Evidence-Based Communication

Practices for Children with Visual

Impairments and Additional
Disabilities: An Examination
of Single-Subject Design Studies
Amy T. Parker, Eric S. Grimmett, and Sharon Summers
Abstract: This review examines practices for building effective communication
strategies for children with visual impairments, including those with additional
disabilities, that have been tested by single-subject design methodology. The
authors found 30 studies that met the search criteria and grouped intervention
strategies to align any evidence of the replication of successful outcomes.

Supporting meaningful communication ing additional disabilities; of this subset

by individuals with multiple sensory, cog-
nitive, and physical impairments has been
a central concern for special education
and rehabilitation professionals for many
years. Of the children and young adults in
special education programs, children who
are visually impaired and have additional
disabilities may experience the greatest
risk factors for developing ineffective
communication skills (Bruce, 2002). The
low-incidence population of children with
visual impairments is highly heteroge-
neous (Ferrell, 2000). For example, of the
202 infants and toddlers with visual im-
pairments in Ferrell, Shaw, and Dietzs
(1998) study, 60% were identified as hav-
The authors would like to thank the leaders of
the National Center for Leadership in Visual
Impairment for their encouragement to pursue
evidence-based practices for our field. We
would also like to thank Nora Griffin-Shirley
and Devender Banda for their guidance in this
process.
of children, approximately 90 different
coexisting impairments were documented
(Ferrell, 2000).
Children with visual impairments often
lack access to powerful visual cues in the
environment, such as facial expressions
and gestures, that support the initial de-
velopment of communication skills
(Fraiberg, 1977). If their visual impair-
ment is combined with other disabilities,
such as hearing loss, cognitive delay, or
physical disabilities, their lack of access
to environmental cues is compounded and
leads to a greater risk of their delayed
development of communication (Row-
land & Stremel-Campbell, 1987). With
diminished access to observing and imi-
tating communication behaviors and pat-
terns, many children with visual impair-
ments and additional disabilities become
passive in their environments, increasing
their risk for learned helplessness,
a condition that can occur when an

540 Journal of Visual Impairment & Blindness, September 2008 2008 AFB, All Rights Reserved
individual perceives no relationship be-
tween his or her behavior and its impact
on the environment (Seligman, 1975).
Because children who are visually im-
paired and have additional disabilities
have extra barriers to environmental cues
that support communication, they can de-
velop limited communicative repertoires
or highly idiosyncratic ways of commu-
nicating that may be unrecognizable to
communication partners (Siegel-Causey
& Downing, 1987). Studies that have
measured communication exchanges be-
tween such children and their partners
have reported that even individuals with
intimate knowledge of the children may
not have recognized, supported, or re-
sponded to the childrens communication
attempts or behaviors, thereby decreasing
the opportunities for building the chil-
drens communication skills (Rowland,
1990; Vervloed, van Dijk, Knoors, & van
Dijk, 2006).
Researchers have reported that educa-
tors and families who support the com-
municative functioning of children with
visual impairments and additional disabil-
ities need not only to recognize and re-
spond to nontraditional expressive forms
of communication (such as movements, fa-
cial expressions, and other behaviors), but
to support the development of reliable,
functional communication systems for the
children (Bruce, 2005). Without a reliable
means of sending and receiving messages,
even in a rudimentary form, children with
multiple disabilities are at risk not only for
not developing their academic potential, but
for experiencing abuse and neglect (Knut-
son & Sullivan, 1993).
In recognition of the need for explicit
instruction in communication for children
with visual impairments and additional
2008 AFB, All Rights Reserved
disabilities, leaders in the field of visual
impairment specifically called for com-
munication interventions in the National
Agenda for the Education of Children and
Youths with Visual Impairments, Includ-
ing Those with Multiple Disabilities
(Huebner, Merk-Adam, Stryker, &
Wolffe, 2004). For the low-incidence
field of visual impairment, current na-
tional policies, such as the No Child Left
Behind Act, emphasize that teachers
practices must be validated through the
use of scientific measurement. These ed-
ucational policies present specific chal-
lenges in determining which types of in-
struction in communication will satisfy
the federally mandated standards for
evidence-based practice.
