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Adapted from the: Parent Information and Resources Center, (2017). Visual Impairment Including Blindness. Retrieved 4.1.19 from  https://www.parentcenterhub.org/visualimpairment/#def public domain

Visual Impairments in Children

Vision is one of our five senses. Being able to see gives us tremendous access to learning about the world around us—people’s faces and the subtleties of expression, what different things look like and how big they are, and the physical environments where we live and move, including approaching hazards.

When a child has a visual impairment, it is cause for immediate attention. That’s because so much learning typically occurs visually. When vision loss goes undetected, children are delayed in developing a wide range of skills. While they can do virtually all the activities and tasks that sighted children take for granted, children who are visually impaired often need to learn to do them in a different way or using different tools or materials. (2) Central to their learning will be touching, listening, smelling, tasting, moving, and using whatever vision they have. (3) The assistance of parents, family members, friends, caregivers, and educators can be indispensable in that process.

Because there are many different causes of visual impairment, the degree of impairment a child experiences can range from mild to severe (up to, and including, blindness). The degree of impairment will depend on:

• the particular eye condition a child has;
• what aspect of the visual system is affected (e.g., ability to detect light, shape, or color; ability to see things at a distance, up close, or peripherally); and
• how much correction is possible through glasses, contacts, medicine, or surgery.

The term “blindness” does not necessarily mean that a child cannot see anything at all. A child who is considered legally blind may very well be able to see light, shapes, colors, and objects (albeit indistinctly). Having such residual vision can be a valuable asset for the child in learning, movement, and life.

Understanding How Children with Visual Impairments Learn

Children with visual impairments can certainly learn and do learn well, but they lack the easy access to visual learning that sighted children have. The enormous amount of learning that takes place via vision must now be achieved using other senses and methods.

Hands are a primary information-gathering tool for children with visual impairments. So are the senses of smell, touch, taste, and hearing. Until the child holds the “thing” to be learned and explores its dimensions—let us say, a stuffed animal, a dog, a salt shaker, or a CD player —he or she cannot grasp its details. That is why sensory learning is so powerful for children with visual impairment and why they need to have as many opportunities as possible to experience objects directly and sensorially.

Families, friends, and others can support sensorial learning in many ways.

“Mmmm. Do you smell dinner?” appeals to the child’s sense of smell.

“Listen to that bird singing outside” calls to the child’s hearing. You might also say, “That’s a robin,” which gives the child a name for the bird that sings the song he or she is hearing.

“Your clothes are so soft today” speaks to the child’s sense of touch and helps the child build a picture of the “whole” from the many details.

Being able to see enables us to capture the “whole” of an object immediately. This isn’t so for children with a visual impairment. They cannot see the “whole,” they have to work from the details up to build an understanding of the whole.

Educational Considerations

Children with visual impairments need to learn the same subjects and academic skills as their sighted peers, although they will probably do so in adapted ways. They must also learn an expanded set of skills that are distinctly vision-related, including learning how to:

• move about safely and independently, which is known as orientation and mobility (O&M);
• use assistive technologies designed for children with visual impairments;
• use what residual vision they have effectively and efficiently; and
• read and write in Braille, if determined appropriate by the IEP team of the child after a thorough evaluation. (11)

These are just some of the skills that need to be discussed by the student’s IEP team and included in the IEP, if the team decides that’s appropriate. Each of the above skill areas—and more—can be addressed under the umbrella of special education and related services for a child with a visual impairment.

(Parent Information & Resources, 2017)

 Evidenced-Based Practices (EBPs) for students with Visual Impairments. Excerpts from:

This fairly accurate description of students with visual impairments demonstrates not only the heterogeneity of children identified as visually impaired, but also the great range of educational services required. Regulations implementing IDEA (2004) define visual impairment including blindness as “an impairment in vision that, even with correction, adversely affects a child’s educational performance. The term includes both partial sight and blindness” (34 C.F.R. § 300.8(c) (13)). In this review, the terms low vision and blind refer to students who generally meet Marder’s (2006) descriptions above, although individual studies cited below may use more specific definitions to describe their participants. Both terms used here —visual impairment and visually impaired—refer to the entire group of students who are blind and have low vision.

Given that the educational outcomes for students with visual impairments are highly variable, the determination of appropriate services must be made on an individual basis, taking into consideration the summary of the research literature that follows.

In this review, we highlighted some of the essential components that are most important while educating students with visual impairments in both general education and specialized settings. We also examined the level of evidence supporting the epistemology of educating infants, children, and youth with visual impairments.

