together we can do more
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Together we can do more. Kansas Instructional Resource Center for the Visually Impaired April 15-16, 2010. What’s Different about children with visual impairments. (3) DEFINITION- . . . the term 'low-incidence disability' means -- - PowerPoint PPT PresentationTRANSCRIPT
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National Center on Severe and Sensory Disabilities 20010
Together we can do more
Kansas Instructional Resource Center for the Visually Impaired
April 15-16, 2010
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WHAT’S DIFFERENT ABOUT CHILDREN WITH VISUAL
IMPAIRMENTS
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What is Low-Incidence Disabilities?• (3) DEFINITION- . . . the term 'low-incidence disability' means --
– (A) a visual or hearing impairment, or simultaneous visual and hearing impairments;– (B) a significant cognitive impairment; or– (C) any impairment for which a small number of personnel with highly specialized skills and knowledge are needed in order for children with that impairment to receive early intervention services or a free appropriate public education.
20 U.S.C.1400 § 662(c)(3)
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Less than 2% of all children with disabilities, ages 6-21
• (Multiple disabilities, 2.18%)
• Autism, 1.67%• Orthopedic
impairments, 1.26%• Hearing
impairments, 1.21%
• Visual impairments, 0.44%
• Traumatic brain injury, 0.35%
• Deafblindness, 0.03%
• Developmental delay, 0.76%
25th Annual Report to Congress (2005)
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Less than one-fifth of 1% of the estimated resident school-age
population• Multiple disabilities,
0.19%• Autism, 0.15% • Hearing
impairments, 0.11%• Orthopedic
impairments, 0.11%
• Visual impairments, 0.04%
• Traumatic brain injury, 0.03%
• Deafblindness, 0.00%
• Developmental delay, 0.07%
25th Annual Report to Congress (2005)
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Tip of the Iceberg
0100020003000400050006000700080009000
10000110001200013000140001500016000170001800019000200002100022000
Cou
nt
State
OSEP APH Estimate @ .1% Estimate @ .2%
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• Sensory inputs altered– Discrete– Fragmented– Intermittent– Passive
• Incidental learning opportunities• Inductive learning
What’s Different About Low-Incidence Disabilities?
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Learning, Generally
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Learning with Sensory Deficits
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Teaching is different:• More than adjustments to the learning environment;• More than modifications of instructional methods;• More than adaptation of curricula;• More than use of positive behavioral supports and interventions;• More than accommodations . . .
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Instruction is Different
• Deliberate not incidental • Parts to wholes• Inductive vs. deductive• Concrete experiences
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Developmental Hurdles
• Sensory information• Intersensory coordination• Imitation• Motor
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UNDERSTANDING OUR COLLEAGUES
(READINGS)
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Evidence-Based PracticeOne of the key strategic goals of the U.S. Department of Education is to "transform education into an evidence-based field." This focus on "what works" includes a call for investment in research-based programs and instructional strategies.
(www.ed.gov)
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How To Decide?
• Tradition• Superstition• Anecdote• “Common sense”• Whatever Works• It worked for me . . .
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• People's opinions are interesting, but it is not something you want to necessarily base the lives . . . of children on with great confidence.
Reyna (2002)
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No Child Left Behind Act of 2001
• Mentions “scientifically-based research” 69-111 times
• Best practices based on scientifically-based research
• Accountability for student proficiency
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Scientifically-Based Research
“Research that involves the application of rigorous, systematic, and objective procedures to obtain reliable and valid knowledge relevant to education activities and programs”
No Child Left Behind Act (2001)
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Components of Scientifically-Based Research
• Systematic, empirical methods• Rigorous data analysis• Measurements or observational methods• Random assignment or other techniques
to eliminate competing explanations• Sufficient detail and clarity to allow for
replication• Peer-reviewed journal or independent
panel of experts• Appropriate designs and methods for
research question
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Characteristics of Reliable Research
• Scientific Method• Replicated• Generalized• Meets rigorous standards• Convergent findings
NCLB, 2001
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Evaluating Scientific Research
• Scientific merit (quality)• Relevance (to practice)• Significance (importance)
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Evaluating Research • Is the intervention supported by “strong”
evidence of effectiveness?• If the intervention is not supported by
“strong” evidence, is it nevertheless supported by “possible” evidence of effectiveness?
• If the intervention is backed by neither “strong” nor “possible” evidence, one may conclude that it is not supported by meaningful evidence of effectiveness.
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http://whatworks.ed.gov
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What Works in Education of Students with VI
Few resources exist to help education decision makers differentiate high-quality research from weaker research and promotional claims.
