Exeley Inc.

Wan, B.Phil., M.Spec.Ed., Grad. Dip., Ying Wah

International Journal of Orientation & Mobility • Volume 5, Number 1, 201244
Providing Orientation and Mobility 
Services to People from Chinese 
Backgrounds in Sydney, Australia
Ying Wah Wan
Australia is a multicultural country with a large number of older people from 
culturally and linguistically diverse (CALD) backgrounds who require orientation 
and mobility (O&M) services. Guide Dogs NSW/ACT receives a majority of CALD 
referrals for people with vision impairment from Chinese backgrounds. To enable 
clients from CALD backgrounds achieve mobility goals that complement their 
lifestyle, it is necessary that O&M providers foster culturally competent perspectives 
to enhance and promote effective working relationships. 
Australia is a multicultural nation that 
experienced successive waves of migration. 
The Australian Bureau of Statistics (2010) 
reported that over the past two decades, the 
nation witnessed a shift in the age structure 
of its population with increases in the 
number of persons who are 65 years old and 
over, while the age profile of migrants is 
older than the age profile of the Australian-
born population.  For example, in the state 
of New South Wales 11% of males aged 65 
years and over and 14% of females were 
born overseas.  As advancing age can be 
concurrent with prevalence of vision related 
disorders (Williams, 2000) service providers 
in vision related services can expect a wide 
and diverse group of consumers from the 
ageing culturally and linguistically diverse 
(CALD) communities requiring services. 
The varied differences in language, culture, 
literacy, practices, customs, and beliefs 
in CALD communities can impact on the 
effectiveness and competence in delivery of 
atypical rehabilitation services, for example, 
orientation and mobility (O&M), especially 
for people who have low vision. 
Guide Dogs NSW/ACT Australia 
provides O&M services to a large 
proportion of clients who are older adults. 
Guide Dogs NSW/ACT offer services 
to CALD communities and has acquired 
most responses from Chinese communities 
throughout Sydney.
Background
As an O&M instructor of Chinese descent 
the author delivers numerous O&M programs 
to non-English speaking older adults 
from Chinese backgrounds who are aged 
between 66-96 years.  Most of these Chinese 
clients emigrated from Hong Kong and the 
province of Canton, south of China.  They 
mainly speak Cantonese and have resided in 
Sydney from 5 to 30+ years. Despite their 
impaired vision mainly caused by cataracts, 
glaucoma, macular degeneration, diabetic 
retinopathy, and severe myopia, all clients 
International Journal of Orientation & Mobility • Volume 5, Number 1, 2012 45
enjoy visiting shops, and meeting with peers 
in Chinese community centres to engage 
in such activities as Tai Chi and Mahjong. 
Some clients are also actively engaged in 
religious pastimes for example, attending 
church regularly and cultural festivals. 
Even though the author can speak the same 
language as most of the Chinese clients, 
some clients remain resistant to receiving 
O&M services. 
O&M Challenges
language
Language barriers affect access to O&M 
services for people from non-English 
backgrounds including older adults from 
Chinese backgrounds. Many people from 
CALD backgrounds are not aware of the 
different types of rehabilitative services 
in Australia and do not seek them. This is 
often the case because such services are 
non-existent in their home country. It is, 
therefore, not surprising that there is an 
apprehension to request O&M given the 
unfamiliarity of the service and the difficulty 
in communicating in English. A difficulty 
also exists in locating a qualified interpreter. 
The process of acquiring an interpreter is 
complex to the uninitiated. As Guide Dogs 
NSW/ACT depends on passive referrals, 
the initial referral for service for most non-
English speaking clients relies largely on 
doctors, CALD social workers, and CALD 
community activity coordinators.
Further, it is often difficult to locate a 
qualified interpreter for the variety of Chinese 
dialects spoken. Migrants in Australia from 
Chinese backgrounds arrive from Mainland 
China, Hong Kong, Vietnam, Cambodia, 
Taiwan, Malaysia, Indonesia, and Papua 
New Guinea and bring with them Chinese 
dialects peculiar to their regions. For 
example, Cantonese spoken in Vietnam is 
not exactly the same as spoken in Singapore. 
The Chinese language has many dialects 
such as Cantonese, Mandarin, Shanghainese 
and Hokkien, just to name a few. As there 
are variations in Chinese dialects, it is 
important to have the appropriate dialect 
interpreter when visiting the client.  Milian 
and Conroy (2001) advised of engaging 
the appropriate interpreter and translator to 
provide the appropriate instructions so as to 
ensure client’s needs are well understood.  
When an interpreter is unavailable, it 
can be helpful to engage a family member 
to translate but the instructor must be aware 
of and consider discrepancies that can 
occur from unprofessional translating.  For 
example, a family member may generalise, 
alter, and omit opinions of the client to suit 
the expected answer to the question.  The 
client may try to describe how much s/
he can see at certain times of the day but 
the family member might translate the 
descriptions very briefly as just blurry 
vision throughout the day.  Therefore, it is 
essential for the instructor to keep observing 
and assessing the client’s functional vision 
during subsequent lessons. Importantly, 
interpreting and translating should be neutral 
and impartial (Fradd & Wilen, 1990).  
culture
People’s behaviours are shaped by culture 
with influences from “ethnic background, 
gender, age, and socioeconomic status” 
(Bau, 1999, p. 291).  For a non-English 
speaking older adult who already has 
steeply entrenched cultural values from the 
home country, it is often difficult for her/
him to understand the western biomedical 
International Journal of Orientation & Mobility • Volume 5, Number 1, 201246
perspective of treating a disability while 
incorporating the rehabilitation component 
(Bau, 1999).  Older clients from Chinese 
backgrounds are often more interested in 
the way to restore their vision than learning 
about coping strategies and assistive aids. 
Many clients from Chinese backgrounds 
cannot accept that their vision loss is a 
disability and will seek traditional herbal 
treatment in their home country, resigning 
their vision impairment to ill fate. Some 
older Chinese clients then become affected 
by depression, denial of the reality of their 
vision impairment, inferiority from social 
stigma of being “abnormal” among their 
community peers, and self-pity because they 
become dependent on others.  
Cross (1995-96) noted that culture has 
numerous variations that are influenced by 
“migration history, generation, rural or urban 
setting, level of acculturation (adjusting 
to the dominant culture but retaining 
one’s own) and assimilation (adopting the 
dominant culture and losing one’s own), 
history of oppression, and mixture of races” 
(p. 291). For example, a Chinese client from 
Hong Kong may perceive the intervention 
of O&M more positively than another 
Chinese client from Vietnam since Hong 
Kong is more western influenced. The task 
of educating clients who do not relate O&M 
to rehabilitation involves much explanation, 
