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Spring 2019

Winter 2008 Table of Contents
Versión Español de este artículo (Spanish Version)

Dr. Natalie Barraga, Professor Emeritus, The University of Texas at Austin

Abstract: This article describes six stages of learning and education students with visual impairment and their families experience as they grow and change. Educational and family issues are discussed.

Key words: blindness, visual impairment, child development, educational issues in vision impairment

Editor's note: Dr. Barraga is an internationally renowned expert in visual impairment. She directed the training program for teachers of the visually impaired at the University of Texas at Austin from 1963 until she retired in 1984 and has stayed active in the field. She was inducted into the American Printing House for the Blind's Hall of Fame in 1992. Read more about her at the APH website: .

From birth and throughout life, babies, children, and youth with visual impairments encounter numerous challenges. Parents along with other team members are responsible for providing opportunities at various stages to identify variables to be considered and decisions to be made as the challenges increase. As progress is made and children become more responsible, the focus gradually changes to the individual for more involvement in educational and personal decisions.

There are six stages in development in which parents and various team members are involved as children grow.

Stage 1. Infants and Parents, from Birth to 2 years

Parents are dealing with emotional issues of shock, trauma, and grief associated with the first diagnosis of visual impairment. Confusion and uncertainty cloud their thinking until they can begin to understand and accept the reality of the situation. By then, they need to seek information though support systems, reading and learning what to do.

Medical and clinical personnel (preferably pediatricians, pediatric ophthalmologists, and low vision specialists) provide knowledge about the eye conditions, possible medical/surgical interventions, and indicated adaptive devices. Regular examinations to monitor the health of the eye and retina are critical.

Teachers of students with visual impairments (TVI's) can establish communication and rapport with parents, provide positive support, interpret clinical information, and try to answer questions honestly or refer to appropriate persons or reading material. They can model teaching techniques for the parents during visits, and leave written instructions for tasks parents can do daily. They will emphasize tactual, visual and auditory stimulation, and encourage talking to infants by naming objects, sounds and actions.

Certified Orientation and Mobility Specialists (COMS) begin to teach infants orientation to touch, sound, and visual objects. They give checklists of activities for parents to follow, and model teaching to reach, learning to sit alone, to crawl, and later to encourage walking. They also teach body parts, body positioning, spatial concepts, and body movements. They may encourage parents to keep a journal of each new voluntary movement and behavior indicating the use of vision.

Other professionals may need to be added to the team, such as a social worker to provide information and help parents secure needed resources; a neurologist in the event of central nervous system anomalies; physical, occupational and/or speech therapists for infants with motor disabilities; and possibly a low vision specialist, to teach parents how to encourage use of vision with appropriate lights, materials, and activities. The VI professionals begin in infancy to perform the functional vision evaluations and the learning media assessments that will guide sensory access decisions throughout the school years. The Early Childhood Intervention program works with the family on an Individual Family Services Plan (IFSP) in coordination with the school district's TVI and COMS to secure the assistance of these needed team members.

Stage 2. Toddlers and Preschoolers, from 2-4 years of age

This is the stage when a child is striving for independence. Parents (or primary caregivers) are still the primary members of the team. The major decision is to determine who gives the regular care during the day; parents, another family member, or day care. One-on-one teaching of skills and language is a necessity. The IFSP team must make decisions about whether there is exclusive home instruction, or a blend of home teaching and center based teaching. In Texas, home based programming is the most prevalent model during the 0-2 year program. At three, the choice of instructional placement is determined by an Admission, Review and Dismissal (ARD) Committee, which includes the family members, and will depend on individual needs. Children may receive instruction in a regular preschool, public school special education in a PPCD classroom, Pre-K general education, or possibly a special class for children with vision impairment.

Preschool teachers begin to be the leaders for learning development and diagnostic assessments and report to parents and therapists. It may best for the student to be placed in a regular classroom with a consulting teacher of students with visual impairments (TVI) or a special classroom, whichever is most appropriate for the child. The challenges are to select and utilize appropriate magnification when needed; focus on development of such major skills as language and story telling; stimulation of all senses; gross and fine motor activities; establishment of concepts; and encouragement of independence and responsibility.

The Certified Orientation and Mobility Specialist (COMS) teaches sensory orientation skills involved in movement, increases the scope of gross motor skills and some fine motor skills such as protective techniques. The COMS may introduce mobility devices for independent movements using push objects and later the cane.

Peers become playmates and important team members; at first they engage in parallel play, then model imitative play and other movement actions. They are actually teachers when engaging in activities such as running, hopping, skipping, and jumping. Language interaction stimulates curiosity and is a motivating force for exploration and engagement of the world beyond tactile and visual reach.