There is no Consumer Reports for blindness and visual impairment.
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Literacy, 1963-2003
• Sponsored by Colorado Department of Education
• 652 articles located• 32 qualifying articles
– 10 reported no data– 2 reported data contradictory to conclusions
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http://www.unco.edu/ncssd/research/literacy_meta_analyses.shtml
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APH Math Meta-Analysis1965-2005
• Conducted in 2005-06• Found and analyzed 125 articles • Found 10 qualifying studies:
– Intervention– Comparison group– Participants with visual impairments, 3-21– With or without additional disabilities
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http://www.unco.edu/ncssd/research/math_meta_analysis.shtml
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Low Vision Meta-Analysis1964-2006
• Also commissioned by APH• Analyzed 2011 articles• Found 31 qualifying studies:
– Intervention– Comparison group– Participants with visual impairments, B-21– With or without additional disabilities
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Qualifying Low Vision Studies
• 7 visual development -- mixed• 15 low vision devices -- positive• 2 print size -- inconclusive• 2 black light -- inconclusive• 2 accommodations -- positive• 3 miscellaneous
National Center on Severe and Sensory Disabilities 2008
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Concerns • No replications• Insufficient information reported
– Gender– Additional disability– Placement– Cognitive ability– Visual status
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The primary question is not what you know, but
how you know it.Aristotle
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Research on early intervention for children with visual impairments has progressed more slowly. . . . This literature reflects a lack of focus on empirical tests of actual intervention models. Indeed, the bulk of published reports address either the application of technological devices or a description of developmental processes for blind children.
Davidson & Harrison, 1997, p. 487
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Literature addressing many aspects of early intervention and education for children with visual impairments seems to reflect a pattern of tradition and ordinary knowledge rather than empirically validated practice.
Ross, 2000, p. 1191
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Research . . . Is also frequently characterized by specialization and separation from the larger contexts of education, social services, psychology, and medicine in which the children, their families, and their services are embedded.
Zambone, 2000, p. 1196
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The literature on the development of children with visual impairments is remarkably devoid of explicit concern for theory.
Warren, 1994, p. 4
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Visually Impaired Infants Research Consortium (VIIRC)
• Began as conference proposal– Group organized after submission!
• Consortium of New York City service providers and 1 university faculty
• No money/all volunteer• No agreement on assessment battery
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• Identified 21 milestones– Individual biases/concerns
• Existing records or parent information• Published when n = 81
– Ferrell, Trief, Deitz, Bonner, Cruz, Ford, & Stratton (1991)• Nationwide contributions
– Final n = 314
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Table 2. Comparison of Age of Acquisition of Selected Developmental Milestones
Milestone and (Median Age of Attainment by
Typical Child (in Months))
Maxfield & Buchholz (1957)
N = 398
Norris, Spaulding, & Brodie (1957)
N = 66
Fraiberg (1977) N = 10
VIIRC (1993) N = 314
Reaches for and touches object (5.4)
Med. 0-12 50% at 9 8.3 8.0 Transfers object from hand to hand (5.5)
8.0 Searches for a removed object (6.0)
12.0 Sits alone without support 5 secs. (6.6)
Med. 13-24 25% at 9 8.0 9.0 Feeds self bite-size pieces of food (7.4) Med. 13-24 12.0 Produces 1 or more consonant-vowel sounds (7.9)
Med. 0-12 12.0 Move 3 or more feet by crawling (9.0)
Med. 13-24 12.0 Plays interactive game (9.7) 12.0 Walks without support 10 feet (13.0)
Med. 25-36 50% at 24 19.3 16.0
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Milestone and (Median Age of Attainment by
Typical Child (in Months))
Maxfield & Buchholz (1957)
N = 398
Norris, Spaulding, & Brodie (1957)
N = 66
Fraiberg (1977) N = 10
VIIRC (1993) N = 314
Points to at least 1 major body part when asked (17.5)
Removes simple garment without assistance (20.5)
Med. 37-48 30.0 Generally follows daily routine directions (20.5)
30.0 Uses 2-word utterances to express meaningful relationships (20.6)
Med. 37-48 26.3 24.0
Uses pronouns I, you, me (24.0) Med. 49-60 36.0 Controls bowel movements regularly (30.0)
Med. 37-48 34.0 Repeats 2-digit sequence (30.0) Walks down stairs alternating feet (30.0)
Med. 49-60 29.0 Copies circle (33.0) 36.0
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What if:• Increase sample size• Increase reliability• Increase rigor• Increase confidence in results
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Project PRISMA National Collaborative Study on the Early Development of Children with
Visual Impairments
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Funding• U.S. Department of Education, 1991-96• $775,000
– 1/5 for travel• Additional funding from Hilton/Perkins National Program, funded by a grant from the Conrad N. Hilton Foundation of Reno, NV
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Research Questions• Developmental Milestones:
– Do children with visual impairments attain developmental milestones at chronological ages that differ from sighted children?– Do they acquire these milestones in a different sequence?
