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The Assessment of Deafblind Access to Manual Language Systems (ADAMLS) is a re­source for educational teams who are responsible for developing appropriate adaptations and strategies for children who are deafblind who are candidates for learning manual lan­guage systems. Our scope here is intentionally narrow; however we want the reader to remember how complex the approach to instructional strategies for children with deafblindness can be and we encourage you to refer to the resources listed.

A child who is deaf or hard of hearing depends heavily on the visual channel to access information and interaction. Sign language, fingerspelling and speechreading are visual by definition, and vision loss can greatly affect the ability of the child who is deafblind to access these modes of communication. Because little or no attention has been focused on this problem, it is typically not addressed in evaluations. As a result, many qualified students are considered incapable of learning these language systems, and educators may be so unfamiliar with adaptations and strategies to teach them that the child fails to show progress. Effective teaching practice requires that the influence of vision loss on the acquisition and use of manual communication forms be fully considered so that appropriate adaptations can be implemented.

The assessment tool should be used for all children with a dual vision and hearing sen­sory loss (deafblindness) in educational settings that use a form of manual communica­tion. Communication is the means by which a child gains access to the curriculum and to education generally. Therefore, if there is a breakdown in this critical exchange, the child is essentially denied the right to a free and appropriate education. We hope the ADAMLS provides unique and important information in a user­friendly manner to fulfill a need that exists in the field of deafblindness.

Download the assessment.

compiled by TSBVI Deafblind Outreach Staff

Testing the hearing and vision of some children may be very difficult if the child does not respond in traditional ways to clinical assessment. To assist the ophthalmologist, optometrist, otologist or audiologist obtain good testing results on these children it is often helpful to conduct informal assessment prior to or in conjunction with their formal assessments. This type of informal assessment may be carried out by the educational staff and parents. Texas Deafblind Outreach has compiled a variety of assessment tools which we hope will help parents and educational staff gather functional information that may then be shared with these doctors to aid them in making a definitive determination of hearing or vision loss. These materials include those which will: guide observations and organize that information to share with medical staff; expand the range of questions to explore with the professionals to get good testing results; and help prepare the student for more formal testing procedures. Additionally, we have included materials which will aid the educational staff in determining modifications to improve programming for the child in the classroom.

These materials are in no way meant to supplant formal testing done by ophthalmologists, optometrists, audiologists or otologists. Law and common sense dictates that formal testing must be done. Rather it is meant to aid in getting good testing results on hard to test children. If you need some help using these materials, the Texas Deafblind Outreach staff is also available to help. You may request their assistance by contacting Cyral Miller, Outreach Director, at (512) 206-9242.

Your region may know of other useful vision and/or auditory assessments. TSBVI Outreach would love to share your resources! 

 

STUDENT CATEGORY DEFINITIONS

FI = FULL INDEPENDENCE

These students are expected to achieve full Independence in adult living roles. They will probably be assessed using TAAS at their appropriate grade level. They may have additional impairments so long as they function within 2 grade levels of their chronological peers. Post high school education for these students is likely to be college, trade school, or vocational programs.

SEMI-I = SEMI-INDEPENDENCE

These students are expected to be able to live independently without direct or constant assistance. They are likely to be assessed using either the TAAS or release TAAS. These students have reading, math, and writing skills at least 2 grade levels below their chronological peers. They can complete tasks which require a moderate degree of abstraction, but they must first have a very concrete learning foundation. Post high school education for these students is likely to be a trade school or vocational program. It is expected that these students will be able to participate in competitive employment in the general job market with only minimal assistance or support.

FS = FUNCTIONAL SKILLS

These students are in 6th grade or above. If this student category is being considered for a K-5 student, assign the student to the Semi-Independent category. These students will be assessed using an alternative instrument (as opposed to TAAS). They are not expected to read, write, and/or perform mathematical computations beyond the second grade. The appropriate curricular focus for these students is on helping them to develop practical skills necessary for living as independently as possible. Their educational program is typically community based, concrete, and action oriented. These students learn best when they can practice what they are learning in age-appropriate settings which provide experience with the tasks of daily living (e.g. cooking, counting money, etc.). They are able to generalize concepts from one environment to another. The expected outcome for these students is that they will be able to participate in competitive employment with assistance, and that they will be able to live with consistent support (e.g. supported living facility, etc.).

SUP-I = SUPPORTED INDEPENDENCE

These students are expected to require continuous ongoing support as adults. They will be assessed using alternative assessment procedures. Educational programs for these students are typically community based and emphasize routines and calendar systems. These students have difficulty generalizing from one environment to another. Instructional domains typically include domestic, vocational, and recreation/leisure skills. Social competence, social interactions, emotional development, and organization skills are the emphasis of these students' instructional programming.

P = PARTICIPATION

These students have multiple impairments, which usually include severe cognitive delays, the inability to generalize from one environment to another, and the inability to use meaningful verbal communication. They are typically assessed with alternative assessment procedures which could include portfolio and biobehavioral state assessment. As adults, they are expected to require extensive ongoing support. The emphasis of their instructional program should be placed on environmental awareness and appropriate forms of communication

References used in developing these definitions include the Assessing Unique Needs (AUEN) , Texas School for the Blind and Visually Impaired's Continuum of Service document, and the Regional Student Performance Indicators (RSPI)


 

Assessment Resources for Vision and Hearing

Assessment Resources for Vision and Hearing

Compiled by Jenny Lace, Texas Deafblind Outreach in 2009

Assessment Area Editor / Order Type Student Categories

ABC Checklist for Vision Observation and History - It's as Simple as A, B, C

Vision

Modified by Tani Anthony: VIBRATIONS Newsletter of Colorado Services for Children who are Deafblind, Winter 2000 Edition

Checklist

FI, SEMI-I

A G Bell Speech & Hearing Checklist

Auditory

Alexander Graham Bell Association for the Deaf & Hard of Hearing

www.agbell.org

Checklist

Infant

Assessing Basic Auditory Skills

Auditory

J.C. Durkel, TSBVI, 1100 W. 45th St., Austin, TX 78756

 

All

Assessing Children's Vision: A Handbook

Vision

Colorado Services for Children who are Deafblind, Lending Library, Sheryl Ayresm, CDE, 201 E. Colfax Ave, Denver, CO 80203

Book

Unknown

Assessing Young Children with Dual Sensory & Multiple Impairments (Ages Birth-Five) Assessment Guidelines Volume 1

Vision

Auditory

By: Ellin Siegel-Causey, Ph.D. University of Nebraska-Lincoln, 1996 GLARCDB, 665 E. Dublin-Granville Rd., Columbus, OH, 43229

Instrument

Infant-Preschooler, SUP-I, P

Assessment and Instructional Resources

Vision

Auditory

Texas School for the Blind and Visually Impaired Website

Website

All

Assessment of Auditory Functioning

Auditory

By: D. Gleason, 1984; found in appendices from VIMI, M. Smith & N. Levack; order from: TSBVI, 1100 W. 45th Street, Austin, TX. 78756

Guide

SEMI-I, FS,SUP-I, Preschooler

Assessment of Auditory Functioning of Deaf-Blind / Multihandicapped Children

Auditory

By: Deborah Kukla & Theresa Thomas Connolly, 1978, South Central Regional Center for Services to Deaf-Blind Children, Dallas Texas

Guide

FS, SUP-I, P

Assessment of Biobehavioral States & Analysis of Related Influences

Vision

Auditory

By: M. Smith & S. Shafer, based on Crib, Simeonsson & Project Able, Guy. Found in Appendices from VIMI, M. Smith & N. Levack; order from TSBVI, 1100 W. 45th Street, Austin, Texas 78756

Guide

P

Assessment of the Visually Impaired

Vision

By: Nan Bulla, M.Ed., 1996; order from: TSBVI, 1100 W. 45th St., Austin, TX 78756

Guide

All

Audiological Assessment of Individuals w/ DeafBlindness Utilizing Behavioral Methods

Auditory

By: Moore, John Mick; Connix, Frans. 1996; Assessment Bibliography from DB Link 

http://nationaldb.org/ISLibrary.php

Paper

FS, SUP-I

Audiometric Procedures Commonly Used to Identify Potential Hearing Loss

Auditory

J.C. Durkel, TSBVI, 1100 W. 45th St., Austin, TX 78756

Chart

All

Auditory Assessment & Programming for Severely Handicapped Deaf-Blind Students

Auditory

By: L.Goetz & B.Utley; order from: The Association of the Severely Handicapped, 7010 Roosevelt Way, NE, Seattle, WA 98115; Words & Pictures Corporation, PO Box 1001, Parsona, KS 67357

Manual

FS, SUP-I, P

Auditory Assessment of the Difficult to Test

Auditory

By: Robert T. Fulton & Lyle Lloyd; Assessment Bibliography from DB Link

Book

FS, SUP-I, P

Auditory Brainstem Response & Otoacoustic Emissions

Auditory

ASHA Let's Talk, Apr. 1994

Article

All

Auditory Development - Objectives for Child

Auditory

Infant Hearing Resource, Good Samaritan Hospital and Medical Center, 1015 N.W. 22nd Ave., Portland, Oregon 97210

Checklist

Infant-Preschooler, ALL

BAR- Beyond Arms Reach

Vision

By: Audrey Smith, Ph.D. & Lizbeth O'Donnel, M.S., Pennsylvania College Of Optometry Press, 1200 Godfrey Ave., Philadelphia, Penn. 19141

Instrument

FI, SEMI-I, FS

Basic Vision Skills

Vision

TSBVI- Outreach 1100 W. 45thSt., Austin, TX 78756

Packet

All

Callier Azuza Scale, The

Vision

Auditory

By: Robert Stillman, 1978; order from: University of Texas at Dallas, Comm. Disorders, 1966 Inwood Rd., Dallas, Tx. 75235

Instrument

SEMI-I, FS, SUP-I,P

Central Auditory Processing Disorders (CAPD)

Auditory

By: Judith W. Paton

LDOnLine http://www.ldonline.org/ld_indepth/process_deficit/capd_paton.html

Article

FI, SEMI-I, FS

CAPD Handout for Parents & Teachers

Auditory

Web site- ABC's of LD/ADD; The Audiology & Speech Pathology Clinic at Wilford Hall Medical Center, The United States Air Force hospital at Lackland Air Force Base, San Antonio, TX

Handout

All

Central Auditory/ Vision Processing Disorders

Vision

Auditory

Search websites: ABC's of LD/ADD

http://www.ldonline.org/ld_indepth/process_deficit/pro_deficits.html

Article

All

Characteristics of Students with Auditory Processing Problems That May Be Observed in the Classroom

Auditory

By: Susan Bell, The Speech Bin, Catalogue No.1545 from "What is Auditory Processing?"

Article

All

Checklist for Deaf-Blind Census of Texas

Vision

Auditory

By: Roseanna Davidson, Ed.D., Texas Tech University, Deafblind Census of Texas, College of Education, PO Box 41071, Lubbock, TX. 79409

Checklist

All

Children with Dual Sensory Impairments Series Guidelines for Determining Functional Hearing in School-Based Settings

Auditory

by: Flexer, Baumgarner, Wilcox, 1990. Order from: M. Jeanne Wilcox, Ph.D., Family Child Learning Center, 90 West Overdale Dr., Tallmadge, OH 44278

Module

All

Children with Dual Sensory Impairments Series: Guidelines for Determining Functional Use of Vision in School-Based Settings

Vision

By: Cambell, Ph.D., Baumgarner, Wilcox 1989 Order from: M. Jeanne Wilcox, Ph.D., Family Child Learning Center, 90 West Overdale Dr., Tallmadge, Ohio, 44278

Module

All

Comparison of the Frequency & Intensity of Various Environmental & Speech Sounds

Auditory

TSBVI- Outreach 1100 W. 45th St., Austin, TX 78756

Graph

All

Conditions with Hearing Loss & Retinitis Pigmentosa Different from Usher Syndrome

Vision

Auditory

By: Davenport, Sandra, M.D., Sensory Genetics/Neurodevelopment, 5801 Southwood Dr., Bloomington, MN 55437-173

Table

All

Considerations for Detecting Hearing Loss in Infants

Auditory

TSBVI- Outreach 1100 W. 45th St., Austin, TX 78756

Article

Infant

Cortical Visual Impairment

Vision

By: Jan, Groenveld, Sykanda, Hoyt, 1987

 Article

 All

Cortical Visual Impairment - An Overview of Current Knowledge

Vision

contact Tanni at: Colorado Dept.of Education, State Office, Bldg. 201 E., Denver, CO 80203

Article

All

Cortical Visual Impairment Presentation. Assessment and Management. Monograph Series Number 3.