Administration

                Important issues surrounding the administration of educational programs serving students with visual impairments focus on credentialed personnel, supervision, workload, and access. IDEA (2004) requires that students with visual impairments be served by licensed or credentialed teachers who have training and experience in visual impairment and are involved in assessment and writing of IEPs as well as in direct teaching according to the individual child’s needs (U.S. Department of Education, 2000). The two most appropriate types of personnel are (a) teachers, certified or licensed by the state education department, who teach students with visual impairments and (b) orientation and mobility (O&M) instructors certified by the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP) or through some states’ own systems (U.S. Department of Education, 2000). These licensing procedures guarantee that students with visual impairments will receive instruction from qualified personnel and that other educational personnel will have access to such personnel for consultation and problem solving. Guidelines for providing services to students with visual impairments and supervision of personnel have been developed by NASDSE (Pugh & Erin, 1999).

Personnel serving students with visual impairments generally do so in an itinerant model in which they travel among several schools within a district or across multiple districts that comprise a region; thus, driving time becomes part of the workday and is one of the considerations in determining caseload size. Other considerations include student needs for direct instruction in  reading and writing Braille, use of technology, classroom instructional materials that require translation into accessible formats, and teacher conferencing time (Michigan Department of Education, 2013; Olmstead, 2005; Spungin & Ferrell, 2007; U.S. Department of Education, 2000). Although related research indicates that mean caseload size ranges from 14 to 20 students (Correa-Torres & Durando, 2011; Correa-Torres & Howell, 2004; Murphy, Hatton, & Erickson, 2008; Olmstead, 1995; Suvak, 1999), the National Plan To Train Personnel recommends a caseload of eight students (C. Mason, Davidson, & McNerney, 2000); other sources recommend eight to 12 students (Hazekamp & Huebner, 1989; Koenig & Holbrook, 2000a), depending on student needs.

Other considerations for caseload size include delivery of the expanded core curriculum (Hatlen, 1996, 2003) and the need for instruction in areas not traditionally part of the school curriculum but critical for children who do not learn by observation and visual imitation (Corn, Hatlen, Huebner, Ryan, & Siller, 1995; DuBose, 1976; Ferrell, 1997; Huebner, Merk-Adam, Stryker, & Wolffe, 2004). Such instruction has been acknowledged in Policy Guidance, issued by the U.S. Department of Education (2000), and a 2013-issued Dear Colleague letter (Musgrove & Yudin, 2013). Policy Guidance also acknowledges extending instruction beyond the school day, suggesting that students may benefit from working with personnel who provide services in non-traditional ways (e.g., at home, in the community).

Education of students with visual impairments has been greatly enhanced at the American Printing House for the Blind by the 2004 creation of the National Instructional Materials Accessibility Standard (NIMAS) and the National Instructional Materials Accessibility Center (NIMAC), now making the goal of providing instructional materials to students with visual impairments at the same time as children without disabilities a real possibility (Association for Education of the Blind and Visually Impaired [AER], 2013; Pugh & Erin, 1999). Authorized by the IDEA amendments of 2004, NIMAC is a technical standard publishers use to create multiple formats (e.g., Braille, large print, audio) for books and instructional materials, greatly reducing the amount of time required to create adapted materials.

Orientation and mobility instruction was first identified as a special-education-related service in the 1997 amendments to IDEA (1997). Children and youth with visual impairments, with and without additional disabilities, are entitled to orientation and mobility instruction as a related service (IDEA, 2004; Pugh & Erin, 1999; U.S. Department of Education, 2000). Note that the essential components related to this topic are included in this review under the Life Skills section of this paper.

Assessment

Assessment considerations for children and youth with visual impairments are similar to those for students with other sensory disabilities. Personnel with experience and training in visual impairment are required by law to participate in the assessment process, and assessment must utilize a variety of measures, both formal and informal, to evaluate development, educational Page 41 of 219 achievement, and access to the general curriculum (IDEA, 2004; Olmstead, 2005; Pugh & Erin, 1999). Such personnel should also consider the interaction of residual vision, additional disabilities, environment, learning strategies, and unique skills needs. Assessment is made more difficult because there are no reliable and valid instruments for students with visual impairments (Bowen & Ferrell, 2003; Ferrell, 2011; Groenveld & Jan, 1992; L. Hunt, 2001; J. C. Miller & Skilman, 2003; Singh, 2004). Thus, the results of an assessment are, at best, considered an underestimate of performance. Cattell (1940), who attempted to measure intelligence in young blind children, found no difference in skill acquisition, providing the children had been previously exposed to the skill and, therefore, knew what was expected. This lack of exposure can be attributed to visual impairment itself and the lack of opportunity to learn through observation, modeling, visual imitation, and visual feedback. This opportunity is often referred to as incidental learning (Ferrell, 1997, 2011). For children with visual impairments, incidental learning cannot be assumed to have occurred (Ferrell, 1997, 2011; Lowenfeld, 1973; Warren, 1994). To reiterate, test results are generally considered an underestimate of performance. The U.S. Department of Education (Musgrove &Yudin, 2013) has acknowledged that “the challenge for educators of blind and visually impaired children is how to teach skills that sighted children typically acquire through vision” (p. 2).