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• Are there differences in the rate and sequence of development among children:– With different visual disorders?– With different visual function?– With and without additional disabilities?– Who differ across other variables?
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Hopes• Find “truth”• Demonstrate the impact of blindness on development • Prove:
– Young children with visual impairments develop differently– Specialized programs superior– Specialized teachers superior
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Collaborating Agencies• Anchor Center for Blind
Children• Blind Childrens Center• Dallas Services for Visually
Impaired Children• The Foundation for Blind
Children• New Mexico School for the
Visually Handicapped Preschool
• Perkins School for the Blind Preschool
• Visually Impaired Preschool Services
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Laurie HudsonTom Miller
Debbie Gleason
Sharon BensingerTerry Goldfarb
Suze Staugus
Earl PalmerMirna PinedaMary Ellen McCannMarion YoshidaDavid WarrenLynne WebberJC GreeleyAllen HuangJanis MountfordMadeline MilianBill MuirRichard GibboneyJohn JostadRose ShawBeth TeetersDean TuttleDin Tuttle
Chris TompkinsAmy MurphyKelly ParrishDiane Pena
Tina SustaetaKathy Tompkins
Patti Watts
Fran BlackBetty DominguezPatrika GriegoDana KingSharon Nichols
CarolDanielsonCarol King
Sally J. DeitzDeborah Hatton
KirchnerJim WarnkePrism People
Brenda HoyJan Nash
Schel Nietenhoefer
Debbie SymingtonAnn Estensen
Pam CraneDonald P. Bailey
Verna HartMarianne Riggio
Stuart Teplin
Corinne
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Subject Selection• New referrals to collaborating agencies• Less than 12 months’ CA• Diagnosed visual impairment, with or without additional disabilities and/or health conditions
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Child Measures• Teller Acuity Cards• Battelle Developmental Inventory• Vineland Scales of Adaptive Behavior• Temperament Scales
• Milani-Comparetti Motor Development Screening Test• ABILITIES Index• Medical and health questionnaires
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Family Measures• Demographic information• Parenting Stress Index• Family Resource Scale• Home Observation and Measurement of the Environment (HOME)
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Service Measures• Amount, type, and extent of special education and related services• Parent satisfaction with services• Primary interventionist’s perception of Family’s participation in services
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Assessment Protocol• At referral
– 4 months– 8 months
• 12, 18, 24, 36, 48 months• Project evaluators assess children• Parents complete packets and submit directly to PRISM
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Interobserver Agreement
Trainings Site Visits Project End
Battelle 85.9 92.9 80.6
HOME 88.4 95.1 85.4
Milani 85.6 89.7 75.8
Teller 83.6 89.7 91.0
Vineland 91.2 95.2 83.2
Mean 86.7 92.9 83.2
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Training of Project Evaluators
New Evaluators
Returning Evaluators Total
New York 1992 9 9
Boulder 1992 8 7 15
Phoenix 1994 4 15 19
Louisville 1995 2 18 20
Denver 1996 19 19
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Mean Chronological Age at Assessment
BDI Interval Number Mean0-5 mos. 36 3.89 mos.6-11 mos. 169 8.95 mos.
12-17 mos. 124 13.06 mos.18-23 mos. 113 18.97 mos.24-35 mos. 109 25.52 mos.36-47 mos. 63 37.46 mos.48-59 mos. 28 49.82 mos.60-71 mos. 1 60.00 mos.
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Number of Assessments
Total Mean per Child Percent of Possibilities
Battelle 569 2.82 88.2%
HOME 544 2.69 84.3%
Milani 248 1.23 56.1%
Teller 543 2.68 84.2%
Vineland 542 2.68 84.0%
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Percent Receiving Repeated Assessments
Number of Administrations
1 2 3 4 5 6
Battelle 19.3 20.3 18.8 20.8 12.9 3.0
HOME 20.8 21.3 17.8 24.8 8.9 1.5
Milani 32.7 24.3 8.4 3.5 .5 0.0
Teller 19.3 19.8 21.8 17.5 13.4 .5
Vineland 23.8 20.3 20.3 17.8 11.4 2.5
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Parent Assessments
Assessment NumberFamily Resource Scale 384Functional Status II® 409Health Questionnaire 406Income 343Evaluation of services 305Parenting Stress Index 375Public assistance 423Temperament 386
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Length of Study
Duration Percent followed
Less than 12 mos. 43.6
12.1-24 mos. 29.7
24.1-36 mos. 20.0
36.1-48 mos. 6.7
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Limitations• All participants received services,
– From specialized agencies for visual disabilities.• The intensity, duration, and frequency of services differed across participants.
