Understanding the Educational Needs of Children with Visual Impairments (A guide for the unimpaired) Lee Lay Hong (MSpecEd) (Qualified teacher of students with visual impairments)

Contents Introduction

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Children with visual impairments --------------------------

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Going Beyond Enlarged Texts ---------------------------- -

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To Braille or Not to Braille --------------------------------

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Assistive Technology ---------------------------------------

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Orientation and mobility -----------------------------------

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Daily/Independent living skills ----------------------------

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Social skills ------------------------------------------------

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Specialized assessments ----------------------------------

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Role of the Vision Teacher --------------------------------

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Conclusion --------------------------------------------------

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References -------------------------------------------------

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About the author ------------------------------------------

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Introduction As much as 90% of what we know is learned through vision. Children with no, partial or distorted vision will have difficulty accessing information, leading to atypical knowledge and skill development. Unless aggressive efforts are made to compensate for the reduced access to the environment, children with visual impairments may have limited development of concepts and the world around them. Children with low vision are also affected by the misconception that they do not require direct instruction in specific visual, social and academic skills, simply because they have some sight. These children are placed in mainstream classrooms and provided with large print materials and perhaps some extended working time, and are then expected to perform alongside their sighted peers. Often, the success of students with visual impairment is measured by their ability to adapt to the regular curriculum and classroom expectations, and to perform the same way as their peers. Although academic success is important, it should not be the only yardstick in measuring a student's future success at employment, life after school, and personal independence. Special educators for children with visual impairments recognize that a unique, specialized or disability-specific curriculum is essential for all children with visual impairments to ensure optimal access to the academic curriculum in the schools, as well as future success in life.

The Expanded Core Curriculum, first developed by Hatlen (1997), defines the concepts and skills typically learned incidentally by sighted students that must be sequentially presented to the student who is blind or has low vision. Components of the ECC have been adopted as the essential core curriculum for students with visual impairments throughout the USA, UK, Australia and New Zealand, but not yet in Singapore.

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Children with Visual Impairments Visual impairment is a low incident disability. Yet, visual impairment is not a single disability, and children with visual impairments are a heterogeneous group. In addition, individuals with the same visual condition and visual acuity level may use their vision functionally, quite differently from one another. Amy, an 8-year old girl, has retinitis pigmentosa. She is currently in a mainstream primary school. She has an array of low vision aids, mainly magnifiers, but she does not use them. She finds them cumbersome and not useful.

Eddy is a 13-year old boy with cone dystrophy, in a mainstream resource secondary school for students with visual impairments. He is extremely sensitive to loud noises, and does not participate in activities like morning assemblies, PE, or other school functions.

Jia Wen has cone-rod dystrophy, and is primary 6 in a mainstream primary school. She uses a handheld magnifier to read small print, but prefers to have her work enlarged (from A4 to A3). Although she does not always use them, Jia Wen is able to use a monocular for viewing distant objects, and also to use a long cane in unfamiliar or dimly lit environments.

Wei Ming has congenital cataracts and secondary glaucoma. He is 5 yearsold and attending a mainstream pre-school. He reads enlarged print, and does not use any form of assistive technology at the moment. His parents are concerned about his educational options when he enters primary school. These children have very different visual conditions, but all are unable to access the environment like a normally sighted person. They also have very different ways of coping with their visual impairment, and encounter varied challenges along the way. To understand the educational needs of children with visual impairments in Singapore, we shall follow Amy, Eddy, Jia Wen and Wei Ming on their trials being in a sighted world.

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Going Beyond Enlarged Text Jia Wen, Wei Ming and Eddy started school with enlarged print, especially with the teacher-prepared worksheets. They were enlarged from A4 to A3 using a photocopier (141%). Eddy however, felt such huge worksheets drew much attention to himself, and his parents requested that the teachers enlarge them on A4 papers with landscape layout.

