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Get Your Coat: Examining the Development of Independent 1 Get Your Coat: Examining the Development of Independent Dressing Skills in Young Children with Visual Impairment in comparison with Young Children with Down syndrome and Typically Developing Children Jessica Antonia Hayton UCL Institute of Education Thesis submitted to University College London for the degree of Doctor of Philosophy Supervisors: Dr. Dagmara Dimitriou and Dr. Karl Wall May 2016 Jessica Hayton 2 Declaration I, Jessica Hayton, confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I can confirm that this has been indicated in the thesis. Signature:……………………………… Date:…………………….. Word count: 89,752 (excluding references and appendices). Jessica Hayton 3 Abstract The ability to independently dress is a fundamental skill for children. Vision is an integrative sense. Sight affords the opportunity for individuals to learn independence skills via observation. The absence of vision, or a reduced visual capacity, restricts access to this form of learning (Lewis & Iselin, 2002). As a result of this restricted access, children with visual impairment (VI) and conditions where VI is a component (e.g. Down syndrome (DS)) require systematic and structured support. This is to facilitate the development of independent dressing skills. There has been little research to date relating to strategies for successful dressing, or the effectiveness of such strategies in children (as most of the research has been based around the re-habilitation of adults: e.g. Klein, 1983). This thesis reports an observationally based pre-test, intervention, post-test study. It examines the effectiveness of novel intervention materials and systematic strategies to support independent dressing abilities in young children. The sample consisted of three groups of children. Namely, children with VI (n=9; age range: 5;06-10;02 years), children with DS (n=9; age range: 5;04-10;00 years) and typically developing children (n=9; age range: 6;05-8;00 years) (N=27; age range: 5-10 years). The effectiveness of the structured intervention was examined over a 10 week period. The longevity of skill development was assessed 1 month and 3 months post-intervention. In addition to the development of novel resources, a supporting document for teachers, parents and carers was developed in order to further support the delivery of the intervention. The thesis reported that VI, DS and TD children benefited from the intervention and dressing strategies to support their development of independent dressing skills. Clear systematic instruction combined with motor activities were found to be useful in the development of dressing skills. The findings from this thesis inform future research regarding the development of independent dressing skills, and could also form a model for future work regarding other skill areas such as personal care and eating in relation to other clinical groups e.g. William’s Syndrome. Jessica Hayton 4 Acknowledgements I would sincerely like to thank those who have made this thesis possible. Firstly, my supervisors Dr. Karl Wall and Dr. Dagmara Dimitriou for their continual support, encouragement, inspiration and patience. Your guidance has enabled my development both personally and professionally. For that I am extremely thankful. I would also like to thank Dr. Frances Le Cornu Knight and Sue Keil from the RNIB who kindly offered their support and guidance during this process. I would also like to thank my family and friends who have offered their unconditional support, at the best and worst of times (we do not mention the Chicken Kiev). In more ways than one you have all made this possible. Your confidence in me and reassurance has really helped me through. Thank you. To my parents in particular, who have always wanted the best for me and supported me throughout. You have kept me grounded and reasonably sane. You have always put your children’s happiness before yourselves. For that I am eternally grateful. To my fiancé, Jamie, who has witnessed me throughout the PhD (including the Chicken Kiev incident) and still popped the question. You have supported me in more ways than I thought imaginable. To the schools and voluntary organisations who so kindly afforded me the opportunity to conduct my research. To the families, and most importantly, the children who inspired and supported this project. I would also like to gratefully acknowledge the Royal Masonic Trust for Girls and Boys, who have sponsored me through my PhD. If it wasn’t for you, this thesis would not have been possible, I cannot express enough how thankful I am for the opportunity you have so kindly provided. Jessica Hayton 5 Table of Contents Declaration ............................................................................................................................ 2 Abstract................................................................................................................................. 3 Acknowledgements ............................................................................................................... 4 Table of Contents .................................................................................................................. 5 List of Figures ..................................................................................................................... 10 List of Tables ...................................................................................................................... 12 List of Terms and Abbreviations .......................................................................................... 14 Glossary of Definitions ........................................................................................................ 16 Thesis Overview ................................................................................................................. 17 1. Introduction ..................................................................................................................... 18 2. The Development of Independent Dressing Skills ........................................................... 30 2.0 Introduction ................................................................................................................... 30 2.1 Independent Living Skills ............................................................................................ 31 2.1.1 The development of dressing skills ..................................................................... 35 2.1.2 The role of caregivers in developing dressing skills ............................................. 35 2.1.3 General skills needed for successful dressing ..................................................... 36 2.1.4 Dressing and developmental disabilities .............................................................. 37 2.1.5 Available dressing literature ................................................................................ 39 2.1.6 The dressing sequence ....................................................................................... 39 2.1.7 Pre-requisite skills for independent dressing ....................................................... 40 2.1.8 The current state of dressing practice ................................................................. 42 2.2 The Role of Incidental Learning .................................................................................. 43 2.2.1 Compensating for restricted access to incidental learning ................................... 45 2.2.2 Restricted access to incidental learning and social implications .......................... 46 2.2.3 Montessori and the importance of instructions .................................................... 46 2.3 Chapter summary ....................................................................................................... 49 3. Vision, Motor Skills in Typical and Atypical Development, and Developmental Delay ...... 51 3.1 The Relationship between Vision and Movement ....................................................... 56 3.2 Visual Impairment/s .................................................................................................... 58 3.2.1 Defining visual impairment .................................................................................. 58 3.2.2. Classification and causes of visual impairment .................................................. 59 3.2.3 Prevalence of visual impairment .......................................................................... 60 3.2.4. Prevalence of comorbidity and visual impairment ............................................... 61 3.2.5 Visual assessment measures .............................................................................. 62 Jessica Hayton 6 3.2.6. Variability and cognition in children with VI ......................................................... 64 3.3 Down Syndrome ......................................................................................................... 65 3.3.1 Historical perspective .......................................................................................... 65 3.3.2 Genetics and diagnostics .................................................................................... 66 3.3.3. Prevalence rates ................................................................................................ 68 3.3.4 Physical and medical characteristics ................................................................... 68 3.3.5 Prevalence of DS and comorbidity .....................................................................
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