Phát triển kĩ năng giao tiếp cho trẻ khiếm thị kèm rối loạn phổ tự kỉ 5 6 tuổi thông qua chơi TT TIENG ANH

MINISTRY OF EDUCATION AND TRAINING
THE VIETNAM NATIONAL INSTITUTE OF EDUCATION SCIENCE

NGUYEN THI THAM

DEVELOPING COMMUNICATION SKILLS
FOR CHILDREN WITH VISUAL IMPAIRMENT AND AUTISM SPECTRUM
DISORDER 5-6 YEARS OLD THROUGH PLAY

SUMARY DOCTORAL THESIS OF EDUCATION OF SCIENCE

Hanoi – 2021

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The thesis was completed at: Vietnam National Institute of Education Science

Instructors: 1. Associate Professor. PhD. Pham Minh Muc
2. Associate Professor. PhD. Nguyen Xuan Hai

Reviewer 1: ....................................................................

Reviewer 2: ....................................................................

Reviewer 3: ....................................................................

The thesis will be defended in the thesis judging committee meeting at the Vietnam
National Institute of Educational Sciences, 101 Tran Hung Dao, Hanoi.
at 8.30 AM at 6th October in 2021

Thesis can be found at:
National Library in Viet Nam
Library of Vietnam National Institute of Education Sciences

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INTRODUCTION
1. Reasons for choosing the topic
Research by Gates and Kappan (1985), Kirchner (1990), Rogow (1998) showed
that about 49-60% of blind children have other disabilities. Thus, the number of
children with multiple disabilities, including blind children with autism spectrum
disorder, accounts for a relatively large proportion. They also need to enjoy the right to
care, education, and social integration like other children of the same age.
According to many studies, one of the important issues that education needs to
be concerned on children with visual impairments and autism spectrum disorder
(ASD) is communication skills (Huebner, Prickett, Welch & Joffee, 1995). The
children have less eye-to-eye contact, use gestures and gestures to interact with others.
Children are also limited in expressing their own emotions and understanding the
emotions and feelings of the people they communicate with [8][48][72]. Children are
less proactive to initiate and have difficulty maintaining communication. On the other
hand, with the age of 5-6 years old, communication skills are one of the essential
skills that need to be formed for children so that they can study and integrate at a
higher education level. Therefore, it is very important to develop communication skills
for children with visual impairments and ASD 5-6 years old.
Studies confirm that through play, children with disabilities have the
opportunity to develop language, cognitive, and social communication skills
[52][59][76]. Play always creates situations and contexts for children with disabilities
to communicate and develop different skills in communication such as listening,
feedback, and taking turns. Participating in the game helps visually impaired children

with autism spectrum disorders develop language, build confidence, reduce negative
behaviors in communication situations [43][53][85].
For the above reasons, we chose the topic: "Developing communication skills for
children with visual impairments and ASD 5-6 years old through play" to research for
doctoral thesis.
2. Research purpose
Based on research and actual situation, the author proposes measures to develop
communication skills for children with visual impairments and ASD 5-6 years old through
playing, helping them omit to have better communication ability.
3. Research objects and population
3.1. Research population
Communication skills of children with visual impairments and ASD 5-6 years old.
3.2. Research objects
The development process of communication skills for children with visual
impairments and ASD 5-6 years old through playing.
4. Research hypothesis
Communication skills of visually impaired children and ASD 5-6 years old are
still limited and the development of communication skills for children also have many
difficulties and inadequacies. If it is possible to build measures to develop
communication skills for children with visual impairments and ASD 5-6 years old
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through playing in a systematic, synchronous manner, suitable to the children's
abilities, needs, and characteristics of communication skills and actual conditions of
the schools, it will contribute to improving the results of the development of
communication skills for children.
5. Research mission and scope
5.1. Research mission
- Research on theoretical for developing communication skills for children with

visual impairments and ASD 5-6 years old through play.
- Research on the current situation of communication skills and the situation of
developing communication skills for children with visual impairments and ASD 5-6
years old through play.
- Proposing measures to develop communication skills for children with visual
impairments and ASD 5-6 years old through playing. Besides, conducting experiments
measures to confirm the scientificity and research hypothesis of the doctoral thesis.
5.2. Research scope
- Limit of research content: The thesis focuses on studying 06 groups of
communication skills of children with visual impairment and ASD 5-6 years old, the
following skills: Group of skills to focus attention and listen, group of skills to make
choices, love request and refusal, skill group to understand and provide more
information, group of skills to control emotions, group of skills to interact, integrate
into groups, skills to identify and adjust distances and postures when communicating.
- Limit of survey audience
+ 30 children with visual impairments and ASD 5-6 years old (blind children and
mild and moderate autism spectrum disorder)
+ 60 administrators and teachers at education centres for children with visual
impairments and ASD.
- Limited research area: Intervention centers, specialized schools, Centers for
supporting the development of inclusive education have been implementing care and
education activities for children with visual impairments with autism spectrum
disorders. century.
- Research period: From January 2018 to November 2020
6. Research methods and approaches
6.1. Research approaches
- Activity approach (active communication and active play)
- Developmental approach
- Overall approach
- Personalized approach

6.2. Research methods
6.2.1. Theoretical research methods
6.2.2. Practical research methods
Questionnaire method; Test method; Interview method; Professional method;
Observation method; Case Study; Experimental method.
6.2.3. Methods of data processing by mathematical statistics
7. Defended arguments
7.1. The combination of visual impairment and ASD affects the development of
children's communication skills.
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7.2. Organizine play in different forms is vital to encourage the participation of
children with visual impairments and ASD 5-6 years old and strengthen communication
skills for them.
7.3. Implement a combination of ways to develop communication skills through play
should match with the abilities, needs, characteristics of communication skills and play
skills of children with visual impairments and ASD 5-6 years old. On the other hand, it
also suit of practical conditions of special educational centres to create opportunities
for children to develop basic communication skills and contribute to enhancing social
integration.
8. New contributions of the thesis
8.1. Theory
- Contributing to building and expanding the theoretical framework on children
with visual impairments and ASD 5-6 years old. Systematizing some theoretical issues
of developing communication skills for children with visual impairments and ASD 5-6
years old through play.
- Theoretical issues on measures to develop communication skills for children
with visual impairment and ASD 5-6 years old through play based on the child's
specific characteristics and the suitability with the educational environment in the

