The reasons blind and partially sighted children and young people need specialist educational provision
Evidence base briefing
1. Introduction
While it may sometimes be difficult for VI services to produce direct evidence of the impact of their service provision in terms of outcomes for children, it is possible to provide evidence from research of the needs of blind and partially sighted children that arise from the developmental effects of visual impairment. Where there is clear evidence of such need, it follows that there is a requirement for specialist intervention to address that need.
This briefing presents evidence from the research literature of the developmental effects of visual impairment on babies, children and young people.
1.2 Key points in the teaching of pupils with visual impairment
It may also be helpful for VI services to be aware of the key points relating to the teaching of blind and partially sighted children that were presented in a review of the literature into best practice in the education of blind and partially sighted pupils (Douglas et al, 2009). The key points are presented in full below:
Key points
· The “craft” of teaching visually impaired children tends to draw on two broad pedagogical strategies that involve using “alternative” or “enhanced” modalities of presentation and communication (for example the use of a tactile diagram as an alternative to a printed diagram, the use of a low-vision aid to enhance the print size,
· etc.).
· Without these strategies, access to the curriculum by visually impaired children would be compromised or even denied.
· These adapted methods of teaching may require more time than conventional teaching strategies (partly because children with visual impairment generally require more time to process information and to complete tasks).
· Some aspects of the curriculum may require significant modifications to enable access by children who are visually impaired (for example braille literacy).
· Many children who are visually impaired require an “additional” curriculum that is “over and above” the mainstream curriculum (for example mobility and independence education, braille tuition, daily living skills, etc.).
(From Douglas, McCall, McLinden, Pavey, Ware and Farrell, 2009, p92)
1. Parents' needs at point of diagnosis
Research with parents consistently obtains the same findings regarding their experiences and needs around the time of diagnosis of their child's VI (Cole-Hamilton, 1996; Keil et al, 2001; Boulton et al, 2004; Rahi et al, 2004, 2005; Keil, 2005; Research Works, 2011). The period around diagnosis is critical for parents to understand and accept their child’s visual impairment and its implications in terms of the child’s specialist needs, providing the foundation for their future role as effective advocates for the child. Information provided by medical professionals can be technical and difficult to understand; parents want both long and short term information at time of diagnosis.
1.1 Key worker
The role of a key worker who can deliver swift, intelligible and timely information is essential in enabling parents to feel empowered at a time when they may otherwise feel ‘lost and unsupported’. Qualified teachers of pupils with visual impairment (QTVIs) were singled out in the RNIB Starting Point research (2011) as the most valued professional in supporting parents.
1.2 Minority ethnic parents
There is some evidence that families from minority ethnic groups tend to place greater reliance on professionals to provide them with information, rather than actively seeking it themselves (Rahi et al, 2005) although this appears to be most likely in non-English speaking families (Brown, 2002).
2. Effect of visual impairment on early childhood development
Severe visual impairment or blindness can substantially delay early childhood development and learning, with some children following an atypical developmental pathway. The potential effect of even a relatively moderate visual impairment is significant, especially in combination with other low level needs.
2.1 Particular needs of blind children
Blind children, in particular, require high levels of specialist input to address crucial needs in their cognitive development, communication, social and independence skills (Perez-Pereira and Comti-Ramsden, 1999). The nature of this input will vary according to the needs and skills of each individual child, the nature of their setting and many other factors.
2.2 Social and communication skills development
Visual impairment creates unique challenges to learning which can only be addressed by specialist knowledge, skills and understanding. If babies with a visual impairment are not identified early and intensive health and education developmental support provided in the first two years of life, the development of their social and communication skills can be seriously impeded (Dale and Sonksen 2002).
Infants with severe VI are later to develop expressive and receptive language. Although they catch up by school age and then tend to have strong structural language and verbal skills they continue to have weaknesses in their pragmatic language skills (i.e. using language for social communication) (Tadic, Pring and Dale, 2010).