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Colorado17.8%
California5.4%Texas
11.4%
Arizona31.2%
New Mexico14.4%
Massachusetts6.4%
Kentucky13.4%
Home States
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Participation atProject End
4% 1%12%
79%
4%
ActiveMovedDiedResolvedWithdrew
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Family Status atProject End
85.6
14.4 0.5
2 parents1 parent0 parents
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Self-identified Ethnicity
6115.9
4.91.117
CaucasianHispanicAfrican-AmNative AmMixed
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Primary Language Spoken in the Home
87%
5%
3%
1%
3%
1%
EnglishSpanishEng/SpanEng/Dan> 50% Eng< 50% Non-Eng
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Parents’ Information
Age Range
Mean Age
Education Mean
Mothers 14 - 44 yrs.
27.3 yrs. 13.4 yrs.
Fathers 17 - 67 yrs.
29.7 yrs. 13.6 yrs.
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Household IncomeState Below
medianIncluding median
Above median
AZ 53.4% 14.3% 33.3%CA 55.6% 44.4%
CO 70.0% 10.0% 20.0%
KY 70.8% 8.3% 20.8%MA 33.3% 8.3% 58.3%NM 40.0% 25.0% 35.0%TX 58.3% 25.0% 16.7%
Total 56.4% 13.4% 30.2%
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Income by Ethnicity
Ethnicity Below median
Including median
Above median
African-American 100.0
Caucasian 47.7% 15.9% 36.4%
Hispanic 80.0% 5.0% 15.0%
Native American 100.0
Mixed 62.5% 8.3% 29.2%Total 57.1% 12.9% 30.0%
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Gender
58%
42%
Male Female
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Birth Order
51%26%
13%8% 2%
1st 2nd 3rd 4th 5th or more
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Birth Weights
21%
12%
67%
< 1000 grams 1001-2499 grams 2500 grams or more
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Birth Weights by Ethnicity< 1000 grams
1000-2499 grams
2500 grams
Mean (grams)
African-American 11.1% 33.3% 55.6% 2686
Caucasian 19.6% 10.7% 69.6% 2674Hispanic 37.9% 17.2% 44.8% 2011Native-
American 100.0% 3303
Mixed 16.7% 6.7% 76.7% 2801
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Gestational Age at Birth
20%
18%62%
26 wks or less 26.1-37.9 wks 38 wks or more
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Gestational Age by Ethnicity26 wks or
less26.1-37.9
wks38 wks or
moreAfrican-
American 33.3% 66.7%
Caucasian 19.8% 17.1% 63.1%
Hispanic 39.3% 21.4% 39.3%Native-
American 100.0%
Mixed 13.3% 23.3% 63.3%
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Birth Weight by Gestational Age
Birth weight
26 wks or less
26.1-37.9 wks
38 wks or more
< 1000 grams 97.4% 8.6%
1000-2499 grams 2.6% 42.9% 5.1%
2500 grams or
more48.6% 94.9%
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Significant Correlations• Birth weight and gestational age
– r = .902, p = .000• Hospitalization and gestational age
– r = .900, p = .000• Hospitalization and birth weight
– r = .842, p = .000
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Additional Disability
40%
22%
38%
None VI/Mild VI/Severe
(PRISM, 1996, n = 202)
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Additional Disability, by Agency
None AdditionalArizona 25.4% 74.6%
California 36.4% 63.6%Colorado 58.3% 41.7%Kentucky 33.3% 66.7%
Massachusetts 46.2% 53.8%New Mexico 37.9% 62.1%
Texas 60.9% 29.1%Total 40.1% 59.9%
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Frequency of Additional Disability Categories
0
10
20
30
40
50
Per
cent
of a
ll ch
ildre
n
CNS DD Eating Auditory Anomalies Pulmonary
Cardiac Infections Endocrine Genetic All others