Personnel experienced and trained in visual impairment conduct at least two types of assessments: (a) a functional vision assessment to estimate how a student is using his or her remaining vision and establish the accommodations and modifications, including the use of low-vision devices and technology, needed in order for the student to progress in the general education curriculum (Corn & Erin, 2010; Lueck, 2004) and (b) a learning media assessment (Bell, Ewell, & Mino, 2013; Koenig & Holbrook, 1995) to determine the sensory channels through which a child learns and assess reading and writing skills as required by IDEA (2004), specifically evaluating a student’s need for instruction in Braille (see also Musgrove & Yudin, 2013; U.S. Department of Education, 2000).

Musgrove and Yudin (2013) recently reinforced these assessment components by stating,

the evaluation of vision status and the need (or future need) for Braille instruction should be thorough and rigorous, include a data-based media assessment, be based on a range of learning modalities, including auditory, tactile, and visual, and include a functional visual assessment. (p. 3)

Assessment of infants and toddlers with visual impairments is conducted in partnership with family members and utilizes a routines-based approach (Hatton, McWilliam, & Winton, 2003; Pugh & Erin, 1999). In terms of statewide assessments, about 18% of students with visual impairments participated in alternate assessments; only 6% did not participate in any statewide testing (Marder, 2009).

We consider the level of evidence for the assessment recommendations to be emerging because these are based on expert opinions, public policy, legislation, and documented practice. Although media assessments are widely used and have been validated for assessment purposes, there is little evidence that their use results in the correct decision regarding a student’s reading medium. Functional vision assessments, which are not standardized, must be considered unreliable because different teachers can obtain different results with the same student. Nevertheless, these two procedures are critical to the assessment process, and research to establish the reliability and validity of these practices is needed.

Assistive Technology

In spite of its potential to facilitate Braille instruction and the development of early Braille literacy skills (McCall, McLinden, & Douglas, 2011; U.S. Department of Education, 2000), AT for students with visual impairments has not been widely researched, and the literature is limited to product reports and case studies. Practice guidelines require educators to ensure that technology is available to students with visual impairments (Pugh & Erin, 1999); however, empirical research examining technology as an intervention or instructional strategy has been limited to audio description (Carver et al., 2012; Ely, Wall Emerson, Maggiore, O’Connell, & Hudson, 2006; Ferrell, Finnerty, & Monson, 2008) and the use of technology on standardized tests (Freeland, Wall Emerson, Curtis, & Fogarty, 2010). Freeland and colleagues (2010) found that AT did not level the playing field in terms of performance of youth with visual impairments on standardized tests in which variability was attributed more to age, race, and gender than to use of technology. Audio description, on the other hand, holds promise as a testing accommodation. Carver and colleagues (2012) demonstrated that Braille readers were more likely to accurately respond to standardized questions in English/language arts, mathematics, and science when descriptions were provided during test administration. Students reading print in this study were equally likely to accurately respond both with and without description, indicating that image description is an unbiased accommodation that makes the content accessible to Braille readers without giving them an unfair advantage

The U.S. Department of Education (2000) professionals stated that AT is an effective method for teaching writing and composition. Koenig and Holbrook (2000a) have recommended providing instruction in technology skills for 30 min to 60 min per day until the student is competent. However, there is some evidence that AT is not being well implemented in the education of students with visual impairments (Hume, 2011; S. M. Kelly, 2009, 2011; S. M. Kelly & Smith, 2011; D. W. Smith, Kelly, Maushak, Griffin-Shirley, & Lan, 2009), although S. M. Kelly (2009) did document greater technology use in specialized schools than in general education settings. The lack of technology utilization may be attributable to the adults surrounding students with visual impairments, who are more likely to be digital immigrants (Prensky, 2001); the majority of teachers who serve students with visual impairments may not be digital natives like the students themselves, who are growing up with technology. Their teachers may employ technology in more limited ways.

Some researchers (Kamei-Hannan, Howe, Hererra, & Erin, 2012; Zhou et al., 2012) have demonstrated that teachers of students with visual impairments are more confident and more likely to teach technology to their students (a) when they have completed a course about technologies for students with visual impairments and (b) when knowledge and skills in technology are periodically renewed through PD. Hume (2011) found a significant positive correlation between the amount of training teachers received and their use of technology with their students. Interestingly, Hume also found a significant negative correlation between teachers’ caseload sizes and their use of technology with students. Reduction of caseload size and ongoing training of personnel in AT may lead to greater technology implementation in the future.

McCall and colleagues (2011) determined through an extensive review of the literature that the provision of low-vision services and other technologies optimizes access to print and Braille. The U.S. Department of Education (2000) recommended that IEP teams determine if a particular child needs school-purchased AT devices in the home. This recommendation clearly places responsibility on the schools to assist students with visual impairments in generalizing technology use to all environments.