Vision

By: Heather Crossman, 1992, The Royal New South Wales Institute for Deaf and Blind Children. North Rocks Press, Australia: http://www.ridbc.org.au/index.asp

Monograph Series

All

CTEVH XXXII Annual Conference: Cortical Vision Impairment, Delayed Visual Maturation, Cortical Blindness

Vision

By: Takeshita, Bill, 1996 Center for the Partially Sighted, Director of Children's Services, 720 Wilshire Blvd., Suite 200, Santa Monica, CA 90401

Handout

All

DAP - Diagnostic Assessment Procedure

Vision

APH, PO Box 6085, Louisville, KY 40206-0085

Instrument

FI, SEMI-I, FS

DB-LINK Assessment Bibliographies

Vision

Auditory

Website: http://nationaldb.org/ISLibrary.php

Website

All

Deaf-Blind Infants and Children: A Developmental Guide

Vision

Auditory

By: McInnes & Trefrey, University of Toronto Press, 1982

Guide

Infant -KDG., FS, SUP-I, P

Deafness and Vision Disorders: Anatomy and Physiology, Assessment

Procedures, Ocular Anomalies, and Educational Implications

Vision

Auditory

By: Johnson, Donald D., Order from: Charles C. Thomas Publisher, LTD.,  www.ccthomas.com

email: 

Book

All

Diagnostic Patching Regimen for the Profoundly Multiply Handicapped,

Vision

By: Freeman, O.D. & Jose, O.D.; Journal of Behavioral Optometry, 1995

Article

SUP-I, P

Early Identification of Deaf-Blindness

Vision

Auditory

By: Davenport, Sandra L. H. 1993; Assessment Bibliography from DB Link http://nationaldb.org/ISLibrary.php

Outline

Infant-Preschooler

Early Identification of Hearing Loss in Infants & Young Children

Auditory

www.hsdc.org/hrgloss

Checklist

Infant

Educating Young Children A Developmental Approach

Vision

Auditory

S. G. Garwood, E. pg 235-281 Rockville, Md. Aspen Systems Corp 1983; "Working with Sensorily Impaired Children," Rebecca Fewell

Book

Infant-Preschooler, P

Educational Methods for Deaf-Blind and Severely Handicapped Students, 1980

Auditory

Texas Education Agency, 1701 North Congress, Austin, Texas 78701

Article

Birth-6YRS.

Effective Practices in Early Intervention - Infants Whose Disabilities Include Both Vision & Hearing Loss

Vision

Auditory

By: Deborah Chen, Ph.D., California State University, Northridge

Guide

Infant, P

Every Move Counts - Sensory Based Communication Techniques

Vision

 Auditory

Therapy Skill Builders, 3830 E. Bellevue, PO Box 42050, Tucson, AZ 85733

Manual, Video

Infant, SUP-I, P

Functional Auditory Assessment

Auditory

By: Gee, Kathy. San Jose State University, 1996; Assessment Bibliography from DB Link nationaldb.org

Packet

All

Functional Hearing Assessment

Auditory

By: Peggy Miller Tarver, Texas School for the Deaf, 1102 South Congress, Austin, TX 78704

Handout

Infant

Functional Skills Screening Inventory

Vision

 Auditory

Functional Resources, 3905 Huntington Drive, Amarillo, TX 79109-4047

Instrument

SEMI-I, FS, SUP-I

Functional Vision & Media Assessment (2nd Edition) for Students who are Pre-Academic or Academic & Visually Impaired in Grades K-12

Vision

By Vision Consultants, Larhea Sanford & Rebecca Burnett, 1996; PO Box 8594, Hermitage, TN 37076 ph: (615)885-0764

Instrument

K-12TH GRADE, FI, SEMI-I, FS

Functional Vision Assessment & Interventions

Vision

Topor, Irene L. 1996; Assessment Bibliography from DB Link 

Packet

All

Functional Vision Assessment Birth to Three Years & Multihandicapped Recording Form

Vision

By: Kathleen Appleby, 1996; Vision Associates, 7512 Dr Phillips Blvd., Orlando, FL.

Form

BIRTH-3YRS., SUP-I, P

Functional Vision Evaluation

Vision

Region VIII Education Service Center, PO Box 1894, Mt. Pleasant, TX 75456-1894

Instrument

All

Functional Vision Screening

Vision

By: Beth Langley & Rebecca Dubose

Instrument

All

Gathering Information for Programming for the Student with the Most Profound Disabilities: Information Packet, 1997

Vision

Auditory

Texas School for the Blind and Visually Impaired Outreach, 1100 West 45th Street, Austin, TX 78756-3494

Packet

P

Getting the Most out of Clinical Low Vision Evaluations & Ophthalmologic Evaluations for the Student w/ Deafblindness

Vision

Tarver, Peggy Miller; Blaha, Robbie 1996; Assessment Bibliography from DB Link

http://nationaldb.org/ISLibrary.php

Packet

All

Great Lakes Area Regional Center for Deafblind Education Assessment Guidelines

Vision

Auditory

University of Dayton/UDRI Project #93985, Assessment Guidelines, GLARCDBE, Poste Lake Building, Suite 100, 665 East Dublin-Granville Rd., Columbus, OH 43229

Guide

Infant-Preschooler; Ages 6-15; Young Adults- SEMI-I, FS, SUP-I

Guide for Observing Auditory Responses

Auditory

By: Karen Wright, Texas School for the Deaf, 1102 S. Congress, Austin, TX 78704

Guide

All

Hearing Observation Form

Auditory

By: TSBVI Outreach, 1995, 1100 West 45th Street, Austin, TX 78756

Chart

All

HELP (Hawaii Early Learning Profile)

Vision

Auditory

Vort Corporation, PO Box 60132, Palo Alto, CA 94306

Instrument

Infant-Preschooler, P

Here's Looking at You Kid - The Proceedings of the Eighth International Conference on Blind & Visually Impaired Children, 1993

Vision

Order from: Diane McConnell & Bill Mckeown, The Canadian National Institute for the Blind, 12010 Jasper Ave., Edmonton, Alberta, Canada T5K 0P3

Paper

All

How is All the Information From a Functional Vision Assessment Put Together?

Vision

Indiana Deaf-Blind Services Project Information Updates.5. Blumberg Center for Interdisciplinary Studies in Special Education, Indiana State University, Terre Haute, IN; 

Unknown

Unknown

How to Read an Audiogram

Auditory

By: Sandra Davenport, M.D., Sensory Genetics/Neuro Development, 5801 Southwood Dr., Bloomington, MN 55437

Article

All

Informal Assessment of Listening Skills

Auditory

TSBVI - Curriculum, 1100 W. 45th St., Austin, TX 78756, ph: (512) 454-8631

Assessment KIT Listening

Infant-Preschooler

Informal Auditory Observation Form

Auditory

By: Robbie Blaha & Stacy Shafer; TSBVI Outreach, 1100 W. 45th St., Austin,

TX 78756

Informal

All

INSITE

Vision

Auditory

Project INSITE, Utah School for the Deaf and the Blind, 846 20th St., Ogden, UT 84401 order: HOPE INC. 55 E. 100 North, Suite 203, Logan, Utah 84321

Manual, Video

Infant-Preschooler, P

Issues Regarding the Assessment of Vision Loss in Regard to Sign Language and Fingerspelling for the Student with Deaf-Blindness

Vision

Auditory

By: Robbie Blaha; Order from: TSBVI, 1100 W. 45th St., Austin, Tx. 78756

Article

F-, SEMI-I, FS, SUP-I

Learning Media Assessment of Students with Visual Impairments - A Resource Guide for Teachers

Vision

By: Alan Koenig & M. Cay Holbrook, 1993; Order from: TSBVI, 1100 W. 45th St., Austin, TX 78756

Guide

All

Low Vision - A Resource Guide with Adaptations for Students with Visual Impairments

Vision

By: Nancy Levack, 1991; Order from: TSBVI, 1100 W. 45th St., Austin, TX 78756

Guide

All

Low Vision: A Resource Guide w/ Adaptations for Students w/ Visual Impairments

Vision

By: Levack, Nancy; Stone, Gretchen; Bishop, Virginia 1996. Texas School for the Blind & Visually Impaired (TSBVI) 1100 West 45th St., Austin, Texas 78756-3494

Guide

All

Making Choices in Functional Vision Evaluations: "Noodles, Needles and Haystacks"

Vision

By: V. Bishop, Journal of Visual Impairment and Blindness. 82, 94-98;  http://www.eric.ed.gov/ERICWebPortal/custom/portlets/recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ368869&ERICExtSearch_SearchType_0=no&accno=EJ368869

Article

All

Making the Most of Early Communication

Vision

Auditory

VIDEO By: Deborah Chen and Pamela Schachter; Order from: AFB Press

Video

Infant-Preschooler

Michigan Severity Rating Scales for Students with Visual Impairments,

Vision

Michigan School for the Blind Outreach Department, 1996-1997

Packet

All

New Methods for Evaluating Vision

Vision

By: Cress, Pamela J. & Spellman, Charles R. 1991; Assessment Bibliography from DB Link  http://nationaldb.org/ISLibrary.php

Article

Infant-Preschooler P

Nonhearing World, The; Understanding hearing Loss

Auditory

Films for the Humanities, INC, Box 2053, Princeton, NJ 08543-2053

Video

All

Oregon Project

Vision

Auditory

Jackson County Education Service District, 101 N. Grape St., Medford, OR 97561

Instrument

Birth-6 Yrs.FI, SI, FS

Parent Checklist

Auditory

By: Peggy Miller Tarver, Texas School for the Deaf, 1102 S. Congress, Austin, TX 78704

Checklist

Infant-Preschooler

Peabody Model Vision Project: Functional Vision for the Multiply & Severely Handicapped

Vision

By Beth Langely, 1980; order from: Stoelting Co., 1350 S. Kostner Ave., Chicago, IL 60623

Manual

SEMI-I, FS, SUP-I

Possible Indicators of Persons Who May Not Be Deaf or Hard of Hearing

Auditory

By: Peggy Miller Tarver, Texas School for the Deaf, 1102 S. Congress, Austin, TX 78704

Checklist

All

Procedures Commonly Used for Determining Potential Hearing Loss

Auditory

By: Jim Durkel, TSBVI-Outreach 1100 W, 45th. St., Austin, TX 78756

Chart

 

Reactions Frequently Reported by Hard of Hearing People

Auditory

TSBVI-Outreach 1100 W, 45th. St., Austin, TX 78756

List

All

Screening for Hearing & Vision Loss

Vision

Auditory

Arizona School for the Deaf and Blind-ASDB Tucson, AZ. Assessment Bibliography from DB Link  http://nationaldb.org/ISLibrary.php

Article

Birth-6 Yrs.

Sensory Assessment Manual

Vision

Auditory

By: Cress, Pamela. Monmouth,1989 OR: Oregon State System of Higher Ed. Teaching Research Division, 345 N Monmouth Ave. 97361

Manual

FI, SEMI-I

Sounds of Texas: Can Your Baby Hear Them

Auditory

Texas Department of Health http://www.tdh.state.tx.us/audio/sotbroch.htm

Checklist

Infant

South Carolina Functional Vision Assessment

Vision

South Carolina Department of Education, 1429 Senate St., Columbia, SC 29201

Instrument

All

Steps in Preparing the Functional Vision Assessment for Students with Multiple Disabilities

Vision

From Foundations of Low Vision: Clinical & Functional Perspectives By:: Corn & Koenig; From Foundations of Low Vision: Clinical & Functional Perspectives.

