Nurturing Independence Among Visually Impaired Children on the Spectrum

During Blindness Awareness Month, Paula Baloga, Clinical Director at Gateway's Sterling Heights location, shines a spotlight on how Gateway Pediatric Therapy provides services for visually impaired children with autism spectrum disorder.

For a child with autism spectrum disorder, ABA therapy can be life-changing. How does that therapy change, though, when the child is also blind or otherwise visually impaired? Paula Baloga, M.A., BCBA, is clinical director of Gateway Pediatric Therapy‘s Sterling Heights location. She works regularly with children in this very situation and stresses that while the therapeutic techniques she uses may differ somewhat for visually impaired children, they are aimed at teaching the same skills that enable a child to live more independently.

Utilizing all senses

“When we work with a child who is visually impaired, we integrate all of his or her senses into therapy,” Baloga says.

As an example of using the sense of touch, Paula encourages visually impaired children to explore items with their hands. As a child touches an item, Baloga asks the child what the object is. If the child is not able to label the object, she then states and repeats its name.

“After I label the item, I have the child practice labeling it as well,” she says. “Then we tie the item to its functional use.”

If the item is a hairbrush, for example, Baloga will say “hairbrush” repeatedly as the child touches and feels the brush all over. She will follow up this labeling with a statement such as “you brush your hair with a hairbrush.”

“This gives the child a whole picture of what that object is as well as how it functions in the environment,” Paula says.

Baloga also uses auditory prompts, such as knocking. In a therapy session this could mean placing a cookie on the table and tapping the table next to the cookie.

“The idea is for the child to independently feel, within a small radius, for that item,” she says. “Over time, we’ll expand to a wider radius when the child is comfortable.”

Baloga likes to use the example of an apple to illustrate how she would help a child integrate a variety of his or her senses to create a complete picture.

“First, we’d label the apple,” she explains. “Then I’ll have the child feel how it’s round and has a stem. Then I would encourage him or her to smell and taste the apple while listening for the sound it makes when taking a bite.”

Ultimately, the teaching methods used for sighted kids with autism and visually impaired kids with autism are very similar, Paula says.

“Sometimes we just have to change our teaching strategies a bit,” she notes. “We may not be able to model things in the way we would with a sighted child, but we have other ways of reaching them by leveraging auditory and tactile perception.”

Fostering independence

Another important component of working with visually impaired children on the spectrum is prompting from behind and guiding at the elbow, Baloga notes. Many times, parents and caregivers instinctively lead their child from the front. “This can cause children to become more dependent where they’re always feeling for the person in front of them,” she says. “If you prompt from behind, it encourages the child to explore on his or her own.”

Above all, meet the child where they are. Try to make small changes in your environment to increase independence- something you can consistently control and something that’s not too difficult for the child. For example, if you were to teach handwashing and the soap dispenser was on a shelf behind the child, move the soap dispenser to the side of the sink to reduce the difficulty of locating the soap.

Advice to parents

Baloga also counsels parents to utilize consistent structures in their home that the child can use to identify and understand where they are in the house. Staircases and tables are good examples.

“Those items aren’t moving and can anchor a child to where he or she is,” Baloga says.

A ticking clock that is always in the same place can also help signal for a child that he or she is getting closer to the living room or the kitchen. Additionally, different rugs and floor textures can be used to define a space and to help the child navigate surroundings more independently. Paula recommends for parents to reach out to their school district to get in touch with a teacher consultant that specializes in visual impairment and seek out community gatherings for a chance to speak with other professionals and parents. Of utmost importance, Paula says, is open and regular communication among therapists, parents, teachers, visual impairment specialists, and mobility instructors. “For my part, it helps me get a feel for what they’re doing at home and in school and how we can generalize that to the rest of the child’s environment.” Baloga says. “We’ll all sit down to talk about different strategies and how our worlds can come together.”

For more information on the services provided by Gateway Pediatric Therapy, visit


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