Early Identification of Visual Impairment and Combined Vision and Hearing Loss

Authors: Holly Cooper, Ph.D. Texas School for the Blind and Visually Impaired Outreach Program, Deafblind Early Childhood Specialist

Keywords: early identification, referral, early vision development

Are you a teacher of students with visual impairment (TVI) or certified orientation and mobility specialist (COMS) with concerns about very young children getting the services they need? You have good reason to be concerned. Examining the registration of students with visual impairment (VI Reg) and deafblind child count collect data from across Texas confirms the youngest children are under-identified. When we compare three-year age periods across all age levels, we find numbers of children 3 through 5 are considerably less than those age six through eight, and those age birth to age 3 comprise an even smaller group.

What are the reasons for this under-identification? Certainly the fact that many families with young children don’t access any educational services until age 5 is a large part of this. Families may have a concern about their child’s development but have difficulty accessing the appropriate medical professional. Medical professionals sometimes recommend a “wait and see” approach to parents’ concerns about disabilities. Eye medical professionals may respond with “untestable” “delayed visual maturation” on examination reports when they have attempted to examine a child who cannot give consistent verbal responses to questions. Many times we find that therapists and early childhood intervention (ECI) specialists working with children with multiple disabilities don’t realize some of the child’s behaviors are due to visual impairment and not developmental or motor delays. Families with children with multiple disabilities can be overwhelmed with the complexity of their child’s disability and not have the time or resources to follow through on a recommendation for an eye exam. Parents may not wish to have additional early childhood professionals in their home. We frequently hear the statement from professionals and sometimes parents: “vision is the least of the child’s problems.”

What can a vision educator do to find, identify and serve infants and toddlers with visual impairment?

• Make connections with professionals in local ECI programs
• Do joint visits with ECI professionals (this is allowable under ECI regulations, because school districts don’t bill for services, so the “double dipping” rule does not apply). When you collaborate with others, point out behaviors and responses which are affected by visual impairment. Ask ECI providers if they know of other babies who display similar characteristics who aren’t known to have a visual impairment.
• Do a brief presentation or even a short announcement at an ECI staff development day and talk about signs of vision loss in infancy and how it impacts developmental milestones.
• Share the “Eye Find” brochure with ECI staff members, distribute at opthalmologist’s offices and other locations in the community.
• Be aware that Child Find regulations allow TVI’s and O&M’s to evaluate the child’s functional vision and orientation and mobility if there is a suspected vision loss (even if the eye report says “untestable” or similar non-specific results). In fact, a comprehensive evaluation where visual impairment in suspected must include the Functional Vision Evaluation (FVE), Learning Media Assessment (LMA), and orientation and mobility evaluation as well as the eye medical exam.

Photo of a toddler touching a teacher-made toy consisting of a large foil wrapped circle with multi-colored lights attached, all covered in clear plastic wrap.

Why should we be concerned when infants and toddlers aren’t identified as having a visual impairment?

• Some researchers say 90% of learning in the early years of life relies on vision
• Visual impairment may significantly impact motor development such as eye-hand coordination, crawling, and walking.
• Prior to the emergence of language, early learning is dependent on visual observation and imitation to a significant degree.
• Early vision intervention includes supporting parents and sharing information about vision and compensation for vision loss. TVI’s and O&M’s empower parents by teaching them about their child’s development and special skills the child will use to compensate for their vision loss.
• Vision professionals can help parents establish connections in the local community and access other resources which can be beneficial to their child. Resources may include: National Braille Press, Texas and National library services for the blind, talking books programs, and downloadable braille materials, TSBVI Outreach training and services, and others.

Photo of a page from the book showing Perkins Panda and his hands (Belly Button, by Odds Bodkin, Perkins School for the Blind, Watertown MA. 2002)

Educational services for young children with visual impairment or combined vision and hearing loss in the early years can support early movement including crawling, walking, and eye-hand use, tactual awareness and exploration. Involving an infant in ordinary activities helps them learn concepts about the world. Literacy learning later in the school years is based on a strong foundation of language and real world experiences. Early intervention by a teacher of students with visual impairment and an orientation and mobility specialist can make a critical difference in a child’s life.