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The BMA - a model to improve development and prevent problems in Blind children with Mental disorders and Autism

Focus: School Years

Topic: MDVI

Kirsten Larsen

Teacher in special education

National Institute for Blind and Partially Sighted Children and Youth Refsnaesskolen,


Kystvejen 112 – DK 4400 Kalundborg

 +59 57 01 00

e-mail: kirsten_larsen_dk@yahoo.dk


I have been a teacher at Refsnaesskolen for 17 years. In this span, the group of children with the combination of blindness, mental disorders and autism (from now on referred to as BMA-students) is the group that has made me feel most powerless; I actually thought of giving up and changing to another profession. However, by now I have had so many valuable experiences that it would take all day to share all of them.

In 1995, “The Autism Class” was established, with three young BMA boys. The students, who are now in their twenties, all began in Kindergarten at Refsnaesskolen and attended different classes together with other blind students, some of them with threatening and aggressive behaviour. This caused anxiety for the BMA-students and blocked their learning.

This is the story about how two teachers built The Autism Class from scratch. We developed appropriate teaching strategies for the students. We were motivated, and the principal and headmaster of Refsnaesskolen supported the project – two factors that are absolutely fundamental for keeping up one's spirit.

Over time, this special combination of disabilities has proved to have special consequences for the education, and it is necessary to develop special methods to ensure that children with this dual diagnosis of blindness and autism have the opportunity to reach their full potential. We had to find new ways.

This empirical study is based on our 6 years of experience and research as classroom teachers for The Autism Class. In the first years, we taught 15 hours per week. The method is based on critical reflection research of the students in their natural environments and includes analysis of videotapes throughout the 6-year period.

The five basic principles of education for the blind

Danish educators for the blind usually point to five basic educational principles. These principles apply to all education, but in the education of blind children, they are absolutely essential.

Individualisation: Naturally, children with visual impairments are as different as all other children. Therefore, one must have an individual approach to each child.

Concretisation: The concrete approach is necessary because blind children do not perceive an object, until they have held it in their hands. It is, thus, a direct sensory approach where the child touches and manipulates the object while listening to an explanation.

A holistic approach: The holistic principle aims to use and integrate the child's sensory possibilities in the way that the child perceives objects, places and situations. Sighted people quickly form the big picture through their vision. The blind child needs a combination of time – lots of time – and experiences received through all the senses – repeatedly. Remember that what we see in two seconds takes a thousand words to describe.

Real-world linkage: The blind child links their experiences with the real world by combining concrete experiences with everyday experiences. The child's awareness expands. He or she learns about a new and unfamiliar entity by going through the familiar. The physical environment is difficult to grasp and cumbersome to examine for blind people, so often it is easier to accept verbal answers and solutions.

Activation is closely linked with the other four principles. The child must be active every step of the way in order to grasp the bigger picture.

Mental retardation

Mental retardation is a cognitive impairment. It implies cognitive difficulties in comprehension, learning and abstract thinking. Often, the child has a severe developmental impairment within all functional areas, but a child with Down's syndrome, for example, often has good empathy skills unlike a child with autism. They develop more slowly than normally. This slower development may be viewed in a quantitative sense. The key educational strategy towards mentally retarded children lies in simplifying – transforming ­– matters.

Educational principles for children with autism

Autism is a comprehensive developmental disorder characterised through a triad of functional disorders that cause delayed development and deviations in:

-    social interaction

-    communication

-    behaviour, scheme of things

This means that a child with autism undergoes a different development, which may be viewed in a qualitative sense. Simplification is also important to children with autism, but the qualitative aspects unique to this impairment make additional clarification necessary.

Today, it is generally agreed that autism is a lifelong developmental disorder with neurobiological causes. Most people with this impairment require lifelong special care.