3. Children/YP with VI and additional needs
3.1 Learning disabilities and visual impairment
There is considerable evidence of a very high prevalence of blindness and partial sight in children with learning difficulties (LD), particularly those with severe learning difficulties (SLD) and profound and multiple learning difficulties (PMLD) (Emerson and Robertson, 2011; Warburg, 2001; Sandfield Nielson et al, 2007). Children and young people with learning LD and VI are currently under represented in official DfE statistics. Specialist skills are required to effectively support CYP with complex needs and visual impairment.
4. Access to the curriculum
4.1 School factors
The majority of blind and partially sighted pupils (around 70%) are educated in mainstream settings (Morris and Smith, 2008). One of the difficulties faced by pupils who are blind or partially sighted is that they have a low incidence disability which teachers often struggle to address. Problems identified by research include a lack of understanding by mainstream class teachers of the effects of a visual impairment (Franklin, Keil, Crofts and Cole-Hamilton, 2001), poor planning by teachers (Keil, Parris, Cobb, Edwards and McAllister, 2006) and an inability of schools to fully meet children's specialist VI needs (Miller, Keil and Whitehead, 2008).
4.2 Literacy through braille
Only around 4 per cent of children and young people with visual impairment read and write through the medium of braille - around 850 in total in Britain (Keil and Clunies-Ross, 2002).
Children who read braille tend to read more slowly than fully sighted children. They also tend to read less accurately and with poorer comprehension (McCall, McLinden and Douglas, 2011).
Many children who are severely visually impaired have useful functional vision and it is important to identify the most appropriate primary reading medium (braille, print, or a combination of the two). Deciding whether Braille is an appropriate route to literacy is complex and involves many issues. Learning literacy through braille is not just an issue of ‘access’ through a different code. Children developing literacy through braille require specific pedagogical approaches that are different from those required by print readers and therefore the class teacher in a mainstream classroom requires support from specialist teachers with a sophisticated knowledge of the issues (McCall, McLinden and Douglas, 2011). The importance of consistent high quality teaching as a key factor for good progress in literacy through braille (Emerson et al, 2009).
4.3 Access to print literacy
The findings in this section are all taken from a review of the literature into best practice in the education of pupils with visual impairment (Douglas et al, 2009).
The majority of children with VI have some remaining or “residual” vision. Specialist services should carry out regular functional visual assessments of visually impaired children to enable professionals to design appropriate educational interventions. Such assessments should draw upon the views, expertise and assessments of a broad range of stakeholders, including optometrists, ophthalmologists, teachers, and parents.
Children with low vision tend to read print more slowly and less accurately than normally sighted children, and this can also have an impact on comprehension.
General “print enlargement” is a common and successful technique for increasing access to print for children with low vision. Establishing a child’s optimal print size is an important aspect of functional vision assessment.
Low vision aids (LVAs), CCTV and electronic magnification (most notably computer-based magnification software) are extensively cited in the literature as useful techniques for enabling low-vision print readers to establish optimal print size and therefore to access print efficiently. While large print is a useful technique in some circumstances, teaching children to gain access to standard print using an LVA is often a better solution and enables independent learning.
To enable children to use their LVAs effectively low vision training is necessary, which to be successful, requires the involvement of a multi-disciplinary team. This is because of the range of skills and views required (for example clinical, optometric, pedagogical, and parental).
4.4 ICT and access technology
The findings in this section are all taken from a review of the literature into best practice in the education of pupils with visual impairment (Douglas et al, 2009).
'Access technology' (for example, screen magnifiers and screen readers) is an important tool for visually impaired children in gaining access to the curriculum. Beyond general access, technology offers the potential for the teaching of particular curriculum areas, for example visual training and braille. Children, however, require appropriate training in order to make effective use of access technology.
In spite of developments in access technology for children with visual impairment, there is evidence in the literature that access to information may be slower compared with sighted children. For example, while blind students could access on-line learning material using a screen reader the participants took twice as long as fully sighted students to access the material.
Learning gains in pupils with visual impairment have also been demonstrated with specialist software.