study areas, contribute to enriching reference materials for special education and
training institutions.
8.2. Practices
- Assessing the level of communication skills of children with visual
impairment and ASD 5-6 years old through research in several cases at care and
educational institutions.
- Providing a real picture of the development of communication skills for
children with visual impairment and ASD 5-6 years old through play in order to
researchers, educators, students and parents have database practices in researching,
teaching, and supporting children in special education.
- Building measures to develop communication skills for children with visual
impairment and ASD 5-6 years old through systematic, scientific play and pedagogical
testing on 03 children. The system of measures to develop communication skills for
children through play is a reference document that teachers and parents can use in the
educational process for this group of children.
9. Thesis structure
Besides the introduction, conclusions, and recommendations, list of references
and appendices, the thesis is structured into four chapters:
- Chapter 1: Theoretical basis for developing communication skills for children with
visual impairment and ASD 5-6 years old through play.
- Chapter 2: The reality of developing communication skills for children with visual
impairment and ASD 5-6 years old through play.
- Chapter 3: Measures to develop communication skills for children with visual
impairment and ASD 5-6 years old through play.
- Chapter 4: Experimenting with measures to develop communication skills for
children with visual impairment and ASD 5-6 years old through play.
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CHAPTER 1

THEORETICAL BASIS ON DEVELOPING COMMUNICATION SKILLS
FOR CHILDREN WITH VISUAL IMPAIRMENT AND AUTISM DISORDER
5-6 YEARS OLD THROUGH PLAY
1.1. Research overviews
1.1.1. Research on education of children visual impairments (VI) and autism spectrum
disorder (ASD) 5-6 years old.
- The thesis refers to the rate of children with visual impairment and autism
spectrum disorder.
- Researching the effects of visual impairment and autism spectrum disorders
on children's development.
- Research on goals, programs, methods, and factors affecting education for
blind children with autism spectrum disorder.
1.1.2. Research on developing communication skills for children with visual
impairment and ASD 5-6 years old.
- Research on the characteristics of communication skills of visual impairment
and autism spectrum disorders.
- Research on assessing communication skills of visual impairment and autism
spectrum disorders.
- Research on how to develop communication skills for visual impairment and
autism spectrum disorders.
1.1.3. Research on play and the development of communication skills for
visually impaired children with autism spectrum disorder 5-6 years old through play
- Research on play skill characteristics of children with visual impairments and
ASD 5-6 years old.
- The relationship between playing and developing communication skills for
children with visual impairments and ASD 5-6 years old.
1.1.4. Assessment of research overview
- Researched issues:
International and Vietnam studies have focused on giving different definitions
of multi-disability, multiple-visual impairment, deaf-blindness, visual impairments

with other disabilities; the rate of children with multiple disabilities and its effects on
child’s developments. The authors also analyzed the specific contents, programs, care
and education for children with multiple disabilities. Particularly, there have been
studies that have pointed out problems related to characteristics of communicational
skills, assessment of communication skills and the development of those for children
with multiple disabilities, visual impairments and ASD.
- Issues that have not been researched yet
+ Age range of children with multiple disabilities is still wide: from 0-6 years
old, 0-22 years old, from 5-11 years old without focusing on research in a specific age
group. In particular, there have been no publications in Vietnam related to the
percentage of children with multiple disabilities in general, and children with visual
impairments and ASD 5-6 years old.
+ The characteristics, content, and methods of developing communication skills
mentioned by the authors are common to all multi-disability, have not yet studied indepth study of each form of disability associated with visual impairment.
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+ In the world, there have been several studies on the assessment of
communication skills of children with visual impairment and multiple disabilities, but
these rating scales are for different ages, not focusing on specific ages, and there is no
rating scale of disability associated with visual impairment (exception of deaf and
blind children). In particular, there have been no studies on rating scales, contents, and
methods to develop communication skills for visually impaired children with ASD 5-6
years old in Vietnam.
+ Studies have also mentioned the influence of multiple disabilities on the
development of all areas of blind children with multiple disabilities, but have not
clearly analyzed the impact of factors on the development of communication skills of
children with visual impairments and multiple disabilities, especially children with
autism spectrum disorders 5-6 years old through play.
- Issues the thesis focuses on research

+ Research on the theoretical framework to the development of communication
skills for children with visual impairment and ASD 5-6 years old through play.
+ Research on the status of the level of communication skills of children with
visual impairments and ASD 5-6 years old and the situation of developing
communication skills through play in Vietnam.
+ Proposing measures to develop communication skills for children with visual
impairments and ASD 5-6 years old through play suitable of children and educational
conditions in Vietnam.
1.2. Common issues of children with visual impairments and ASD 5-6 years old
1.2.1. Definitions
Children with visual impairments and ASD are children who have both visual
impairments and ASD, the combination of these two disabilities affects the areas of
development, children's life and learning activities but cannot use the education
method specifically for visually impaired children or ASD.
1.2.2. Cause of visual impairments with autism spectrum disorder
Many factors lead to children with visual impairment and ASD, which can
appear before, during and after birth. In particular, the diseases that are prone to have
visual impairments associated with ASD including: retinopathy of prematurity (ROP),
cortical visual impairment (CVI), no eyeballs, Anaphthalmia and Optic-Nerver
Hypoplasia.
1.2.3. Criteria of identifying children with visual impairment and ASD
There are four important criteria to identify child with visual impairment and
ASD: (1) Visual (vision and visual field); (2) Language and communication; (3) Social
interaction; (4) Behavior and ability to respond to sensory information.
1.2.4. Effects of visual impairment and ASD on children's development
Characteristics of psychophysiological development of visually impaired
children with ASD 5-6 years old follow the general rule of children. However, due to
the influence of visual disabilities and ASD, children have their own psychological
and personality characteristics. Children's developmental stages are often slower than
those of their peers. This includes significant effects on children's speech and language