demonstration of O&M skills that would 
assist them, and patience.
literacy
The different levels of literacy and 
socioeconomic backgrounds of clients from 
CALD communities can influence the levels 
of acceptance and achievement of O&M 
objectives.  La Grow (1998) noted that 
O&M instruction is based on the westernised 
“rehabilitation system of individualised 
service that is linear and future oriented, 
sequential and compartmentalised, 
scientific, and objective” (p. 262).  This 
might explain why few clients from Chinese 
backgrounds can relate to the complexity 
of establishing their O&M objectives 
and instead opt for a short service.  Some 
clients who come from higher literacy and 
socioeconomic backgrounds in their home 
country often display more enthusiasm in 
learning and acquiring additional skills in 
O&M.  It is a challenge for the instructor 
to provide an O&M service to client’s from 
Chinese backgrounds that improve their 
level of safety and functionality while trying 
to assist them maintain the lifestyle they 
previously enjoyed. 
Practices, customs, anD beliefs
As respecting the elders are part of Chinese 
cultural practice, the young are expected to 
take care of the old.  Some of the author’s 
clients rely on their children to take them 
on visits especially to the specialist doctor 
and the need for independent travel does not 
arise.  It is quite customary for aged parents 
to concede most decision-making issues 
to their children, especially health issues. 
Therefore, it is necessary for the O&M 
instructor to modify O&M goals to cater to 
the client’s reduced need for independence. 
For example, an elderly client who regularly 
goes to the doctor’s clinic with her son may 
only need to learn (i) how to use the support 
cane to safely negotiate the steps and (ii) 
guiding skills to negotiate narrow spaces 
and doorways at the clinic. 
Knowing the customs and beliefs of clients 
can be helpful to establish trust between 
client and instructor which can strengthen 
the working relationship.  For example, 
International Journal of Orientation & Mobility • Volume 5, Number 1, 2012 47
it is customary to greet Chinese elders by 
calling females aunty or Mrs, and males 
as uncle or Mr as an ice-breaking gesture. 
At the same time it is important to clarify 
the role of the instructor as a trainer rather 
than a companion as elderly Chinese clients 
are often not familiar with individualised 
westernised training. The instructor needs 
to maintain a mutual professional distance 
with such clients.
Many of the author’s client’s, particularly 
elderly males, are hesitant in revealing their 
disabilities because culturally it is face-
saving to be seen as invincible.  Morioka-
Douglas and Yeo (1990) noted that many 
people from Asian backgrounds tend to 
avoid using community services so as not to 
be seen complaining about their problems. 
Hence, the instructor has to be creative in 
providing O&M in a different modality 
for example, offering group training to 
establish a rapport of togetherness which 
is less confrontational when problems are 
shared among acquaintances with similar 
difficulties.  Therefore, it is important 
to identify people in various Chinese 
communities and provide their O&M needs 
in the context of their real life activities.  For 
example, a cultural festival or celebration like 
the Chinese Lunar New Year or the Hindu 
Dwali Festival of Lights can be celebrated 
as an O&M activity with interested CALD 
groups in the community.   
Future Ahead  
Providing O&M services in a cross-
cultural context is essential to meet the needs 
of CALD communities as Australia becomes 
increasingly culturally diverse.  It is a 
requisite for an O&M instructor to understand 
and be sensitive to multiculturalism because 
“cultural competence has been shown to 
improve the accuracy of assessments and to 
yield more successful results” (Minnesota 
Public Health Association, 1996).  Although 
it is an advantage to have a bilingual 
instructor who is cognisant of the culture 
and can relate to the clients, Rodriguez 
(1995-1996) commented that openness, 
observation, listening, and redefining one’s 
viewpoint with professional perspectives are 
fundamental strategies for any professionals 
working with people with disabilities. 
Lynch and Hanson (1998, p. 491) referred 
to “the characteristics of a culturally 
competent professional include respect for 
people of other cultures, understanding of 
different perspectives, willingness to learn, 
and flexibility”.   For O&M to be effective 
in meeting the needs of Australia’s diverse 
cultural communities, it is necessary for 
service providers to consider advocating 
alternative O&M modalities that embrace 
and respect the values of the ethnic groups. 
For O&M to be conducive and relevant to 
the needs of CALD clients, the provision 
of service ought to correspond with a more 
comprehensive approach that recognises the 
culture and the community.    
References
Australian Bureau of Statistics. (2010). 
Australia to 2050: Future challenges, 
(Intergenerational Report 2010), Attorney 
General’s Department. Retrieved from 
http://www.abs.gov.au/ausstats/
Bau, A. M. (1999). Providing culturally 
competent services to visually impaired 
persons.  Journal of Visual Impairment & 
Blindness, May, 291-297.
Cross, T. (1995-96). Developing a 
knowledge base to support cultural 
International Journal of Orientation & Mobility • Volume 5, Number 1, 201248
competence. Family Resource Coalition 
Report, 14, 2-7.
Erin, J. N., & Milian, M. (2001). 
Professionals and diversity, Diversity and 
Visual Impairment, pp. 383-412.  New 
York: AFB Press.
Fradd, S. H., & Wilen, D. K. (1990). Using 
interpreters and translators to meet 
the meets of handicapped language 
minority students and their families. 
Retrieved from http://www.ncbe.gwu.
edu/ncbepubs/pigs/pig4.htm
 La Grow, S. J. (1998). A cultural perspective 
on orientation and mobility.  Journal of 
Visual Impairment & Blindness, May, 
260-264.
Lynch, E. W., & Hanson, M. J. (1998). Steps 
in the right direction. In E. Lynch and M. 
Hanson (Eds.), Developing cross-cultural 
competence (pp.127-158). Baltimore, 
MD: Paul H. Brookes Publishing 
Company.
Milian, M., & Conroy, P. (2001). Providing 
professional services to individuals who 
speak English as a second language. In 
M. Milian and J. N. Erin (Eds.), Diversity 
and Visual Impairment: The influence of 
race, gender, religion, and ethnicity on 
the individual (pp. 366). New York: AFB 
Press.
Minnesota Public Health Association, 
Immigrant Health Task Force. (1996). 
Six steps toward cultural competence: 
How to meet the health care needs of 
immigrants and refugees. Minneapolis, 
MN: Minnesota Department of Health.
 Morioka-Douglas, N., & Yeo, G. (1990). 
Ageing and health: Asian/Pacific Island 
American elders (Working paper Series 
No.3: Ethnogeriatric Reviews). Stanford, 
CA: Stanford Geriatric Education Center. 
Rodriguez, B. M. (1995-96). From self to 
other: Communication across cultures. 
Family Resource Coalition Report, 14, 
11-15. 
Williams, T. F. (2000). Vision impairment in 
older adults. The Lighthouse Handbook, 
Volume 2, Vision Rehabilitation, 
1279-1286. 
Ying Wah Wan, B.Phil., (Special Ed., Vision 
Impairment), M.Spec.Ed., (Sensory Disability), 
Grad. Dip. (Early Childhood Development), O&M 
instructor, Client Services, Guide Dogs NSW/ACT, 
2-4 Thomas Street, Chatswood, NSW, 2067, Australia; 
e-mail:<ywan@guidedogs.com.au>.