To respond to this complex challenge
of creating educational practices that are
scientifically based, the Division for
Research of the Council for Exceptional
Children (CEC) identified four types of
research methods in special education: (1)
experimental group, (2) correlational, (3)
single subject, and (4) qualitative designs
(Odom et al., 2005). Researchers in low-
incidence fields, such as visual impair-
ment, may find the single-subject design
method the most feasible experimental
design to create a body of scientifically
based evidence because of the heteroge-
neity, geographic spread, and diversity of
educational contexts of the population
(Horner, Carr, Halle, Odom, & Wolery,
2005). This body of research could then
be instrumental in devising the specific
teaching strategies that will result in the
most efficacious outcomes for students
who are visually impaired and have addi-
tional disabilities.
Ultimately, the need for educators and
parents to have access to information
Journal of Visual Impairment & Blindness, September 2008 541
about highly effective, scientifically
proved methodologies for teaching, sup-
porting, and fostering the communication
skills of children with visual impairments
and other disabilities is not only compel-
ling, but highly practical. This need
provided the context for this studys
approach to examining the body of lit-
erature.
Method
RESEARCH QUESTIONS
In undertaking this research, we devised
three research questions:
1. What studies used single-subject re-
search in the area of practices in in-
struction in communication for chil-
dren and young adults with visual
impairments, including those who are
deaf-blind (aged 6 22) from 1965 to
2006?
2. What types of communication prac-
tices and interventions were found to
be effective with children and young
adults with visual impairments, in-
cluding those who are deaf-blind?
3. Are there any patterns of replication
among the identified studies?
SEARCH TERMS
The following search terms were used to
isolate the interventions that were used:
communication (including all devices and
systems), tactile symbols, tactile prompts,
calendar boxes, calendar systems, activ-
ity schedules, manual sign language,
Tadoma methods, palm signing, Ameri-
can Sign Language, choice making, and
gestures. In addition, the following search
terms were used to parse out the focus
population for the study: visually im-
paired, blind, blindness, partially sighted,
542 Journal of Visual Impairment & Blindness, September 2008
deafblind, deaf-blind, vision disorders,
eye disorders, and eye diseases. Articles
that included one or more of the search
terms were then examined for additional
inclusionary criteria: The participants had
to be aged 6 to 22, the studies had to have
been published in English in peer-
reviewed journals, and single-subject de-
sign methodology had to have been used.
SEARCH PROCESS
We engaged in a search process using the
following online databases: PsycINFO,
Academic Search Premier, ERIC,
PubMED, and EBSCO host. We also en-
gaged in specific journal searches from a
list of journals in special education or
gifted education, which was compiled by
CEC and is listed on the ERIC web site
(http://ericed.org/fact/journals.html). This
list was divided into thirds, and each au-
thor was responsible for searching these
journals using the specific search terms.
We also consulted librarians at DB-
LINK, a national information clearing-
house that is a component of the National
Consortium on Deafblindness. DB-LINK
houses over 8,000 forms of literature per-
taining to deaf-blindness, although much
of this information is not peer reviewed in
a formal sense.
ANALYSIS AND CODING OF ARTICLES
As studies were identified, the first and third
author used an article-analysis form that
was based on the indicators of quality that
are recommended for single-subject design
studies developed by CEC (Horner et al.,
2005). Additional questions were added to
the rating form to determine if a formal
preference screening was conducted as
part of the intervention and if the re-
searcher specifically noted intervention
2008 AFB, All Rights Reserved
adaptations to accommodate the chil-
drens visual impairments. The second
author independently checked 30% of the
sample ratings of studies and calculated
interrater reliability to be at 94%.
Results
We found 30 studies that met the criteria for
inclusion. Several distinct types of interven-
tions emerged on the basis of a thorough
description of the independent variables
that were used to improve childrens com-
munication skills. These interventions were
grouped thematically into five categories:
microswitch interventions (n 17), multi-
component partner training (n 6), dual
communication boards (n 4), interven-
tions using object symbols (n 2), and
adult-directed prompting (n 1).