development. In addition, children also have many difficulties in perceiving the
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surrounding world, especially forming symbols and imagination.
1.3. Communication skills of children with visual impairment and autism
spectrum disorder 5-6 years old.
1.3.1. Definition of communication skills
- Skill is the use of knowledge and experience to perform actions to achieve a set goal.
- Communication is an activity of interaction between people to exchange information,
emotions and realize social relations.
- Communication skills are understood as the effective performance of a specific
action in the communication process by using knowledge, skills, different means and
forms of communication to influence the communicator to achieve the set purpose.
- Developing communication skills is an impactful process to create a positive change
in the level of a person's communication skills from unskilled to skilled at all levels.
1.3.2. Characteristic of communication skills of children with visual impairment
and autism spectrum disorder 5-6 years old
- Being limited Understand and provide additional information during communication.
- Children have difficulty in focusing attention, limited in actively establishing
bilateral attention and expanding communication topics.
- Children are less sensitive to emotions and feelings of caregivers and peers, have
difficulty controlling their own emotions, understanding questions, and responding, are
less likely to listen and wait for others when communicating.
- Children often tend to have little communication with friends in the classroom, do
not understand the rules when working in groups, and have difficulty being patiently
and emotionally controlling when waiting for their turn.
- Visually impaired children with ASD show more difficulty understanding and using
non-verbal language in communication. Most children lack eye contact and use
gestures and facial expressions. In particular, children have difficulty in understanding

the meaning of words and expressing by verbal language, instead of, children tend to
use communication by actions, tactile symbols.
- Behavior of visually impaired children with ASD in communication: there are typical
behaviors to attract the attention of people around, children rarely use communication
to aim jointly create interactions with others or collect information.
- Due to limited vision, children with visual impairments and ASD also have difficulty
in determining their own distance with communicators. It is difficult for children to
observe the correct posture when communicating with others, so they cannot imitate it.
1.3.3. Assessing communication skills of children with visual impairment and ASD
- Purpose and content: Determine the child's level of communication skills.
- Methods and forms: Direct evaluation and indirect evaluation.
- Tools to assess communication skills for children with visual impairments and ASD.
1.4. Play and developing communication skills for children with VI and ASD 5-6
years old through play
1.4.1. Definitions
* Games: Games are children's special activities, reflecting their interactions with the
surrounding environment: objects, groups of friends, natural and social events; Games
are considered as ways of organizing educational activities to solve goals and develop
knowledge and skills for children to adapt to the reality of social life.
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- Classification of games: This thesis chooses to approach the classification of
games according to the purpose and genre of the game. In which the purpose of games
that the thesis uses is to develop communication skills for children.
* Play: According to the Vietnamese dictionary, play is an action that
expressing participation in the game voluntarily, happily and comfortably, thereby
achieving a certain purpose (relaxing, creating relationships, develop skills, etc.).
* Game organization: Game organization is an arrangement of activities
according to a structure to achieve the goals of games. Play organization includes

activities such as determining the purpose, content of play, specific play activities of
children, interactions between children and participants in the play process.
1.4.2. Playing characteristic of children with VI and ASD 5-6 years old
- Characteristics of development of play stages: Children are delayed in playing
stages compared to children of the same age, especially having difficulty in functional
and imaginative play.
- The interaction with you and others in the play process, the forms of play:
mainly play alone, difficult in associational and cooperative play with others.
- The ability to solve situations during play: Children have many difficulties
handling situations that occur during play with friends.
1.4.3. Steps of play organization for children with VI and ASD 5-6 years old
Play organization for children with visual impairments and ASD 5-6 years old
to develop communication skills needs to four steps: (i) Step 1: Prepare to play; (ii)
Step 2: Make a game plan; (iii) Step 3: Proceed to play; (iv) Step 4: Evaluate the
results of the game.
1.5. The process of developing communication skills for children with visual
impairments and autism spectrum disorder 5-6 years old through play
1.5.1. Purpose and significance of developing communication skills for children
with visual impairments and autism spectrum disorder 5-6 years old through play
Through encouraging children with VI and ASD to participate in differently
organized play activities to suit their psycho-physiological characteristics, abilities and
needs in order to develop children's communication skills. It includes paying attention
and listen skill, expressing needs, choose, refuse, understanding and providing more
information, skills to understand and express feelings and emotions, skills to identify
be distanced from the object to communicate with, alternately interact in the group.
1.5.2. Contents of developing communication skills for children with visual
impairments and autism spectrum disorder 5-6 years old through play
In this thesis, the content of developing communication skills for children VI
and ASD 5-6 years old is focused on six skill groups: (i) Focusing and listening skills;
(ii) Group of using different forms of communication to express their needs; (iii) Skill

group to understand and provide more information in communication; (iv) skill group
to control emotions in communication; (v) Skill group rotation, group interaction; (vi)
Group of skills to adjust posture and distance in the process of communication.
1.5.3. Method of developing communication skills for children with visual
impairments and autism spectrum disorder 5-6 years old through play
There are many methods of developing communication skills for children with
VI and ASD 5-6 years old; and the thesis focuses on analyzing the main methods:
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Developing communication skills through free play – Floortime; Developing
communication through interactive play – INREAL; Developing communication
through the play environment (Environmental Communication Teaching - ECT);
Develop complementary and alternative communication/Total communication through
play and practice practicing communication skills through play.
1.5.4. Forms of developing communication skills for children with visual
impairments and autism spectrum disorder 5-6 years old through play
There are many different forms to develop communication skills for children
with VI and ASD through play. Within the thesis, it mainly refers to the forms that can
be organized including through: (i) Through playing in individual lessons; (ii) Through
playing in group lessons by topic; (iii) Through playing in fun activities, picnics; (iv)
Through play in daily activities (mealtime, bedtime, pick-up time). The forms of
playing can be implemented for visually impaired children with mental retardation at
5-6 years old to develop communication skills in the above forms such as: playing
freely, playing alone with adults, letting children play with friends, playing in
association, or play cooperatively with friends in small groups, large groups.
1.5.5. Affecting factors on the development of communication skills for visually
impaired children and autism spectrum disorder 5-6 years old through play
There are subjective and objective factors affecting the effectiveness of the
developing communication skills for children with VI and ASD. However, the thesis

focuses on analyzing objective factors (factors that affect children outside). Affecting
factors on the development of communication skills for children with VI and ASD
through play including: Classroom and school facilities (light, seating, play corners,
ect.), utensils, toys, the interest, knowledge, skills and experience of the teacher,
awareness, interest, support of the family, the cooperation between the family and the
school (teachers and parents), the relationship between friends and family, friends in
class, in school, program, content, time to develop communication skills for children.
Conclusion chapter one
1. Children with VI and ASD are children who have both vision difficulties and problems
related to communication, social interaction and behavior. Particularly, the combination of
these two visual impairments and autism spectrum disorder has caused significant
limitations in children's communication with those around them.
2. Communication skills of children with VI and ASD has many different characteristics:
the ability to focus and maintain attention, use language in communication (understanding
and expressing in language), the ability to wait alternately when communicating, typical
behaviors when communicating, difficulty understanding and expressing emotions.
3. Organizing play and developing communication skills for children with VI and ASD
have a close relationship. Through play, visually impaired children with ASD can easily
access activities to implement basic communication skills.
4. Developing communication skills for children with VI and ASD through play needs to
be researched with reality of children, class characteristics and support programs that
centers, schools are implementing. In order to develop communication skills suitable for
children with VI and ASD through play, it is necessary to research specifically and
propose measures and implementation methods for teachers to easily apply.
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CHAPTER 2
REALITY OF DEVELOPING COMMUNICATION SKILLS OF CHILDREN
WITH VISUAL IMPAIRMENT AND ASD AGED 5-6 THROUGH PLAY