Most students in the lower primary years are still able to access their school materials with minimal aids. However, as the child progresses in the academic years, the prints get smaller, and some form of magnification becomes necessary.

Traditionally, students with low vision are provided with enlarged format of all print materials. However, enlarged print is a less desirable option than standard print with the use of a low vision device. Enlarged print is more expensive, cumbersome to transport, and enlargement, especially through the use of a photocopier sometimes results in blurred and smudgy print. It also removes the captivating colours used extensively in our school textbooks. As the child progresses in his/her school years, the sheer amount of reading materials makes it inefficient to use enlarged print. Our national exams: PSLE, GCE 'O' and 'A' Levels: Students with low vision taking the PSLE are provided with enlarged print. Only students attending the resource secondary schools are given the option to choose between regular print and the use of assistive technology, or enlarged print. All other students will have enlarged print if requested. For the first time, in 2009, a student in a mainstream primary school successfully applied for the use of a CCTV in her PSLE exams. Most students with low vision in post-secondary education rely on either enlarged print from their institutions or their own portable handheld magnifiers (optical or electronic).

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When bigger isn't better! When Eddy was transitioning from primary to secondary school, his parents requested a note from his eye doctor on the preferable print size for Eddy, so that the teachers at the new school would know how to help him. The doctor recommended Arial 36-point.

This is

Arial 36-point

Using Arial 36-point size print means that • the average number of words per line on an A4 paper is 4 to 5 words, • the average number of words per A4 page is about 45 words, and • the number of pages for a regular comprehension passage at secondary one would be approximately 18-20 pages.

The GCE exam board (UK) allows up to Arial 18-point font size.

Requests for larger font size can be made, but seldom approved.

While larger print size may cause less visual fatigue for the student, an excessively large font size results in inefficient reading. The reading rate is considerably slowed, and affects the comprehension of what is read. Excessively large print can be counteractive and induce fatigue, especially during sustained and extended reading, like a comprehension passage or a novel. Depending solely on enlarged print also pose a problem of access to ordinary mainstream materials like storybooks, newspapers and magazines. How small is small enough? Amy's mother requested that Amy's work be made smaller because of her constricted peripheral vision, The teachers reduced everything to 11 or even 10 point size, but Amy still claims she is 'unable to see'. The school intends to refer Amy to the special school. How can we help Amy? Students with low vision may need instructions on how to use their vision more effectively and efficiently in order to access information. Merely providing them with their preferred font and font size will not facilitate access, even with extended working time. These students need instruction in visual efficiency skills such as fixating, tracing, scanning and tracking. 6

To Braille or Not To Braille? Wei Ming's parents are concerned about how their child would access print, and the possibility of Wei Ming losing most of his vision later in life. They had enquired about Braille, but received the impression and belief that Braille is unnecessary.

Jia Wen's reading rate at 36 words per minute is way below her peers. She is also experiencing visual fatigue much earlier, even when using her desktop CCTV. Her parents are unwilling to start her on Braille, and Jia Wen herself does not think Braille is necessary. Braille is a better option for some children with visual impairments, even though they have good functional vision. Many teachers of students with visual impairment argue that children with a progressive condition like RP would benefit from instruction dual media (Braille and print). A Learning Media Assessment would provide objective data on the most efficient medium of literacy for children with visual impairments. A good Braille reader is always preferred to a poor print reader. None of the children with visual impairments in Singapore has access to a Learning Media Assessment to determine their primary (and secondary) learning medium. Decisions whether or not to teach the child Braille is subjective and ad hoc. It has often been argued that advances in technology will make the learning of Braille unnecessary and thus Braille as a literacy medium will become obsolete. Contrary to this believe, technology is not making Braille obsolete, but actually making it more accessible. Braille texts can now be stored electronically, and there are also portable embossers for personal use. Indeed, telling a child with visual impairment not to learn Braille is akin to asking fully sighted children not to learn how to write with a pencil because technology can do word processing in the future.