AUGMENTATIVE INTERVENTIONS
INVOLVING MICROSWITCHES
In Lancioni, OReilly, and Basilis (2001)
review of the literature, microswitch in-
terventions were defined as supportive
speech-output systems or devices that
serve the purpose of building communi-
cation interactions or choice-making as-
sociations for the adults or children who
use them. All 17 studies in this category
that we found examined microswitch in-
terventions as a means of building the
choice-making and purposeful communi-
cation capacities of the participants with
people in their environment. These stud-
ies were published between 1986 and
2006. Topographies of communication
behaviors to activate switches were far
ranging throughout the studies, from sub-
tle fine-motor movements to more overt
gross-motor movements. They included
switch activations achieved through a
number of disparate actions across the
2008 AFB, All Rights Reserved
studies: eye movements (Lancioni,
OReilly, Singh, Sigafoos, Oliva, Coppa, &
Montironi, 2005; Lancioni, Singh,
OReilly, Sigafoos, Oliva et al., 2006); chin
movements (Lancioni et al., 2004; Lan-
cioni, Singh, OReilly, Sigafoos, Olivia
et al., 2006); head movements (Cosbey &
Johnston, 2006); vocalizations (Lancioni &
Lems, 2001; Lancioni, Singh, OReilly,
Oliva, & Groeneweg, 2005; Lancioni,
OReilly, Singh, Siggafoos, Didden
et al., 2006); word utterances (Lancioni,
OReilly, Singh, Sigafoos, Oliva, Montironi
et al. 2005); knee or leg movements (Lan-
cioni, OReilly, Singh, Oliva et al., 2006);
and hand or arm movements (Dattilo, 1986;
Lancioni et al., 2002; Leatherby, Gast, Wol-
ery, & Collins, 1992; Locke & Mirenda,
1988; Mathy-Laikko et al., 1989; Sandler &
McLain, 1987; Schweigert, 1989; Singh et al.,
2003). Targeted communication functions
included making requests for objects, inter-
actions, or preferred stimuli. Twenty-three
children aged 6 to 18, with an average age
of 9.16 years, participated in these studies.
The settings for the studies were diverse
and included inclusive and self-contained
classrooms, institutions, day habilitation
centers, and participants homes.
Of this group of 17 studies, 4 measured
generalization and 3 formally measured so-
cial validity. Six of the 17 articles docu-
mented specific adaptations of the micro-
switch interventions to accommodate the
participants visual impairments. The spe-
cific types of adaptations were a sheepskin
overlay (Schweigert, 1989), the addition of
color or texture (Dattilo, 1986), positioning
for optimal use of the visual field (Cosbey
& Johnston, 2006), backlighting a micro-
switch (Singh et al., 2003), and tactile or
textured overlays (Locke & Mirenda, 1988;
Mathy-Laikko et al., 1989).
Journal of Visual Impairment & Blindness, September 2008 543
MULTICOMPONENT PARTNER TRAINING
INTERVENTIONS
All six studies in this category, published
between 1991 and 2006, examined the
complexities of building communication
exchanges with partners, both educatio-
nal staff members and peers. They were
characterized by the intense training and
support of partners to respond to the com-
munication behaviors of the student par-
ticipants as the most salient component of
the intervention designs. Although the
microcomponents of the interventions
varied among this group, all the studies
documented that the participants had var-
ious types of alternative media for com-
munication. In addition, all six studies
used communication exchanges that were
embedded in the participants natural rou-
tines as part of the communication inter-
ventions. The topographies of communi-
cation behaviors included reaching,
vocalizing, pointing, gesturing, signing,
and using words (Hunt, Alwell, & Goetz,
1991; Hunt, Alwell, Farron-Davis, &
Goetz, 1996; Janssen, Riksen-Walraven,
& van Dijk, 2002, 2003, 2004, 2006). The
functions of communication behaviors in-
cluded commenting, requesting, turn tak-
ing, turn giving, and initiating.
Despite the small number of studies in
this category, 24 children aged 6 19,
with an average age of 7.25 years, partic-
ipated. The settings included classrooms
in both residential and typical schools. All
six studies documented the generalization
of the behaviors across settings or com-
munication partners, while five formally
measured the social validity of the inter-
vention outcomes.
Another distinctive feature of this cat-
egory was that all the studies included
544 Journal of Visual Impairment & Blindness, September 2008
specific adaptations and accommodations
for children with visual impairments. The
types of adaptations to foster exchanges
between partners were tactile sign lan-
guage, large print, tactile calendar sys-
tems for communication, touch cues, and
multiple sensory media.
DUAL COMMUNICATION BOARDS
The four studies in this category were
all conducted by the same lead re-
searcher, and all used dual-board sys-
tems consisting of a printed board for
the student to use for expressive com-
munication (from the student to the
communication partner) and an identi-
cal board for the partner to use for re-
ceptive communication (Heller & All-
good, 1996). Communication behavior
topographies included the students
pointing towards bold-line written mes-
sages with pictures and gesturing with
the communication partner (Heller &
Allgood, 1996; Heller et al., 1996;
Heller, Allgood, Ware, Arnold, & Cas-
telle, 1996; Heller & Ware, 1994).
Targeted communication objectives
included turn taking, greeting, com-
menting, and asking for information.