Communication

There is conflicting evidence that children with visual impairments experience delays in language development that may hamper acquisition of literacy skills (Bigelow, 1987; Erickson & Hatton, 2007b; Fraiberg, 1977; Preisler, 1995; Urwin, 1978; cf. Ferrell, 1998). General professional agreement supports strategies that assist children who are blind and visually impaired to acquire language skills (Erickson & Hatton, 2007a; Ferrell, 2011; Wormsley & D’Andrea, 2000), including:

• expansion of verbal language and non-verbal cues;
• short and simple sentences to follow directions;
• questions that engage children or clarify their understanding;
• use of concrete objects to label and explore;
• use of songs, nursery rhymes, and chants;
• use of rich descriptions and feedback; and
• book sharing.

Ferrell (1998) determined that many language milestones were acquired earlier by children with visual impairments, and others fell within a range of performance. Pérez-Pereira (1999) confirmed that appropriate pronoun usage by children with visual impairments occurred within the same age range as for typical children.

Research in language and communication in children with visual impairments must be considered emerging. The articles cited here are primarily practice reports, expert opinions, or are descriptive in nature.

Early Identification and Early Intervention

Early intervention services are generally considered mandatory for infants and toddlers with visual impairments (Ferrell, 2000, 2011; Hatton et al., 2003; Murphy et al., 2008). Although only anecdotal evidence is available, these services are believed to be more effective if personnel are trained and certified in visual impairment fields and services are designed to establish routines within the home environment (Ferrell, 2000, 2007; Hatton et al., 2003; Murphy et al., 2008), although opportunities to meet with other families of children with visual impairments are also important (Ferrell, 2000, 2011). Developmental areas that appear to be at greatest risk for children with visual impairments are cognitive and motor-skill areas (Erickson & Hatton, 2007a, 2007b; Ferrell, 2000, 2011; Hatton et al., 2003; Murphy et al., 2008). Kesiktas (2009) stated that giving attention to developing orientation and mobility skills and supporting parent-child interactions are also needed. Lueck, Chen, Kekelis, and Hartmann (2010) provided effective practice guidelines and strategies for promoting early child development in infants and toddlers with visual impairments.

Life Skills (Expanded Core Curriculum)

Educators of students with visual impairments have long included instruction in life skills as an important component of the services they provide. These services were first identified by Spungin (1977) but have also been supported by Alonso (1987), DuBose (1976), Hazekamp and Huebner (1989), Koenig and Holbrook (2000b), and Spungin and Ferrell (2007). Instructional services in skills and behavior that lead to adulthood include adaptive technology and AT, orientation and mobility, leisure and recreation skills, social interaction skills, independent living skills, career education, and visual efficiency. Since 1996, these educational needs have been known as the expanded core curriculum (Hatlen, 1996). The need for this specialized instruction is attributed to the impact that visual impairment has on learning and the resulting limitation in observation, visual imitation, and demonstration and feedback. The emphasis on standards-based education limits the amount of time available to address this type of instruction.

The importance of attention to life-skills instruction is demonstrated in the Newman and colleagues (2011); Wagner, DiAmico, Marder, Newman, and Blackorby (1992); and Wagner, Newman, Cameto, and Levine (2005b) studies. In these analyses of the National Longitudinal Transition Studies (NLTS, NLTS2), students with visual impairments, when compared to students with other categories of disability, spent the greatest amount of time in general education classes and had higher rates of high school graduation and postsecondary education, although they had lower rates of competitive employment. They also received more life-skills training after graduation. Although students with visual impairments made gains in these areas in the decade between the two studies, especially in comparison to students with other disabilities (Wagner et al., 2005b), only 55.4% of young adults with visual impairments lived independently at the end of the second transition study (Newman et al., 2011). In a survey of parents about independent living skills, Lewis and Iselin (2002) found that parents of children with visual impairments reported that their children were able to independently perform only 44% of tasks, but parents of children without visual impairments reported that 84% of living-skills tasks could be independently performed. The proportions of young adults with visual impairments who were married (i.e., 8.3%) or who were parents (i.e., 10.7%) were among the lowest of all categories of disability studied by NLTS2 (Newman et al., 2011).

The U.S. Department of Education (2000) acknowledged in Policy Guidance the importance of instruction in areas not usually taught by educators when it stated that the IEP team may need to address compensatory skills, extended school-year services, social interaction skills, recreation and leisure skills, career education, and visual efficiency skills in order to ensure access to the general education curriculum. Similar to the evidence provided in the section later in this paper that addresses students who are deafblind, children and youth with visual impairments require systematic instruction to acquire skills in dressing, eating, grooming, hygiene, and self-care. There is some evidence that children who acquire these skills are more competent in their social interactions, are better integrated into their communities, have larger support systems, and may have better opportunities for employment (Bina, 1991; DeLaGarza & Erin, 1993; DeMario, 1990; Lewis & Iselin, 2002; Rettig, 1994).

