Cody’s congenital blindness and autism has resulted in developmental delays in all areas. This includes cognitive, speech, social, emotional and physical development. Physically, he is delayed in areas of motor skills such as gross motor (big movements) and fine motor (small, more detailed movements with fingers and hands). These motor delays as well as his dual diagnosis, make basic daily living skills and self-care much more challenging for him to learn and for us to teach.
It is very typical for children with blindness and other special needs to be delayed in self-care, and this is even more the case because us as parents tend to compensate and do too much for them, for various reasons! I knew a consultant I visited in Cody’s early years who really tried to encourage me in this area. She worked with children, youth and adults with varying degrees of visual impairment teaching them Orientation and Mobility skills. Many of the clients she had did not have cognitive delays and, as is typical, were very strong in school and academics. She would remark on the dichotomy she often witnessed; youth who were getting straight A’s, but who still didn’t know how to get dressed on their own. Parents were doing all the work, making sure their child was on time for school…yet in doing so were encouraging dependency and a complete imbalance in development.
Objectively, as a parent, it is easy to see that this is unhealthy. But, practically, it is very hard to remain diligent and consistent in teaching them to be independent.
I have a fantastic Occupational Therapist who has been helping me set goals and teach Cody in various areas of self-care.
One of our goals is in the area of dressing. He has come so far in the past year! We started by regularly having him explore the parts of a shirt; the neck, the sleeves, the body. We also did the same with shorts and pants.
We then used a method called “backwards chaining”. This involves slowly adding challenge and difficulty, but starting from the end of the action as opposed to the beginning.
If we are to break down the action of putting on a shirt, it would look like this:
- Grab shirt from drawer
- Place shirt on bedside with the proper orientation
- Locate shirt and figure out orientation using touch
- Insert arms in the correct place and reach for sleeves
- Pull arms through sleeves
- Grab shirt by collar and pull over head
- Pull down shirt to cover body
In backwards chaining, I help Cody with steps 1-6, and then wait for him to do step 7 all on his own. Once he’s mastered this, I help him with steps 1-5 and then wait for him to do steps 6 and 7 entirely on his own. In this way, we continually move backwards and he experiences the pride and accomplishment of success step by step.
At this point, Cody has mastered steps 7, 6, 5, and 4! We are working on perfecting step 3. Teaching step 2 (Place shirt on bedside with proper orientation) will be especially challenging. We will have to figure out a way to make the front and back of the shirt tangibly distinct. This involves good tactile sensitivity as well as strong fine motor skills.
Here is a video of Cody getting dressed this morning. As you can see, he finds a lot of joy and pride in his ability to do this much on his own! At this point I lay out his shorts and shirt for him before he sits down to dress.
This video represents many, many hours of discussion and work for Cody’s therapist, myself, family and of course Cody himself! It sure is worth it to see that smile and to hear those squeals of delight! Good work Cody! We’ll keep at it, you and I and the others that care for you. And one day, you will do each and every step, all on your own.