The participants were 15 young adults,
aged 16 20, with an average age of 18,
from an urban residential school for stu-
dents who are deaf. The settings for the
studies were community-based employ-
ment work sites.
Generalization measures of commu-
nication behaviors across people or set-
tings were comprehensively reported
for this practice. Social validity was
formally measured as a component in
three of the four studies. By design, the
types of adaptations that were made to
2008 AFB, All Rights Reserved
the communication boards, which in-
cluded high-contrast line drawings for
students with low vision, met the criterion
for accommodating vision loss. In addi-
tion, individual students were instructed
and coached in using the dual-
communication board using American
Sign Language with close-range modifi-
cations for accommodating low vision.
OBJECT SYMBOL INTERVENTIONS
Rowland and Schweigert (2000) defined
the use of object symbols to build com-
munication skills as the use of part or all
of a three-dimensional item within a
meaningful context to build associations
between the item and an activity or expe-
rience. Two studies measured the effects
of using object symbols with two students
aged 8 and 17. Both studies were con-
ducted in self-contained classrooms
(Reichle, Sigafoos, & Piche, 1989; Tur-
nell & Carter, 1994). Generalization was
measured in both studies, and social va-
lidity was measured in one study. Object
symbols are, by design, adaptations for
individuals with visual impairments and
are used for individuals with multiple dis-
abilities as well.
ADULT-DIRECTED PROMPTING
AND REINFORCEMENT
One study (Van Hasselt, Hersen, Egan,
McKelvey, & Sisson, 1989) defined this
category. The purpose of the study was to
determine the effect of prompting and
reinforcement on social communication
for two 21-year-old participants with
deaf-blindness and severe disabilities at a
residential school for students who are
blind. In this study, generalization and
social validity were not reported. Al-
though specific adaptations for visual im-
2008 AFB, All Rights Reserved
pairment may have been included in the
intervention design, they were not docu-
mented in the article.
Discussion
The evidence of replication of these
communication interventions for chil-
dren with visual impairments and addi-
tional disabilities offers both pragmatic
information for educational teams and a
platform for future research. This re-
view has detailed the initial alignment
of types of intervention studies that ad-
dressed communication with this popu-
lation.
IMPLICATIONS OF THE FINDINGS
Both CEC and the American Psycho-
logical Association have developed
frameworks to determine if a practice
can be considered evidence based; these
frameworks define well-established
practices as having at least nine repli-
cations across studies, while practices
having support from three replications
are considered to be probably effica-
cious (Horner et. al., 2005; Lonigan,
Elbert, & Johnson, 1998). Using these
recommendations, we note that the find-
ings of this review indicate that mi-
croswitch interventions have a well-
established research base for practice
with individuals who are visually im-
paired and have other disabilities, par-
ticularly children with orthopedic
impairments. According to this frame-
work, multicomponent interventions
that involve the training of and support
from partners are considered probably
efficacious, as is the practice of using
dual-communication boards.
The 30 studies we reviewed were con-
ducted with 66 participants, each of
Journal of Visual Impairment & Blindness, September 2008 545
whom was reported to have various mul-
tiple disabilities. Although it is not pos-
sible to state that one type of intervention
is most appropriate for children with vi-
sual impairments and additional disabili-
ties, the groupings of intervention ap-
proaches are helpful in offering some
guiding practices. The analysis of effects
in this examination is qualitative in
nature.
Role of preference in building
communication exchanges and choices
Whether the intervention used technol-
ogy, tangible or object symbols, or ba-
sic choice boards, the majority of the
researchers used some form of operant
conditioning to train the participants to
use the augmentative communication
supports. Positive reinforcements had to
be chosen before the intervention was
implemented to ensure the most accu-
rate rate of response. Toward this end,
several researchers used some form of
preference screening or assessment to
determine the participants preferred
stimuli (Lancioni, OReilly, Singh,
Oliva et al., 2006; Reichle et al., 1989;
Schweigert & Rowland, 1992; Turnell
& Carter, 1994). Cognizant of possible
threats to validity in using positive re-
inforcement techniques, many research-
ers used various internal checks to en-
sure the reliability of their findings.