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Assistive Technology Assistive Technology is an integral part of a visually impaired person's life. This can range from low tech, non-optical devices like a reading stand, to a high tech piece of equipment like the Braille Note. When accessing regular print becomes difficult, Jia Wen, Wei Ming and Eddy turned eventually to assistive technology. When 36-point font size was not feasible for Eddy, it was recommended that he used a desktop CCTV to access regular print in school. Eddy had previously purchased a handheld CCTV, but it did not allow him to perform some school tasks, especially in writing and drawing. A desktop model was thus the preferred assistive technology for Eddy. Assistive technology for students with visual impairments must be prescribed based on the needs of the individual student. What works well for one child may not necessarily work for another, although their visual conditions may be similar. Jia Wen was prescribed a When a child is prescribed an assistive monocular for distant viewing when technology, regardless of the complexity she was 10. She dislikes using it, of the equipment, structured instruction saying that he is unable to use a on its use must be provided. This will monocular because of her ensure the equipment is used properly and nystagmus. Jia Wen was never efficiently, so that the child can derive given instructions on how to use maximum benefits from the said her monocular until much later. equipment. She now uses it with confidence.

Assistive technology can be easily bought off the shelves by anyone. There are no guidelines regulating their sales or the provision of adequate training in their use.

Eddy was 'recommended' an electronic video magnifier when he was 8 years old. However, when the battery power dried up one day, he was unable to access any print as he did not know how to use a simple handheld magnifier.

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Orientation and Mobility When Jia Wen was 8 years old, her mother sought O&M instructions for her daughter. However she was turned away, being told that it is not necessary for young children to learn the use of the cane. Jia Wen later learned O&M skills from a vision teacher, and now uses the cane in unfamiliar environments. Eddy's mother requested for O&M for her son when he was transiting from primary to secondary school. He was given a total of 8 lessons and taught how to travel to and from school. Eddy has also been prescribed a white cane. Although many recognize O&M as an important skill to be acquired by a person with a visual impairment, children with visual impairments are not in receipt of these skills. Currently, there are no Orientation is knowing where one is in relation to O&M programmes for his environment, and where one wants to go. children in Singapore. O&M Mobility is the ability to move to one's target is only available, upon location in the safest and most efficient way. request, for transition from primary to secondary The white cane, or sometimes referred to as the school. Students are long cane, is but only one of the essential taught fixed routes of mobility skills to be taught to a person with travel between the home visual impairment. Other skills include the use of and school. the sighted guide technique, protective Child-size canes are also techniques, and the use of guide dogs. There are unavailable locally. structured sequences to the instruction of mobility skills to persons with visual impairments. Orientation skills include the use of all sensory modalities to determine one's current location vis à vis the environment, and the ability to plan and execute a journey to a target location. The acquisition of orientation skills develops an independent traveler as opposed to a route traveler. This involves learning skills such as reading maps and directories, as well as bus and train guides. Some tactile graphic markers on our pavements actually lead unsuspecting visually impaired travelers into the direction of on-coming traffic!

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Amy does not use a cane. She has on several occasions walked into walls, pillars and furniture. She has also fallen down steps a few times. Despite this, Amy's mother was reluctant for Amy to learn mobility skills. She has been advised that a cane is unnecessary for Amy at this age. Amy does not participate in any school outings as her mother is afraid she will get hurt. The safest and most efficient way to travel for a person with visual impairment is the sighted guide or human guide, where a sighted person guides the other with a visual impairment, basically taking the latter where he/she wants to go. Knowledge of this technique seems to be assumed in children with visual impairments and their families, and it is not formally taught to either. Lack of orientation and mobility skills will severely restrict the movement and independence of a person with visual impairment. For a child, this will restrict his/her opportunities to learn from the wider environment. Assistive technology in Orientation and Mobility The use of assistive technology is just as crucial in orientation and mobility, and like any other assistive technology introduced to any one with a visual impairment, this must be followed with instructions and activities to facilitate its use. Jia Wen uses a monocular to access objects at a distant. She uses her monocular when she visited the zoo to observe the animals. She also uses her monocular to look at the route directories in the MRT stations. However, this was not always the case. Her first monocular was big and difficult to use. Jia Wen calls it a 'bazooka'. She didn't successfully use a monocular until her mother bought one that can fit in the palms of her hand, and instructions given on its use.