Providing Orientation and Mobility Services to People from Chinese Backgrounds in Sydney, Australia

Storebø, Ole Jakob

Bölte, Sven

1 
 
 
Scandinavian Journal of Child and Adolescent Psychiatry and Psychology 
Vol. 1, pp. 1-2 (2013) 
 
 
Editorial                                                                                                                               Open Access 
 
 
Access 
Open Access, Peer-reviewed, Fast Track Processing, and High Quality 
Articles on all Topics related to Child and Adolescent Psychiatry and 
Psychology 
 
Ole Jakob Storebø and Sven Bölte 
 
 
 
The Scandinavian Journal of Child and Adolescent 
Psychiatry and Psychology (SJCAPP) is a new inter-
national scientific journal of research and practice 
covering a broad scope of high value articles in the 
field of child and adolescent psychiatry and psy-
chology. The journal publishes quantitative and 
qualitative research on: diagnosis, assessment, psy-
chotherapeutic and psychopharmacological treat-
ments, behaviour, cognition, epidemiology, devel-
opment, training, cross cultural issues, neuroscience 
and genetic aspects related to mental disorders in 
children, adolescents and families. The journal also 
welcomes interdisciplinary and transdisciplinary 
submissions if relevant for childhood psychopa-
thology. The Journal publishes short and full length 
original papers, systematic and narrative reviews, 
case studies, letters, and theoretical articles including 
perspectives and debate, and book reviews. 
 
