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Virtual visits are a telehealth service where patients and providers communicate in real-time using audio and/or video technology. Setting up a virtual visit is complex and may pose challenges for some autistic adults. We conducted semi-structured interviews with autistic adults (n = 7), family members of autistic adults (n = 12), and clinic personnel (n = 6) from one US-based clinic and used thematic analysis to identify factors affecting usability of virtual visits. We found virtual visit preparation involves multiple contacts between clinic personnel and patients or family members via a variety of channels and usability was affected by technology considerations, logistical considerations, and expectations for visits. Participants said technological experience and using the patient portal enhanced usability, but technological issues could increase anxiety. Clinic personnel reported time constraints created logistical barriers to virtual visits; streamlining the process before the visit via the patient portal may improve the usability of virtual visits for autistic adults, family members, and clinic personnel. Participants also reported unclear expectations for virtual visits reduced usability and recommended reminders, instructional videos, and estimated wait-times to clarify expectations. While our findings are based on a single clinic, they may help inform usability improvement efforts in other clinics offering virtual visits for autistic adults.

The changing racial and ethnic demographics in the United States school-age population is a defining phenomenon of its educational system. Classrooms across the country are a microcosm of the expanding cultural diversity in society. This growing demographic of students of color extends to students in low-incidence disability groups: deaf or hard of hearing (DHH), blind or visually impaired (BVI), or deafblind (DB) children. A greater understanding of and responsiveness to the increasing cultural and linguistic diversity among DHH, BVI, and DB students is critical for the educators who serve them. To that end, this introductory article on culturally sustaining pedagogy (CSP) with DHH, BVI, and DB students from culturally and linguistically diverse (CLD) backgrounds (a) reviews the need for CSP, including how racial, disability, and other marginalizing identities intersect and impact the educational experiences and outcomes of these students, and (b) describes three ways educators can practice CSP in their work with these students and their families: critical self-reflection, personalized literacy, and collaborative partnerships with CLD families. Vignettes adapted from the authors' experiences as teachers and researchers illustrate instructional strategies exemplifying core CSP tenets and practices.

Communication infuses all dimensions and stages of life, influencing one's self-determination and quality of life. A number of empirical studies have demonstrated that people with severe disabilities continue to develop communication and language skills well into their adult years and make measurable gains when provided with appropriate communication services and supports. Several myths about age, ability, and experiences limit opportunities for persons with severe disabilities. In this paper, we confront and address these myths.

Autistic adults experience barriers to primary care, including distant/inaccessible clinics, sensory stressors, and communication barriers with providers. Synchronous telehealth visits, termed "virtual visits," may be a way to minimize these barriers. We investigated the advantages and disadvantages of primary care virtual visits using a phenomenological approach. We interviewed autistic adults (n = 7) and caregivers of autistic adults (n = 12) from one primary care clinic. Using thematic analysis, we identified three advantages to virtual visits: (1) increased patient comfort from avoiding travel to the clinic, crowded waiting rooms, and other sensory stressors; (2) increased safety by avoiding physical contact with others who may be sick; and (3) similar or better patient--provider communication than in-person visits. Disadvantages included the following: (1) Internet instability and other technological issues, (2) the inability to receive hands-on care from the provider, and (3) reduced patient engagement due to environmental distractions. Virtual visits may minimize barriers to care for autistic adults by reducing travel time, exposure to sensory stressors, and barriers to communication with the provider. While we recognize that virtual visits may not be appropriate for all patients or in all situations, they may be a promising model of health care delivery for autistic adults.

Students who are Deaf with Disabilities (DWD) comprise an extremely heterogeneous population. Similar to students who are d/Deaf or hard of hearing (DHH), students who are DWD vary in terms of degree, type, and age at onset of hearing loss, amplification, and preferred communication method. However, students who are DWD are also diverse in terms of type, etiology, and number and severity of disability(ies). Presented in this article is an overview of DWD followed by foci on Deaf with learning disabilities, Deaf with intellectual disabilities, Deaf with autism spectrum disorder, and deafblindness. Particular attention is given to communication, language, and literacy development.