The U.S. Department of Education (2000) recognizes orientation and mobility as an essential component of special education. The ability to move around the home and community is a “fundamental and enabling life skill” (Huebner & Wiener, 2005, p. 579) taught to children and youth by certified orientation and mobility specialists (COMS) and is identified as a related service by IDEA (2004). Marder (2006) documented in SEELS that a large majority of blind students (i.e., 78%) with and without mental retardation or developmental disabilities received orientation and mobility services; a smaller percentage of low-vision students (i.e., 36% to 38%) with and without mental retardation or developmental disabilities received these services. In the NLTS2 study, 54% of youth with visual impairments received these services, according to Cameto and Nagle (2007). They found that the provision of orientation and mobility services was influenced by (a) placement—students who attended specialized schools were more likely than students in regular schools to receive the services and (b) severity of visual impairment—students who were blind were more likely than those with low vision to receive the services.

Using an expert Delphi technique, Wall Emerson and Corn (2006) identified several components of an orientation and mobility curriculum for children and youth. There is professional agreement that orientation and mobility begins in early childhood with:

• sensory skills,
• concept development
• motor development
• environmental awareness practiced in the home and community.

This progresses to formal orientation and mobility training such as;

• cane travel and
• street crossings (Anthony, Bleier, Fazzi, Kish, & Pogrund, 2002; Anthony, Lowry, Brown, & Hatton, 2004; Budd & La Grow, 2000; Dodson-Burk & Hill, 1989; Franks, 1974; Hill et al., 1984; Wright, Harris, & Sticken, 2010).

Still, there is little empirical evidence supporting orientation and mobility instruction in the schools or identifying which instructional techniques work best for which children. Wright and colleagues (2010) conducted a literature synthesis of this research, but it was limited to the use of tactile maps and models. Berlá (1973) and Berlá and Murr (1975) examined scanning approaches and task time for tactile materials (particularly maps) and concluded that tactile materials should be as simple as possible with few background textures. Wright and colleagues (2010) suggested utilizing Braille reading strategies (e.g., two-hand approach, left-to-right movement) while reading maps. However, Wright and colleagues concluded that “the three experimental studies . . . cannot be assumed to be applicable to the greater population of children with visual impairments because of the lack of replication, restrictive sampling techniques, artificial environments, and other limitations” (p. 104).

This seems to be the case for the entire area of life skills. The research literature is sparse, so most of the evidence is based on expert opinions. Although there is professional consensus regarding the expanded core curriculum, which includes orientation and mobility, there is emerging yet contradictory evidence that provision of the expanded core curriculum has any effect on student educational and postschool outcomes.

Literacy

Literacy is the key to social and economic opportunity (Bell & Mino, 2013; Musgrove & Yudin, 2013; Rex, Koenig, Wormsley, & Baker, 1964; Ryles, 1996; Schroeder, 1996). The U.S. Department of Education (Musgrove & Yudin, 2013) has specifically emphasized Braille literacy as an important factor in future employment. Education of students with visual impairments has always been about providing access to print or finding an alternative modality that will provide an equivalent quality and quantity of information. Instruction follows the evidence-based principles identified by the NRP (2000) and the National Early Literacy Panel (2008). However, there has been general agreement that the quality and quantity of literacy experiences in both print and Braille must improve (Erickson & Hatton, 2007a, 2007b; McCall et al., 2011; Murphy et al., 2008; Parker & Pogrund, 2009; Wormsley & D’Andrea, 2000). Recommended practices for students of school age have included repeated readings, direct instruction in phonics, decoding morphemes, and exposure to a wide variety of reading genres (Erickson & Hatton, 2007a, 2007b; Legge, Madison, & Mansfield, 1999; McCall et al., 2011). Recent research has indicated that instruction in vocabulary requires more attention as students grow older (Wall Emerson, Holbrook, & D’Andrea, 2009). Holbrook and Spungin (2009) recommended continual monitoring of children’s literacy achievement. As children mature over time, (a) the disparity in reading rates between children with and without visual impairments appears to grow wider (Corn et al., 2002), and (b) some researchers believe the increasing disparity is related to the level of visual acuity, with children who are blind falling further behind (Erickson & Hatton, 2007a, 2007b; Krischer & Meissen, 1983).

Braille awareness begins as early as possible. Erickson and Hatton (2007a) considered readiness, the concept that children must display certain prerequisite behaviors before being introduced to Braille or print, to be a myth. Erickson and Hatton (2007a, 2007b) and Legge and colleagues (1999) suggested that age at introduction of Braille is correlated to faster Braille reading speed at school age.  Working as a team, teachers and families of students with visual impairments can support language and concept development while giving attention to sensory input (Erickson, Hatton, Roy, Fox, & Renne, 2007). Koenig and Holbrook (2000c) and Murphy and colleagues (2008) have discussed a variety of early strategies.