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Disability Associations
CNS DD Eating Auditory Anom-alies
CNS 81.3% 72.7% 72.0% 63.6%
DD 76.5% 75.8% 76.0% 59.1%
Eating 28.2% 31.3% 32.0% 36.4%
Auditory 21.2% 23.8% 24.2% 12.5%Anom-alies 16.5% 16.3% 24.2%
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Ethnicity
0
10
20
30
40
50
60
70
Perc
ent
CaucasianHispanic
African-Amer.Other
PrismRegistry
(PRISM, 1996, n = 202; Registry, 2000, n = 365)
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Additional Disability by Ethnicity
None Mild Severe
African-American 44.4% 33.3% 22.2%
Caucasian 39.3% 26.8% 33.9%Hispanic 31.0% 24.1% 44.8%Native
American 50.0% 50.0%
Mixed 29.0% 12.9% 58.1%All children 40.1% 22.3% 37.5%
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Disability Classifications
0.05.0
10.015.020.025.030.035.040.045.0
Per
cent
PI Pediatrician
None Mild Severe
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Visual Disorders of PRISM Children (1996)
Number PercentCortical visual impairment 41 20.6
Retinopathy of prematurity 38 19.1Optic nerve hypoplasia 33 16.6Structural anomolies 22 11.1Albinism 16 8.0Retinal disorders 15 7.5Anoph-/microphthalmia 10 5.0All other 22 11.0Resolved 2 1.0
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Changes in Visual Functionby Visual Disorder
0%10%20%30%40%50%60%70%80%90%
100%
Perc
ent
CVI ROP ONH StructuralAlbinism
All others
ImprovedDeclinedNo change
(PRISM, 1996, n = 142)
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Changes in Visual Function,by Disability Risk
0%
20%
40%
60%
80%
100%
None Mild SevereImproved No change Declined
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Ethnicity of Visual Disorders
0%10%20%30%40%50%60%70%80%90%
100%
Perc
ent
CVI ROP ONH AlbinismStructural
Others
CaucasianHispanicAfrican-AmOthers
(PRISM, 1996, n = 182)
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Visual Disorders of Ethnic Groups
0%10%20%30%40%50%60%70%80%90%
100%
Perc
ent
African-AmCaucasian
HispanicOther
OthersStucturalAlbinismONHROPCVI
(PRISM, 1996, n = 182)
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Additional Disability Riskby Visual Disorder
0
10
20
30
40
50
60
70
80
90
100
Perc
ent
CVI ROP ONH Albinism Structural Others
VI/severeVI/mildNone
`
(PRISM, 1996, n = 199)
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T-Test for Teller Card Scores
N Mean log s.d. t df Sig
Project entry 116 .1850 .4015 -.5150 115 .000
Project end 116 .3827 .4079
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Age at Project Entry
7.887.26
9.027.96
9.38.62
0123456789
10
None Mild Severe
CACCA
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Delay from Diagnosis to Referral
3.3
8.5
0123456789
DiagnosisReferral
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Children with VI Only
0
10
20
30
40
50
60
0-5 mos.6-11 mos.
12-17 mos.
18-23 mos.
24-35 mos.
36-47 mos.
48-59 mos.
BDI AgeC.A.
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Milestones,by Disability Risk
0
10
20
30
40
50
mon
ths
Reach
XferSearch
SitsFeeds
C+VCrawls
PlaysW
alks
PointsRemoves
Follows
2-word
Pronouns
ToiletRepeats
StairsCircle
Past
None Mild Severe
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Battelle Age Equivalent Scores,by Disability Risk
05
1015202530354045
BD
I Age
Equ
ival
ent
(mos
.)
None Mild Severe
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No Additional Disability vs. ABILITIES Rank
0
10
20
30
40
50
BD
I age
equ
ival
ent (
mos
.)
0-5mos.
6-11mos.
12-17mos.
18-23mos.
24-35mos.
36-47mos.
48-59mos.