Book

P

Suggestions for Parents in Preparing a Childe for Audiologicals

Auditory

By: Karen Wright & Peggy Miller Tarver Texas School for the Deaf, 1102 S. Congress, Austin, TX 78704 ph: (512) 462-5353

Article

All

Systematic Procedures for Eliciting and Recording Responses to Sound Stimuli in Deafblind Multihandicapped Children

Auditory

By: Susan M. Kershman & Deborah Napier

Article

Toddlers, SUP-I, P

Teachers Guide to the Special Educational Needs of Blind and Visually Handicapped Children - Functional Vision Checklists-pg..37-44

Vision

American Foundation for the Blind, 11 Penn Plaza, Suite 300, NY, NY 10001

Book

FI, SEMI-I, FS

Teaching Students with Visual & Multiple Impairments

Vision

Auditory

By: M. Smith & N. Levack; Order from: TSBVI, 1100 W. 45th St., Austin, TX 78756

Guide

All

Team Approach to Audiological Assessment

Auditory

VIDEO: Infant Hearing Resource/Hearing & Speech Institute, 3515 SW Veterans Hospital Rd., Portland, OR 97201

Video

Infant

Test of Auditory Perceptual Skills

Auditory

Morrison F. Gardner (for ages 4-13); order from: Stoelting Co., 620 Wheat Lane, Wood Dale, IL 60191; ph: 630-860-9700; fax: 630-860-9775; www.stoeltingco.com

Kit

FI, SEMI-I

Texas Early Childhood Intervention Vision & Auditory Forms

Vision

Auditory

Contact your local ECI program

FORM

Infant, SUP-I, P

The Nonhearing World; Understanding Hearing Loss

Auditory

VIDEO: Films for the Humanities, Inc., Box 2053, Princeton, NJ 08543-2053

Video

All

Things to Consider: Preparing for an Eye Exam of your Child

Vision

By: Tani Anthony CDE, 201E. Colfax Ave., Denver, CO.

Checklist

All

Things to Know Before You Go To the Audiologist

Auditory

By: Stacy Shafer, Robbie Blaha, 1997. order from: TSBVI, 1100 West 45th St., Austin, TX 78756 ph: (512) 454-8631

Packet

All

Things to Think About When Looking at CAPD

Auditory

By: Jim Durkel, TSBVI Outreach 1100 West 45th St., Austin, TX 78756

Handout

Infant

Understanding Central Auditory Processing Disorder

Auditory

By: Dorothy A. Kelly; Order from: Communication Skill Builders

Guide

FI, SEMI-I, FS

Understanding Low Vision

Vision

by: Randal T. Jose, Ed., 1989; American Foundation for the Blind

Book

All

Usher Syndrome Screening Checklist

Vision

Auditory

TSBVI- Outreach 1100 W. 45th St., Austin, TX 78756

Checklist

FI, SEMI-I

Usher's Syndrome Adolescent

Vision

Auditory

TSBVI- Outreach 1100 W. 45th St., Austin, TX 78756

SCREENING FORM

Adolescent, FI, SEMI-I

VIISA (Resources for Family Centered Intervention for Infants, Toddlers, and Preschoolers Who Are Visually Impaired)

Vision

SKI*HI Institute, Utah State University, Department of Communication Disorders, Logan, UT 84322-1900; order: HOPE INC., 55 East 100 North, Suite 203, Logan, Utah 84321

Manual

Infant-Preschooler

Vision Assessment and Program Manual for Severely Handicapped and/or Deaf-Blind Students

Vision

Eric [document Reproduction Service No. ED 250-840] Reston, VA: Council for Exceptional Children

Unknown

Unknown

Vision Associates

Vision

7512 Dr Phillips Blvd., #50-316, Orlando, FL 32819 

Checklist, Instrument, Kit, Video, Book

All

Vision Questionnaire - For Teaching Parents / Teachers Usher)

Vision

TSBVI- Outreach 1100 W. 45th St., Austin, TX 78756

Questionnaire

Usher, FI, SEMI-I

Vision Screening for Deaf & Hard-of-Hearing Students

Vision

Auditory

Minneapolis Children's Medical Center, 2525 Chicago Ave-South, Minneapolis, MN 55404; Sensory Genetics/Neuro-development, 5801 Southwood Dr., Bloomington, MN 55437

Questionnaire

All

Vision Test for Infants

Vision

By: Chen, Deborah California State University order: AFB Press, American Foundation for the Blind, Eleven Penn Plaza, New York, NY 1001

Video

Infant

Visual and Auditory Processing Disorders

Vision

Auditory

National Center for Learning Disabilities, 381 Park Avenue South, Suite 1420, New York, NY 10016

Variety

All

Visual Impairment and Learning Disabilities

Vision

By: Bulla, 1997 TSBVI 1100 W. 45th St., Austin, TX 78756

Article

FI, SEM-I, FS

What Can Baby Hear?

Auditory

VIDEO By: Deborah Chen, Ph.D., California State University, 1997; Order from: AFB Press

Video

Infant

What Can Baby See?

Vision

VIDEO By: Deborah Chen; Order from: AFB Press

Video

Infant

What is Usher Syndrome? How to Recognize the Combination of Hearing Loss and Retinitis Pigmentosa

Vision

Auditory

DRAFT - Indiana Deaf-Blind Services Project http://www.indstate.edu/blumberg/

Guide

FI, SEMI-I, FS

What's Functional About a Functional Vision Assessment?

Vision

By: I. Topor (with Penny Rosenblum) (1994), Indiana Deaf-Blind Services Project Information Updates. 5., Blumberg Center for Interdisciplinary Studies in Special Education, Indiana State University, Terre Haute, IN; 

http://www.indstate.edu/blumberg/

Article

Unknown

When Families & Staff Go to the Ophthalmologist or Audiologist

Vision

Auditory

By: Blaha, Robbie 1995 TSBVI Outreach 1100 West 45th St. Austin, TX 78756

Article

All

Why is it Important to Screen for Usher Syndrome?

Vision

Auditory

TSBVI- Outreach 1100 W. 45th St., Austin, TX 78756

Article

FI, SEMI-I, FS

Terese Pawletko, Ph.D
reprinted from: FOCAL Points, Fall 2002 Volume 1, Issue 2
The journal concerning Optic Nerve Hypoplasia & Septo Optic Dysplasia

As a former teacher of the visually impaired I was struck by the fact that a subgroup of children with whom I worked did not respond to typical interventions used in early intervention with children with significant visual impairment – for instance, multi-sensory approaches, narrating everything that was going on around the child, hand-overhand presentation. In fact, several of these children appeared to “retreat” and/or become distressed (e.g., might engage in stereotypic behaviors, “appear to be deaf”). Literature in the vision field did not provide an adequate explanation as to the cause for these behaviors aside from labeling the mannerisms as “blindisms” and calling them “autistic-like” – the belief being that some of these behaviors were related to the child’s sensory impairment and lack of opportunities to engage in more typical social exchanges. Rarely was the following question raised: “could this child also be autistic?” At the end of this brief introductory article, I hope that you will have a general understanding of the definition of autism and why it is possible for a child to have both a significant visual impairment and autism.

1. What is autism?

Autism is a biological developmental disorder of the brain that impairs communication and the ability to relate to others. It is often referred to as a spectrum disorder given its presentation ranges from mild to severe in any of its features.

2. What causes autism? How is it diagnosed?

Autism is not etiology specific – that is, it has many possible causes including genetics, environmental toxins, metabolic dysfunction, etc. The commonality among all the causes is that it is a brain-based disorder.

Autism is diagnosed by the presence of certain behavioral features – it cannot be diagnosed by a specific blood test or scan. The defining features include: impairments in reciprocal social interaction that is sustained (e.g., impairment in use of nonverbal behaviors; with young children may fail to develop peer relationships appropriate to developmental level; may lack spontaneous seeking to share enjoyment and interests with someone; may prefer solitary activities; limited to no concept of needs of others); impairments in communication marked and sustained affecting spoken language and nonverbal skills (e.g., delay in or lack of development of spoken language; or may have impairment in ability to sustain conversation; or may show repetitive use of language or idiosyncratic language). For those with speech present, may have unusual pitch, intonation, rate, or rhythm to speech.

Grammar may be immature and include stereotyped use of language (e.g., repeating phrases; repeating commercials). Child may have difficulty understanding simple questions or commands. There may be a lack of varied, spontaneous make-believe or social imitative play commensurate with developmental level. Individuals on the autism spectrum also have restricted, repetitive, stereotyped patterns of behavior, interests (e.g., intense preoccupation with dates, phone numbers; electronic equipment; perhaps with parts of objects), and activities; inflexible adherence to nonfunctional routines or rituals; stereotyped/repetitive motor mannerisms, etc. They may insist on sameness and show resistance and/or anxiety over small changes. There may be stereotyped body movements (e.g., flapping, rocking, toe walking, hand posturing).

Finally, these delays or abnormal functioning in one or more of the above areas must be present before the age of three. While not a defining feature, a number of children and adults on the spectrum have hypo or hypersensitive responses to various stimuli (e.g., certain sounds; certain textures including clothing or food; smells).

3. I’ve read about autism but my child does not have every feature exactly as described in the article. Does that mean he/she doesn’t have autism?

Several issues need to be considered here. First and foremost, autism (and its related disorders, including Aspergers, PDD/NOS, for instance) is defined by the presence of the cluster of behaviors – the presence of any one behavior (e.g., flapping) does not mean that a child is autistic. In addition, it is developmental in nature and as a result, it will change somewhat in presentation as a result of the maturational process. What is important is that the cluster of behaviors be present prior to the age of 3. Finally, given it is a spectrum disorder (e.g., child’s level of function can vary on all dimensions including cognitive ability, behavioral presentation, sensory sensitivities, language/communicative abilities, social relatedness) it is highly unlikely that any individual will fit any one description to a “T.”

4. Can a child with a visual impairment be autistic too? I heard that they have “autistic-like tendencies” but not autism. Is that true?

Children with visual impairments can be on the autism spectrum as well. Remember, it is a brain-based disorder so those children with neurological vulnerabilities (e.g., seizure disorders, septo-optic dysplasia, Prematurity associated with bleeds, agenesis of the corpus callosum, congenital rubella syndrome, etc.) may be at increased risk. The literature in the field of visual impairment needs to be more cautious in its use of the terminology “autistic-like” in that it can result in missed diagnosis and/or delay in procuring appropriate services for those children who are on the autism spectrum. Strategies useful for children who are visually impaired and autistic vary considerably from those effective for children who are just visually impaired.

5. Why are we hearing so much about autism now?

Autism is not as rare as was once thought. According to Dr. Marie Bristol-Powers (1999) National Institute of Child Health and Human Development, autism spectrum disorder is not rare as was once thought. Current estimates suggest that 1 in 1,000 individuals fit the definition of "classic" autism and that 1 in 200 individuals fall within the Autism Spectrum, including Pervasive Developmental Disorder and Asperger's Syndrome.

Why the increase?

We now have clearer diagnostic criteria, increased public awareness and “acceptance”, broader definition of autism as a spectrum disorder, more children, tinier and neurologically more vulnerable children are surviving prematurity; and we have the presence of environmental toxins as potential contributors.