What is the safest and fastest way of travel for a person with visual impairment? White cane; sighted guide; laser cane; GPS Singapore does not have qualified O&M specialists who work exclusively with children. It is not enough that such specialists who have been trained to work with adults be roped in to service young children as well.

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Daily/Independent Living Skills How does a child with unimpaired vision learn skills like self-feeding, brushing teeth, preparing a simple meal and ironing clothes? A child with a visual impairment may miss out important details about daily activities, like how to brush one's teeth, or iron the clothes. These are learned incidentally by children with unimpaired vision. Children with visual impairments therefore, would require direct instruction in the skills that are at their developmental level. One should not try to teach a 3-year old child to tie shoelaces. Like all instructions to children with visual impairments, lessons on independent living skills should be structured and closely monitored. List the steps to be taken when teaching a young child with a visual impairment to brush his/her teeth. Identify the pre-requisite skills needed at each stage. Independent skills like food preparation is equally important for a child with visual impairments, and significant adults in the child's life should not prevent the acquisition of such skills based on fears of safety. When Eddy started secondary school, Home Economics was a subject in the curriculum. His mother was concerned about Eddy hurting himself in the kitchen, while the teachers were uncomfortable with having someone with a visual impairment in their class. However, when accommodations and modifications were made known to the teachers, Eddy was allowed to participate in Home Economics. Eddy now enjoys cooking for his family on the weekends. It is however, not enough to depend on the current school syllabus for Home Economics to teach daily independent skills to children with visual impairments. The Home Economics syllabus only includes 'Food and Nutrition'. Other essential skills are thus not taught. There are currently no structured programmes to teach daily living skills to children with visual impairments. 11

Social Skills The acquisition and maintenance of socially appropriate behaviour is mediated by vision for individuals with sight. Much of what is learned socially is acquired through imitation and modeling. Children with visual impairments however, are unable to acquire skills and behaviours through incidental learning as sighted children typically do. Hence, it is important that these skills and behaviours are deliberately taught through structured experiences. Support in this area should come from all the significant people in the child's life – the parents, teachers, caregivers, friends, etc. Having a visual impairment also makes the child visually different from his/her peers, from the equipment they use – white cane, magnifiers, telescopes, thick lenses, to the way they look at things – from the sides, using eccentric viewing. These, together with negative notions associated with blindness, can inhibit the development of positive self-esteem in children with visual impairments. Amy dislikes group work and team projects, often requesting for permission to complete the assignment on her own rather than with her classmates. Her mother and teachers feel that Amy is not accepted by her peers due to her visual impairment.

Eddy feels his classmates are "not very friendly". He does not share much experiences with his peers. Eddy is exempted from school events like the weekly assemblies, sports day and morning assemblies. His mother sees to his needs at school, and waits in the school canteen while Eddy is in class. Attempts by the school to include Eddy in school activities (on the recommendation of the vision teacher) have met with resistance from both Eddy himself and his parents.

This incident was related by Jia Wen's mother: Jia Wen was then six, and was playing a board game with her friends in her class. When it was Jia Wen's turn to roll the dice and move her piece according to the number of spaces shown, she accidentally picked up the wrong piece and moved ahead of others. The other children yelled at Jia Wen, calling her a "cheater and a dummy". Jia Wen hung her head and walked away from the group.