The idea of launching this Journal was born in 
the beautiful, majestic and wild mountains and 
fjords in “Nærøyfjorden” in Norway. This is one of 
the most marvellous areas in Norway, showing the 
strength of the Scandinavian nature, and like the 
Swedish forests and the Danish beaches, shows the 
best of Scandinavia. It is our hope that this new 
journal will develop to be a marker of Scandinavian 
quality. 
 
There is a great need for a Scandinavian journal 
in child and adolescent psychiatry and psychology. 
The research in the area is in high growth in Scan-
dinavia and worldwide. Scandinavian research in 
different topics of child and adolescent psychiatry 
and psychology is of high quality and there is clearly 
a lack of Scandinavian journals in the area. The need 
for this journal was also underlined by the positive 
response to our initiative. All the section editors are 
among the best researchers in this field in Scandina-
via, as the editorial board members are among the 
best internationally.  
 
The concept of the journal has been prompted 
by several thoughts. First of all, empirical research 
has driven the progress in child and adolescent psy-
chiatry and child psychology during the past dec-
ades. To continue this progress, the area between 
basic science and clinical research is important. 
Complex and sophisticated models of childhood-
onset psychiatric disorders have been accomplished 
by interdisciplinary cooperation between basic sci-
entists and clinicians, and shown in findings in the 
gene-environment research. Another important area 
is the area between clinical research and implemen-
tation of evidence based interventions in clinical 
practice. Other important areas are, e.g. research in 
genetics of neurodevelopmental disorders, longitu-
dinal studies of child psychopathology, twin studies 
of child psychiatric disorders, neuroimaging studies 
of childhood onset psychiatric disorders, and stud-
ies of newly defined DSM-5 disorders. 
 
A lot of new research in basic and clinical neuro-
sciences has documented that the most common 
psychiatric disorders in adolescence and adulthood 
have their onset in the first periods of life and are 
thus connected to development. This is another 
reason why we wanted this journal to be both 
grounded in psychiatric research as well as research 
and clinical reports from the area of psychology. 
Furthermore, we wanted the journal to be a journal 
for both clinicians and researchers. It is a challenge 
turning basic research findings into clinically useful 
applications, but it is important to work on this. 
The journal will be an open access because it is 
important that the articles will be accessible for 
everyone. We have no publication fee. Many jour-
nals have large publication fees which can make it 
2 
 
difficult especially for the clinicians to publish their 
work. 
 
Child and Adolescent Psychiatry is in rapid de-
velopment. Many families suffer largely and the 
research in the above mentioned areas is very im-
portant both for improving the assessments and the 
treatment of families and their children. We are very 
pleased to introduce our new open access journal, 
and our hope is that this new publication will sup-
port child and adolescent psychiatry, both in Scan-
dinavia and internationally.  
 
Acknowledgments 
We have looked forward to this moment when we 
could present a new open access scientific journal 
on child and adolescent psychiatry and psychology 
to the public. We are grateful to the State and Uni-
versity Library in Århus making this possible. We 
furthermore thank Psychiatric Research Unit in 
Region Zealand for the strong support. We are also 
indebted to Dr. Angela Reiersen at Washington 
University in St. Louis, Professor Ørjan Martinsen 
at Oslo University for their invaluable support and 
help. We also wish to thank the advisory board 
members and the section editors for their advice 
and willingness to support the journal.  
 


Open Access, Peer-reviewed, Fast Track Processing, and High Quality Articles on all Topics related to Child and Adolescent Psychiatry and Psychology

Neumann, Nicola

Braun, Christoph

Dubischar-Krivec, Anna M.

Recognition Memory for High and Low Associative Stimuli in Autistic Individuals with Outstanding Memory Skill

Sauerburger, MA., COMS., Dona

Bourquin, DHA., COMS., CI.&CT., CLVT., Eugene

Sauerburger, Jomania

The Effectiveness of Deaf-Blind Pedestrians Warning Signage on Drivers&rsquo; Behaviour

Zebehazy, Ph.D., COMS, CLVT, TSVI., Kim T.