Print readers. For students who are print readers, there is strong evidence that training in and use of low-vision devices increases oral comprehension, oral and silent reading speed, and the amount of total reading accomplished (Corn, Wall, & Bell, 2000; Corn et al., 2002; Erickson & Hatton, 2007a, 2007b; Farmer & Morse, 2007; Ferrell, Dozier, & Monson, 2011; Ferrell, Mason, Young, & Cooney, 2006; Helnsley, 1986; Howell, 1980; Jose & Watson, 1978; Lackey, Efron, & Rowls, 1982; La Grow, 1981; Lusk, 2012; Rossi, 1980; Schwartzenberg, Merin, Nawratzki, & Yanko, 1988; J. K. Smith & Erin, 2002). Older studies indicated that large print resulted in better overall performance in terms of reading rates, reading accuracy, and comprehension (Bock, 1971; Sykes, 1971). However, teaching children to use low-vision devices and other technology has been shown to provide optimal access to print (Corn & Koenig, 2002; Douglas et al., 2011; Lussenhop & Corn, 2002; H. Mason, 1999; H. Mason, McCall, Arter, McLinden, & Stone, 1997). Magnifying technology is generally considered more effective than hard-copy enlarged print (Corn & Koenig, 2002; Douglas et al., 2011; H. Mason et al., 1997). Students who read print have been found to require regular and intensive assessment and intervention from trained and certified personnel in the effective use of functional-vision and low-vision devices (Bock, 1971; Cobb, 2008; Corn & Koenig, 2002; Douglas et al., 2011; Lussenhop & Corn, 2002; H. Mason, 1999; H. Mason et al., 1997; Sykes, 1971). Bosman, Gompel, Vervloed, and van Bon (2006) found that low vision affects the reading process quantitatively and not qualitatively. In addition, other studies have shown that a student whose visual condition incorporates a central visual-field defect requires greater support for early decoding skills (Erickson & Hatton, 2007a, 2007b; Gompel, Janssen, van Bon, & Schreuer, 2003; Legge, Rubin, Pelli, & Schleske, 1985; van Bon, Adriaansen, Gompel, & Kouwenberg, 2000). Another study by Douglas, Grimley, McLinden, and Watson (2004) suggested that low-vision readers may have a different reading strategy than children without visual impairments, although Corley and Pring (1993a, 1993b) concluded that low-vision readers resembled younger readers without visual impairments

Braille readers. Daily literacy instruction for young Braille readers is essential (Koenig & Holbrook, 2000a). Braille instruction must be systematic, regular, adequate to the child’s needs, and provided by knowledgeable and appropriately trained personnel to give the child who is blind the best opportunity to become a proficient reader (Barclay, Herlich, & Sacks, 2010; Koenig & Holbrook, 2000a; Lusk & Corn, 2006; Musgrove & Yudin, 2013; U.S. Department of Education, 2000; Wall Emerson, Sitar, et al., 2009). Strong evidence suggests that reading instruction within a structured format, including drill and practice in Braille reading, results in increased reading achievement, faster silent and oral reading rates, fewer reading errors, and greater comprehension (Crandell & Wallace, 1974; Ferrell, Mason, et al., 2006; Flanagan, 1966; Flanagan & Joslin, 1969; Kederis, Nolan, & Morris, 1967; Layton & Koenig, 1998; Lorimer, 1990; Mangold,1978; McBride, 1974; M. R. Olson, 1977; Wall Emerson, Holbrook, et al., 2009).

Recent research has indicated that introduction of Braille contractions as children naturally encounter them is associated with higher literacy performance as children mature (Wall Emerson, Page 56 of 219 Holbrook, et al., 2009). Similarly, spelling accuracy is also associated with early introduction of Braille contractions, increased reading experience, and orthographic knowledge (Arter & Mason, 1994; Corley & Pring, 1993c; Erickson & Hatton, 2007a, 2007b; Gompel, van Bon, Schreuder, & Adriaansen, 2002; van Bon et al., 2000). Two-handed approaches to Braille reading seem to be associated with greater reading speed and accuracy (L. K. Mason, 2012; Wright, Wormsley, & Kamei-Hannen, 2009). For some Braille readers, audiobooks can be an efficient reading medium for some types of literacy genres. This seems to be more effective when the student can control the rate of speed (Esteves, 2007; R. M. Jackson, 2012; Lesnick, 2006).

There is strong evidence that (a) low-vision devices can increase reading speed and comprehension, and (b) drill and practice in the Braille code (the Braille alphabet) results in greater reading fluency and comprehension. There are several studies that have used correlational research designs that have linked Braille literacy to adult employment, thus providing a moderate level of evidence. Other recommendations are supported by emerging and limited levels of evidence, given their reliance on expert opinions and systematic reviews of the literature. Intervention studies that seek to identify the most effective instructional strategies are surprisingly sparse, but collaborative studies like the ABC Braille Study (Barclay et al., 2010) are a promising trend.