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At the start of each new school year, Amy's class teacher made it a point to introduce Amy to her classmates, highlighting also her visual impairment. It was hoped that this would help integrate Amy socially among her classmates. This however was not so, and Amy's mother wondered if it should have been done at all. Amy feels herself being ostracized by her friends. Merely placing a child with a visual impairment in a regular mainstream school does not automatically result in social inclusion. In fact, research examining the social acceptance of children with visual impairments suggests that these children experience tolerance rather than acceptance by their peers. First of all, the school environment must be one that promotes social integration, and the acceptance of differences among the students. Teachers have to actively promote positive social interaction among all students, and be seen as role models of social inclusion themselves. Children with visual impairments need problem solving skills and self-advocacy skills. Having such skills will build their self-confidence and enhance their social interaction with their peers as well as adults. The confidence that they can participate in most activities decreases the likelihood that they perceive activities as difficult and avoid them. Avoidance of communal activities in the school reduces the opportunities for social interaction and the development of social skills. The acquisition and utilization of social skills for children with visual impairments is an individual journey that is influenced by family support, early learning experiences, and developmental abilities and skills. Social skills are also culturally and linguistically dependent. It is important that social skills activities and strategies for instructions are created differently for each student. Learning culturally accepted social skills begins from the day the child is born and continues throughout the child's life. Hence, early intervention is crucial, and its maintenance, critical.

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Specialised Assessments for Children with Visual Impairments In addition to the clinical examination by a medical doctor (ophthalmologist) and a clinical low vision evaluation performed by a low vision specialist, it is recommended that children with visual impairments are further assessed to meet their needs in the critical areas, for example, orientation and mobility, learning media, assistive technology, etc. In 1999, the National Association of State Directors of Special Education (NASDSE), USA, recognized that critical skills were affected by the presence of a visual impairment or blindness. It endorsed the term expanded core curriculum (ECC) to describe the additional areas that should be included in a comprehensive evaluation of students with visual impairments and in developing an individualized education programme (IEP). In order to meet the unique and highly individualized needs of children with visual impairments, specialized educational assessments have to be conducted. These include: •

Functional vision assessment (FVA) provides a description of the child's typical use of vision in everyday activities in a variety of environments – home, school and community. This helps in the planning of educational and intervention programmes for children with visual impairment.

•

Learning Media Assessment (LMA) does more than prescribe print or Braille for a child with a visual impairment. It also assesses the practicality of using a single literacy medium and explores the use of tactual and auditory media as well.

•

Assistive Technology Assessment will help determine the appropriate device for the individual student's needs.

•

Orientation and Mobility Assessment. This usually includes a component on daily or independent living skills.

There are currently no specialized educational assessments for children with visual impairments.

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Role of the Teacher of Students with Visual Impairments The teacher of students with visual impairments (TVI), is also referred to as the Vision Teacher (VT), or qualified teacher of students with vision impairments (QVI), depending on country or location. In the USA, UK as well as Australia and New Zealand, they are legally mandated team members for all students with visual impairments (including children with deafblindness and multiple disabilities, including a visual impairment). The Vision Teacher is responsible for the educational assessments and evaluation of all students with visual impairment under their care. Based on medical, low vision as well as functional vision assessment reports, the Vision Teacher will plan and evaluate an Individual Education Programme, incorporating the components of the Expanded Core Curriculum. The teacher is also involved in the direct instruction of the Expanded Core Curriculum. The supporting roles of the Vision Teacher in the education of children with visual impairment include: • •

• •

supporting families in early intervention programmes supporting transitions at various levels (early childhood programmes to primary school, primary to secondary, secondary to post-secondary or tertiary) working in consultation with the families, general education teachers and other professionals on the instruction in the expanded core curriculum providing in-service training and consultation to parents, teachers, and other professionals in the team.

There is at the moment, only ONE fully trained and qualified teacher of students with visual impairment in Singapore. There is an urgent need to train more qualified Vision Teacher in order to adequately meet the educational needs of all our children with visual impairment.