International Journal of Orientation & Mobility • Volume 5, Number 1, 2012 53
The Multisensory Handbook: 
A Guide for Children and 
Adults with Sensory Learning 
Disabilities
ISBN: 978-0-415-59754-8
Paul Pagliano (2012). Routledge.
The Multisensory Handbook: A guide for children and adults with sensory learning 
disabilities, while not specifically written for our field, is a relevant resource that provides 
an in depth perspective on the importance of multisensory development. Dr. Pagliano, the 
author, has experience working with individuals with vision impairments and provides 
several examples specifically related to vision impairment throughout the book. The main 
focus is on individuals with significant sensory disabilities such as individuals with multiple 
challenges who need structured intervention. Refreshingly, however, Dr. Pagliano does not 
present a deficit model, but rather encourages collaboration and thoughtful intervention to 
build upon an individual’s sensory strengths. The book is organised into two parts, each with 
six chapters. Part I lays the foundation for multisensory stimulation, and Part II applies this 
theory to the presentation of a unified approach for working with individuals with sensory 
learning disabilities within a structured multisensory environment. 
Part I: Multisensory stimulation
From the perspective of orientation and mobility (O&M), Part I of the book is an 
enriching read that enhances how we think about the interaction of the senses to gain and 
use information. Part I is theory and information based that the O&M specialist will need 
to consider how to apply to h/er practice. However, the chapters provide a more intricate 
understanding of the senses and their relationship to learning than is typically discussed. Dr. 
Pagliano goes beyond an isolated surface level discussion of the senses, and he structures 
the chapters in a way that keeps reminding the reader of the main points from the previous 
chapter and how they connect to the upcoming information. This style is useful in helping 
the reader to meaningfully absorb the density of the information and consider its application 
to practice. 
Neuroplasticity and early sensory development, sensory processing, sensory thresholds, 
multisensory communication, and avoiding learned helplessness are among the many topics 
with related examples presented in the chapters that are relevant to enhancing our work as 
O&M professionals. The discussion of sensory thresholds in Chapter 2 was particularly 
B
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International Journal of Orientation & Mobility • Volume 5, Number 1, 201254
interesting for me as an O&M specialist, highlighting that there are levels that lead to an 
individual’s ability to gather information from the senses: one might detect sensory input, 
then recognise what it is, then be able to differentiate its qualities from other input. This is a 
concept we apply to collecting functional vision information, but I was reminded by reading 
this book about how it applies to all senses and how strong of an impact it can have on a 
person’s O&M skills. What our clients/students will perceive and understand in their travel 
environments is linked to the concepts they have built through an ability to use multisensory 
information at a differentiation level. When we are working with a client or student to select 
a travel route, build concepts, or understand and explore a new environment, Part I serves 
as a valuable read in that it reminds us of the importance of taking the sensory perspective 
of the individual and provides an opportunity to more deeply think about how theory related 
to multisensory stimulation can improve and enhance O&M outcomes.
Part II: A unified approach 
In Part II, Dr. Pagliano introduces a unified approach for working with individuals with 
sensory learning disabilities in a structured multisensory environment (e.g., Snoezelen 
room). By interlacing what was learned in Part I, he introduces the reader to working 
collaboratively, establishing a caring relationship, conducting assessments that will provide 
a starting point for multisensory stimulation interventions, creating an environment that 
meets the needs of the individual, and then using this environment to start a sensory 
conversation and move the individual forward. While harder to directly apply this part of 
the book to the type of instruction O&M specialists generally do in less controlled everyday 
environments, aspects and concepts of Part II can still be very useful. 
First, for O&M professionals working with students who have multiple exceptionalities, 
this section is very pertinent since the starting point for developing concepts for O&M begins 
with finding sensory thresholds, which for individuals with significant sensory learning 
disabilities will need to be explored initially in a controlled environment. O&M professionals 
may be working in teams to provide input into what a multisensory environment should 
include and might benefit by working with students in such environments themselves. Part 
II gives the reader a perspective on what these environments can provide and considerations 
to make them as effective as possible. In addition, I found the forms provided in Chapter 8 
on assessment to be a great reference for collecting sensory information and understanding 
an individual holistically. This holistic perspective on the client or student can help to guide 
O&M instruction and initial goals. Finally, the author highlights in this part of the book the 
importance of establishing a caring relationship and gives practical considerations for doing 
so. This concept extends beyond the walls of a multisensory stimulation environment and is 
something of which all practitioners should be mindful. 
Overall Resource
Overall, I would recommend this book to O&M specialists as a way to re-establish a 
deep understanding about multisensory stimulation - a topic in general very applicable to 
International Journal of Orientation & Mobility • Volume 5, Number 1, 2012 55
our profession. As a reader with an O&M perspective, I was excited about the connections 
I made while reading and the ideas they inspired. A perfect “sequel” from my perspective 
would bridge the practical application of working in a multisensory structured environment 
to effectively transitioning to a more fluid environment where clients and students are 
beginning to develop O&M travel skills. 
Kim T. Zebehazy, PhD, COMS, CLVT, TSVI. Assistant professor in the department of Educational and 
Counselling Psychology, and Special Education, University of British Columbia, 2125 Main Mall, Vancouver, 
BC V6T 1Z4, Canada; e-mail: <kim.zebehazy@ubc.ca>.


The Multisensory Handbook: A Guide for Children and Adults with Sensory Learning Disabilities

Hogan, B.A., Dip.Ed., Grad. Cert. O&M, M. Sc., Claire L.