6. Is the notion of autism co-occurring in a child with visual impairment new?

Dr. Stella Chess - her observations of children with Rubella noted “…the difference between the autistic and nonautistic rubella children with sensory defects is the use they make of alternative…modes of experiencing. Nonautistic youngsters … are very alert to their surroundings through their other senses, especially exhibiting visual alertness and appropriate responsiveness... also through seeking of affectionate bodily contact. Some are shy, some slow to warm up, some perhaps wary; but one is impressed by their readiness to respond to appropriately selected and carefully timed overtures. …the autistic children neither explore alternative sensory modalities nor manifest appropriated responsiveness. They form a distinct group whose distance from people cannot be adequately explained by the degree or combination of visual and auditory loss, nor by the degree of retardation where this also exists. … whether retarded or not, their affective behaviors do not resemble those of children of their obtained mental age – in fact, there is no mental age for which the behaviors are appropriate.” Chess... P. 116 - 117

Why the controversy? Why the ongoing debate? Confusion in literature

  • Treated symptoms in isolation (e.g., mannerisms)
  • Viewed as indicative of emotional and behavioral problems (e.g., self-stimulatory behaviors; problems of hyperactivity, inattention, impulsivity; disruptive behaviors such as oppositional; problems of social interaction; problems of mood, affect)
  • Viewed as being totally associated with sensory deprivation (e.g., turn inward for stimulation)
  • Viewed as related to mother-child attachment (e.g., in incubators longer; lack of eye contact so hard to read cues; maternal depression further limiting her involvement w/child)

Examples of some of the eye conditions where Autism Spectrum Disorder has been documented

  • Anophthalmia (may occur at critical periods in brain development and yield higher co-morbidity)
  • Lebers Congenital Amaurosis
  • Peters Anomaly
  • Retinopathy of Prematurity
  • Septo-optic dysplasia
  • Congenital Rubella Syndrome

Key thing to remember: autism is a brain related disorder; that estimated that 50% of blind children have LD and 56% of those with severe LD or IQ<50 have autism (Steinberg et al., 2002)

7. What do we do about it?

It is important to begin to advocate for appropriate diagnosis for your children through collaborative efforts between autism diagnostic centers and teachers of the visually impaired, and by advocating with your primary care providers. Cooperative efforts between vision and autism programs will be critical as most of the strategies used for children with autism rely on vision – not always an option for our children and students. For more information you can go to:

and others…

About the author:

Dr. Terese Pawletko has worked with children since 1976, first as a teacher of the visually impaired, then as school and pediatric psychologist. Starting in 1989, after completing a postdoctoral fellowship in Pediatric Psychology at UNC-Chapel Hill, she worked at UNC School of Medicine with chronically ill children, and with autistic students, their parents, and related service providers. In 1997 she joined the staff of the Maryland School for the Blind where she worked with multiply handicapped children with a variety of disabilities including visual impairment, autism spectrum disorders, cerebral palsy, mental retardation, and learning disabilities, as well as training staff to work with these students. While at MSB, Dr. Pawletko and her colleagues developed the first program in the country for children with visual impairment and autism. She is considered a national expert in this area and has presented at regional, national, and international conferences, conducted evaluations of children suspected of dual diagnosis, and provided consultation to and training of parents and service providers.

 
Terese's contact information:
email:  
Snail mail:
Terese Pawletko, Ph.D.
33 Johnson Lane, Eliot, Maine  03903

Terese Pawletko, Ph.D. & Lorraine Rocissano, Ph.D.
Psychology Department
Maryland School for the Blind

AER/DENVER, July 18, 2000

Explanations for "Autistic-like" Behaviors in Blind Children

Their behaviors (e.g., stereotypes, rituals; restrictions in play) seen as:

  • indicative of emotional disturbance
  • associated with sensory deprivation (e.g., turn inward for stimulation)
  • related to mother-child attachment (e.g., in incubators longer; lack of eye contact so hard to read cues; maternal depression further limiting her involvement with child)

Non-Autistic and Autistic Rubella - 
Distinctions noted by Chess et al.

Non-autistic rubella children with sensory defects:

  1. Are very alert to their surroundings through their other senses
  2. Exhibit appropriate responsiveness - "Some are shy, some slow to warm up, some perhaps wary; but one is impressed by their readiness to respond to appropriately selected and carefully timed overtures."

Rubella children with autism and sensory defects

  1. Do not explore with alternative senses
  2. Maintain distance from people that is not explained by the sensory deficits nor by degree of retardation
  3. Their affective behaviors do not resemble those of the same mental age.

Caveats in Diagnosing

  1. Autism is a developmental disability, not parent induced, not induced by blindness
  2. It is a syndrome; no one symptom yields a diagnosis.
  3. Autism is a spectrum disorder, with a wide range of functional levels, and behavioral presentations.
  4. While symptoms show improvement over time, the individual remains autistic. Autism is a lifelong disorder and for most individuals some level of support may be required.

Note: the following sections were depicted as "icebergs." They detail the key diagnostic features of autism using an iceberg approach - the behaviors one might observe on the surface, and the processing difficulties that might account for them.

Problems with Socialization

YOU SEE:

  • Fails to or has difficulty engaging in reciprocal interactions
  • Treats others as though they were objects
  • Seems uninterested in peers

What you do not see: 

  • Problems shifting attention
  • Unable to process social information effectively
  • Difficulty processing complex stimuli due to difficulties telling figure from ground, and problems making very rapid shifts of attention
  • Cannot process multiple sensory stimuli simultaneously

Implications for Parents and Educators

  1. Recognize that the social world is more complex and less predictable for an individual with autism, and therefore more stress producing.
  2. Do not assume that simple exposure to peers will result in the acquisition of social skills.
  3. A child cannot be pushed to acquire social skills. Begin with something short, structured, teacher directed, and success oriented.

Problems in Language

YOU SEE:

  • Seems very verbal but can't follow instructions
  • Poor receptive language
  • Echolalia (Echolalia is a positive sign in that it shows that the child is at least discriminating among phonemes, sequencing sounds, using working memory)
  • Pronoun reversal
  • Non-verbal

What you do not see: 

  • May use words expressively which they don't really understand (receptive language lower than expressive)
  • Difficulties discriminating language sounds - poor central auditory processing
  • Difficulties with sequencing phonemes and words
  • Can't break the linguistic code

Implications

  1. Check out whether child understands what he/she is saying (e.g., "what does that mean?")
  2. Use controlled language (e.g., short, concrete phrases with time between statements to allow for processing)
  3. If student has vision, try to provide some information visually; if not, provide information tactually.

Problems in Communication

YOU SEE:

  • Perseverates on one topic
  • Shows no interest in other people's topics
  • Too close or too far when talking
  • Says something unrelated to the conversation
  • May become angry when he hears certain words

What you do not see: 

  • Can't apply rules in context
  • Problems with impulse control
  • Inability to take the perspective of another, as well as problems shifting attention

Implications

  1. Direct instruction in the actual setting is key.
  2. Identify clear, concrete rules that the child needs to follow in specific situations.
  3. Social stories can be helpful in providing a child with a script to follow.

Perseverative or Narrowly Focused Interests

YOU SEE: 

  • Need for sameness, predictability
  • Motor stereotypies
  • Focuses on parts of objects in play (e.g., wheels, spins everything, flips handle of basket repeatedly)
  • Age appropriate pretend play not observed
  • Restricted and perseverative interest (e.g., elevators, Xerox machines, CD titles)

What you do not see: 

  • Difficulty getting meaning from environment due to all cognitive processing deficits
  • Repetitive events are easier to understand and make sense of than multifaceted input
  • Repetitive behavior may be experienced as soothing

Implications

  1. Recognize that the routines and self-stimulatory behavior are the things that the child understands best and may serve as a "life-preserver" for the child. It is the child's retreat to his comfort zone.
  2. The child's reliance on such behaviors will tend to increase in times of stress and anxiety (e.g., transition, lack of clear expectation, challenges). Ask yourself "why is the child engaging in this now?"
  3. Identify a time when the child can engage in his self- stimulatory behavior; tighten up the structure, schedule, routine to decrease anxiety and increase non-verbal information.

Hypo- and Hyper-Sensory Systems

YOU SEE:

  • Over-reacts to certain noises (e.g., fire-alarms, vacuum cleaner, fan motor)
  • Finds certain tactile experiences aversive (e.g., certain foods, texture of clothing, soft furry objects, being touched)
  • Often finds warm temperatures aversive
  • May not react to bumping head, falling down, etc.
  • Stops listening to instructions when asked to open book

What you do not see: 

  • Has poor regulation of auditory system (e.g., at times may find raindrops sounding like gunshots, other times not a problem; visceral panic regulation to sudden loud sounds like fire alarm - heart and respiration rate do not return to normal for several hours)
  • Can only process one sensory input at a time
  • Brains process temperature, texture, multi-sensory things differently

Implications

  1. Be alert to how the sensory environment may be impacting on your student.
  2. Try to keep the environment as low key as possible (e.g., visually clear, sound absorbing materials, no extraneous noise or conversation; balance lighting needs for children's visual impairment with those of arousal).
  3. Be aware of possible multi-sensory input issues and adjust instruction accordingly.

 

By Thomas Fields-Meyer and Frances Dinkelspiel

Reprinted from the December 11, 2000 issue of People Weekly Magazine by special permission; © 2000, Time Inc.

In her bedroom at her family's Benicia, California, home, Dionne Quan keeps on video dozens of Disney movies that she has watched over and over, dreaming of one day performing in the kind of films that have captured her imagination since she was a child. But she watches them in her own unique way, pressing her face right up to the picture tube. "My nose is right next to the TV so I can see whatever I can see," says Quan, 22. "Whatever I can't see, I manage to figure out."

Visually impaired since birth, Quan has never let her disability stop her from pursuing her dreams. Now with a voice-over role as Kimi, an energetic Japanese toddler in Rugrats in Paris, the latest animated feature based on the Nickelodeon hit series, she's living them. "She's an incredibly talented kid," says the film's voice director Charlie Adler, 44. "There was no doubt when she came in. She wanted this. She had the ability to do this."

And do it well. Producers had to make some minor adjustments to accommodate Quan's disability while they recorded, repositioning the microphone so it wouldn't pick up the sound of her fingers on her braille script; they also avoided last minute dialogue changes. But before long, any difference between Quan and her castmates melted away. "She gives a fresh immediacy to all of her lines," says her voice teacher Mike Matthews. " I forget she's not sighted. She actually sees more, if you will, than most of us do."

That insight has developed through hard work and dedication - both from Dionne and her parents, Daryl, 46, and Lori, 44, who run a sewing machine and vacuum store in nearby Vallejo. The older of their two children (brother Daryl is 20), Dionne seemed healthy at birth. But four months later Lori noticed that her daughter's eyes weren't following the mobile twirling above her crib. A CAT scan showed she had some brain irregularities, and at 6 months she was diagnosed with hypoplasia - or underdevelopment - of the optic nerve. The unusual condition left her with extremely limited sight, allowing her to make out only some colors and vague shapes.

Determined to help her daughter succeed, Lori rearranged her life to focus on Dionne, speaking to her all day and describing everything she did and saw to orient the child. "I wanted to help her as much as I could so she could achieve her dreams," say Lori, who told her daughter: "You want to act, go act. You want to play ball, go play ball."

Quan didn't take long to choose. Drawn to reading, having learned braille at age 7, she liked to act out the characters in her storybooks. At 10, she enrolled in an after-school program at a San Francisco drama school, where she learned how to make her way around a stage. "Obviously things like pantomiming didn't work so well," she says, "because I couldn't imagine something in my hand when it really wasn't there."

Then, when Quan was 12, her father heard voice-over teacher Samantha Paris on a radio talk show and took Dionne to study with her. "It just opened up a whole new world," Dionne says, because I didn't have to worry about gesturing." In fact, her impaired vision may have heightened her other senses. "She has an incredible ear," says Paris. "To hear this girl sing makes you cry."

Having found her niche, Quan flourished, landing her first commercial job at 14 in an ad for a health maintenance organization. Voice-overs for such projects as jelly bean ads and children's cartoons, including Nickelodeon's The Wild Thornberries, followed. By the time she auditioned for Rugrats, Quan was a pro. "It was a challenge to find a voice that would meld with the ensemble and have the same youth, the innocence, the vitality," says talent director Barbara Wright, who chose Quan from 200 hopefuls. "Dionne had a unique, very dear quality."

So dear, in fact, that she was promptly offered - and accepted - a recurring role on the Rugrats television show. Early next year Quan plans to move out of her parents' home and into one she will share with brother Daryl, a UCLA student, in Los Angeles, which presents its own challenges. "It's going to be a good experience," she says. "But in a way it's scary." To prepare, she got special training in programs that teach blind people basic skills. And for the first time, she learned to write in conventional script - for the express purpose, she says, of signing autographs.

Download all Banquet Recipes

You may download a zip file containing all the Banquet Recipes in accessible Word files.