Mathematics

Mean percentile scores for school-age students with visual impairments participating in SEELS were 41.3 (n = 232) for applied problems and 45.6 (n = 233) for calculation (Marder, 2006). Similarly, NLTS2 (2003) determined that secondary-age students with visual impairments achieved mean percentile scores on the Woodcock-Johnson III subtests for mathematics applied problems and calculation (Woodcock, McGrew, & Mather, 2001) of 32.3 (n = 317) and 42.2 (n = 416) respectively (Wagner, Newman, Cameto, & Levine, 2006). These percentile scores, are among the highest for all students with disabilities, are misleading because more than half of the sample of students with visual impairments participating in these two studies was omitted from the standardized assessments (i.e., NLTS2). Some students with visual impairments seem to do well in mathematics, but a significant proportion, both with and without additional disabilities, does not.

For more than 40 years, concrete materials have been recommended for teaching students with visual impairments (Lowenfeld, 1973; Koenig & Holbrook, 2000b). Belcastro (1993), Champion (1976/77), and Hatlen (1975) demonstrated that concrete mathematics aids can increase computation accuracy; the three studies also demonstrated that aids and devices increase the acquisition of mathematics skills. The talking calculator Champion (1976/77) investigated is not generally considered a concrete material, and Kapperman, Heinze, and Sticken (2000) recommended against its use until mathematics skills are mastered. Indeed, a wide variety of computational aids, such as the cubarithm slate; Braille, large print, and stick-on number lines; various other manipulatives; and the new talking graphing calculator, are available from the American Printing House for the Blind. These devices are useful to demonstrate math concepts in a tactual manner and provide independent feedback to students through the medium of speech. Finger math, or Chisanbop, was shown to increase mathematics skills in three students who read Braille (Maddux, Cates, & Sowell, 1984)

The Cranmer abacus, an adaptation of the traditional Asian calculation tool with a different arrangement of counting beads and a back that keeps the beads in place, is often used to teach calculation skills to students with visual impairments. In fact, more than half of teachers responding to a survey about abacus instruction reported that they were currently teaching abacus to children with visual impairments (Amato, Hong, & Rosenblum, 2013; Rosenblum, Hong, & Amato, 2013), and most began instruction sometime between preschool and second grade. This study also documented multiple instructional methods and pointed out that more research is needed. Nolan and Morris (1964), who documented an increase in achievement scores in mathematics after training with the abacus, supported the use of the Cranmer abacus as an instructional tool. Kapperman (1974), however, found that Braille and mental calculation were more accurate than use of the abacus. No additional studies have been conducted. Although a position paper by the American Printing House for the Blind (Terlau & Gissoni, 2012) promoted the abacus as equivalent to pencil-and-paper calculation, the evidence for instruction in the abacus must be considered limited.

Despite documented lower achievement scores in mathematics for students with visual impairments, research investigating effective intervention strategies is woefully absent. There is limited evidence that mathematics comprehension is facilitated by the use of concrete aids and devices. The Cranmer abacus, a device that appears to be widely taught, also has limited conflicting evidence supporting its use.

Placement/Inclusion

More than half (i.e., 53%) of elementary and middle school students with visual impairments receive their education in general education classrooms; almost one third (i.e., 29%) attend special education classes in regular schools; and about one fifth (i.e., 19%) attend specialized schools (Marder, 2009). The amount of time spent in general education settings appears to be associated with the degree of visual impairment and the presence of cognitive impairments (Marder, 2006). Students with visual impairments without cognitive impairments are more likely to attend general education classes (i.e., 65% of the sample) and are less likely to attend special education classes in regular schools (i.e., 19%), but those with cognitive impairments are less likely to attend general education classes (i.e., 3%) and more likely to attend special education classes (i.e., 47%; Marder, 2006). Far more students with visual impairments and cognitive impairments attend special schools (i.e., 50%) than do those without cognitive impairments (i.e., 16%; Marder, 2006).

Research on the performance of students with visual impairments based on educational setting has not been conducted. Douglas and colleagues (2011) found no empirical evidence that supported a particular placement as being superior to any other placement. IDEA (2004) required a continuum of placement options, and both OSEP at the U.S. Department of Education (2000) in Policy Guidance and NASDSE in Educational Service Guidelines (Pugh & Erin, 1999) supported the utilization of a variety of placement options depending on child needs as determined by the IEP team. This practice is also supported by the professional literature—including most notably Hazekamp and Huebner (1989), Huebner, Garber, and Wormsley, 2006, and Huebner and colleagues (2004)—and by parents and advocates for students with visual impairments (Crane, Cuthbertson, Ferrell, & Scherb, 1997; LaVenture, 2007).