Introduction: The purpose of this study was to identify effective individualized positive behavior support strategies and cognitive behavior therapy strategies for young adults who are deafblind. It discusses findings specific to four young adult students with CHARGE syndrome. Methods: This collaborative action research study employed collective case study design and elements of grounded theory analysis. Principles of positive behavior support and modified cognitive behavior therapy supported the identification and implementation of individualized behavioral interventions that addressed environment arrangement, sensory needs and sensitivities, and how adults communicated with the students. Results: Eight themes were identified as being important to each of the students, although to varying degrees. These were: provide structure, establish and maintain a positive climate, address students' sensory needs and sensitivities, support on-task behavior, support transitions between activities and environments, support mature behavior, support students in coping with anxiety, and use adult language supports. Each theme included multiple strategies. Discussion: Proactive and reactive strategies must be individualized even when children share an etiology. Educational team members must know each student's preferences, likes, dislikes, reinforcers, and unique communication needs in order to identify and effectively implement behavioral supports. Modified cognitive behavior therapy may be helpful in addressing the anxiety experienced by individuals with CHARGE syndrome. Teams require time to collaborate on behavioral assessment, the identification of individualized behavioral strategies, and the effectiveness of behavioral plans. Implications for practitioners: Providing well-structured environments and teaching rules and routines can reduce anxiety because students know what to expect. Educational team members should prevent sensory overload, provide structured desensitization opportunities, and teach relaxation techniques to these students. Adult communication must be positive, clarify what will happen next, and redirect behaviors when needed.

Students who are visually impaired may face unique literacy challenges as they learn to read and write braille. One such challenge relates to slower reading speeds for students who read braille as compared to those who read print. In addition to learning letters, sounds, grammar, and spelling, braille readers must learn contractions and composition signs and the rules for using such symbols. This extra hurdle influences the decoding skills of braille students. This study was conducted as collaborative action research, which involved two teachers of students with visual impairments and one university professor. The findings of this study yielded a number of implications for practice and further research that included: (1) Analysis of decoding errors and strategies utilized in designing individualized reading instruction, and (2) Focus more specifically on the types of errors that students make while reading. In addition, research should consider whether decoding and instructional strategies have a positive impact on reading.

While the medical home has proven effective at improving continuity of care among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults. We conducted a retrospective cohort study to compare the continuity of care of autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the Center for Autism Services and Transition (CAST), to propensity score matched national samples of autistic adults with private insurance or Medicare. The unadjusted median Bice-Boxerman continuity of care index was 0.6 (interquartile range = 0.4-1.0) for CAST patients, 0.5 (interquartile range = 0.3-1.0) for Medicare beneficiaries, and 0.6 (interquartile range = 0.4-1.0) for privately insured autistic adults. In multivariable models controlling for demographic characteristics, on average, CAST patients had continuity of care indices that were 10% higher than national samples of autistic adult Medicare beneficiaries (p < 0.0001). Continuity of care among CAST patients did not significantly differ from that of the national sample of privately insured autistic adults (p = 0.08). Our findings suggest that medical homes, like CAST, may be a promising solution to improve healthcare delivery for the growing population of autistic adults.

This paper presents the essential programming components resulting from a systematic review of research studies, legislation, and policy documents on the topic of administration issues in educational programming for students who are deaf/hard of hearing, visually impaired, or deafblind. It is recommended that educational teams should include a member whose educational preparation and credential matches the disability of the student who is deaf/hard of hearing, visually impaired, or deafblind to support assessment and instructional programming. Additional recommendations including limiting the caseloads of itinerant teachers of students with visual impairment to 8-20 and limiting the size of groupings that include children who are deafblind to support access and engagement. With the exception of the caseload recommendation, which is at the limited evidence level, all other essential programming components were determined to have an emerging level of evidence. The heterogeneity, low prevalence, and geographic disbursement of these disability groups create challenges for conducting educational research.