2.1. Organizing survey of the situation
2.1.1. Purpose of survey
Evaluate the developing communication skills for children with visual
impairment and ASD 5-6 years old through play to propose measures for the
development of basic communication skills for the children.
2.1.2. Content of survey
(i) Evaluate the current situation of levels of communication skills of children
with visual impairment and ASD from 5-6 years old.
(ii) Evaluate the reality of the development of communication skills for children
with visual impairment and ASD aged 5-6 through play.
2.1.3. Tools of survey
To evaluate the levels of communication skills for children with visual
impairment and ASD aged 5-6, the author has built evaluating tools that include 6
criteria with 30 specific indicators. The reseacher tested the reliability and correlation
of evaluating criteria for communication skills of children with visual impairment and
ASD aged 5-6 (Cronbach’s Alpha constant). The result of testing showed that
variables of observations have suitable total correlation (≥ 0.3). Cronbach’s Alpha
constant is 0.96 ≥ 0.6, which matches the reliability of the measurement.
Survey instrument of developing the communication skills for children with
visual impairment and ASD aged 5-6 include: Survey forms for teachers, managerial
staff; interview forms for teachers and parents; Observation forms of children’s
activities.
2.1.4. Objective and location of the research
* Location: Specified center, schools supporting children with visual
impairment and ASD in Hanoi, Hai Phong, Bac Ninh, Ho Chi Minh city, Dong Nai,
Da Lat, Da Nang, Khanh Hoa.
* Evaluation form: The thesis has deployed the evaluation of communication
skills for 30 visually impaired children with ASD aged 5-6 (blind children with
average the level of ASD) studying at educational centers in the location of evaluation.
The thesis also surveys 60 teachers that have been teaching visually impaired

children with ASD at schools and centers under evaluation.
2.1.5. Stages of the deployment of practical research
Stages of practical evaluation: (i) Step 1: Build tools for evaluaion; (ii) Step 2:
Deploy tools for evaluaion; (iii) Step 3: Gather, process the survey results by using
statistical formular, softwares.
2.1.6. Evaluate the result of survey
Quantitative data: Analyze the meaning of gathered statistics by handling the
results from SPSS software and statistical formula.
Qualitative data: Analyze, elaborate gathered results with deep interview and
opinions of subjects taking part in the survey and observation forms.
2.2. Reality of communication skills of visually impaired children with ASD 5-6
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Range = (Maximum – Minimum)/n= (3-1)/3 = 0,67
There are 3 main levels of evaluation for communication skills of visually
impaired children with ASD partake in the survey as followed:
(1) 1,00 – 1,67
Cannot execute skills even with support
(2) 1,67 – 2,34
Correct execution of skills with the partial or the full support
of others
(3) 2,34 – 3,00
Proficient execution of skills without support
2.2.1. Levels of execution for 6 groups of communication skills for visually impaired
children with ASD aged 5-6
Bảng 2.2. Tổng hợp so sánh mức độ thực hiện 6 nhóm KNGT (6 tiêu chí)
Skill group
Mean
Std.

Rank
Deviation
1. Focusing and listening skills
1.85
0.46
1
2. Using communicational forms to express needs
1.78
0.37
3
3. Understanding and providing additional
1.55
0.42
6
information
4. Identifying and expressing emotions
1.79
0.39
2
5. Alternating and interacting in group of friends
1.59
0.49
5
6. Adjusting posture and distance in communication
1.67
0.46
4
The statistics in the table above have shown hat six groups of communication
skills of visually impaired children with ASD 5-6 years old remain at a level with an
average score of 1,55 to 1,85 “cannot execute skills even with support” or “Correct

execution of skills with support.” In which, the skill group which children excel in is
“Focusing and listening skills” with
expressing one’s emotions” (

= 1.85. With skill group of “identifying and

= 1.79) and “Using communicational forms to express

one’s needs” ( = 1.78), visually impaired children with ASD aged 5-6 can begin to
execute with support. Other skill groups have been met with difficulties and most
children cannot execute.
2.2.2. Level of execution by group of visually impaired children with ASD aged 5-6
- Criteria 1 (TC1): Group of maintaining focus and listening
Table 2.3. Comparison between levels of executing communication skills in criteria 1
Criteria
Skills
Mean
Std.
Rank
Deviation
Focusing 1. Responing to calling the name
2.23
0.50
1
and
2. Turn to the communicational person
2.07
0.52
2
listening 3. Listen, pay attention to the other person

1.67
0.55
4
skills
while speaking
4. Draw the attention of others to you
1.73
0.64
3
5. Transfer the attention of others in which
1.53
0.63
5
children are concerned
No skill in the 5 skills in group one that the children can execute proficiently. In
which, the skill that is best executed by the children is “Respond to calling the name”.
- Criteria 2 (TC2): Skills using means of communication to express one’s needs
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Table 2.4. Comparison of levels of communication skills in criteria 2 (TC2)
Criteria
Skills
Mean
Std.
Rank
Deviation
Using means 6. Using body movements
2.27
0.45

1
of
7. Using gestures, facial expressions,
2.00
0.53
2
communication and sounds
to express
8. Using specific symbols (real objects,
1.67
0.48
3
one’s needs
simulations, models, etc.)
9. Using abstract symbols: finger letters, 1.33
0.48
5
hand signs, braille, braille charts
10. Using verbal language
1.63
0.62
4
This chart can be seen that levels of execution of communication skills of
visually impaired children with ASD in the criteria “Using means of communications
to express one’s needs” is not high with an average score of 1,33 to 2,27.
- Criteria 3 (TC3): Skill group of understanding and providing additional information
in communication
Table 2.5. Comparison between levels of execution in criteria 3 (TC3)
Criteria
Skills