TEACCH (Treatment and Education of Autistic and related Communication handicapped Children) is a recognised approach within the field of autism. The philosophy behind TEACCH is based on cognitive psychology and a basic humanistic view. The overall long-term goal in the TEACCH programme is to educate for a meaningful adult life. In my experience with the TEACCH approach, I have seen education as e a dynamic process, where problems with social understanding, communication, conceptualisation, abstract thinking, differentiation and generalisation constantly have to find new solutions. The view of human nature that my educational practice builds on is the belief that the student contributes to creating his or her own life through his or her actions and choices on an everyday basis. Therefore, the teacher has to be creative and dynamic, and if these children end up in the hands of inflexible teachers their education will be blocked. The TEACCH concept is the antithesis of the behaviouristic behaviour-modifying teaching methods. These are not based on the active mental involvement, self-organisation and increasing independence of the child. Nor do they require that learning first of all be meaningful to the student.

Key words for the education of both blind children and children with autism

-    Structure

-    Security

-    Order

-    Predictability

Vygotsky claims that a child with a defect develops in a qualitatively different way, and a child with a defect that reaches the same level of development as a normal child has done so in another way, through another process and through other means. In the light of the new disability concept, which focuses on shortcomings in the environment, this means that the teacher's task is to find another didactic key to reach this qualitatively uniqueness. We aim to live up to the UN´s Standard Rules on Equal Opportunities for people with disabilities by directing our efforts at communication, social skills and meaningful actions.

Thoughts underlying the BMA-model

Throughout the process of developing the BMA-model, discussions and deliberations in the interdisciplinary teamwork with colleagues have led to new understanding and changes in the model. We based out explanation to the parents of our concept of our work with their children on this statement:

“The blind autist is only able to develop through concrete actions in interaction

with others – adults with knowledge, courage, strength and true involvement.”


Especially in the beginning, the educational practice was explorative and experimental. As we built structures and rooms and got to know the students' special fields of interest, we were able to focus on what we felt gave the students the biggest "push": quality interactions.

In the initial process, we were urged to view the idea of inclusion as a new and creative concept and consider the philosophy of how these students learn. We had to move outside the classroom – into the real world – and learn true sensory impression – multi-sensory education. We are responsible for ensuring that the BMA-students are not made to deal with artificial activities in an unreal world. 

Educational principles

In the beginning, we witnessed some very counterproductive behaviour, which we channelled into more productive paths by:

      -    preparing the student for changes in activity

      -    doing something else – something simple and meaningful

      -                                             making unambiguous demands

      -    only offering two options

The education is practical and project-oriented. It is better to address a few large issues that can be explored in depth. The students learn through action – by making experiences through practical work in a qualified interaction with others. The key point in the education is communication in natural and social contexts. The students need a hands-on approach.


The core of the project throughout the 6 years has been the concept ”From the soil to the dinner table”. We have a produce garden, where we began to grow potatoes. Later, we added corn, carrots, leeks, celery and beet roots. The students take part in all the processes: choosing what to grow, shopping at the tree nursery, sowing/planting, adding fertiliser, weeding and harvesting. We used the produce to prepare tasty exotic dishes. Side projects like selling carrots and corn led to a new project: "Miss Saigon". We invited teachers, social workers, parents and relatives on a fieldtrip to Copenhagen. We began with a candlelight dinner for all of us at a Vietnamese restaurant. Afterwards, we saw the musical “Miss Saigon”. It was an unforgettable event for all 21 persons involved.

The BMA-principles

            BMA-educational approach

            Autism is an organic impairment

            Cooperation between parents and staff

            Holistic view

            Lifelong perspective

The educational principles are based on the five principles for the education of blind children in combination with the TEACCH-model.

Based on our knowledge of blindness, autism and mental retardation, we try to imagine the students' mind and to base our practice on the conditions for the development of the normal child. I have used N. Stern's theories on the child's interpersonal universe. A key developmental principle is what Stern calls ”vitality feelings”, an affective quality. Stern claims that in this phase, the child senses the world through amodal perception, a phenomenon in a sensory universe perceived as a perceptual unit. Stern's theory on representation can be used to analyse and describe interactions and developmental disorders. Howard Gardner's modular theory is a useful supplement as a practical tool.