Introduction: Deafblindness limits access to social cues and social feedback, thus restricting the development of social skills. Many children with CHARGE syndrome, a leading cause of deafblindness, experience challenges with emotional self-regulation and anxiety that may interfere with socialization. Learning about self-determination skills such as goal setting, problem solving, and choice making, in the context of socialization instruction, may improve emotional regulation and social skills. Methods: This collaborative action research study employed grounded theory design, with ongoing data analysis. The primary research question was: How will interactions between adolescent students with CHARGE syndrome and younger students with mixed etiologies of deafblindness change over time, in the context of an arranged interaction space? Data sources were videotaped observations of interaction and feedback sessions, evaluation forms, and field notes. Independent qualitative analysis by two raters and member checks enhanced the trustworthiness of findings. Results: The younger students learned to make toy choices when presented with them by the adolescent students. Joint attention challenges occurred, as adolescent students did not understand their pals' visual latency and play skills. The adolescent students learned to interact more effectively with younger students while rehearsing self-determination skills such as goal setting and problem solving. Discussion: Adult support was essential to successful interactions and to adolescent students' engagement in self-reflection and self-evaluation during the feedback sessions. More research is needed on socialization and self-determination instruction of children who are deafblind, including those with CHARGE syndrome. Implications for practitioners: Children who are deafblind require direct instruction for social skills and opportunities to practice interactions with differently aged children. They also require opportunities to problem solve in the context of socialization opportunities. Support from familiar adults may reduce the anxiety experienced during socialization.

Introduction: This study examined the effect of an animal-assisted humane education course on the knowledge of students about caring for dogs physically and psychologically and making informed decisions about dog ownership, including working dogs. Method: This collaborative action-research study employed case study design to examine the effect of an eight-week animal-assisted humane education course on the knowledge and skills of four secondary students with visual impairments. Two independent raters applied constant comparative analysis for all of the following data sources: pre-and postintervention interviews, pre-and postintervention tests, videotaped observations, and field notes. Findings were determined for individual students and the class as a whole. Results: The greatest gains made by students included learning how to greet, feed, play with, obtain, and pay for dogs; they also learned about appropriate equipment and the roles of working dogs. Effective instructional strategies included assessing prior knowledge and experience with dogs, practicing skills, using tactile techniques, using routines and repetition, and correcting misconceptions. Discussion: Findings indicate that although students did not master all of the knowledge and skills taught in the course, they became more knowledgeable about care and ownership of dogs. Limitations of this study are the small sample size and short intervention time. Future research may feature longer intervention periods and make connections between humane education, orientation and mobility, and the core content areas of science and mathematics. Implications for practitioners: Students with visual impairments must be provided with experiences with different types of working dogs. Ample time should be given to explore equipment and to practice skills that are essential to responsible care and ownership of dogs.

There are many reports that identify the communication of persons with deafblindness. These reports are descriptive in nature, highlighting comprehension, gesture development, communication actions (that is, forms) and purposes (that is, functions), and the collection of verbal skills. This report extends the literature with an in-depth descriptive analysis of sign language, spoken words (that is, speech), communication repair strategies, and Communication Matrix levels. As already noted, sign language and speech are typically included in other research reports, but few consider Communication Matrix levels or repair skills despite the importance and relevance of both. Results of the study reported here imply that parents and educators might expect a wide range of skills as children who are deafblind develop speech and sign language abilities, specifically, and communication skills more generally. It is difficult to know why particular children develop more skills than others. To address this gap, future research needs to consider which intrinsic and environmental influence the acquisition of communication skills so that parents and professionals (that is, special education teachers, developmental pediatricians, educational psychologists, or speech-language pathologists) can consider evidence-based prognostic elements during educational assessment activities.

