLIOTECA "JOAN AMADES" Guía "Paso a paso para el cuidado personal en ciegos".
- FRAIBERG, Selma "Niños ciegos" La deficiencia visual y el desarrollo inicial de la personalidad.
- BRAUNER, Alfred y Françoise "Vivir con un niño autístico" Editorial Paidos.
- FREEMAN, Peggy "El bebé sordo ciego" Editorial ONCE.
-OSTERRIETH Paul A. "Psicologia infantil" Editorial Morata.
- MASSIF, Henry y ROSENTHAL, Judith "Las psicosis infantiles en los primeros cuatro años de vida" Editorial Paidos.
- BETTELHEIM, Bruno "Con el amor no basta" Hogar del libro. Colección Navidad.
- TUSTIN, Frances "Autismo y
psicosis infantiles" Editorial Paidos.