None None + #1
0-5 mos. 6-11 mos. 12-17 mo s. 18-23 mo s. 24- 35 mos. 36-47 mo s. 48-59 mo s.No ne 2.67 6.45 10.09 15.57 20.334 27.13 40.17Mild 1.75 4.64 7.64 10.79 13. 28 19.08 32.5Se vere 2 2.77 4.41 7.23 8. 78 12.06 12.12
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Milestones that Differed Significantly by Disability Risk
0
10
20
30
40
Med
ian
age
SearchSits Feeds
C+V CrawlsPlays
WalksPoints
Removes
Follows2-words
Repeats
None
None Additional
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Milestones that Differed Significantly by Gestational Age
North 45.9 46.9 45 43 .9
Nort h 45 .9 46.9 45 43.9
0
10
20
30
40
Med
ian
age
ReachSearch
Sits FeedsC+V Crawls
PlaysPoints
Removes
Follows2-words
Pronouns
Repeats
Term
Term < Term
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Milestones that were NOT Significantly Different
• For disability risk:– Reaches for and touches objects– Transfers objects from hand to hand– Uses pronouns– Controls bowels
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• For gestational age:– Transfers object from hand to hand– Walks without support– Controls bowel movements regularly– Walks down stairs alternating feet– Copies circle– Relates past experiences
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Milestones that Differed Significantly by Visual Function
• Plays interactive games with adult– Children with NLP acquired behavior significantly later than all other children.– Also impacted by additional disability and prematurity
• Possible interaction effect
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Milestones,by Visual Function
0
10
20
30
40
50
Med
ian
age
Reaches
Transfers
Searches
Sits FeedsC+VCrawls
PlaysWalks
PointsRemoves
Follows2-words
Pronouns
BowelsRepeats
StairsCircle
Relates
NLP
MLV
NLP LP SLV MLV
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Milestones that Differed Significantly by Visual Disorder
05
10152025303540
Med
ian
age
Sits FeedsC+V Crawls
PlaysWalks
PointsRemoves
2-wordsPronouns
ONH
ROP
ONH Albinism ROP CVI
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Significant Differences in Developmental Scores,
by Visual DisorderVineland Battelle
6-11 mos. Yes Yes
12-17 mos. Yes Yes
18-23 mos. Yes Yes
24-35 mos. Yes Yes
48-59 mos. Yes
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Sources of Significant Differences
(Scheffe Pairwise Comparisons)
6-11 mos.Albinism > ROP, CVIONH > CVI
12-17 mos.Albinism > ROP, CVIOthers > CVI
18-23 mos.Albinism > ROP, CVIOthers > CVI
24-35 mos. Albinism > All
48-59 mos. None
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• Children with no additional disabilities scored significantly lower for all age groups except 0-5 mos.• Large standard deviations
– Comparison of means not sufficient• Range in developmental scores is greater as children become older
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Significant Differences in Developmental Scores,
by Visual FunctionVineland Battelle
0-5 mos. Yes
6-11 mos. Yes Yes
18-23 mos. Yes Yes
24-35 mos. Yes
48-59 mos. Yes Yes
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Sources of Significant Differences
(Scheffe Pairwise Comparisons)
0-5 mos.. None
6-11 mos. Moderate low vision > NLP
18-23 mos. Moderate low vision > NLP
24-35 mos. Moderate low vision > NLP
48-59 mos. Moderate & severe low vision > NLP & LP
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Rate of Development,by Disability Risk
• Vineland & Battelle scores higher for children with no additional impairments, across almost all age groups– Not evident at 0-5 mos.– At 48-59 mos., mild additional disability similar to no additional disability
• Effects of mild impairment may disappear over time
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Parenting Stress Index• Higher percentage of high scores than in the norming population
– Not on child subscale at 0-5 mos.– Higher scores primarily due to child subscale, not parent subscale
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Parent Satisfaction
3
3.5
4
4.5
5
Mea
n
0-5 mos.
6-11 mos.
12-17 mos.
18-23 mos.
24-35 mos.
36-47 mos.
Preterm Term
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Parent Satisfactionby additional disability
3
3.5
4
4.5
5
Mea
n
0-5 mos.
6-11 mos.
12-17 mos.
18-23 mos.
24-35 mos.
36-47 mos.
None Mild Severe
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There are three types of lies:Lies,
Damn lies,and
StatisticsMark Twain
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No Significant Differencesbetween additional disability groups
• Birth weight• Gestation• Parents’ age or education level• Parent evaluation of services• Primary interventionist’s rating of parent
participation
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Significant Differencesbetween additional disability groups
• Battelle scores after 5 months• Age at entry
– Additional disability group entered later• Home learning environment at 18-23 and
24-36 months– Lower scores for additional disability group
• Hospitalization after birth– Longer for additional disability group
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• Overall health between 6-23 mos.– Additional disability group less healthy
• Child-associated stress at 6-11 mos.– Stress for parents of additional disability group greater
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Advantages Not Apparent• Greater visual functioning• Specialized programs• Income• Home learning environment
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Apparent Advantages• Higher birth weights• No additional disability• Less hospitalization after birth
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Infancy to 18 Months• More toys that are
– Interactive– Manipulative– Problem solving
• More books• More literacy events
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Do children with visual impairment attain developmental milestones at chronological ages
that differ from sighted children?
• 12 milestones delayed• 5 milestones within the range of typical
acquisition• 2 milestones acquired early
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Do children with visual impairments attain developmental skills in a different sequence than
sighted children?