Stage 3. Kindergarten and the Primary Grades, from 5-7 years of age

This stage involves many of the same team members with addition of others as indicated. Parents, in consultation with teachers have important decisions to make in regard to placement and instructional service delivery depending upon the child's readiness for and progress in the general and VI-specific expanded core curriculum. The visual status of the child is not the only determinant in placement. One placement may be appropriate initially but depending on the progress and needs of the individual may change later. If more VI service intensity is needed, increasing local TVI time and/or short or long-term placements at a residential school might be considered.

At home, the parents are challenged to encourage more independence in personal and home activities. Play opportunities with peers are especially critical as is time with parents to talk about incidents of the day. Children often have questions and they should be encouraged to talk freely about them and to receive open and candid answers. They need to know exactly what their visual condition is and be able to explain it to peers and teachers. If they use special devices they should explain how they are helping them do their work (and let others experiment with the device). Children can learn to express their visual needs and ask for help graciously when needed but politely refuse offers of help when not needed.

The TVI works closely with the instructional and assessment staff to assess visual, auditory, tactual concepts; evaluate fine and gross motor coordination; evaluate receptive and expressive language; and note any sensory preferences and their efficiency. The Educational Diagnostician is part of the team to develop educational and cognitive measures as indicated, and share assessment data with parents and teachers to develop the individualized educational program (IEP).

Teachers, TVIs, and parents are in constant communication regarding placement options and educational plans. Special skills may be a part of the school day or scheduled after school or on weekends.

They may include handwriting, selection of primary learning media, proper use of magnification devices, monoculars, and/or other devices for greater independence.

The Orientation and Mobility Specialist teaches travel in the school building or local neighborhood, location in space on playground and safety in cane travel.

Medical/clinical team members receive reports from others and continue to monitor visual condition and appropriate lenses or devices.

Stage 4. Middle to Late Elementary School, from 8-12 years of age

This is a crucial time for students and team members when issues and decisions require communication and cooperation among all members, who have both individual and team responsibilities.

The key challenge is to develop the learning scope and efficiency of the students as a priority to make maximum progress possible. Instructional decisions based upon student achievement will determine the type and amount of VI specialized instruction. Placement changes may be indicated if progress is not satisfactory, such as moving from regular class to a self-contained or resource class or placement in residential school. Ongoing evaluation of the efficiency of the student's primary learning media (visual, tactual or both) supplemented by auditory is critical. As the nature of visual materials the student will need to access changes, the TVI will refine the learning media assessment and determine the efficiency of regular print, magnification, and/or braille. A CCTV may be useful for some specific activities, such as to enhance handwriting skills or to look up words in the dictionary or read shorter passages. New skills to be emphasized are keyboarding for the computer and other technology-related instruction. Social skills are important to enhance communication and interaction with peers and teachers, and as a means to effect natural independence as a prelude to middle and high school.

Stage 5. Middle School and High School, from 12 to 18 years of age.

The early and later teen years indicate the need for additional members of the previous teams to ensure a broader scope of academic, vocational and job-seeking considerations. Rehabilitation counselors and/or job coaches, adults with visual impairments as role-models, and extended family members are valuable members of the team. The following emphases are crucial:

  1. Refinement of academic and personal skills.
  2. Learning to acquire, evaluate, and organize information.
  3. Selecting, using, and maintaining equipment and tools including technology.
  4. Setting personal and vocational goals.
  5. Analyzing and solving problems at school, home, and community.
  6. Developing personal and behavioral values such as honesty about the visual condition related to peer pressure.
  7. Emphasizing job-seeking skills and performing volunteer and/or paid work.
  8. Applying for admission to college or vocational training.

Peers may have a strong influence during these years, but students still need values, standards of behavior, and knowledge about being respectful of parents and other adults when interacting with others. Interactive clubs and sports participation may boost self-esteem and provide a unique identity, helping compensate for being unable to drive a car.

Stage 6. Transition to Adulthood, from 18 years and beyond

The major decisions center around, What now? Where do I live? Where can I work? Should I pursue further education? When an individual has other disabling conditions, these decisions require consultation with team members about the optimal situation for each individual. Some may be unable to live away from home or other protected environments. Creative personal living and working situations, including sheltered or supported employment, may be suitable for those with limited independence. If additional education is indicated, then it may be a trade school for placement as an apprentice related to skills; community college can prepare one to be a teacher's aide or childcare worker or small business employer or owner. University can be a goal for those who have reached a higher level of independence in routine activities, travel, work habits, and mature decision making in relationships, self evaluation and self advocacy, and have realistic future plans.

The ideal goal is for maximum growth of each individual according to their physical abilities and cognitive development.