This file contains the following recipes:

Banquet Boneless Pork Ribs

Banquet Chicken Nuggets

Banquet Chicken Pot Pie

Banquet Enchilada Combo

Banquet Fried Chicken

Banquet Heartyone Fried Chicken Dinner

Banquet Heartyone Salisbury Steak Dinner

Banquet Popcorn Chicken

Banquet Meatloaf Dinner

Object Calendars can be used to help facilitate communication. Calendars also help children transition from one activity to another. The team chooses a few activities that the child does on a daily basis. They then choose an object from each activity to represent that activity. The chosen activities should include several that the child enjoys. The object that is used to represent an activity needs to be meaningful to the child. The team slowly keeps adding to the number of activities in the child's day that are represented in her calendar. You can work on joint attention, social interactions, anticipation, sequencing, object exploration, choice-making, turn-taking, etc. There are many different types of calendar systems you can use with a student. The first level of calendar system is described below:

  • The team chooses a few fun activities (4-6) that the child does on a daily basis (playing with the tent, sit-and-spin, water play, jumping on a rebounder, going for a walk outside, eating a snack, etc.). Then choose an object from each activity to represent that activity. (You will have 4-6 different objects.) The object that is used to represent an activity needs to be meaningful to the child and needs to be used during the activity.
  • Cue the child that an activity is about to occur by presenting the object associated with that activity to her. Allow her to handle the object and explore it as she wishes, then IMMEDIATELY take her to the area the activity is going to occur, preferably while she's still holding the object, and engage in the activity.
  • Cue the child that the activity is finished by presenting a distinctive basket that is unlike any other basket in her daily life. This will be her "finished basket". For example: When it is time to end the activity, present the finished basket to her, let her tactually explore the basket, then help her take the object that represents that activity and place it in the finished basket. Then IMMEDIATELY pick up the materials or move her out of the area.
  • At least once a day, present a different basket containing all 4-6 object symbols to the child and let her explore with it. When she picks up one object symbol and begins to play with it, go do that activity with her.
  • When the child begins to search for the object symbol for her favorite activity, this is the beginning of pre-symbolic object-based communication and she will be ready for the next level. (Or when she places the object symbol for an activity that she doesn't like into the finished basket as soon as it is given to her.)
  • The team slowly keeps adding to the number of activities in the child's day that are represented in her calendar.

The next step will be to set-up a permanent location in the classroom for the calendar system. Instead of taking the object to the child, you bring the child over to the calendar. Then while the child explores the next object in her calendar, you have a short discussion with the child about the up-coming activity, then the child takes the object with her, goes and does the activity, brings the object back to the calendar and puts it in the finished basket.

Developed by Stacy Shafer

For additional information please contact Sara Kitchen

A wonderful resource book about Calendars is now available!!

Robbie Blaha's, Calendars for Students with Multiple Impairments Including Deafblindness is available from the Curriculum Department at the Texas School for the Blind and Visually Impaired.

Quiet residential area

The first time you complete this exercise use your monocular.  If you have a bioptic, try this exercise a second time to compare the difference.

Quiet residential street as seen from the driver's seat.Residential driving is often considered easier and safer because of the slow speeds.  However, they can provide as many or more challenges to safety.  Many more cars, people, animals and objects can suddenly appear in your path. There are four-way stops, yield signs, school crossings. Drive through a quiet residential area and as you use your monocular or bioptic comment on what you see to include:

  • Stops signs and other traffic signs
  • Pedestrians near or in the street
  • Vehicles approaching from the opposite direction
  • Vehicles turning into the street from other streets or driveways
  • Hazards, animals or objects in the street

Considering your observations, answer these questions:

  • What did looking farther down the road allow you to do?
  • What things were difficult for you to spot?
  • What things surprised you while you were scanning at a distance?
  • Did you see any potential collision “traps”?  If so, what would have been your “out”?
  • Did you feel comfortable using your monocular or bioptic during this exercise?  If not what skills do you think you need to practice?
  • Did the weather, amount of light or other uncontrollable conditions impact your performance?
  • What skills do you most need to work on related to driving with low vision?

Developed by TSBVI Outreach Programs based on materials provided by Chuck Huss, COMS, Driver Rehabilitation Specialist with the West Virginia Bioptic Driving Program, 2015.

Return to:

Bioptic Driving: Passenger-in-car Skills

Exercise 2

Exercise 3

 

Busy medium business setting or small metropolitan areas

The first time you complete this exercise use your monocular.  If you have a bioptic, try this exercise a second time to compare the difference.

Exercise2Unlike most residential areas, where there are few traffic lights and generally light vehicle and pedestrian traffic, medium business settings and small metropolitan areas make greater demands on all drivers.  After you feel confident in distance scanning in residential areas, take a drive in a busier setting where there may be multiple lanes of traffic, a variety of traffic lights, one-way streets, and many cars and pedestrians moving into traffic.  Once again as you ride along, let the driver know what you spot and when using the distance scanning technique. As you are traveling, look ahead as far as possible and comment on these things:

  • Stops signs, traffic signs, traffic lights and other warning lights
  • Pedestrians approaching the street to cross
  • Vehicles approaching from the opposite direction
  • Vehicles traveling beside and in front of you on a multi-lane road
  • Vehicles turning into the street from other streets or driveways
  • Things that must be maneuvered around like delivery trucks and vans parked on the street
  • Hazards, animals or objects in the street

Considering your observations, answer these questions:

  • How was this experience different from driving in a quiet residential area for you?
  • What things that were difficult for you to spot?
  • What did you find confusing or surprising about the roadways, pedestrian traffic, or vehicle traffic?
  • Did you see any potential collision “traps”?  If so, what would have been your “out”?
  • What things did you specifically need to use your monocular or bioptic to see?
  • Did the weather, light or other uncontrollable conditions impact your performance?
  • What skills do you most need to work on related to driving with low vision?

Developed by TSBVI Outreach Programs based on materials provided by Chuck Huss, COMS, Driver Rehabilitation Specialist with the West Virginia Bioptic Driving Program

Return to:

Bioptic Driving: Passenger-in-car Skills

Exercise 1

Exercise 3

Highway and interstate travel

The first time you complete this exercise use your monocular.  If you have a bioptic, try this exercise a second time to compare the difference.

View from the driver's seat of a multi-lane highway.Your next challenge is highway and interstate travel.  One of the greatest challenges for any driver is long drives on unfamiliar roadways.  Interstate highways involve high speeds (and often heavy traffic) and unpredictable drivers.  County roads and two- or four-lane highways have various speeds, more traffic entering from driveways and roadsides, vehicles that move slowly like tractors or construction vehicles, and other vehicles passing to get ahead of you.  Factors like fatigue and changing light have great impact on any driver.  For your next exercise with your monocular or bioptic, take about an hour’s drive along various county roads, state highways and interstate highways. While you ride along look ahead as far as possible and comment on:

  • The contour of roadways (i.e. hills, curves, dips in the road) 
  • Restricted sight distances, road narrowing, narrow bridge ahead, changes in pavement markings, etc.
  • Traffic signs and lights
  • Speed and driving patterns of cars ahead of and passing you

Considering your observations, answer these questions:

  • What was more fatiguing about this experience from the other driving exercises you have complete prior to this?
  • What aspects of the roadways did you find challenging or think might be a challenge if you were behind the wheel?
  • Did most drivers obey the speed limit and other traffic laws?
  • What unexpected things did you spot along the roadways?
  • What potential “collision traps” did you discover along the way?  How would you handle them if you were actually driving?  For example, choosing to brake suddenly, swerve out of the way, reduce your speed, change lanes, etc.
  • How was your vision impacted by glare, dirt on your windshield, lights, etc.?
  • What did you find that was distracting or potentially distracting while traveling?
  • Did the weather, light or other uncontrollable conditions impact your performance?
  • What skills do you most need to work on related to driving with low vision?

 

Developed by TSBVI Outreach Programs based on materials provided by Chuck Huss, COMS, Driver Rehabilitation Specialist with the West Virginia Bioptic Driving Program

Return to:

Bioptic Driving: Passenger-in-car Skills

Exercise 1

Exercise 2

Here are some resources to help you learn more about driving with low vision using bioptics.  This resource list was developed for a collaborative workshop from Short-term and Outreach Programs for parent and students with low vision called, In the Driver's Seat, which is offered annually at Texas School for the Blind & Visually Impaired.

Books

Peli, E. & Peli, D. (2002). Driving with Confidence: A Practical Guide to Driving with Low Vision.  Singapore: World Scientific Publishing Co.

Region 4 Education Service Center. (2013). 2nd ed. Program in Low Vision Therapy. Houston, TX: Region 4 Education Solutions (Chapter 10, Driving)

Corn, A.L. & Rosenblum, P. (2000). Finding Wheels: A Curriculum for Nondrivers With Visual Impairments for Gaining Control of Transportation Needs. Austin, TX: Pro-Ed Publishers. (Unit 7, Bioptic Wheels: Low Vision Driving)

Websites                                                      

Bioptic Driving Network (BD) http://www.biopticdriving.org/countries/USA.htm with the American Optometric Association

Bioptic Driving USA (Drs. Richard and Laura Windsor) http://www.biopticdrivingusa.com/publications/

The Low Vision Gateway http://www.lowvision.org/Default.htm

Webinar

Steps to Becoming a Bioptic Driver presented by Chuck Huss, April 4, 2011. http://www.youtube.com/watch?v=S7Aat58FrsA&list=UU5OAT-O6MFn-iNAsNH4uwDw&index=1&feature=plcp

Organizations

Strowmatt Driver Rehabilitation Services (Texas Education Agency licensed driving school member) http://www.driverrehabservices.com/              

The Association for Driver Rehabilitation Specialists (ADED) http://www.driver-ed.org/

NOAH (National Organization for Albinism and Hypopigmentation http://www.albinism.org/publications/driving.html

Handouts

Huss, Chuck, 2014. Step-by-Step Guide to Reinforcing Pre-Driver Readiness Skills with Novice Bioptic Driving Candidates. Handout from TSBVI Outreach Programs workshop, In the Driver's Seat.  Download this document in regular print (Word or PDF) or in large print (Word or PDF).

Woman driving a car using bioptics.

Many individuals with low vision are eligible to become drivers using bioptics, a small telescopic lens mounted on the frame(s) of glasses.  Each state has its own laws governing the use of bioptics when driving and most states have certified driving instructors who can provide driver's education for these individuals.  Considering whether or not to become a driver using a bioptic is a complex decision.

A good place to start considering whether bioptic driving is to practice Passenger-in-Car Skills.  With your parent(s) or other licensed drivers, grab the front passenger seat and go for a drive using your monocular or bioptic.  Practice refines the essential skill of rapidly moving your focus into and out of the bioptic. These activities will focus on the following skills:

  • Distance viewing
  • Bioptic usage
  • Hazard perception

5 Keys to Safe Space Cushion Driving

There are 5 key things to remember that will keep you at a safe distance from hazards while driving.  These are:

  • Aim high in steering
  • Keep your eyes moving
  • Get the big picture
  • Leave yourself an out
  • Use lights, horn and signals properly

(Source: Smith System Driver Improvement Institute, Arlington, TX) 

When we talk of aiming high in steering, it means looking down the road as far as possible when traveling.  It is important to understand that as speed goes up, you must look further ahead to have time to respond to traffic and hazards.  Though you are looking forward using your bioptic as necessary to spot targets when driving, you also have to be scanning so you can get the big picture.  This allows you to use to always have “an out” for yourself while in traffic or when an unsafe condition occurs.  That way you can use your lights, horn, signals, and brakes properly to keep you and others safe when you are behind the wheel.

About the Bioptic Driving Exercises

The Bioptic Driving Exercises 1-3 that accompany this introduction are developed by Chuck Huss, COMS, Driver Rehabilitation Specialist with the West Virginia Bioptic Driving Program and are meant to be activities that prospective bioptic drivers can utilize to improve their use of a bioptic before actually getting behind the wheel.  Done with the support of a parent or other licensed driver they can help the aspiring driver identify skills that they need to work on and provide practice to improve these skills.  They can also help parents understand better what their child is able to see from the front seat of a car before deciding if their child should get behind the wheel.

The exercises that follow were developed by TSBVI Outreach Programs based on materials from Chuck Huss, COMS, Driver Rehabilitation Specialist with the West Virginia Bioptic Driving Program in 2015 for the In the Driver's Seat workshop.