Mean
Std.
Rank
Deviation
Understand 11. Saying thank you, sorry in the right
1.37
0.49
4
and
context
provide
12. Calling name an object or person that is
1.70
0.60
2
more
appearing
information 13. Anwsering yes – no question
1.67
0.66
3
14. Listening and comprehending questions, 1.83
0.39
1
and simple information
15. Giving comments, more information or
1.20
0.41
5
simple questions when communicating

In this chart, children with visual impairment and ASD 5-6 years olds could
not execute proficiently, most skills at the level with support or unable to execute.
Where in, skills that children can best execute in this skill group is “Comprehending
orders, questions, and simple information” with = 1,83.
- Criteria 4 (TC4): Skill group of identifying and expressing emotions
Table 2.6. Comparison between levels of execution in criteria 4
Criteria
Skills
Mean
Std.
Rank
Deviation
Identifying 16. Expressing comfort/satisfaction/happiness 2.07
0.52
1
and
17. Expressing discomfort/ dissatisfaction/
2.03
0.41
2
expressing anger
emotions 18. Actively expressed interest in the people
1.40
0.62
5
communicating with
19. Responding to the love/emotions of the
1.73
0.52
3

communicator
20. Greet and respond to greetings from others 1.70
0.60
4
This table has showed that in the skill group “Identifying and expressing
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emotions”, the communication skills of “Expressing comfort/satisfaction/happiness”
and “expressing discomfort/dissatisfaction/anger” is best expressive with = 2,07 and
2,03. All children can do these with supports of others.
- Criteria 5(TC5): Skill group of alternating and interation in a group
Table 2.7. Comparison between levels of execution in skill group in criteria 5 (TC5)
Criteria
Skills
Mean
Std.
Rank
Deviation
Alternating 21. Participating in group activities of 3-5
1.73
0.74
1
and
people
interacting 22. Waiting your turn to play
1.57
0.57
3
in a group 23. Meeting others’ requirements

1.53
0.57
4
24. Sharing toys and gadgets with others
1.50
0.51
5
25. Participating and following directions
1.63
0.56
2
during group activity
Statistics in the chart above showed that performance level in communication
skills of Criteria 5 were not high ( mostly remained at 1,5 – 1,73 – Cannot execute
skill). Execution level of each communication skills in skill group “Alternating and
interacting in a group” has little to no difference.
- Criteria 6 (TC6): Skill group of adjusting posture and distance in communication
Table 2.8. Comparison between levels of execution between skills in criteria 6
Criteria
Skills
Mean
Std.
Rank
Deviation
Adjust posture 26. Determine the direction of the
2.03
0.62
2
and distance in person communicating with
communication 27. Adjust your posture and appearance 1.43

0.68
3
to suit the person communicate with
28. Identifying between acquaintances
2.17
0.46
1
and strangers
29. Determining the appropriate
1.40
0.50
4
distance to the person communication
30. Maintain an appropriate distance
1.30
0.47
5
from others during communication
The chart above showed the difference in levels of execution in communication
skills in visually impaired children with ASD aged 5-6. The best communication skill
they can execute is “Identifying between acquaintances and strangers” with = 2,17
(proficient execution of skill).
2.2.3. Comparison between communication skills of visually impaired children with
ASD 5-6 years old about their gender
Levene testing analysis: Value of Sig. in Levene testing (testing F) > 0.05 proves
that the variance of 2 overalls (level of communications of visually impaired children
with ASD both male and female) are identical, with no differences (Reference 6)
Independent-samples T-test analysis: Sig.(2-tailed) > = 0,05 which indicates that
there is no difference statistically on the level of execution of groups of
communication skills of visually impaired children with ASD. It shows that the gender

of visually impaired children with ASD has no impact or affect on the level of
12


execution of communication skills (Reference 6).

Table 2.6. Comparison between levels of execution between genders of visually
impaired children with ASD 5-6 years old
2.2.4. Comparison between levels of execution of visually impaired children with
ASD aged 5-6 about their verbal and non- verbal
Levene testing analysis: Value of Sig. in Levene testing of Criteria 1, 2, and 4
(testing F) > 0.05 showed that the variance of both overalls was identical.
Independent-samples T-test: p (Sig. (2-tailed) < = 0,05 should have a statistical
difference in the level of execution of criteria 1, 2, 4 (skill group) with a possibility of
children with verbal and nonverbal (Reference 6).
Levene testing analysis: The value of Sig. in Levene testing of criteria 3,5, and
6 (testing F) <= 0.05 shows that the variance of both overalls was different.
Independent-samples T-test analysis: p (Sig. (2-tailed) < = 0,05 so there is a statistical
difference in the level of execution of criteria 3, 5, 6 with the ability to have verbal and
nonverbal (Reference 6). This result has shown the statistical difference in the level of
execution of communication skill groups of visually impaired children with ASD with
verbal and non-verbal.

Table 2.7. Comparison of levels of execution of children with visual impairment and
ASD 5-6 years old with verbal and non-verbal
2.3. Survey of the reality of the development of communication skills for children
with visual impairment and ASD 5-6 years old through play
2.3.1. Reality of awareness of teachers on the importance of the development of
communication skills for children through play
When teachers of special centers and schools took the survey, they said that the

development of communication skills for children with visual impairment and ASD 56 years old is very important (48/60 teachers taking 80%) with the rest of 12/60
choosing importance taking 20%. No teachers chosed “less importance” or “no
importance”.
13


2.3.2. The reality of awareness of teachers on the impact of visual impairment and
ASD on the development of children
Visual impairment and ASD have significal affected the development of
different aspects of children. Through the survey of 60 teachers, the result has shown
that the effect is vast with = 3,57 and the level of affection on each field of growth
is different. The field was the most affected by visual impairment and ASD in
children is their communication and verbal skills.
2.3.3. Current situation of content for the development of communication skills for
children with visual impairment and ASD 5-6 years old through play
Table 2.12. Level of execution of teachers for development content of communication
skills for children with visual impairment and ASD 5-6 years old through play
Stt
Content of communication skills
Rank
1.
2.
3.
4.
5.
6.

