Q: Characteristics of a Visually Impaired Child

Definition
A visual impairment is any visual condition that impacts an individuals ability to
successfully complete the activities of everyday life. Students with visual
impairments are infants, toddlers, children and youths who experience
impairments of the visual system that impact their ability to learn.
There are three classification systems for individuals with visual impairment that
are used by education professionals. To be declared legally blind, an individual
must have visual acuity of 20/200 or less, or have a field of vision restricted to 20
degrees or less at the widest point. However, this federal classification system is
used primarily to determine eligibility for adult agency services.
For educational purposes, a specially trained teacher must determine that the
visual impairment impacts the childs ability to learn, and this professional
determination, with the agreement of the IEP team ensures access to special
education services. To implement appropriate classroom accommodations for
students with visual impairment, these students are also classified according to
their level of functional vision:

Low vision students use their vision as their primary sensory channel

Functionally blind students can use limited vision for functional tasks but
need their tactile and auditory channels for learning

Totally blind students use tactile and auditory channels for learning and
functional tasks

A third classification system exists is based on the advent of the visual

impairment itself:

Congenital occurs during fetal development, at birth or immediately

following birth; visual impairment is present before visual memory has been
established

Adventitious occurs after having normal vision either through a hereditary

condition or trauma; visual memory may remain.

Students with congenital visual impairment typically have more difficulty

mastering visually strengthened concepts such as spatial orientation and many
environmental concepts

Prevalence
It is difficult to obtain an exact prevalence of visual impairment due to the often
hidden nature of visual impairment in special education. Many students with
visual impairments also have additional coexisting impairments and are thus
classified in an alternate disability category. The National Dissemination Center
for Children with Disabilities reports that the rate of occurrence for visual
impairments in individuals under the age of 18 is at the rate of 12.2 per 1,000.
Legal or total blindness occurs at a rate of .06 per 1,000. Current special
education demographics obtained from the American Foundation for the Blind
2009 report that there are:

93,600 students who are visually impaired or blind;

55,200 students who are legally blind;

5,500 Braille readers

Characteristics of a Visually Impaired Child

It is not always easy to recognize that a child might be visually impaired. Although even
very young children can show some physical signs of having trouble with vision, many
times problems with a child's eyesight are not detected until after he goes to school. The
American Optometric Association points out that because 80 percent of a child's
learning relies on his vision acuity, early detection and treatment are needed.

Physical Signs
Crossed eyes, eyes that turn out, eyes that flutter from side to side or up and down, or
eyes that do not seem to focus are physical signs that a child has vision problems.
Other problems are less obvious. The American Academy of Pediatrics recommends
that children have their eyes checked during regular well-baby visits throughout their
first years. A child should have a routine eye exam every year beginning at age 5.

Clumsiness
A child might have a vision problem if he appears to be overly clumsy. Poor vision might
be the cause when a child is constantly running into things or falling down. He might
have trouble realizing how close or far away objects really are. The eyes provide the
information about surroundings and spatial position that is transmitted to the brain.
Consequently, clumsiness can occur when the eyes misjudge a distance. Sometimes
young children who do not walk well actually have problems with their vision.

Behavior
Some children who have vision problems appear to have a short attention span. Other
children might blink frequently or squint whenever they read or watch television. Often

children are sensitive to bright light or might sit close to the television or hold books that
they are reading close to their face. Likewise, younger children with visual impairments
might hold toys very close to their face.

Poor Eye-Hand Coordination

Poor eye and hand coordination can be another sign that a child has a vision problem,
therefore parents should observe a young child as he plays. Older children who go to
school might have difficulty with sporting activities or certain projects in class. Signs of
poor eye-hand coordination might include difficulty throwing or catching a ball, tying
shoes or copying schoolwork from the blackboard. Poor handwriting is often another
sign of poor eye-hand coordination. Children who suffer from lazy eyes, crossed or
wandering eyes can have problems with coordination, balance and depth perception,
primarily because they learn to use only one eye at a time.