Exercise 1

Exercise 2

Exercise 3

 

 

In the Driver's Seat: Low Vision Specialist, Dr. Laura Miller

Description: In the Driver's Seat. A conversation with Low Vision Specialis Dr. Laura S. Miller, O.D. about bioptic designs, and the visual acuity & fields necsssary to pursue a Texas Driver's License.

DriversSeat_Miller
Downloads: Transcript (txt) Audio (mp3)

In the Driver's Seat: Pre-Driver Readiness Skills - Part 1

Description: In the Drivers' Seat Interview with Rehabilitation Specialist, Chuck Huss, about pros and cons of hand-held and head-borne telescopes, specialized training for drivers with low vision, and common restrictions for drivers with low vision.

In the Driver's Seat: Pre-Driver Readiness Skills - Part 1
Downloads: Transcript (txt) Audio (mp3)

In the Driver's Seat: Pre-Driver Readiness Skills - Part 2

Description: In the Drivers' Seat Part two of an interview with Rehabilitation Specialist, Chuck Huss, about pre-requisite skills that any person needs to learn to drive safely; i.e. learning how, where and what to look for when traveling.

In the Driver's Seat: Pre-Driver Readiness Skills - Part 2
Downloads: Transcript (txt) Audio (mp3)

In the Driver's Seat: From the Parent's Perspective

Description: In the Drivers' Seat An interview with Rehabilitation Specialist, Chuck Huss, about how parents can build the prerequisite skills needed to be a safe traveler, and how to help their child explore whether or not bioptic driving is for them.

In the Driver's Seat: From the Parent's Perspective
Downloads: Transcript (txt) Audio (mp3)

In the Driver's Seat: From the COMS Perspective

Description: In the Drivers' Seat An interview with Rehabilitation Specialist, Chuck Huss, about how Certified Orientation & Mobility Specialists and help in teaching the prerequisite skills needed to become a bioptic driver.

In the Driver's Seat: From the COMS Perspective
Downloads: Transcript (txt) Audio (mp3)

Spring 2003 Table of Contents
Versión Español de este artículo (Spanish Version)

By Eva Lavigne and Ann Adkins, TSBVI Outreach


Parents and teachers of students with visual impairments often have questions about how the choice is made regarding a student's literacy medium. They express concerns about whether a student should be primarily a print reader or a Braille reader, and want to know how and when decisions about reading media are made. Dr. Phil Hatlen, Superintendent of the Texas School for the Blind and Visually Impaired, addressed this issue in a previous See/Hear article (Winter, 2001), and stressed the importance of the Learning Media Assessment (LMA) and the role of the teacher of the visually impaired. While the definition and purpose of the LMA are clearly defined by State Board of Education (SBOE) rules and the Individuals with Disabilities Act (IDEA), a definition of literacy is not always easily understood, especially for visually impaired students.

What is the Learning Media Assessment (LMA)?

A learning media assessment is mandated in the State Board of Education Rules for each student who is referred for an initial evaluation to determine eligibility as visually impaired. It is also required every three years as part of the reevaluation process to maintain eligibility. Best practices indicate that the learning media assessment should be an ongoing process and it should be updated as often as needed, sometimes annually for very young students or those whose needs and abilities change.

All students who are referred for evaluation or reevaluation to determine eligibility as visually impaired must receive a learning media assessment conducted by a certified teacher of students with visual impairments. It must include:

  • Recommendations for the use of visual, tactual, and auditory learning media.
  • A recommendation for ongoing assessment when it is needed.
  • A determination of the student's primary learning medium to decide whether the student is functionally blind.

The LMA gathers three types of information on each student:

  1. The efficiency with which the student gathers information from various sensory channels: visual, tactual, and auditory
  2. The types of general learning media the student uses, or will use, to accomplish learning tasks
  3. The literacy media the student will use for reading and writing

The LMA focuses on two phases:

  1. The selection of the initial literacy medium (this phase begins at infancy and continues through the beginning of formal literacy instruction).
  2. The continuing assessment of literacy media (this continues throughout the student's school years).

The learning media assessment is "an objective process of systematically selecting learning and literacy media" (Koenig and Holbrook). This includes the total range of instructional media needed to facilitate learning, and is understandably different for each student. It consists of general learning media (instructional materials and methods) and literacy media (the tools for reading and writing). Instructional materials can include a range of options, such as pictures, real objects, tactile symbols, videos, worksheets, tapes, and augmentative communication devices. Methods can involve modeling, demonstrating, prompting, questioning, pointing, and lecturing. The wide range of possible materials and methods provides for students at all ability levels. The scope and definition of literacy media is more complicated, however. The "tools for reading and writing" generate concerns about print and Braille, prompting many questions about literacy for visually impaired students.

What is "literacy"? What does literacy mean for a visually impaired student?

Most people acknowledge that literacy has something to do with reading and writing. Many recognize the importance of literacy in order to be "an educated person" and realize that success in school and employment are fundamentally linked to the attainment of literacy skills. Braille literacy is directly addressed in the 1997 amendment to the Individuals with Disabilities Act (IDEA). In developing the IEP (Individual Education Plan), the ARD committee must:

& in the case of a child who is blind or visually impaired, provide for instruction in Braille and the use of Braille unless the IEP team determines, after an evaluation of the child's reading and writing skills, needs, and appropriate reading and writing media (including an evaluation of the child's future needs for instruction in Braille or the use of Braille), that instruction in Braille or the use of Braille is not appropriate for the child. [IDEA Section 1414(d)(3)(B)(iii)]

Literacy, however, is more than just legal terminology and involves more than the ability to read and write in Braille. The following definition reveals the role literacy plays in everyday life:

"Literacy is the ability to read and write at a level that would enable an individual to meet daily living needs. Literacy is a continuum from basic reading and writing skills all the way up to various technical literacies. It is different for different people, in distinct times and various places." (Marjorie Troughton, One is Fun, 1992)

This definition indicates the importance of looking at the student individually along a literacy continuum and the value of re-examining literacy needs and skills as the student progresses. Many VI students need an array of literacy tools and perhaps several literacy media to be successful in school. For example, a student might use Braille for note taking, speech output for the computer, audiotapes or a scanner for reading novels, and print for math. Students learn and develop as individuals, not as a group. Their needs may change as they become older and as they approach tasks beyond the school environment. It is important to identify the medium/media which most benefits each student. For example:

  • Some students may benefit most from using print.
  • Some students may benefit from using uncontracted Braille.
  • Some students may benefit from using contracted Braille.
  • Some students may benefit from using both print and Braille.
  • Some students may not be able to benefit from either Braille or print, and may primarily use an auditory medium, tactile symbols, real objects, or other tactual media.

The degree to which a given student uses a specific medium will be influenced by many factors: age, general ability, visual and tactual functioning, visual prognosis, motivation, academic/nonacademic demands, environmental conditions, personal and interpersonal factors (such as an acceptance of one's blindness), reaction to societal attitudes about blindness, and/or a lack of exposure to Braille (Caton, APH, 1991). Each student with a visual impairment has a unique personal journey to literacy that should include all the necessary literacy tools and media to meet school and daily living needs. It may take an extended period of time for a visually impaired student to master the multimedia he or she will be required to use. Planning and preparing for a student's literacy needs throughout his life is a challenging yet important task.

How are these decisions about literacy made? How does the LMA indicate which students might benefit from using print and which might benefit from using Braille?

It is clear that decisions about literacy media are to be made based on the assessed needs of the student and not on other factors such as the availability of a teacher of the visually impaired, financial considerations, convenience, or any other outside factor. The learning media assessment is a process of gathering objective information to provide a basis for selecting appropriate learning and literacy media for blind and visually impaired students. Objective data is collected from many different observations and is used to make decisions about the student's learning and literacy needs. Parents are key members of the educational team, and parent observations and parent interviews provide valuable information to include in the decision-making process. It is important for teachers and parents to work together to gather information, increasing the accuracy and effectiveness of the LMA. Results of the LMA guide instructional planning and programming to insure that each student gains literacy skills in a medium or media (print and/or Braille) and develops an array of literacy tools to meet school and daily living needs.

A valuable reference to help with making these decisions is a publication entitled Learning Media Assessment of Students with Visual Impairments: A Resource Guide for Teachers, by Alan Koenig and Cay Holbrook (1995). It provides a process and rationale for conducting learning media assessments, and has a variety of forms for gathering objective data. This text also reveals the characteristics of students who might be likely candidates for a print or a Braille reading program (page 43):

Characteristics of a Student Who Might Be a Candidate for a Print Reading Program:

  • Uses vision efficiently to complete tasks at near distances (reaches for object on visual cue, explores toy or object visually, discriminates likenesses and differences in object or toy visually, identifies object visually, etc.)
  • Shows interest in pictures and demonstrates the ability to identify pictures and/or elements within pictures.
  • Identifies name in print and/or understands that print has meaning.
  • Uses print to accomplish other prerequisite reading skills.
  • Has a stable eye condition.
  • Has an intact central visual field.
  • Shows steady progress in learning to use her vision as necessary to assure efficient print reading.
  • Is free of additional disabilities that would interfere with progress in a conventional reading program.

Characteristics of a Student Who Might be a Candidate for a Braille Reading Program:

  • Shows preference for exploring the environment tactually (explores object or toy tactually, uses tactual means to travel and explore the environment, etc.).
  • Efficiently uses the tactual sense to identify small objects.
  • Identifies her name in Braille and/or understands that Braille has meaning.
  • Uses Braille to accomplish other prerequisite reading skills.
  • Has an unstable eye condition or poor prognosis for retaining current level of vision in the near future.
  • Has a reduced or nonfunctional central field to the extent that print reading is expected to be inefficient.
  • Shows steady progress in developing tactual skills necessary for efficient Braille reading.
  • Is free of additional disabilities that would interfere with progress in a conventional reading program in Braille.

Other Factors to Consider in Determining a Student's Literacy Medium/Media:

Debra Sewell, of TSBVI, lists these considerations:

  1. School requirements:
    • Can the student "keep up" with peers?
    • How much time is spent completing homework?
    • How much energy is spent completing work?
    • Is the workload being reduced?
    • Is there enough practice with meaningful text? (extended reading, not just line by line reading, such as on worksheets)
    • Are the skills adequate for the future?
  2. Are there (diagnosed or undiagnosed) reading problems?
  3. Are there neurological issues? (such as reduced fine motor skills, etc).
  4. What is the availability and use of optical devices?
  5. What is the portability of optical devices?
  6. Is the student motivated to learn?

What is the Continuing Assessment phase of the LMA?

In the continuing assessment phase of the LMA, the educational team will consider the appropriateness of the initial decisions and examine the student's need to develop new literacy skills. The continuing assessment phase annually collects and examines:

  • The results of any new medical information to determine if there has been a change in visual functioning since the last review
  • Reading rates and reading grade levels, to determine whether the student reads with sufficient efficiency to perform academic tasks successfully
  • Academic achievement, to determine whether or not the student is making academic progress in the current medium
  • Handwriting skills, to determine whether or not the student is able to read his or her own handwriting and whether or not the handwriting is legible to others
  • The effectiveness of the student's existing array of literacy tools, to determine whether instruction is needed in additional literacy tools to meet current or future literacy needs
  • Diagnostic teaching allows for ongoing assessment of the appropriateness of the initial decision about literacy. If a student is not making adequate progress, the educational team might consider adding supplementary literacy tools or changing the primary literacy medium. Additional instruction may be needed in new methods or the use of new materials. Diagnostic teaching will continue to evaluate the student's efficiency with literacy tasks.

Conclusion

It should be evident that the determination of a student's literacy medium/media is not an "either/or" decision. Nor is it a final one. Students change, as do their needs for different types of information. More and more visually impaired students are realizing the benefits of using both print and Braille, and many supplement their reading with auditory information. Supplementary literacy tools, such as E-books and materials on CD-ROM, are helpful as students approach tasks requiring increased reading and writing skills in higher education. All students need access to a variety of literacy tools. This is no less true for visually impaired students. Future See/Hear articles will not only address the increasing variety of literacy methods and materials available for VI students, but also the use of dual or multiple media and the importance of ongoing, continued assessment.