• 7 milestones acquired in a different sequence
• 3 acquired later:– Searching for dropped object– Feeding bite-size pieces– Crawling 3 or more feet
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• 3 acquired later by children with additional impairments:– Walking without support– Controlling bowel movements– Repeats 2-digit sequences
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Are there differences in the rate and sequence of development among children with different visual
disorders?
• For 10 milestones, children with ROP acquired skills later than other children with visual impairments
• Children with albinism scored significantly higher Vineland and Battelle scores at ages 6-11, 12-17, and 18-23 months.– Also at 24-35 mos., but only for Battelle
• No significant differences at 36-47 and 48-59 months
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Are there differences in the rate and sequence of development among children with varying levels of
visual function?
• Only one milestone demonstrated a significant difference among visual function levels:– Plays interactively with adults.– Children with NLP acquired later
• Differences not apparent for any other milestone
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• Milestones acquired in different order by visual function level,– But not statistically significant– No pattern is apparent
• No differences in Vineland and Battelle scores for 0-5, 12-17, or 36-47 month age groups
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• At 6-11 and 18-23 mos., children with moderate low vision scored significantly higher than children with NLP• At 24-35 and 48-59 mos., children with moderate low vision scored significantly higher than children with NLP on the Battelle only
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Are there differences in the rate and sequence of development between groups of children with and
without additional disabilities?
• Children with additional disabilities generally acquired milestones later
• Age of acquisition was significantly later for children with additional impairments for 12 of 19 milestones
• Children without additional disabilities acquired some milestones (6) sooner, or within the range (4) of typical children
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• Vineland and Battelle scores were significantly higher for children with no additional disabilities at all age groups except 0-5 mos.• At 36-47 and 48-59 mos., children with mild additional impairments were more like those with no additional impairment
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Are there differences in the rate and sequence of development among children who differ along
various social, cultural, or other variables?
• No differences in development apparent based on income, ethnicity, parent age, parent education, or other socio-cultural variables.
• Age of acquisition for 13 milestones was significantly different for children whose gestation was full-term.– Acquired milestones earlier.
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What differences in rate and sequence of development are associated with infant
temperament styles?
• Parenting Stress Index total scores indicate a high proportion of high scores than in the norming sample.
• Greater proportion of higher child subscale scores than in the norming sample, except at 0-5 mos.
• At 6-11 mos., significant difference in developmental scores for children whose parents reported high stress on the child subscale– Developmental scores lower
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Thoughts on the Challenges• For children receiving services, degree of visual loss does not appear to have as great an impact on early development as the literature suggests.
– Is blindness really an issue?• Greatest impact occurs with the presence of additional disabilities
– The more severe, the greater the impact
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• Children without additional disability and typical intellectual functioning develop within the normal range of their sighted peers– Nevertheless, they seem to be losing 1/10th
of a month per month• Effects of mild impairment may
disappear over time
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• Children with additional disabilities comprise approximately 60% of this sample of young children• Children with NLP at project entry still had NLP at project end• Children with LP or greater tended to increase their visual function over time
– Associated with age
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• Clinical judgments of project evaluators much better at observing present and predicting future visual function• Children with CVI and ROP most at risk • Children without color (albinism) least at risk
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• Tremendous variability within and among children.
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Milestones that were NOT Significantly Different
• For disability risk:– Reaches for and touches objects– Transfers objects from hand to hand– Uses pronouns– Controls bowels
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• For gestational age:– Transfers object from hand to hand– Walks without support– Controls bowel movements regularly– Walks down stairs alternating feet– Copies circle– Relates past experiences
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Milestones that Differed Significantly by Visual Function
• Plays interactive games with adult– Children with NLP acquired behavior significantly later than all other children.– Also impacted by additional disability and prematurity
• Possible interaction effect
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• Children with no additional disabilities scored significantly lower for all age groups except 0-5 mos.• Large standard deviations
– Comparison of means not sufficient• Range in developmental scores is greater as children become older
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BDI Age Scoresby Visual Function at Project End
26719 341137 381031 331431 552351 1427N =
Visual function at project end
Moderate low visionSevere low visionNLP
Age
Equ
ival
ent (
mos
.)40
30
20
10
0
Age Interval
0-5 mos.
6-11 mos.
12-17 mos.
18-23 mos.
24-35 mos.
36-47 mos.
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BDI Age Scoresby Additional Disability
321315 511832 441935 412235 573956 6421N =
Additional Disability Status
SevereMildNone
Age
equ
ival
ent (
in m
os.)