Poor Academic Performance

Children who have trouble seeing often perform poorly at school. Frequently, problems
with learning are actually related to poor vision and not to a learning disability. A child
might not read well, or might use her finger to follow along when she is reading so that
she doesn't lose her place. Some children also have trouble remembering what they
read. Children with vision problems can find it difficult to write as well or might have
problems with math and other subjects. Schoolwork can be a challenge for a child who
cannot keep a clear focus, deals with double vision or blurred print on pages.
Unfortunately, not all vision problems are easily detectable. For children who have had
vision problems from the start, their vision seems perfectly normal to them, so they don't
usually complain.

Characteristics
Visual impairment is essentially an umbrella term used to describe the loss of
sight that can be a consequence of a number of different medical conditions.
Some common causes of visual impairment are glaucoma, retinopathy of
prematurity, cataracts, retinal detachment, macular degeneration, diabetic
retinopathy, cortical visual impairment, infection and trauma. These are just a
handful of dozens of conditions impacting sight, and each condition has its own
unique characteristics and clinical features. In addition, the impact of the visual
impairment on individual learning is also tied to the onset, the severity, and the
type of visual loss, as well as to any coexisting disabilities that may be present in
the child. For this reason, all classroom accommodations, modifications, and
strategies must be designed with the individual needs of each student with a
visual impairment in mind. There is no one-size-fits-all model.

In addition to decreased visual acuity and visual field, a number of other vision
problems may also impact the visual functioning of the student with visual
impairment. There may be issues with sensitivity to light or glare, blind spots in
their visual fields, or problems with contrast or certain colors. Factors such as
lighting, the environment, fatigue, and emotional status can also impact visual
functioning in many of these students throughout the day. Students who have the
same visual condition may use their sight quite differently. To ensure accessibility
to classroom instruction, it is essential that you know how your student is using
his/her vision. A specially trained teacher of students who have visual
impairments, working with the IEP team members, can help determine the best
adaptations and learning media to use with each student.

Impact on Learning
One characteristic that is shared by all students with visual impairment is that
these students have a limited ability to learn incidentally from their environment.
It is through sight that much of what we learn is received and processed. It is
believed that up to 80% of what children without visual impairments learn is
through visual cues. The other senses do not fully compensate for the loss of
sight. Touch and hearing can be ineffective substitutes for many individuals.
Children with visual impairments must be taught compensatory skills and
adaptive techniques in order to be able to acquire knowledge from methods other
than sight. The presence of a visual impairment can potentially impact the normal
sequence of learning in social, motor, language and cognitive developmental
areas.
Reduced vision often results in a low motivation to explore the environment,
initiate social interaction, and manipulate objects. The limited ability to explore
the environment may affect early motor development. These students cannot
share common visual experiences with their sighted peers, and therefore vision
loss may negatively impact the development of appropriate social skills. As a
result, these students may experience low self-esteem that limits their sense of
mastery over their own lives.
It is not enough to just provide instruction in the general core curriculum.
Students with visual impairments also need specialized instruction in a number of
other essential skill areas. These areas, called the expanded core curriculum,
include communication skills, social interaction skills, orientation and mobility,
independent living skills, recreation and leisure skills, use of assistive technology,

visual efficiency, and career education skills, and self-determination. Mastery of

these skills is essential for students long-range educational and life outcomes.
Students with visual impairments can learn at roughly the same rate as other
children but require direct interventions to develop understanding of the
relationships between people and objects in their environment.

Teaching Strategies
Classroom accommodations will be quite varied and should be individualized
according to the specific needs of the student. However, there are some basic
best practices that can guide the development of the most effective adaptations.
One thing to always consider is that it is often difficult for these students to
become as fully independent as they are capable of being. The classroom
teacher should encourage independence as often as possible to avoid the trap of
learned helplessness. Encourage the student to move independently through
the classroom, and organize your classroom accordingly. Materials, desks, and
other objects in the classroom should be maintained in consistent locations.
Ensuring that cabinets are fully closed, chairs pushed in, and doors are not left
half ajar will help with safety in navigating the classroom. Part of becoming
independent for students with a visual impairment is learning when to advocate
for assistance. Not all instructional tasks will be immediately possible for a
student with a visual impairment, even with accommodations. The key is to
design your instruction so that the student has the most opportunity to act
independently. The students orientation and mobility specialist and teacher of
students with visual impairments can assist with room arrangements and room
familiarization.
Adapting your classroom to accommodate a student with a visual impairment is a
relatively easy taskit just requires an awareness of the students level of visual
functioning (how the student sees) and how the student works and learns. For
example, for the student with low vision, make sure that he is near the front of the
room where he can see the blackboard. Control lighting variables when
presenting learning materials to those students who are sensitive to light and
glare. Use verbal cues with those students who cannot see body movements or
physical cues. A trained teacher of students visual impairments can help you
make a few simple changes to classroom design that may mean all the
difference in the education of the student with a visual impairment.