Deafblindness is complex, and there is very limited research on literacy for learners who are deafblind, including on comprehension. This study investigated current practices for comprehension development for learners who are deafblind. Data were collected through a survey and interviews from 63 U.S. participants who were teachers, interveners, and parents. Thematic analysis resulted in the emergence of themes and strategies related to supporting and measuring comprehension during shared reading for learners who are deafblind. Strategies for supporting comprehension include multiple communication forms, customizing the text, repeating, exploring materials, and integrating technology. For measuring comprehension strategies include questioning, completing phrases, commenting and discussing, retelling, sequencing, and extension activities. Implications for research include future investigations on the effectiveness of the strategies currently reported to support and measure comprehension. Implications for practice include developing understanding by supporting communication and access during shared reading while using multiple measures of comprehension. [ABSTRACT FROM AUTHOR]

Means-end behavior occurs when the child can carry out a sequence of steps, including the removal of a physical obstacle, to achieve a goal. The development of means-end knowledge occurs in three stages: transitional, intentional, and comprehensive. Comprehensive means-end is achieved when the child can generate solutions without demonstration of the solution by another and without trial and error. The achievement of means-end is considered a pivotal developmental milestone because of its strong positive correlation to intentional communication and its relationship to understanding the intent of other's actions. It is important to create accessible opportunities for children with disabilities to observe others solving means-end problems. High interest and personalized materials that are age appropriate will motivate children to solve means-end problems. This article presents a review of research on means-end development in children with severe disabilities, information on how to assess and teach means-end, and two case studies (with lessons and video) to illustrate key concepts. (Contains 5 figures.)

This article presents an overview of recommended practices for assessing students who are deaf/hard of hearing, visually impaired, or deafblind. These recommendations were originally derived from a systematic review of research studies, policy documents, and professional literature on assessment (1990-2013) for the Collaboration for Effective Educator Development, Accountability, and Reform (CEEDAR) Center. This review was then updated through 2016 on select topics identified in the original review with the addition of research on assessment accommodations, dynamic assessment, and curriculum-based assessment. The authors applied the CEEDAR Center rubric criteria for evaluating the strength of evidence for each identified practice. Across the disability groups, evidence was at the emerging to moderate levels, with the highest level of evidence for assessment accommodations specific to each disability.

This article tells the story of how Colby, a young boy who is congenitally deafblind, developed language and literacy. Narrative is coupled with video to illustrate how the following four instructional approaches and interventions supported his development: (1) daily schedule, (2) home-school journal, (3) experiential based literacy, and (4) child-guided instruction. Both Colby's mother and his teachers developed individualized literacy lessons that were delivered with daily consistency. Repetition of highly interesting activities paired with consistent exposure to representations about those activities (expressed in objects, verbalizations, sign language, and braille) supported Colby to literacy.

Morning Circle, also known as Morning Meeting, is often a daily lesson in both general education and special education classrooms. The primary purpose of the Circle is to support each child to establish membership in the class while developing a classroom community and culture. The Responsive Classroom Approach recommends four Circle components: greeting, sharing, group activity, and news and announcements (Kriete, 2002). Strategies such as embedding the instruction of IEP objectives, differentiating instruction, encouraging the active physical involvement of students, and creating opportunities for communication support the participation of children with disabilities. This article shares Circle components, routines, and strategies as demonstrated by ten special educators serving children with severe disabilities, ages 3-10 years. Video clips are used to illustrate key concepts. (Contains 4 photos and 5 video clips.)

Daily communication journals are a powerful tool to promote communication development in children with severe disabilities. Each page of the daily journal features three parts: a print or braille label, a recording device, and a tangible symbol. Children should participate in both the preparation of the daily journal and its review, thus gaining opportunities to develop associations between important school events and the symbols that represent those events. The review of the daily journal in the home creates opportunities for children to recall school events and to share those events with family members. (Contains 1 figure.)