International Journal of Orientation & Mobility • Volume 5, Number 1, 2012 49
Stigma, Embarrassment and the 
Use of Mobility Aids
Claire L. Hogan
Client resistance in using the white cane is discussed. Fears about stigma and 
embarrassment are expressed by clients as the main barrier to using mobility aids. 
Assertiveness training is proposed as a means of reducing that resistance.
The perception of stigma, embarrassment, 
and changed identity, experienced by many 
people with low vision, is proving to be a 
hurdle to the acceptance and use of mobility 
aids such as the white cane (Baskett, 2005; 
Hayeems, Geller, Finkelstein, & Foden, 
2005).
Seybold (2005) found that “client’s 
anxiety, fears, and stress have been 
recognised as some of the main causes for 
non-acceptance of orientation and mobility 
(O&M) training. Evidence showed that the 
acceptance of training “advertised” their 
disability, causing vulnerability, thereby 
creating additional stress.” This paper will 
discuss the potential negative impact of 
social perception on client acceptance of 
mobility aids and briefly describe training 
strategies to reduce these impacts.
Some people with low vision will 
acknowledge the need for and agree to 
undergo mobility cane and orientation 
training. However, when their cane skill 
progress is reviewed, they often admit 
they have not practiced (Higgins, 1999). 
Addressing the perceived stigma and 
embarrassment felt by clients might result 
in an increased uptake of aids (Conrad & 
Overbury, 1998).
Resistance to using a white cane
The author’s vision deteriorated from the 
age of eight resulting from dominant optic 
atrophy. Consequently, aged in the mid 
40’s cane training occurred and recently in 
the mid 50’s, dog guide training. In both 
cases the author was ambivalent to mobility 
training mainly due to losing anonymity. 
The author went through a process of 
confronting her own negative opinions 
about conspicuous mobility aids. When 
the author first started using the cane, she 
loved and hated it and named it “the crab,” 
a shiny thing that moved from side to side 
and nipped pedestrians on the heels. She 
did not like the way it altered her arm swing 
and felt self-conscious. That experience 
taught her to encourage people to voice their 
emotions. For example, to express what they 
fear most about losing vision and what they 
fear most about using the white cane as well 
as discussing the process of acquiring cane 
skills and the dignity moving around with a 
cane brings.
The majority of the author’s clients are 
over the age of 70 years and are losing vision 
later in life. Hence, any stigma associated 
with disability is often entrenched in the 
client and creates resistance to adopting 
mobility aids such as the white cane. Using 
International Journal of Orientation & Mobility • Volume 5, Number 1, 201250
a cane is sometimes the most appropriate 
option for people who are 80 + years with 
glaucoma. However, clients in this age 
group have often declined to use the cane 
after training and risk injury for example, a 
broken hip. Some clients resist using a cane 
even though they describe embarrassing 
situations like walking into mirrors or 
talking to shop mannequins. Further, 
because they cannot see faces, some people 
who are unaware of their vision impairment 
view them as ‘snobs’ or rude. 
As another example, a young client of the 
authors was diagnosed with clinical anxiety 
and severe hyper myopia. He resisted using 
the cane and said he would prefer to take the 
risk of injuring himself. He agreed to use 
the Navigon GPS app on the iPhone and is 
trialling a monocular. After several “travel 
safe” sessions where he was encouraged to 
walk slowly, scan, and use his hearing more 
effectively, he was shown a black cane but 
remained definite that he would not use a 
cane. His main fear was he would “look like 
a freak.”
Fears and prejudices often exclude a 
person with a physical disability from being 
accepted into a mainstream culture (Becker, 
1991). Even cultural norms such as basic 
manners are affected when a person loses 
vision, for example, people learn to share the 
pavement and move with other pedestrians 
but the cane is a signal to ‘get out of the 
way’. To participate in society we are taught 
to conform, to be part of the herd. The cane 
is white and shiny and the user stands out in 
a crowd. This ‘white cane spotlight’ might 
deter people from using mobility aids such 
as the cane.
People with deteriorating vision find 
creative and sometimes dangerous ways to 
“fit in”. They can avoid using the cane by: (i) 
following other pedestrians across the street; 
(ii) walking more slowly; (iii) using another 
person for assistance; (iv) relying on young 
children for guidance; and (v) developing 
and relying on other senses.
It appears that many clients do not want 
to stand out with a cane. When the author 
asks clients “what frightens you the most?” 
the answers include feeling vulnerable, 
embarrassed, looking different, and being 
conspicuous. Many of the author’s younger 
clients with retinitis pigmentosa comment 
that starting white cane training ‘hurts’ 
because it is accepting that they have little 
