Infant Toddler Development Training
Module 6, Lesson 3
Adapting the Developmental Assessment for the Child with a Visual Impairment
A parent interview should be conducted as a first step when a vision (or hearing) impairment is suspected. The Parent Interview Protocol for Child Hearing and Vision Skills is available to guide the interview. This document is available in the Resource Bank.
Once it is confirmed that the child has vision impairment, the major consideration for assessment is to have the appropriate team members present. Information from the eye care specialist should be available and presented if the child has a previously diagnosed vision disorder. If a vision problem is known or suspected, it is recommended that a teacher for the visually impaired participate as the primary evaluator of functional skills. Vision protocol requires a full functional vision assessment by a teacher of the visually impaired. A team approach is crucial for infants and toddlers with vision problems. The primary provider and the ophthalmologist should communicate regularly with the family so everyone is operating with the same expectations.
When the child uses glasses or is patched, the team needs to ensure that the glasses and/or eye patch are in place during the assessment. If the child has low vision, a light board and/or a bright background for the presentation of toys and items is recommended. The parents and major caregivers for the child should be present and may be used as the primary presenter of items as they generally know how to ascertain the best responses. The team should observe the child's interactions with people and the environment. Key to the assessment process is knowledge of developmental milestones and how they are affected by decreased vision and reduced interaction with the environment. It is also important to utilize knowledge from the eye care specialist when a diagnosis is provided in order to plan the intervention strategies.
If the vision diagnosis is known prior to the assessment for intervention planning, the team needs to take appropriate intervention strategies with them in order to assist the family in planning outcomes for the Individualized Family Support Plan (IFSP). The teaching strategies found in the resources on Blind Babies are excellent as are those found on the strabismus web page (referred to earlier). A teacher of the visually impaired or other vision specialist should be an involved team member in planning the outcomes for the IFSP.
The developmental assessment must accommodate for the visual impairment when choosing the actual instruments for the assessment. The team needs to read the administration manual of the developmental tests being considered and make appropriate accommodations per the publisher's instructions. Many norm-referenced instruments do not include children with vision problems in the norm sample and therefore would not be appropriate for testing the child. If the child has qualified for Early Steps based on an Eye Specialist Report, then the team would provide only the assessment for intervention planning and would not need to administer a norm-referenced test for eligibility. The team would need to be familiar with the items ahead of time to eliminate or substitute strategies in order to accommodate any that require vision.
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