Focusing and listening skills
3,53
3

Using communicational forms to express needs
3,81
1
Understanding and providing additional information
3,26
5
Identifying and expressing emotions
2,9
6
Alternating and interacting in group of friends
3,7
2
Adjusting posture and distance in communication
3,41
4
Mean
3,43
The table shows that teachers focused on various development of
communication skills for children with visual impairment and ASD 5-6 years through
play. However, the quantity of teaching content of communication skills by teachers
was not high with = 3,43.
2.3.4. Current situation of methods that teachers used to improve communication
skills for children with visual impairment and ASD 5-6 years through play
Table 2.13. Methods to improve communication skills for visually impaired children
with ASD aged 5-6
Level of using measures
Rank
Measures
Always Sometimes Rarely Never
1. Determine the level of

communication skill
2. Prepare playing environment
for the development of
communication skill
3. Planning the development of
communication skill
4. Using techniques to encourage
and motivate children to
participate in communicational
development activities
5. Organize activities outsides to
develop communication skill
6. Collaborate with family to
practice communication skills
through play

15

40

5

0

3,16

1

0

16

32

12

2,06

10

2

39

13

5

2,62

7

14

36

10

0

3,06

2

5

24

21

10

2,4

9

5

25

30

0

2,58

8

14

7. Self-improvement of
knowledge and skills on
education for children with
visual impairment and autism
8. Organize individual lessons to
develop communication skills
for children
9. Teach children to use different
means of communication
10. Use a variety of games to
enhance your child's
communication skills

10

34

10

6

2,65

6

10

43

7

0

3,05

3

9

32

19

0

2,83

5

17

28

15

0

3,03

4

Mean
2,89
It can be seen from the table above that the average level that teachers execute
the 10 measures given is not high; most remained at the level of “often use” = 2,89.
In which, the level of usage teachers is different.
2.3.5. Current situation of forms of developing communication skills for visually
impaired children with ASD aged 5-6 through play

Table 2.10. Forms of developing communications skills for children with visual
impairment and ASD 5-6 years old
It can be seen from the table above that these are most forms used by teachers
to develop communication skills for children with visual impairment and ASD 5-6
years old. However, forms were applied various. The form that was used the most
(60/60) by teachers with = 4.0 is “Organizing games with individual.”
2.3.6. The reality of elements affecting the development of communication skills for
children with visual impairment and ASD 5-6 years old through play
Table 2.14. Elements affecting the development of communication skills for children
with visual impairment and ASD 5-6 years old through play
Level of affect
Rank
Factors
Very
Afect
Little Unaffected
affect
afect
1. Teachers' qualifications,
57

3
0
0
3,95
2
experience, and teaching
methods
2. Cooperation between
60
0
0
0
4,0
1
family and schools
3. Environment, toys in the
37
13
10
0
3,45
5
15


classroom
4. The care and support of
the family
5. Program and content of
communication skills

education for children
6. Relationship friends in
class

42

18

0

0

3,7

4

52

8

0

0

3,86

3

31

19

10

0

3,35

6

Mean

3,74

The table above shows that many elements affect the efficiency of
communication skills development for visually impaired children with ASD aged 5-6
through play and the level of them is high with = 3,74 (very affected). The level of
impact between the elements has no significant difference, almost on the same level (
from 3,35 to 4,0). In which the factor that has the most impacted with = 4,0 is “Coordination between family and schools” and “Teachers' qualifications, experience, and
teaching methods for visually impaired children with ASD”.
2.4. Overall evaluation of the result of the survey on the situation
2.4.1. Achieved results
Through the results about the level of communication skills of 30 children with
visual impairment and ASD 5-6 years old, most children have difficulties executing
communication skills. This has been affecting how they study and engage in daily
activities. The result also shows that developing communication skills for visually
impaired children with ASD is necessary and important.
Teachers taking the survey have certain knowledge, skills and experience in the
field of education for visually impaired children with varied deficiency in general, and
visually impaired children with ASD particularly. All teachers are wholehearted, love

children, and are creative in supporting children.
Survey result also shows that teachers have deployed some contents on developing
communication skills for visually impaired children with ASD aged 5-6, as well as
applying some methods and measures to develop communication skills for children. The
result also clearly shows some elements as well as advantages and difficulties of teachers
when commencing the development of communication skills for visually impaired
children with ASD aged 5-6 through means of play. These results serve as a crucial basis
for suitable and effective methods to develop most basic communication skills for visually
impaired children with ASD aged 5-6 through play.
2.4.2. Shortcomings and the cause
- Shortcomings:
The level of development for communication skills for visually impaired
children with ASD aged 5-6 remained at a low level based on the result of evaluation
of communication skills for 30 children. Especially, some children develop strongly on
one communication skills but poorly on another. Therefore, the selection of which skill
to develop for children as well as having priorities is crucial. On the other hand,
teacher should not focus on developing a single communication skill but a variety of
16


groups of communication skills for children with a final goal of helping children
acquire the most necessary communication skills.
Teachers have used some forms of communication skills development for
children with visual impairments with ASD, but these forms are not used frequently
and are still mechanical, not flexible enough to meet the needs of each child. Notably
they mainly focus on forms in the classroom, group activities that are integrated into
general activities of the group/class. Outdoor and individual forms have been deployed
but are still few and not frequent.
Although teachers have initially used some measures to develop
communication skills for children with visual impairments and ASD, these measures

have not been used frequently, are still highly dependent on teachers, and are not
flexible enough for each child. The coordination between teachers and parents of
visually impaired children with ASD has been implemented but has not been
consistent and effective. Methods of exchange and guidance for parents have not been
given to support the development of communication skills for children at home.
- The cause of the situation
Visually impaired children with ASD are mainly detected very late and have not
received early intervention at stage 1 (from 0-3 years old), so not only their communication
skills are limited but they also face many difficulties in other areas of development.
The work of teaching and professional training in the field of education of
visually impaired children with multiple disabilities in general and visually impaired
children with ASD, in particular has not yet received much attention. There have been
only a few training courses to share general education for children with multiple
disabilities as well as visually impaired children with ASD.
The facilities in supporting and educational facilities participating in the survey
in Vietnam still lack many specific tools and equipment to develop communication
skills for children with visual impairments and ASD. In addition lack of guidance
documents, if there were any documents they would mainly be in English, so it is
difficult for teachers to refer to the appropriate way to support this group of children.
Families have limited and incorrect awareness about the education of visually
impaired children with ASD. Therefore, parents have the mindset that the education of
children is for the school and teachers and have not actively cooperated.
Teachers also have not actively equipped themselves with knowledge and skills
as well as adjusted goals, contents and methods of developing communication skills to
suit children with visual impairments and ASD. The methods that teachers use are not
systematic and synchronous, there are no specific instructions for implementation,
most mainly derived from personal experience.