Researchers who used technological
communication systems had an inherent
methodological component that strength-
ened both the validity and reliability of
their findings, since microswitches and
other technology can typically count
and record the response rate of each
participant. Because of the relative dif-
ficulty of rating affective behavior in
546 Journal of Visual Impairment & Blindness, September 2008
previously noncommunicative children,
other researchers used stringent interob-
server reliability tests to ensure the ob-
jectivity of their findings (see, for ex-
ample, Locke & Mirenda, 1988; Reichle
et al., 1989). Singh et al. (2003) went so
far as to include checks for reliability
within the design of their intervention,
so that the participant first had to press
an initial observing response switch
before he or she was able to press the
microswitches that actually connected
to the preferred-response stimuli. If the
participant pressed both rounds of
switches, it was then seen as an act of
purposeful choice making.
Role of a supportive partner
Another significant finding, which may be
self-evident to many in the field of com-
munication, is the critical role that the
communication partner plays in building
the communication capacity of students
who are visually impaired and have addi-
tional disabilities. Across all the catego-
ries of communication interventions that
were documented, the communication
partner was required to recognize and re-
spond to the participants communication
behaviors, regardless of the form of com-
munication that the participant was using.
The communication partner, whether a
research assistant, teacher, family mem-
ber, or peer, was also integral in support-
ing a topic that the participant was inter-
ested in talking about. As Rowland and
Stremel-Campbell (1987) emphasized, to
build communication skills, the partner
must be someone who is responsive to the
persons signals or able to provide access
to something the person is interested in
having. For persons who communicate
nontraditionally, using behaviors, objects,
2008 AFB, All Rights Reserved
and microswitches, the role of a support-
ive partner is all the more critical, to en-
sure that communication attempts are rec-
ognized and reinforced (Rowland &
Schweigert, 2000).
Generalization and social validity
Of the 30 studies, 16 included generali-
zation measures of some kind, across in-
dividuals, settings, communication be-
haviors, or some combination of the
three. For example, in the four studies that
used dual-communication boards, Heller
and her research team (Heller & Ware,
1994; Heller & Allgood, 1996; Heller,
Allgood, Davis et al., 1996; Heller, All-
good, Ware et al., 1996) measured the
generalization of communication behav-
iors across coworkers and supervisors,
greatly increasing the social opportunities
for the participants involved. In imple-
menting multicomponent training inter-
ventions, they also tested for generaliza-
tion, assessing the transfer of new
communicative skills across people, en-
vironments, and behaviors. Two studies
actually addressed generalization across
both new individuals and new settings to
determine the permanence of the new
communication behaviors (Hunt et al.,
1991; Hunt et al., 1996). The two studies
that used object symbols likewise as-
sessed the participants for generalization
across settings (Reichle et al., 1989; Tur-
nell & Carter, 1994).
It is interesting to note that few of the
studies of microswitch interventions ac-
tually tested for generalization in any
manner, perhaps because of the relative
expense associated with these types of
interventions, with microswitch technol-
ogy not available for full-time use in a
classroom or at home. However, 4 of the
2008 AFB, All Rights Reserved
17 studies in this intervention category
did test for generalization. Earlier studies,
such as those by Dattilo (1986) and
Schweigert (1989), measured the gener-
alization of the use of microswitches
across home and classroom settings,
whereas later studies focused on the gen-
eralization of the use of microswitches
across different choices and behaviors
(Cosbey & Johnston, 2006; Singh et al.,
2003).
Of the 30 studies, 12 formally mea-
sured the social validity of their re-
search findings. Three of the 4 studies
of interventions using dual communica-
tion boards assessed the outcomes of
the studies as socially positive for the
participants, as did 5 of the 6 studies of
multicomponent training interventions.
One study that incorporated peer train-
ing reported socially valid outcomes not
just for the focus students, but for the
typically developing peers as well
(Hunt et al., 1996). At the conclusion of
the study, these young elementary stu-
dents now openly identified themselves
as friends of the focus students and had
a clear understanding that these com-
munication strategies allowed their new
friends to say things [they] cant say
(p. 65). Most researchers who used mi-
croswitch interventions did not for-
mally assess the social validity of their
research outcomes. However, it should
be noted that many of these researchers
(such as Schweigert, 1989; Singh,
et. al., 2003) commented on the positive
lasting effects of their interventions on
the communicative skills of their par-
ticipants, adding a subjective opinion of
social validity, albeit on an anecdotal
level.
Journal of Visual Impairment & Blindness, September 2008 547
Implications for practitioners, family
members, and consumers
For teachers, family members, and pro-
fessionals, identifying effective commu-
nication interventions for children who
are visually impaired and have additional
disabilities can be a daunting process,
since many strategies that have been doc-
umented in the research literature on aug-
mentative communication rely on stu-
dents having an intact visual sense.