40
30
20
10
0
Age Interval
0-5 mos.
6-11 mos.
12-17 mos.
18-23 mos.
24-35 mos.
36-47 mos.
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Rate of Development,by Disability Risk
• Vineland & Battelle scores higher for children with no additional impairments, across almost all age groups– Not evident at 0-5 mos.– At 48-59 mos., mild additional disability
similar to no additional disability
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Table 2. Comparison of Age of Acquisition of Selected Developmental Milestones
Milestone and (Median Age of Attainment by
Typical Child (in Months))
Maxfield & Buchholz
(1957) N = 398
Norris, Spaulding, &
Brodie (1957) N = 66
Fraiberg (1977) N = 10
VIIRC (1993)
N = 314
PRISM (1998)
N = 202
Reaches for and touches object (5.4)
Med. 0-12
50% at 9 8.3 8.0 8.3
Transfers object from hand to hand (5.5)
8.0 9.3
Searches for a removed object (6.0)
12.0 15.0 Sits alone without support 5 secs. (6.6)
Med. 13-24
25% at 9 8.0 9.0 10.9
Feeds self bite-size pieces of food (7.4)
Med. 13-24 12.0 12.6
Produces 1 or more consonant-vowel sounds (7.9)
Med. 0-12 12.0 10.9
Move 3 or more feet by crawling (9.0)
Med. 13-24 12.0 12.8
Plays interactive game (9.7) 12.0 11.4 Walks without support 10 feet (13.0)
Med. 25-36
50% at 24 19.3 16.0 19.8
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Milestone and (Median Age of Attainment by
Typical Child (in Months))
Maxfield & Buchholz
(1957) N = 398
Norris, Spaulding, &
Brodie (1957) N = 66
Fraiberg (1977) N = 10
VIIRC (1993)
N = 314
PRISM (1998)
N = 202
Points to at least 1 major body part when asked (17.5)
19.5 Removes simple garment without assistance (20.5)
Med. 37-48 30.0 22.7
Generally follows daily routine directions (20.5)
30.0 24.3 Uses 2-word utterances to express meaningful relationships (20.6)
Med. 37-48 26.3 24.0 28.2
Uses pronouns I, you, me (24.0) Med.
49-60 36.0 25.8 Controls bowel movements regularly (30.0)
Med. 37-48 34.0 36.5
Repeats 2-digit sequence (30.0) 33.4 Walks down stairs alternating feet (30.0)
Med. 49-60 29.0 33.4
Copies circle (33.0) 36.0 31.8 Relates his/her past experiences (40.0)
Med. 49-60 29.0 37.3
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What impact does research have, anyway?
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The Good• Collaborative relationships• Working together for common good• Assessment training• Observation opportunities
• Reliable data• Confidence in results• Impact of visual function minimized• Food• Potential of typical development
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The Not-So-Goodand Not-So-Bad
• Cheerleader role• Coordination• Time• Counseling• Reminders
• Working with friends– Missing data
• Cause of sequence differences– Artifact or iatrogenic?
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The Bad• Did not turn out the way everyone thought it would
– Findings unexpected, unpopular• Reluctance to publish• Reluctance to change status quo• Was it necessary?
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The Ugly• Loss of long-term friendships• Building other’s careers • Changing alliances • Self-doubt
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Chicken & Egg Questions• Is proximity to typical development due to services received?
– Then why aren’t all children doing better?• Was sequence difference always there?
– Or did early intervention create it?
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What Happened to Our Hopes?
Did we find truth? Did we?
Demonstrate the impact of blindness on development? No
Young children with visual impairments develop differently? Yes
Specialized programs superior? No, but . . .
Specialized teachers superior? No (only 3)
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What is visual disability?
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About the words we choose,About the things we do.
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The Words We Choose . .
• Compensatory• Service• Feed• Grieve• Tactilely defensive• Vision stimulation• Partnerships• Vision Specialist
• Alternative• Serve• Eat• Cope• Tactilely selective• Vision development• Privileges• Teacher of Students
with Visual Impairments
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The Things We Do . . .• Sonicguides• Vibrators• PVC piping• Flashlights• Little Rooms
• Black lights• Sensory stimulation• Early intervention• Resonance boards• Buncher
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Secrets to Collaborative Research?
• Choose collaborators thoughtfully– Like philosophies
• Reduce individual investment• Know the politics
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An educator has to question himself or herself about options that are inherently
political, though often disguised as pedagogical to make them more
acceptable within the existing structure. Thus, making choices is most important. Educators must ask
themselves on whose behalf they are working.
Paolo Freire