One key accommodation that is absolutely essential is access to textbooks and

instructional materials in the appropriate media and at the same time as their
sighted peers. For students who are blind this may mean braille and/or recorded
media. For the student with low vision, this may mean large print text or the use
of optical devices to access text and/or recorded media while in class. Working
closely with a students teacher of students with visual impairments in advance
helps ensure accessible materials and availability of these materials in a timely
manner.

Assistive Technology
In order to access print information, students with visual impairments must be
trained in the use of a number of adaptive devices, methods, and equipment that
are collectively referred to as assistive technology. Some of this technology
allows access to information presented on a computer while others are devices
to be used independently. Computer hardware and software are continuously
advancing, allowing for more access to information than ever before. Some
examples:
Computer adaptations:

Braille translation software and equipment: converts print into braille and
braille into print.

Braille printer: connects to a computer and embosses braille on paper.

Screen reader: converts text on a computer screen to audible speech.

Screen enlargement software: increases the size of text and images on a

computer screen.

Refreshable Bbraille display: converts text on computer to braille by an output

device connected to the computer.

Adaptive devices:

Braille notetakers: lightweight electronic note-taking device that can be

connected to a printer or a braille embosser to produce a printed or brailled
copy.

Optical character reader: converts printed text into files on a computer that
can be translated into audible speech or Braille with appropriate equipment
and software.

Electronic braillewriter: produces braille, translates braille into text or synthetic

speech.

Talking calculators: calculates with voice output.

Optical devices:

Closed Circuit Television (CCTV): enlarges an image to a larger size and

projects it on a screen

Magnifiers: enlarges images

Telescopes: used to view distant objects

A specially trained teacher of students with visual impairments can help supply
many of these devices and can provide training for the student to become
independent and proficient in using assistive technology.

Low Vision: If someone's vision is between 20/70-20/160 and cannot be corrected,

the student has moderate to low vision.

Legally Blind: From 20/200-20/400 is legally blind with severe low vision. From
20/400-20/1000 is profound visual impairment, and is very close to total blindness.

Totally Blind: The lack of light perception is known as total blindness or total visual
impairment.

Refractive Errors
The most common types of visual impairments are simple refractive errors. These
include nearsightedness, farsightedness, and astigmatism. In nearsightedness images
are focused in front of the retina, making far away images appear blurry.
Farsightedness results from an image being focused behind the retina, which means
the child will have trouble focusing on objects that are close up. Astigmatism results
from curvature of the cornea, which keeps light rays from focusing properly in one area
of the retina. This condition results in the inability to focus on objects far or near.
Fortunately, refractive errors are correctable. Many children use glasses and enjoy clear
vision. These students will have no need for special services unless the refractive error
is not correctable for some reason.

Common Eye Conditions

Amblyopia:
Amblyopia is also known as lazy eye. Children with a lazy eye may or may not be
perceptible. Sometimes a lazy eye visibly turns in or out, but sometimes there is no
outward sign. Amblyopia causes the eye to have reduced acuity due to the poor
positioning of the eye and weak muscles. The treatment is commonly a patch over the
normal eye that makes the lazy eye work harder. Surgical corrections are also common.

Retinitis Pigmentosa:
This is a degenerative condition that is inherited. Retinitis pigmentosa results in a loss of
peripheral vision, and eventually the student is left with a severe visual impairment.

Retinopathy of Prematurity:
This condition is common in children who were premature babies that required high
concentrations of oxygen at birth. Scarring and detachment of the retina can result from
this condition.

Strabismus:
In this condition, both eyes are unable to gaze at an object at the same time.
Strabismus is caused by a muscle imbalance.

Cortical Visual Impairment:

Cortical visual impairment is not a problem with the eye itself, but with the visual cortex
area of the brain. These children may also have other developmental delays or cerebral
palsy. Vision may change throughout the day, depending on the health, mood of the
child, or his environment.