A prerequisite for working with these students is a dynamic two-teacher approach. The lifeblood of the daily work is inspiration and feedback, if one is to avoid isolation and burnout. The planning of any activity must be based on didactic considerations: choice of subject and method to aim the effort at appropriate, targets, which can be evaluated in order to constantly adjust the effort. I have made a theoretical attempt at separating the BMA-principles to see when and why we use methods targeted for blind students, mentally retarded students or autists. Are there any overlaps or similarities between the methods? The letters in the parentheses indicate the basis for the choice of approach.

            - We should be able to put ourselves in the students' place (B-M-A)

            - We should work with age-appropriate subjects and projects (M-B-A)

            - We should provide the support that the student needs, but does not request.


In this, we work within the nearest zone of development (A-B-M)

- We should help the students be in touch and communicate actively with

  us and with each other, optimising their interaction (A-B-M)

- We should give the students developmental support, helping them to become less  

  dependent on us ( A-M-B are equal)

- We should be consistent and stick to one set of rules (A-M-B)

The basis of the BMA-principles is the dynamic view of the individual, which is based in the dialectic/critical paradigm.

Why do we need dialogue between theory and practice?

Throughout the process, my experiences with the BMA-students have shown me that:

Practice without theory is practice without direction

Theory without practice is barren

- Teachers are strong when it comes to practice

- Theories within the BMA-field are not very developed

- The importance of theories is not fully realized

- The understanding of the relation between the theory and practice varies

- Dialogue is a kind of boundary between theory and practice.

What is dialogue?

Dialogue is a process of knowing in a reflective way. It combines reflections and action.

There is a need for new ways to understand good practice. Practice is not only doing something or using particular of methods. Practice is the result of mental processes that facilitate making judgements about what to do.

The core in BMA-research is to integrate theory and practice and to include human aspects. Constant interplay between professional knowledge and the way it is translated to action.


The Danish primary and lower secondary school is firmly anchored in Danish democratic societal structures, which we have spent centuries developing. One of the key terms is freedom with accountability. In Denmark, the individual teacher is free to choose his or her method of teaching. We also have a high degree of freedom to choose relevant subjects

The point of departure is an analysis of students’ backgrounds and elementary needs. The students’ areas of competence are clarified so that realistic aims can be proposed. What is the individual student capable of, what areas of competence does he or she possess? Teachers determine the educational objectives together with students and parents.

The overall aims are to make students as competent as possible throughout the entire course of education – to live independent lives together with others to the extent that they wish, and not in undignified dependence. We must strengthen students’ self-esteem and confidence and their positive perception of themselves, alone and together with others.

We emphasise quality of life in our teaching. Quality of life is created in an active fellowship with others, something that must be included when we plan education that aims to strengthen self-esteem and self-confidence.


When we focus on the “soft” areas of competence we cannot carry out tests in the same way as we can with more technical objectives. We must pay attention to signs that students are progressing  towards the aims.


Our experiences with the BMA-principles, which define special needs education for BMA-students, have shown that a positive personal development does take place. The more one knows and is capable of, the stronger one feels. We teachers, parents and social workers have been surprised by the students' ability to work independently. Education based on functional, age-appropriate and meaningful activities together with others, and a high degree of closeness and quality lead to a development of the students' social behaviour. As professionals, we must be advocates for these BMA-students.

Success depends on the adults in the students' environment. The students are completely dependent on the basic views of the adults, who must strengthen their professional practice through improved understanding. The teachers must be willing to take on the new role for the teacher that the BMA-model requires.

The students like this way of learning, and with their joint attention on the work, the stereotypic behaviours decreases.

Anyone with an in-depth understanding of something is able to approach this subject in many different ways. This is the type of understanding that the BMA-students need in order to develop. It is difficult, it takes time, but it is possible.

Our experiences have provided professional justification and proof of success.

Remember: ”Constant change is here to stay.”

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