References:

Caton, Hilda, Ed. (1991). Print and Braille Literacy: Selecting Appropriate Learning Media. American Printing House for the Blind.

Koenig, Alan J. and Holbrook, M. Cay. (1995). Learning Media Assessment of Students with Visual Impairments: A Resource Guide for Teachers. Austin: Texas School for the Blind and Visually Impaired.

Sewell, Debra. Workshop Presentation, "The Fine Line Between Print and Braille". Austin: Texas School for the Blind and Visually Impaired.

Troughton, Marjorie. (1992). One is Fun: Guidelines for Better Braille Literacy. Ontario: Canadian National Institute for the Blind.

 Although the VI teacher may have other ideas for intervention, the following suggestions may help in getting started. Only the major milestone skills have been addressed; consult with the VI teacher for expanded suggestions. Include parents and other specialists on the planning team; each has invaluable experience and knowledge to contribute.

To help achieve head control:

  • Provide several short periods daily of supervised prone position.
  • While the infant is on his/her stomach, gently lift the child's head with one hand under the chin and the other behind the head; stroke the back of the neck, and talk in soothing tones to the infant; withdraw manual support gradually, as the infant is able to lift his/her head independently.
  • Continue brief periods of prone position, to allow practice of head lifting.
  • As head control increases, provide trunk support with a rolled towel under the child's chest; begin positioning child's forearms under his/her upper torso, providing support and preparation for independent lifting of head, neck, and chest.

To help achieve "reach:"

  • Securely suspend objects with interesting and varied sounds and/or textures within arm's reach of infant, so that accidental "swipes" will make contact with them.
  • Guide the infant's hands toward the objects if necessary, to let him/her know they are there.
  • To help encourage hand use:
  • Encourage mid-line hand use by placing the child's hands on the bottle; play "patty cake"; play with baby's hands at midline.
  • When facing baby, place his/her hands on caregiver's face and talk to him/her.
  • Put sticky-tape on the child's fingers; he/she will try to get it off. (This is a supervised activity only; never leave a child with anything that can be put into the mouth and swallowed.)
  • Place tactually interesting objects in the child's hands for exploration and manipulation. If the child has any useful vision, objects should be high contrast (black and white) for the first few months; colors are not as interesting until about 3-5 mos. and then red, yellow, orange are the most appealing.

To encourage rolling over:

  • From stomach to back: (about 3-4 mos.) When child is on hi0wr stomach, tuck his/her bent arm under his/her chest and assist with roll-over; praise and practice daily.
  • From back to stomach: (about 5-6 mos.) When child is on his/her back, extend one of his/her arms up, next to his/her head; gently roll baby's head over this arm (towards the floor) while lifting the same-side leg, with the knee bent and crossing over the other leg; gently press knee to floor and hip should follow; roll baby over to stomach; praise; practice daily.

Note: Check with the Physical Therapist before doing these exercises if the child has orthopedic impairments.

To encourage independent sitting:

  • From about 3 mos., prop infant with pillows in the comer of a chair, couch, infant seat, or crib - for only a few minutes at a time; infant should not be totally vertical until head control is achieved and back muscles are mature; a backwards leaning is preferable at first.
  • Around 6 mos. (if torso and head control are present), place child in a sitting position between adults legs (child's back to adult's stomach); gently place child's hands, palms down, in front of him/her, to provide independent support; praise, and practice daily; as balance improves, place toys in front of the baby, between his/her legs, and encourage him/her to play with the toys; provide cushions or pillows for support until baby can sit without them (may take several months).

To encourage standing:

  • Around 10- 11 mos., put baby in a standing position next to a couch or heavy overstuffed chair; put toys on the chair or couch, within reach; encourage the child to play with the toys while standing (leaning on the couch or chair); limit time to only a few minutes at first, extending time as the child is able; child may need assistance in sitting down; practice daily.

To encourage walking:

  • Around 11- 12 mos. , place child in standing position, next to a couch or low table; place toys just out of reach, to the left or right of the child; encourage him/her to "side-step" to attain the toys; practice daily.
  • Place child in a standing position, with back against the wall; offer a hand or finger to the child, for support; keep physical assistance minimal, and remove gradually as the child gains in confidence. A small chair, cardboard box, or walker (to push) might be used as practice supports; some toddler push toys (e.g., shopping cart, lawnmower, wagon) can also be used as "bumpers" for toddlers who are blind or have low vision.

To build language:

  • TALK (constantly) to the visually impaired infant and toddler; describe what you're doing (and what he/she is doing) and how (whether the child understands or not; intonation and syntax may be imitated later); repeat sounds the baby initiates. A radio or TV is not the same as the caregiver's direct situational conversation. Do not use a radio or TV to provide meaningful sounds for the VI child.
  • Name things and actions (e.g., "This is a spoon."). If the child is blind, put objects into his/her hands as you name them Let the child explore the objects before taking them away.
  • Give the child time to absorb what is being said; it may take many repetitions for meaning to be attached to labels.
  • As expressive language begins to emerge ("talking" begins), make extra effort to associate labels and objects; let the child manipulate as many things as possible, and encourage him/her to name them. Meaningful language requires direct experience for visually impaired children; it is critical because it will be the basis of formal reasoning later.
  • Remember that it is difficult to learn while someone is talking. A VI child may stop an activity to listen; allow quiet time' occasionally, when thinking & problem solving can take place.

To encourage social interaction:

  • For infants and toddlers who are blind, or who have low vision, it is important to provide extra tactual and - auditory contact (nuzzling, cuddling, conversation); hands-on social contact must be substituted for eye contact and facial expressions.
  • Social behaviors that are normally observed visually and imitated (e.g., waving bye-bye, shaking head "yes" or "no," shaking hands) must be physically demonstrated to the visually impaired child.

To build cognitive ability:

  • Build meaningful language, both receptive and expressive. Language will be the medium of learning later - the means to manipulate ideas, and to "think" - so be sure every word the child learns has meaning to him/her.
  • Make extra effort to answer questions, not so much with words as with demonstrations ("Let me show you.")
  • Many visually impaired children do not know how to ask questions, because the situation or conditions they would ask about are based on visual observation. The caregiver must try to anticipate what the child may not understand, and "show him/her."
  • If you can't bring the world to the child, take the child to the world. Insofar as possible, provide participatory experiences. The visually impaired child should not just hear about the world; he/she must interact with it.
  • Pay special attention to cause-effect situations; demonstrate, or provide hands-on involvement. Every time there is a "What happens when " situation, remember that the visually impaired child does not see "what happens when" and must learn the result first-hand.
  • Talk about sequences. As you prepare dinner, describe what you are doing (e.g., "First we have to get the pan out, then we put water in it; now we can put the potatoes in the pan."). There are many sequential events daily (e.g., getting ready for bed, taking a bath, getting dressed); watch for them, and talk about them. Sequence will be important later, as events are organized in a story, a chapter, or an outline.
  • Don't be too quick to solve a problem for your child; sometimes, give the child time to figure out a solution for him/herself. (Waiting for the child to devise solutions to problems can be frustrating for the caregiver, but it is essential if independence is to be encouraged.) Something as simple as how to get around an obstacle in his/her path can provide a problem solving experience for a child. He/she will have many occasions to use this skill later, and the earlier it is learned and practiced, the better it will be when needed.
  • Enjoy your child. Play games with him/her. Beginning with very simple hiding games (even "peek - a - boo"), progressing to guessing games ("What Am I" and then giving clues), and on to memory games ("What did we do when...?") . Encourage the child's brain to work, and the earlier the better!

Back to Main Page

Next Section of Infants and Toddlers with Visual Impairments by Virginia Bishop

with Eric Grimmett and Sara Kitchen, Certified Teachers of the Visually Impaired.

Sara: We observed Brandon one time and then we had multiple opportunities to directly assess him.  Given that Brandon was unable to engage in visual behaviors for a very long time due to the amount of work he was having to do to look, so we had just a few short sessions with him with direct assessment.  But the first session, we got a lot of information from him actually at the observation.  So let's look at the clips we got when we were videotaping Brandon's regular day in his classroom.

Eric: In this clip, you'll see Brandon engaged in a favorite leisure activity, playing the keyboard.  This is in his classroom under normal conditions after he's completed his morning routines.  Watch how he looks directly up at the light spontaneously, engaging in light gazing in very obvious fashion.

[Video Dialog]

We talked about it but,

yeah--

[Humming]

[end Video Dialog]

Eric: All right, so you'll want to come down to Row 6 on your CVI resolution chart and we'll mark about 1-2 for Brandon on this.

Sara: The next clip involves Brandon again, playing a fun interactive game with his TA, that's very familiar to him.  She has gone to get the whoopee cushion right before the clip starts.  And the whoopee cushion is a pretty, brightly colored, single-colored object that is familiar to Brandon because they do this all the time.  But she brings it into his best visual field from what we know so far which would be on his left side because that's where he has vision.  And he doesn't notice it at all.  As you're gonna see his response, he's pretty surprised.  But again, it's not something that's aversive to him.  You'll see later in the video.  It's something that he really enjoys.  And so, let's just watch this clip.

[Video Dialog]

[Blurts]

[Wheezing]

Oh, goodness. I'm sorry.

[Unclear].

[Mumbling]

Ah! Ah!

Charlie where-- Fetch!

[Mumbles]

[Tapping sounds]

[Laughing]

[end Video Dialog]

Sara: And so we're gonna mark that in complexity.  This is a complexity of environment issue since Brandon is playing, doing his thing,  He's in his zone.  He is not using his vision at all.  So let's mark that in Range 1-2.  Another thing that you're gonna want to note is that yellow is probably not one of his favorite colors.  Because when that thing came into his field, it was moving and it's, you know, one of those colors that's supposed to be, you know, one of the colors that kids with CVI respond to, right?  But it's not.  So yellow, I would say, you know, we're not going towards the yellow range from the information we have so far.

Eric: All right, this clip, you're going to see Brandon traveling down the hallway toward a really motivating activity for him.  And notice when the teacher is actually speaking, saying, "Left, right, left, right," you don't get too much visual activity.  He's really focused on that or auditory input, that stimulus, that's coming through his ears at that time.  Now when we have the teacher become quiet and take away that auditory input, we see Brandon actually raises head up and look about every three steps.  So without that auditory, he's able to use his vision much more effectively.

Sara: And he looks at you and you're a couple of feet away from him at that point, right?

Eric: I'm at least three to four feet away from him at that point, so.

Sara: So we're looking at complexity and distance in this one?

Eric: In this case, yes, definitely.

Sara: This one is one you gotta be really careful when, you know, it's just one of those things that this person, this teacher has bonded with this child.  She's doing things that are motivating for him because Brandon loves that silly kind of engagement.  That's a lot of verbal.  And sometimes you have to, you know, kind of decrease the fun a little bit when you're really wanting somebody to focus on using their vision.  So let's watch this video.

[Video Dialog]

Left.

Left.

Left.

Right.

Left.

Oh, off.

Uh-oh.

We're gonna scrape up

against the wall unless we change course.

[end Video Dialog]

Eric: So in this case, we're looking at visual complexity and at distance.  So you're going to want to mark in Row 5, about a Range 1-2.  And then mark in Row 7 for Distance at about a Range 3-4.  He was able to see me at about 3 to 4-foot distance.

Sara: Oh, it was that far?

Eric: It was, yeah, about three feet.

Sara: Okay.

Eric: And that was a really good point that you made about really balancing, what Brandon is motivated by, and how much we want him to use his vision because he is so much into the social aspect and the connection, being able to communicate on his level with his people.  And we want him to be able to do that but at the same time, we wanna build up his vision.

Sara: Yes.  So in this clip, you're gonna see Brandon getting to the end point of that, of all that walking, and it's a very motivating activity for him.  He talks about it a lot.  He gets to push the button and "button" is one of the words he says.  And the button is blue.  It's a single color.  And another thing that we're gonna look at other than color is complexity.  The background behind the button is very plain.  It's just one color.  So it's a pretty good contrast to the blue button.  One last thing about this is there's a novelty issue and that's something is happening that usually does not happen in his routine.  And that's me, videotaping him.  And so it's probably causing some distraction for him that this shape over here that's moving around, that's not usually there.  So let's look at this video.

