Early Childhood Education

Visual Impairment

 

A visual impairment is any degree of vision loss that affects a child’s ability to complete age-appropriate tasks and is caused by a visual system that was not formed correctly or is not working properly. Visual impairments include low vision and blindness. Low vision refers to a visual impairment that even with correction affects a child’s ability to complete tasks, though the child still has the potential to use their vision. Blindness refers to the absence of usable vision, but the term blind is often used nontechnically to refer to severe visual impairments, including low vision.

When a child has a visual impairment, there are three primary ways it manifests: visual acuity problems, visual field defects, and visual processing issues. When a child has a visual acuity problem, the images received by the eyes are not crisp and clear. Children with acuity problems resulting from visual impairments have difficulty seeing images at near, intermediate, and far distances, and they may be unable to see clear images at any distance. A person with typical sight has a visual field that allows the person to see approximately 180 degrees left to right and 120 degrees top to bottom. A child with a visual field defect may lack peripheral vision (the vision around the edges), central vision, or may have scotomas (blind spots in any part of the visual field). When children have visual processing problems, there is damage to the posterior portion of the optic nerve and/or the visual cortex. The eye sends a clear image to the optic nerve, but the nerve is unable to transmit the image accurately or the brain is unable to interpret the image correctly. Most children with visual impairments experience a combination of at least two of these manifestations: acuity, field, and processing problems.

Many visual impairments can be treated or controlled through medical intervention. For example, antibiotics can prevent onchocerciasis (river blindness), one of the leading causes of blindness worldwide. Other visual impairments, such as glaucoma, are degenerative but can be treated with medication to slow or halt the progression resulting in the maintenance of some usable vision. Many other visual impairments cannot currently be treated or cured through medical interventions. When medical intervention is possible, it is important to seek treatment as early as possible to increase the chance of successful intervention and to decrease the impact of the visual impairment on development.

In first world countries, many children with visual impairments also have additional disabilities. The concurrent nature of these disabilities is due to the advances in medical technology that increases survival rates for children born prematurely and for children with physical and medical disabilities that carry increased risks for developmental delays. When children are born prematurely, they are at risk for developmental delays and for retinopathy of prematurity, a visual impairment that can result in low vision or total blindness. When children experience brain damage from a physical disability or medical problem, they are at risk for cortical visual impairments in which the portions of the brain that interpret visual images are impaired. Advances in medicine allow for many children born prematurely and with medical or physical problems to survive, and often these children have visual impairments as a result of their other conditions. It is estimated that in the United States approximately 40 percent of children with visual impairments have significant additional disabilities. When additional disabilities exist, they add to the potential for delays in development.

 

Impact of Visual Impairments on Development

Because vision is a unifying sense, a visual impairment, whether low vision or blindness, impacts a child’s overall development. When children with visual impairments receive adequate early intervention services, they develop at rates similar to that of their peers with typical sight. Unfortunately, many children with visual impairments do not receive early intervention services and many developmental delays and mannerisms arise. When children are blind, they have difficulty connecting to the world outside their own body, and when children have low vision, they primarily look and interact with what is within arm’s reach, severely limiting their opportunities to learn. Children with visual impairments are at risk for experiencing delays in all areas of development: social-emotional, communication, motor, cognitive, and self-help.

Without intervention, children with visual impairments often develop delays in social-emotional skills, which begin with difficulties bonding with their caregivers owing to lack of eye contact and nonintuitive behaviors. For example, infants who are blind often become still when an adult speaks to them rather than moving their body in excitement as typically sighted children do. This behavior, known as attentive stillness, is an excellent compensatory skill that allows the child to better hear the caregiver, but many caregivers misunderstand the stillness as a sign that the child is uninterested in interacting and stop speaking to the child.

Children with visual impairments often experience differences in their communication development. A child with typical sight is able to learn about a concept (e.g., trucks) by seeing trucks on the street and in books and on TV. Children with visual impairments will learn very little from trucks at a distance or pictures of trucks; they will best learn about trucks by climbing in and on real trucks. Owing to the many visual avenues for learning about trucks, a child with typical sight will likely have opportunities to learn about multiple trucks (pick-up truck, dump truck, fire truck, etc.), while a child with a visual impairment may only be familiar with the pick-up truck driven by the child’s family. In addition, many adults engage in atypical communication with children who are blind by labeling everything for them or by asking them many questions. Children imitate what they hear, so many children who are blind ask questions and label objects rather than engaging in meaningful conversations.

Without intervention, children with visual impairments also often experience delays in motor skills. Vision is a strong motivator for children to develop motor skills such as pushing up to see a person or crawling to reach a favorite toy. Children with visual impairments need encouragement and opportunities to explore and develop motor skills that are often delayed without the benefit of typical visual motivators.

Children with visual impairments who have no other disabilities have the cognitive potential of typically sighted children, but their environments often put them at a disadvantage resulting in cognitive delays. All children develop cognitive skills (e.g., object permanence) and concepts (e.g., what is a dog) through experiences and interactions with people and objects in their environments. As discussed above, visual impairments may limit interactions with people, can result in atypical communication patterns, and can inhibit motor exploration. When children with visual impairments have such limited experiences, they have few opportunities to develop cognitive skills and concepts, often resulting in developmental delays.

Many adults feel sorry for children with visual impairments and want to help and protect them. Although all children need protection and help, they also need to learn to care for themselves. Children with visual impairments are unable to observe others taking care of self-help skills such as dressing/undressing, food preparation, eating/drinking, bathing, housecleaning, etc. When children with visual impairments are not actively involved in doing these tasks, they cannot learn how to care for themselves. From a very early age, children with visual impairments should be involved in daily living tasks through partial participation just as their typically sighted peers are.

 

Interventions

With adequate early intervention and early childhood special education services, children with visual impairments can develop into healthy, intelligent children and adults who are able to make meaningful contributions to their communities. It is vital that children with visual impairment and their families receive services and supports to encourage appropriate development. Owing to the wide range of visual functioning in children with visual impairments, interventions must be tailored to meet the unique needs of each child; what is appropriate to assist one child with a visual impairment may be detrimental for another. For example, most children with low vision benefit from increased lighting, but some types of visual impairments result in sensitivity to light. Children with these impairments see best with dimmer lighting. Early interventionists and early childhood educators who work with children with visual impairments should be knowledgeable about visual impairments, the impact of visual impairments on development, and interventions appropriate for the child’s specific visual impairment. Interventionists and educators must be able to share information with families and assist families in finding culturally appropriate ways of meeting their child’s needs. They must also be able to provide direct intervention services to children as needed to teach them disability-specific skills such as braille and orientation and mobility (i.e., moving safely and independently without the use of vision) when appropriate. Educators who specialize in visual impairments and early childhood education are most qualified to meet the needs of children with visual impairments and their families. With appropriate intervention, children with visual impairments can develop and learn at similar rates to children with typical sight.

Further Readings: Web Site: American Foundation for the Blind, www.afb.org. Chen, D., ed. (1999). Essential elements in early intervention: Visual impairment and multiple disabilities. New York: AFB Press; Pogrund, R. L., and D. L. Fazzi, eds. (2002). Early focus: Working with young children who are blind or visually impaired and their families. 2nd ed. New York: AFB Press.

Wendy Sapp