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Conclusion Current practice here in Singapore addresses only the academic concerns of children with visual impairment. Even then, the focus is on the provision of accommodations and modifications, which in many instances may not always be appropriate. There are suggested teaching strategies abound, to help classroom teachers make their lessons more accessible to students with visual impairments. However, the provision of classroom and instructional accommodations and modifications does not always result in access to the curriculum. For Amy, attempts by the school to accommodate to her request for smaller print did not enhance her access to the curricula. It is important therefore to assess the specific needs of the student, and facilitate the acquisition of disability specific skills like orientation and mobility, use of assistive technology, social interaction, and independent and daily living, Children with visual impairments should thus have access to such quality services provided by qualified teachers. Amy and Eddy are unable to access the wider learning environment due to the lack of orientation and mobility skills as well as skills in social interaction with their peers. Their absence from official school functions places them at risk of developing inappropriate social interaction skills. Although Jia Wen has comparatively better orientation and mobility skills, the lack of a trained O&M specialist is hindering her development in this skill area. Also the lack of structured training and programming in the expanded core curriculum means that Jia Wen will only continue to acquire such skills in ad hoc and piecemeal manner. Wei Ming has the potential to develop to his fullest before he even starts formal schooling. However, without a trained specialist teacher and early intervention, Wei Ming will probably go through similar experiences to Amy, Eddy or perhaps Jia Wen. Studies have pointed to the low employment rate of persons with visual impairment, despite having comparable academic achievements. It is argued however, that it is not the visual impairment per se that resulted in low employability, but the lack of independent, mobility as well as social skills.

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References (Only the main books used in the preparation of this document are listed here. The list is by no means exhaustive, and there is a wealth of literature available on teaching children with visual impairments. Readers are advised to research into available publications for more information.) Corn, A.L. & Erin, J.N. (Eds). (2010). Foundations of low vision: Clinical and functional perspectives, 2nd Ed. New York: AFB Press. Kelley, P. & Gale, G. (Eds). (1998). Towards excellence: Effective education for students with vision impairments. Sydney: North Rocks Press. Koenig, A.J. & Holbrook, M.C. (Eds). (2000). Foundations of education:

Instructional strategies for teaching children and youths with visual impairments, 2nd Ed. New York: AFB Press.

Lewis, S. & Allman, C.B. (Eds). (2006). Seeing eye to eye: An administrator's guide to students with low vision. New York: AFB Press. Sacks, S.Z. & Wolffe, K.E. (Eds). (2006). Teaching social skills to students with visual impairments: From theory to practice. New York: AFB Press. South Pacific Educators in Vision Impairment. (2004). Principles and standards

for the education of children and youth with vision impairments, including those with multiple disabilities. Retrieved July 10, 2010 from www.ebility.com/spevi/downloads/principles_and_standards_04.doc

Telec, F., Boyd, A. & King, J. (1997). Vision impairment: A reference for schools. Sydney: NSW Department of School Education, Special Education Directorate.

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About the writer Lee Lay Hong graduated with a Master in Special Education, specializing in teaching children with visual impairments, from the University of Newcastle, Renwick Centre, in Sydney, Australia. She is also a qualified teacher with the MOE, and taught in local mainstream secondary schools before specializing in visual impairments. She is currently supporting students with visual impairments in mainstream schools on a freelance basis, and also does consultancy work with schools and organizations wishing to include persons with visual impairments in their environment. Lay Hong is also a parent to a child with visual impairment, and together with some other parents, has started Beyond Vision, a parents' support group. She endeavours to improve the level of educational services to children with visual impairments here in Singapore, and hopes to work collaboratively with other service providers in achieving this. [email protected]

Acknowledgment The writer would like to express thanks to Dr Audrey Looi who first suggested the writing of this guide, and for her painstaking efforts in reading and offering valuable advice. While this guide is a shared effort with Dr Looi, all mistakes and oversights are solely the writer's.

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