Some access technology is critical for access to the curriculum generally and the benefits of being taught to use technology and having relevant skills seems to be associated with great employment success among adults with visual impairment.
4.5 Teaching assistants (TAs)
Douglas et al (2009, p62) found that "there is general agreement in the literature that teaching assistants can best help visually impaired children if they have an understanding of visual impairment and how it affects the individual child". This highlights the importance of effective training for TAs as does (published and unpublished) research evidence suggesting that although TAs play an important role, they may also in some cases prevent social inclusion by acting as a barrier between the child and their classmates, and their class teacher. There are also concerns that where TAs are employed by individual schools they may rely on enlarging texts for pupils by photocopying onto A3 paper, which many pupils dislike finding this unwieldy and sometimes more difficult to read (Keil et al, 2006).
5. Mobility and independence
There is some evidence that key longer term independence skills (including mobility and social skills) that fall beyond the traditional curriculum may be neglected (Douglas et al, 2009).
In their comprehensive literature review, Douglas and colleagues (2009, p119) cite a number of studies that demonstrate the importance of mobility and independence education from "trained specialists" for pupils with VI to ensure they can participate safely and confidently in activities within and outside school. The authors go on to note that: "Without intervention it is argued that visually impaired children would otherwise face many difficulties in acquiring orientation and mobility skills, particularly in forming body concepts, mental maps of their surroundings and the wider world, and concepts of distance. This has been demonstrated in developmental delays observed in young children and babies who are blind or have severe visual impairment…for example delays in reaching…a greater likelihood of being physically passive…,and delayed posture control, co-ordination, and self-initiated mobility".
Sue Keil
Children, young people and families team
RNIB
27 January 2012
References
Many of the findings in this briefing (in particular, sections 8 and 9) are taken from a review of the literature into best practice in the education of pupils with visual impairment carried out by Douglas et al (2009). The full reference is below:
Douglas D, McCall S, McLinden M, Pavey S, Ware J and Farrell A M (2009) International review of the literature of evidence of best practice models and outcomes in the education of blind and visually impaired children. VICTAR, University of Birmingham and St Patrick's College, Dublin report for NCSE. NCSE Research Report no. 3
Boulton M, Clegg S, McDonald, E and Fielder A (2004) Families of young children with visual impairment: initial summary of findings. Oxford Brookes University and Imperial College London. www.vision2020uk.org
Brown J (2002) Spreading the Word: Research document Henshaws Society for Blind People
Cole-Hamilton I (1996) Taking the Time: telling parents their child is blind or partially sighted. London: RNIB
Dale N and Sonksen P (2002) ‘Developmental outcome, including setback, in young children with severe visual impairment’ Developmental Medicine and Child Neurology 2002, 44: 613-622
Emerson E and Robertson J (2011) The estimated prevalence of visual impairment among people with learning disabilities in the UK. Improving Health and Lives: learning disabilities observatory/CeDR, University of Lancaster report for RNIB and SeeAbility.
Emerson W R, Sitar D, Erin J N, Wormsley D P and Herlich S L (2009) ‘The effect of consistent structured reading instruction on high and low literacy achievement in young children who are blind’. Journal of Visual Impairment and Blindness, Oct 2009, Vol 103, No. 10, pp 595-609
Franklin A, Keil S, Crofts K and Cole-Hamilton I (2001) Shaping the Future: The educational experiences of 5 to 16 year old blind and partially sighted children and young people. London: RNIB
Keil S, Franklin A, Crofts K, Clery L and Cole-Hamilton I (2001)
Shaping the Future: the social life and leisure activities of blind and partially sighted children and young people aged 5 to 25. RNIB: London
Keil S and Clunies-Ross L (2002) Teaching braille to children. London: RNIB
Keil S, Parris D, Cobb R, Edwards A and McAllister R (2006) Too little, too late: Provision of school textbooks for blind and partially sighted pupils. London: RNIB
McCall S, McLinden M and Douglas G (2011) A review of the literature into effective practice in teaching literacy through braille. VICTAR, University of Birmingham for RNIB.