Picture-exchange communication sys-
tems or visual schedules that are success-
ful with other children with multiple dis-
abilities may not be accessible to students
with visual impairments. This review has
offered insights for parents and educa-
tional teams into strategies that have been
effective in building communication re-
sponses with children with visual impair-
ments and multiple disabilities.
In many of the articles that were re-
viewed, the participants were considered
incapable of expressive communica-
tion (see, for example, Dattilo, 1986;
Schweigert, 1989). In one such case, the
parents of the participant had been told
for 14 years that their daughter would
never be able to communicate meaning-
fully because of her cognitive impair-
ments (Singh et al., 2003). However,
through the combined use of augmenta-
tive communication devices and positive
reinforcement techniques, the large ma-
jority of the participants in the combined
30 studies displayed purposeful choice
making and the beginnings of self-
advocacy by the conclusion of the inter-
ventions. The impact on the quality of the
lives of these individuals was immediate
and profound, since they were able to
express themselves to others for the first
548 Journal of Visual Impairment & Blindness, September 2008
time. This self-determination and the sub-
sequent ability to choose preferred items
or stimuli is a highly significant act, and
once the initial cognitive connection is
made, these techniques can be applied to
many different settings or activities (Lan-
cioni, OReilly, Singh, Oliva et al., 2006).
LIMITATIONS
This study represents one view of com-
munication interventions that were
grouped on the basis of a specific meth-
odology: single-subject research. Other
seminal quasi-experimental large-group
studies (see Mar & Sall, 1994; Rowland
& Schweigert, 2000) were excluded, to
promote the alignment of research de-
signs. Still other communication studies
that did not use single-subject research
examined the correlation of communica-
tion behaviors between caregivers and
children with visual impairments and
other disabilities (see Romer & Haring,
1994; Rowland, 1990). These studies pro-
vide a richer context for understanding
the ways in which nontraditional commu-
nication behaviors are overlooked. It is
important to note that several of the
single-subject studies were predicated on
the types of information provided by
studies that used diverse research designs
that were cited in the single-subject stud-
ies. Thus, the findings from this study
provide one type of evidence, based on
replication, that cannot be divorced from
the larger corpus of research from which
it emerged.
A second clear limitation is that the
search parameter, 6 to 22 years, precluded
us from examining studies that measured
interventions for young children or adults.
With more time and expansion of age
ranges, more studies may be identified
2008 AFB, All Rights Reserved
that shed further light on what types of
communication interventions prove to be
the most effective at various developmen-
tal stages of life.
Finally, the nature of visual impairment
in children with multiple disabilities is
often hidden. In the educational system,
as well as in the literature, children with
numerous disability labels, including vi-
sual impairment, may not be readily iden-
tified as needing systematic supports and
adaptations to compensate for reduced or
absent visual acuity (Silberman & Sacks,
2005). This study was limited in that it
examined articles that identified children
with visual impairments generally, not by
specific eye diseases or conditions. Addi-
tional research certainly exists that has
been conducted with children who have
multiple disabilities but has not included
reduced visual functioning in the descrip-
tions of the participants.
Conclusion
Despite multiple barriers to access and
long-standing patterns of social with-
drawal of students who are visually im-
paired and have additional disabilities,
numerous studies have provided evidence
that these students can develop functional
communication skills if they are given
intensive, consistent communication in-
terventions and a mechanism for express-
ing themselves. The ability of these stu-
dents to make meaningful choices,
express interests, and connect with other
human beings through such interventions
represents a triumph of the human voice.
For the field of blindness, these findings
offer a road map for providing appropri-
ate, evidence-based interventions to chil-
dren who have significant barriers in de-
veloping communication skills. For
2008 AFB, All Rights Reserved
researchers, this group of studies offers an
impetus for conducting future research
that will examine additional types of in-
terventions, which, at this point, may be
described only in qualitative research. For
children with visual impairments and ad-
ditional disabilities, the effort to bridge
environmental isolation and empower
students to communicate with those
around them decreases their risks of de-
veloping learned helplessness and pro-
vides a means for them to contribute to
the world around them. The marriage of
scientifically based practices and inter-
ventions with high social validity, then,
may not be an impractical hope for edu-
cators and family members who seek to
build the communication capacities of
children with visual impairments and ad-
ditional disabilities. The further examina-
tion of single-subject research conducted
in the low-incidence field of visual im-
pairment may provide opportunities to
validate practice, as well as to collaborate
to build and sustain new practices.
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2008 AFB, All Rights Reserved