17

Conclusion of chapter 2
The thesis has built 06 groups of criteria with 30 specific indicators to assess
the level of communication skills of children with visual impairments and ASD aged
5-6. These criteria were tested by Cronbach's Coefficient Alpha reliability system by
0.96 to ensure reliability. Especially through the analysis of Pearson correlation
between 06 groups of criteria as well as among 30 communication skills that are
closely correlated with each other.
The results of the level of communication skills of 30 visually impaired
children with ASD aged 5-6 through the assessment of communication skills that the
thesis has built show that the level of implementation of communication skills of
children is still limited, most remains at the level of unable to perform. There are very
few children who have implemented some communication skills with support such as:
skills of paying attention, listening, skills of making choices, asking or refusing.
Comprehension skill groups of providing more information, understanding and
expressing emotional feelings are not yet capable by children.
Teachers and parents were also aware of the importance of developing
communication skills for children with visual impairments and ASD aged 5-6. As a
result teachers began to pay attention and implement some content of developing
communication skills into individual plans for children. Teachers use different forms
and methods to develop communication skills, but the use is not frequent, systematic,
and there is no flexible coordination to suit each child. Mainly teachers work based on
their own experiences without in-depth instructions and training.
Many factors are the effectiveness of developing communication skills for children
with visual impairments and ASD. Special attention is paid to factors related to teachers'
specialized knowledge and skills on education for this group of children. In addition, the
cooperation between teachers and families is also mentioned; the family's interest in the
development of children's skills. Elements of documents, utensils, means, physical and
psychological environment are also very influential to the development of communication
skills for children.

18


CHAPTER 3
MEASURES TO DEVELOP COMMUNICATION SKILLS FOR CHILDREN
WITH VISUAL IMPAIRMENT AND AUTISM SPECTRUM DISORDERS
5-6 YEARS OLD THROUGH PLAY
3.1. Principles of proposing measures to develop communication skills for
children with visual impairments and ASD 5-6 years old through play
Measures are built on the following principles: (i) ensure education; (ii) ensure
systematicity; (iii) ensuring inclusiveness, (iv) ensuring practicality, (v) ensuring
individual accessibility, and (vi) ensuring voluntary participation.
3.2. Proposing measures to develop communication skills for children with visual
impairments and ASD 5-6 years old through play
Determining the level of communication
skills and making plan to develop
communication skills for children
through play

Building an environment that
promotes development of
communication skills through play

Group of preparatory measures

Group supplementary measures

Group of implementation measures

Flexible use of
techniques to
encourage
children to
participate in
play to develop
communication
skills

Diversify
forms of
developing
communication
skills for
children
through play

Coordinate
methods and
instruments to
develop
communication
skills for
children
through play

Collaborate
with parents in
developing
communication

skills for
children
through play

Practice and
regularly
reinforce
communication
skills for
children
through play

Diagram 3.1. Measures to develop communication skills for children with visual
impairments and ASD 5-6 years old through play
3.3. Investigate the necessity and feasibility of measures
Table 3.1. Necessity and feasibility of measures to develop communication skills for
visually impaired children with ASD 5-6 years old through play
No
Measures
Necessity Feasibility
1

Determining the level of communication skills and making
plan to develop communication skills for children

3,96

4,0

2

Building an environment that promotes development of
communication skills through play

3,93

3,86

3

Flexible use of techniques to encourage children to
participate in play to develop communication skills

3,7

3,96

19


4
5
6
7

Diversify forms of developing communication skills for
children through play
Coordinate methods and instruments to develop
communication skills for children through play
Collaborate with parents in developing communication

skills for children through play
Practice and regularly reinforce communication skills for
children through play

Mean

3,7

3,83

4,0

4,0

3,93

3,7

3,6

3,43

3,83

3,82

Through the survey from experts, most of their opinions said that the proposed
measures in the thesis are necessary and highly feasible with average points of 3.83
and 3.82 points. The result of the correlation index r equal to 0.593 proves that there is
a linear relationship, a close correlation between the feasibility and the effectiveness of

the measures to develop communication skills for children with visual impairments
and ASD 5-6 years old through play.
Conclusion chapter 3
The system of measures to develop communication skills for children with
visual impairments and ASD 5-6 years old through play is proposed on scientific
grounds that ensure both theory and practice. Measures are built with a strict structure
consisting of four main parts: purpose, content, procedure and notes for use. Each
measure has different values to develop each group of communication skills for
children with visual impairments and autism spectrum disorder 5-6 years old.
Measures to develop communication skills for children with visual impairments
and autism spectrum disorder 5-6 years old through play are built in three main
groups: preparation group, impact group and support group to reinforce
communication skills for children. Three groups measures have the most consistent
relationship and complement each other in developing communication skills for
children with visual impairment and ASD 5-6 years old. However, for these measures
to be really effective, teachers need to use them flexibly, creatively, in accordance with
the characteristics of each child's communication skills as well as local practical
conditions.
Through a survey of experts who are researching and working in the field of
education for children with multiple disabilities, most of the opinions said that the
proposed measures by the thesis are very necessary to develop communication skills
for children with visual impairment and ASD 5-6 years old through play. Measures
also be implemented in the practical conditions of care and education in Viet Nam.