sight left. At the commencement of training, 
the author has observed that clients usually 
do not want to hear too much enthusiasm 
about the cane. Rather, clients want to simply 
learn of the cane’s functionality as a tool, for 
example, that it serves like an antenna and 
feels the ground and you can fold it and put 
it away.
Embarrassment and 
assertiveness training
People with vision loss might benefit from 
working through their self-consciousness or 
embarrassment. In the initial interview the 
author listens to the client’s stories and often 
asks: (i) what is your biggest challenge or 
what frightens you the most? (ii) would you 
be embarrassed using the white cane at home 
by yourself? (iii) what is the worst thing that 
could happen when using the white cane in 
public? (iv) how many “close calls” or “near 
misses” have you had?
Responses to these questions often bring 
forward emotions such as anger, laughter, 
and sadness. By answering these questions, 
clients give the author an authentic place 
International Journal of Orientation & Mobility • Volume 5, Number 1, 2012 51
to start working with them. For clients, 
answering these questions seem to assist the 
development of mutual trust and gives them 
a perspective to their fears and resistance.
The author has observed that clients 
are more likely to use a cane if taught in 
conjunction with assertiveness training. 
The author often refers to the book Facing 
the crowd (Fullwood & Cronin, 1986) that 
details simple yet effective ways to be 
assertive. The book is designed for parents 
of children with low vision but can be 
adapted to use any age.
Appropriate assertiveness training 
builds confidence and provides clients 
with a repertoire of coping strategies. For 
example, clients need to feel comfortable 
saying ‘no’ to well-meaning offers of 
assistance. In addition, clients need to learn 
appropriate ways to request help. A client 
who benefited from assertiveness training 
holds a management position and has 
retinitis pigmentosa. His peripheral vision is 
narrowing and his night vision has reduced 
significantly in the last year. What frightened 
this client the most was the thought of 
becoming dependent on others and making 
a fool of himself. His concerns were also 
about the loss of anonymity by using the 
cane and the need to frequently explain the 
enigma of his condition such as being able 
to read small print but needing to use a cane. 
The two hints related to assertiveness the 
client found most helpful was finding out 
about the “meet and greet” services offered 
by airlines at the airport, and identifying 
when he believed it was appropriate to 
ask for assistance. He also began slowly 
making changes at work, and read some 
autobiographies written by people losing 
their vision for ideas, differing perspectives, 
and motivation.
When discussing mobility aids the 
author explained how they provide dignity 
by enabling a person to move about 
independently. His feedback on the second 
occasion was that being able to move about 
with dignity gave him hope. The client 
explained that his main personal challenge 
was his “change of identity”. He was 
prepared to learn cane techniques but wanted 
to defer using the cane until he “absolutely 
had to.” 
Although the author has observed client 
resistance to using the cane, research is 
needed to provide additional insight into 
reasons why some people do not use O&M 
skills after training, and useful approaches 
to assist resistant clients use mobility aids. 
Further, research investigating the methods 
and effects of assertiveness training might 
also benefit clients who resist using mobility 
aids. 
Acknowledgement
Thanks to the clients who helped develop 
the ideas for this paper.
References
Baskett, L. (2005). Fear of orientation and 
mobility. International Congress Series 
1282- Vision 2005, 469 - 473.
Becker, H. S., (1991). Outsiders: Studies in 
the sociology of deviance. New York: The 
Free Press. 
Conrad, B., & Overbury, O. (1998). The 
effectiveness of perceptual training and 
psychosocial counsellng in adjustment 
to the loss of vision. Journal of Visual 
Impairment and Blindness, 92(7), 
464-482.
International Journal of Orientation & Mobility • Volume 5, Number 1, 201252
Fullwood, D., & Cronin, P. (1986). Facing 
the crowd: Managing other people’s 
insensitivities to your disabled child. 
Burwood, Victoria: Royal Victorian 
Institute for the Blind.
Hayeems, R. Z., Geller, G., Finkelstein, D., 
& Foden, R. R. (2005). How patients 
experience progressive loss of visual 
function: A model of adjustment using 
qualitative methods. British Journal of 
Ophthalmology, 89, 615-620.
Higgins, N. (1999). The O&M in my life: 
Perceptions of people who are blind 
and their parents. Journal of Visual 
Impairment & Blindness, 93(9), 561-578.
Seybold, D. (2005). Psychosocial impact of 
acquired vision loss particularly related 
to rehabilitation, involving orientation 
and mobility training. Vision 2005 
International Low Vision Conference, 
London, U.K.: Internal Congress Series, 
1282.
Claire L. Hogan, B.A., Dip.Ed., Grad. Cert. O&M, 
M. Sc. (Hons). Orientation & Mobility Instructor/
Consultant, Victoria, Australia; e-mail: < poet@
bellingen.com>.