[Video Dialog]

Button.

Yeah, that's where we are.

We're at the button.

All you got to do is reach out. You'll totally gonna find it.

I got you. I got you.

You are not gonna fall.

You're not gonna fall.

Here you go.

He's gonna reach in.

There.

[end Video Dialog]

Sara: So let's mark on the resolution chart, Row 1, Range 1-2.  Row 5, Complexity, Range 3-4.  And Row 9, Novelty, Range 1-2.

Eric: This next clip we wanted to show you because it was really the only time that we saw Brandon spontaneously use a visually guided reach.  He's using his reach and his vision at the same time to reach out for this familiar motivating activity, the big blue button. Let's take a look.

[Video Dialog]

Blue.

Are you gonna use that hand? Are you gonna use that hand?

Nice job.

Go ahead and push that button.

Push, push, push.

Push, push, push.

Push, push, push.

Give it a push.

Nice!

Oh, feel that cold air?

[end Video Dialog]

Eric: Okay, for this question, you'll want to come down to Row 10, Visually Guided Reach, and give Brandon a range of 5-6 on this.  He was able to use his vision and his touch at the same time, and also when his teacher was talking.  So he did have auditory stimulus coming in at the same time for this one as well.  Then you'll also want to come down to Row 5 for Visual Complexity and mark Range 3-4.  Both Sara and I were there, right in front of him, and he was still able to focus on that motivating blue button.

Sara: And that is the last clip in the observation.  So now we're going to go to our first direct assessment.

Case Study, Phase 1: Parent Interview

with Eric Grimmett and Sara Kitchen, Certified Teachers of the Visually Impaired.

Sara: Let's get started with the parent interview.

Eric: Let's.

Sara: Okay.  So the first question, "Tell me what you do with the toy to get your child interested in it?"  Brandon's parents said, "I put the toy in his hand to hold."  The school said, "Shake it, tap it, make noise, introduce it on his lap, put it on the light board and move it."

Eric: All right, this question targets Movement and Fields, and in terms of what the school answered, we had positive for a CVI for Movement.  So, if you're doing this for practice, you mark Row 2, you go down this Resolution Chart and Brandon's basically in the Range 1-2.

Sara: Question Number 2.  "When you show your child something, how do you know he or she sees it?"  Brandon's parent wrote, "Not! Brandon is blind." The school wrote, "Head orientation towards object, "slow reach out towards it.  Usually with light board or art."

Eric: This question targets Visual Attention

and Non-purposeful Gaze, that's Row 6 on your Resolution Chart.  Again, we have the school answering positive for light gazing here and they speak about the light box.  So, if you're practicing, mark this in Row 6, and Brandon, again, is about in Range 1-2.

Sara: Question Number 3.  "Does your child have a favorite side or a favorite head position?"  Parent says, "The right side, also, head position."

The school says, "Left side for viewing, right side for most activity, usually head's slumped."

Eric: Okay, this question is asking about Field Preference, Row 4, and additional disabilities.  The answer is positive for Fields so you mark in Row 4.  Again, Brandon is about Range 1-2 there.

Sara: Question Number 4.  "Does your child usually find objects by looking or by feeling for them?"  Brandon's parents say, "He is blind."  The school says, "He is not usually motivated to look for items, but primarily, he uses touch when he does."

Eric: This question asked about Visually Guided Reach which is Row 10 or Visual Complexity which is Row 5.  And in this case, really, we have to say the answer is inconclusive on both interviews.

Sara: Number 5. "Do you have concerns about the way your child sees?"  The parent says, "No, he is blind."  The school did not answer that.

Eric: Okay, so number 5 is asking about appearance of the eye, the eye exam, and the answer is inconclusive on this one as well.

Sara: Number 6.  "Where do you usually hold objects for your child to look at?"  Brandon's parent say, "I put them in his hand to hold only, he is blind."  The school says, "The center to the left side within a 1-foot range."

Eric: This question asked about Visual Field Preferences, Row 4, and Visual Complexity, Row 5.  Answers are positive for field, center-left, and for distance, within 1 foot.  So you mark in Row 4 fields, Range 1-2.  And in Row 7, the Distance row, Range 1-2 as well.

Sara: Number 7.  "What are your child's favorite things in your house?"  The parent says, "The piano, the radio." The school says, "The radio, shakers, rain sticks, drums, instruments, keyboards."

Eric: Okay, this question targets Light Gazing, Non-purposeful Gaze, Row 6, Movement, 2, and Visual Novelty, Row 9.  Answer is inconclusive for this but we do see that Brandon does really like sound devices and devices that emits some kind of music.

Sara: Question number 8.  "What if anything have doctors told you about your child's eyes?"  Brandon's parent said, "They said he was totally blind but I don't think so."  The school did not answer.

Eric: Okay, this question is focusing on the eye exam again and the parents' answers are very telling.  They've been told that their child is totally blind but their answer is, "But I don't think so." So, positive for CVI there, I'd say.

Sara: Okay.  Number 9.  "When does your child usually like to look at things?"  Parent, "Not! He is blind."  The school says, "In front of the light board, he will look at sounds."

Eric: This question asked about Visual Novelty, Row 9, and Complexity, Row 5.  The answer is positive for Light Gazing, which is in Row 6, and Brandon's in about a Range of 1-2 there.

Sara: Number 10.  "What color are the things your child likes to look at most?"  His parents say, "None, he is blind."  The school says, "He might be a little more attentive to red."

Eric: This question is asking about Color Preference, obviously, which is Row 1, and Novelty, Row 9.  The answer is positive for Color Preference in terms of the school, so you mark in Row 1, Range 1-2 for Brandon.

Sara: Question Number 11, "What does your child do when he or she is near very shiny or mirrored objects?"  Brandon's parents say, "Nothing, he is blind."  The school says, "There's no noticeable change in affect but they do use tin foil on some symbols, but it's also coupled with noise."

Eric: This question is asking about three different areas, Light Gazing, which is Row 6, Movement, Row 2, and Color Preference, Row 1.  However, the answer is inconclusive on both interviews for this question.

Sara: Question Number 12.  "Describe how your child behaves around lamps or ceiling fans."  Brandon's parents say,  "He looks upward to fans and up to light."  School, they didn't notice a change in behavior.

Eric: This question is asking about Non-purposeful Gaze and Light Gazing, Row 6.  The answer is positive, so mark in Row 6, Range 1-2.

Sara: Number 13. "Are you usually able to identify what your child is looking at?"  Brandon's parents say, "Yes."  The school says, "If he is trying to use his vision, he will put his face on the object to see it."

Eric: This question is asking about Non-purposeful Gaze but the answer that we received is positive actually for distance. So you wanna mark that in Row 7, Range 1-2.

Sara: Number 14.  "Does your child usually first notice things that move or things that don't move?"  Brandon's parents say, "Things that move."  The school says that they're undecided.

Eric: This question is asking about Movement, Row two, and Fields, Row 4.  The answer is positive CVI for Movement.  So you mark that in Row 2, Range 1-2.

Sara: Number 15.  "How does your child position his head when you think he is looking at something?"  Brandon's parents said, "He leans to the right to listen to things."  The school says, "No answer."

Eric: Okay, this question targets Fields in Row 4, and the answer is inconclusive because they actually address listening at this point.

Sara: Number 16. "Do you think your child has a 'favorite' color?"  Parents say, "No."  The school says, "Maybe red."

Eric: Okay, again, this question is about Color Preference and the answer is positive.  Mark on Row 1, Range 3-4 this time for Brandon.

Sara: Number 17. "Does your child seem to notice things more at home or in new environments?"  The parent says, "No."  The school didn't answer.

Eric: And this question targets Complexity of Array and Non-purposeful Gaze and Novelty.  And, of course, the answer is it's inconclusive on both interviews here.

Sara: Number 18.  "Describe how your child positions his head when swatting or reaching towards something."  The parent says, "Straight."  The school says, "No regular correlation."

Eric: Okay, this question targets a Visual Motor, Row 10, and Field Preferences, Row 4.  The answer is inconclusive.

Sara: Number 19.  "How does your child react when you give him new things to look at?" Parent says, "He does not, he is blind."  The school says, "He will reach out and touch it."  Eric: Okay, this question targets Novelty, Row 9, and Complexity, Row 5. For the school's sake, answer is positive for Novelty because he does reach for new things. So you mark that in Row 9, under Range 3-4 for Brandon.

Sara: Number 20.  "Do you position your child in a certain way to help him see things?"  The parents said, "No."  The school said, "Items on the left side, light underneath."

Eric: This question asks about Fields and Complexity, Rows 4 and 5.  The answer is positive for Fields, so you mark that in Row 4, Range 1-2.

Sara: Number 21.  "Have you ever been concerned about the way your child's eyes move?"  The parents say, "No," and the school says, "No answer."

Eric: Okay, this question is asking about eyes and it targets those kids who do not already have a CVI diagnosis.  The answer in this case is inconclusive.

Sara: Number 22.  "What does your child do when there are many objects

in front of him to look at?"  His parents says, "He is blind."  The school didn't answer that one.

Eric: Okay, this question targets Complexity, Row 5, and Novelty, Row 9, and the answer is inconclusive.

Sara: Number 23.  "Tell me about the faces your child prefers to look at."

The parent says, "None, he is blind."  Eric: This question targets Novelty, Row 9, and Complexity, Row 5, and the answer again is inconclusive.

Sara: Twenty-four.  "If your child had his own object to look at and a new object, which object would he prefer?"  His parent says, "Remember that he's blind."

Eric: Okay, this question is looking at Novelty, Row 9, and Complexity, Row 5 again, and the answer again here is inconclusive.

Sara: Question number 25.  "Tell me what your child's favorite objects or toys look like."  Brandon's folks say, "He has no favorite objects or toy."

Eric: And again, this question is focusing on Novelty and Complexity, Rows 9 and Row 5.  The answer is inconclusive, and that gives us really a total of 13 positives for CVI, 0 negatives and 12 inconclusives.

Sara: And that's probably enough to think, you know, just to think about CVI might be contributing to Brandon's visual behaviors considering also the red flag of him having a closed head injury.  Don't you think?

Eric: Yes, definitely, definitely.

With Sara Kitchen and Lynne McAlister, Certified Teachers of the Visually Impaired.

Sara: Case Study 2 is about Cassie.  Um, Cassie, in these clips that we're gonna show you is 9-years-old.  She is diagnosed with CVI and secondary to anoxia that happened while she was having surgery as an infant.  Um, she also has an auditory processing disorder, and is labeled as deaf-blind.

She has developmental delays, speech impairment.  She's an extremely social child.  She uses an object calendar and there were thoughts at the same time of transitioning her to a picture calendar.  And according to her low vision report, she has intermittent nystagmus while tracking. 20/200 Snellen equivalent distance acuity.  Which was figured out using Teller cards.  She has also sight hyperopia but no glasses were prescribed to her at the time.

And we're gonna start with Cassie's parent interview.  If you would like to look at the parent interview answer guide in Christine Roman-Lantzy's book, feel free to do that.  The information that we're gonna be sharing with you is all in your handouts as well.  The questions and the answers, as well as the cheat sheet.  The only thing that we don't have in our handouts is the answer guide.  So, that's in the book.  So, you'll have all those things if you want to look at all those things.  One more form that you'll need to look at is the CVI Range. We're gonna be recording the scores for the parent interview, the observation and the direct assessment directly on that form. So, this is on your handouts, if you want to get that out, because it's good practice to start looking at that and start using it, and that's what we're gonna do. 

Lynne: And each...each individual assessment has a different color when you score it.

Sara: That's right.  We're going to be.  And if you noticed in your handouts, the parent interview will be purple.  And it will have a corresponding star on the chart for people who don't use their vision to see the colors.  And the observation video clips and corresponding things that we record on the chart will be green.  And will have a bullet next to them.

And the direct assessment clips will be recorded on, uh, the...

Lynne: Range?

Sara: No.  The resolution chart.  In red or with a little caret in front of the numbers.  So, just to give you an idea of what all that is, and you already have actually a resolution chart that's filled out in your handouts.

But if you want to get a blank one, so you could practice this along with us, it might be helpful.