Social Emotional/Behavior

Social-emotional behavior of students with visual impairments does not appear to deviate from the behavior of students without disabilities. Most literature focuses on interaction with peers and adults (Erwin, 1993); self-esteem (Tuttle & Tuttle, 2004); and teaching the everyday social skills that are not possible to acquire through visual cues (Sacks & Wolffe, 2006). A limited level of evidence supports the use of self-evaluation and feedback to assist students in maintaining and generalizing social skills to new situations (Jindal-Snape, 2004, 2005a, 2005b; Jindal-Snape, Kato, & Maekawa, 1998). Interaction with peers in neighborhoods, classrooms, and playgrounds can be mediated by adults, but it is generally agreed upon that social skills must be deliberately taught in order to facilitate and sustain entry into multiple types of social groups (Celeste, 2006; Erwin, 1993; J. S. Hodges & Keller, 1999; Jindal-Snape, 2004; Kekelis, 1992; MacCuspie, 1996; McGaha & Farran, 2001; Peavey & Leff, 2002; Rosenblum, 1998; van Hasselt, Herzen, Moor, & Simon, 1986). Thus, the evidence for this category is moderate in terms of the need for specifically taught skills to mediate the social environment, but the actual interventions to accomplish this have been investigated by a limited number of researchers.

Transition

Transition, an important topic within the education of students with visual impairments, has not been widely researched. Administrative guidelines (Pugh & Erin, 1999) and Policy Guidance from the U.S. Department of Education (2000) viewed transition as an important part of the secondary curriculum. Wolffe and Kelly (2011) found a positive relationship between career education and intervention in social skills during secondary school years with employment following graduation for youths participating in the NLTS 2. However, the rate of employment of adults with visual impairments nationally remains low. Bell (2010) estimated that only 37% of legally blind adults exiting the vocational rehabilitation system secured employment. Bell and Mino (2013) estimated that only 31.3% of adults with visual impairments of working age (ages 18 to 64) were currently employed.

Administrative guidelines (Pugh & Erin, 1999) and Policy Guidance from the U.S. Department of Education (2000) viewed transition as an important part of the secondary curriculum. In addition, Musgrove and Yudin (2013) underscored Braille literacy as an important factor in future employment.

Research and expert opinions have identified variables important to quality-of-life transition paradigms but often based only on secondary analyses of large data sets. These variables have never been tested in a prospective intervention study. The fact remains that the rate of employment of blind adults has remained at the same low level for more than 50 years. It would seem that posthoc analysis does not lead to the right answers.

Conclusion

Scientifically based research in special education for infants, children, and youth with vision loss is difficult because the low prevalence of visual impairment dictates small sample sizes broadly distributed over large geographic areas. This one fact means that research is costly in terms of both travel and time. The heterogeneity of visual impairment results in flawed or inadequate comparison groups such as inappropriate comparisons to students without disabilities. Warren (1994), believing that comparisons to children without disabilities only documented discrepancies and failed to establish cause or lead to an understanding of why or how to intervene, addressed these issues and recommended an individual-differences approach to the study of children with visual impairments.

As we have documented, there is little empirical evidence to support the methodologies and practices used to educate children and youth with visual impairments. Some lines of research, such as instruction in Braille, training in use of low-vision devices, and transition, stand out because they have received more attention than others. Others, such as orientation and mobility instruction for children, placement decisions, determination of individual reading media, and AT, require research. Taken as a whole, education of infants, children, and youth with visual impairments is characterized by surveys, case studies, correlational research designs, expert opinions, and public policy. There are notable exceptions, but in the absence of funding and specialized research institutes with dedicated researchers, the prognosis is dim for building an evidence base that informs educators and families about what truly is effective practice. The essential components are supported by quality research, expert opinions, and educational policies. The level of evidence ranges from emerging to strong, but the overall level is limited. For a field with one of the longest histories of providing educational services, this limited level of evidence is shocking and must be improved.

(Ferrell, Bruce & Luckner, 2014)

Supplementary Resources for Future Reference

The IRIS Center. (2005). Accommodations to the physical environment: Setting up a classroom for students with visual disabilities. Retrieved 4.1.19 from https://iris.peabody.vanderbilt.edu/module/v01-clearview/  This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

The IRIS Center. (2005). Instructional accommodations: Making the learning environment accessible to students with visual disabilities. Retrieved from
https://iris.peabody.vanderbilt.edu/module/v02-successsight/

The IRIS Center. (2007). Serving students with visual impairments: The importance of collaboration. Retrieved on [4.2.19] from  https://iris.peabody.vanderbilt.edu/module/v03-focusplay/

Willings, C. (n.d). Accessible Educational Materials for Students who are Blind or Visually Impaired. (TVI website), from https://www.teachingvisuallyimpaired.com/accessible-educational-materials.html

Image sources

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Image “Braille Alphabet” Wikipedia.Content is available under CC BY-SA 3.0

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