Stigma, Embarrassment and the Use of Mobility Aids

Reiersen, Angela M.

Todorov, Alexandre A.

Exploration of ADHD Subtype Definitions and Co-Occurring Psychopathology in a Missouri Population-Based Large Sibship Sample

 41 
 
 
Scandinavian Journal of Child and Adolescent Psychiatry and Psychology 
Vol. 1 (2), pp. 41-42 (2013) 
 
 
Editorial                                                                                                                               Open Access 
 
 
 
 
The First Year with the Scandinavian Journal of Child  
and Adolescent Psychiatry and Psychology 
 
Ole Jakob Storebø and Sven Bölte 
 
 
 
The Scandinavian Journal of Child and Adolescent 
Psychiatry and Psychology (SJCAPP) is now one 
year old, and it is time to make a status report and 
also to revise our strategy for the future. The gen-
eral idea behind SJCAPP was to create an open-
access, no publication-fee, fast-process, high-quality, 
online scientific journal for child and adolescent 
psychiatric and psychological research and clinical 
practice. We strongly believe in open access as the 
future solution for research policy and practice. The 
latest results from international research should al-
ways be readily available to everyone, regardless of 
the economy of their university or institution. 
More-over, open access also increases the research 
impact of the publishing author (1).  
The choice of not having a publication fee has 
been possible only because of the willingness of 
many voluntary contributors and the positive sup-
port from the Psychiatric Research Unit in Region 
Zealand, Denmark. We hope to keep things this 
way as long as possible, but we realize that we may 
need some economy when the number of submis-
sions grows. When we established SJCAPP, we had 
an unofficial goal as a young journal of publishing 
five to six articles during the first year, doubling that 
the next year, and then gradually converging toward 
publishing one article per week. We ended up pub-
lishing seven scientific papers during the first year, 
which we consider to be a good result. All of these 
papers have been downloaded a large number of 
times. In fact, as of November 1, 2013, there have 
been 4939 article downloads from SJCAPP since 
the first article was uploaded. It has also been inter-
esting to follow the activity on the SJCAPP site us-
ing tools such as Google Analytics (2). Two main 
conclusions can be drawn from this: The readers of 
SJCAPP come from all over the world, and interest 
in SJCAPP has been steadily increasing.  
Being indexed or abstracted in the large databases 
is of highest priority for SJCAPP. In 2013 the jour-
nal was indexed in NOAP and PKP. The journal 
can be searched on Summon, Google, Google 
Scholar, and worldcat.org. We will continue to ex-
pand our accessibility in 2014 by sending applica-
tions for indexing to PubMed, DOAJ, Index Co-
pernicus, and Journal TOCs. We also have a very 
distinct goal of finally having the journal indexed by 
the Thomson ISI Web of Knowledge and receiving 
an impact factor. Even prior to establishment of 
PubMed indexing for the journal overall, authors 
can submit the accepted versions of their manu-
scripts to PubMed Central (PMC) in compliance 
with the U.S. NIH Public Access Policy. 
We are fortunate to have an extremely competent 
group of section editors and reviewers, and we are 
grateful for their contributions to the quality of the 
journal. 
There is a plan for five special issues of SJCAPP 
to be published during the next two years. One spe-
cial issue will focus on personality disorders in ado-
lescents and will be guest-edited by Erik Simonsen 
and Mickey Kongerslev and overseen by Ole Jakob 
Storebø; the second, which will address the autism 
spectrum, will be guest-edited by Angela Reiersen 
and overseen by Sven Bölte; the third issue about 
psychosis in children and adolescents will be guest-
edited by Ulrik Haahr and overseen by Sune Bo; the 
fourth issue, which will focus on attention-
deficit/hyperactivity disorder, will be guest-edited 
by Niels Bilenberg and overseen by Sven Bölte; and 
the fifth issue about attachment and psychopathol-
ogy in children and adolescents will be guest-edited 
by Pernille Darling Rasmussen and overseen by Ole 
Jakob Storebø. We are optimistic that these special 
issues will further strengthen the profile of SJCAPP; 
a special call for papers is planned for each of the 
 42 
 
issues and will be sent to experts in the respective 
fields. 
  
We are currently discussing additional possibilities 
for the future development of the journal. We plan 
to inform researchers about the journal at interna-
tional conferences. The journal’s website will be 
enriched and more user-friendly, and we will engage 
a web editor to improve the interface. Increased 
interconnection of the journal with various social 
media, such as Facebook, Twitter, and Google+, is 
on our agenda. The proposed twin impact factor 
may be a useful and timely metric to measure the 
uptake of research findings and to filter scientific 
findings for communication with the public (3). We 
now have two social media editors, Trine Danvad 
Nilausen and Erica Ramstad, who will help us with 
this process. 
 
 
References 
 
1. Bernius S. The impact of open access on the management of scien-
tific knowledge. Online Information Review 2010;34:583-603. 
 
2. http://www.google.com/analytics (September 27, 2013)  
 
3. Eysenbach G. Can tweets predict citations? Metrics of social im-
pact based on Twitter and correlation with traditional metrics of 
scientific impact. J Med Internet Res 2011;13(4):e123. 


The First Year with the Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

Greger, Hanne K.

Jozefiak, Thomas

Myhre, Arne K.

Child Abuse Management Units: How can Mental Health Services be Further Improved?

Petersen, Tóra

Armour, Cherie

Elklit, Ask

Modeling Patterns of Negative Life Events and Mental Health in Faroese Adolescents

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