20


CHAPTER 4
EXPERIMENTS ON DEVELOPMENT OF COMMUNICATION SKILLS FOR
VISUALLY IMPAIRED CHILDREN WITH ASD AGED 5-6 THROUGH PLAY

4.1. General problems of organizing experiments
4.1.1. Purpose of experiments
Conduct experiments to test the feasibility and effectiveness of the proposed
measures to develop communication skills as well as the correctness of the scientific
hypothesis posed by the research topic.
4.1.2. Content of experiments
The research topic applies the proposed measures to develop communication
skills for 03 cases of visually impaired children with ASD who are studying in special
education at Khanh An Special Education Center - Hanoi.
4.1.3. Hypothesis of experiment
03 visually impaired children with ASD aged 5-6 have many limitations and
difficulties in communication. If the proposed measures are flexibly used in
accordance with the abilities, needs and characteristics of the communication skills of
these three children, it will contribute to the development of communication skills for
them and affirm the necessity, feasibility and effectiveness of these proposed
measures.
4.1.4. Experiment location and subjects
- Experimental site: Khanh An Special Education Center, Hanoi
- Experimental subjects: The thesis conducts experiment on 03 cases of visually
impaired children with ASD aged 5-6 studying at Khanh An special education center.
These cases are described in detail as follows:
Table 4.1: List of subjects in educational experiment
No
Name
Gender
Birth
Time of intervention
Birthplace
1
P.L.T

Male
2014
From 4 years old
Yen Bai
2
N.N.P.Th
Female
2014
From 4,5 years old
Ha Noi
3
N.M.H
Male
2015
From 3 years old
Nam Dinh
4.1.5. Experimental procedures
The experiment proceeds through 5 steps: (1) Collecting initial information; (2)
Pre-experiment assessment; (3) Professional training for teachers to conduct
experiments; (4) Developing plans and experimenting with measures; (5) Evaluation
of the results after impact experiment.
4.1.6. Evaluate the result of experiment
4.1.5.1. Evaluation tools
The researcher evaluated the effectiveness of measures to develop
communication skills for visually impaired children with ASD, the thesis used a tool to
assess children's communication skills including 6 criteria presented in detail in
Chapter 2. These criteria were also used to evaluate the level of communication skills
of visually impaired children with multiple disabilities in the current situation study
and were tested for reliability using Cronbach's Coefficient Alpha model.
4.1.5.2. Analysis of experiment results

The results of measuring 6 criteria are calculated by scores according to
different levels from performing the skill proficiently (3 points) to unable to perform
21


the skill (1 point). The score for each criterion is the sum of each skill that the child
performs in that criterion. SPSS software is used to process results and to check the
reliability of experimental results.
4.2. Evaluate the result of experiment
4.2.1. Case 1 (D.M.H)
After 6 months of experimenting the methods, the result of level of
communication skills of D.M.H are as followed
Table 4.6. Result comparing level of communication skills of D.M.H before and after
experiment on 1st trial and 2nd trial
Skills
Before
First
Second
experiment experiement experiment
∑
∑
∑
1. Focusing and listening skills
11 2.2
13
2.6
14
2.8
2. Using communicational forms to 10 2.0
11

2.2
14
2.8
express needs
3. Understanding and providing additional 10 2.0
12
2.4
15
3.0
information
4. Identifying and expressing emotions
10 2.0
12
2.4
13
2.6
5. Alternating and interacting in group of 11 2.2
12
2.4
14
2.8
friends
6. Adjusting posture and distance in 12 2.4
13
2.6
14
2.8
communication
Average
64 2.13 73

2.43
84
2.8
The above table has shown the progress in communication skills of H before
and after the experiment. Before experimenting, the level of communication skills of H
is 2.13 but after first trial, the communication skills are 2.43 and after the second
experiment it is 2.8, achieving the level of self-implementation of the communication
skills. In particular, the group of skills in understanding and providing information
made the most progress after 2 experiments with the average score increasing from 2.0
to 3.0 at the skill proficiency level.
To test whether there is a significant difference in the progress of H before and
after the experiment, we used the Paired-Samples T test. There is a p value (Sig. (2tailed) = 0.001< α = 0.05. Thus, there is a statistically significant difference between
groups of criteria before and after the experiment of D.M.H. There is a linear
relationship before and after the experiment, the p-value Sig.(2-tailed) corresponding
to the t-7.050 statistic is significant, which proves that there is an improvement in the
communication skills of children H before and after the educational experiment.
4.2.2. Case of experiment 2: N.N.P.Th
Table 4.6. Result comparing level of communication skills of N.N.P.Th before and after
experiment
Before
First
Second
Skills
experiment experiement experiment
∑
∑
∑
1. Focusing and listening skills
5
1.0

8
1.6
11 2.2
2. Using communicational forms to 7
1.4
9
1.8
13 2.6
22


express needs
3. Understanding and providing additional 5
1.0
6
1.2
7
1.4
information
4. Identifying and expressing emotions
5
1.0
9
1.8
12 2.4
5. Alternating and interacting in group of 5
1.0
6
1.2
10 2.0

friends
6. Adjusting posture and distance in 5
1.0
6
1.2
9
1.8
communication
Average
32
1.1
46
1.47 62 2.06
The results of the level of communication skills of Th have improved after the
experiment. However, among the criteria, the skills group of expressing emotions and
feelings had the most improvement after 6 months of experimentation, and Th initially
knew how to actively express unpleasant, pleasant and happy emotions with gestures
and actions. The skill group that made the slowest progress was the skill group of
understanding and providing more information. It is possible that because there is no
verbal language, it takes longer time to develop for Th using other means of
communication to give more information, demonstrating comprehension.
Sample t-test before and after the experiment of groups of communication skill
1,2,3,4,5,6 with p value (Sig. (2-tailed) = 0.002 < α = 0.05, showing the statistically
significant difference of average scores of the groups of criteria before and after the
experiment. This difference is -0.60000. This result proves that the scores before and
after the experiment of Th have changes and these changes have statistical
significance. This has shown that measures to develop communication skills for Th
during the experimental process are effective and bring scientific value.
4.2.3. Case 3 P.L.T
Table 4.6. Result comparing level of communication skills of P.L.T. before and after

experiment
Nhóm KNGT
Before
First
Second
experiment experiement experiment
∑
∑
∑
1. Focusing and listening skills
9
1.8
11 2.2
14
2.8
2. Using communicational forms to express 8
1.6
10 2.0
13
2.6
needs
3. Understanding and providing additional 7
1.4
9
1.8
11
2.2
information
4. Identifying and expressing emotions
9

1.8
12 2.4
13
2.6
5. Alternating and interacting in group of 7
1.4
11 2.2
13
2.6
friends
6. Adjusting posture and distance in 7
1.4
9
1.8
12
2.4
communication
Average
47
1.6
62 2.07
46
2.53
After six months of experimenting with measures to develop communication
skills for P.L.T, T's communication skills have made significant progress in all criteria.
In which, the group of communication skills under criterion 1 is the group of skills in
which after the experiment T has the highest score with being 2.8. The skill groups
under criteria 2, 4 and 5 are the group of skills that T performed well with being 2.6
23