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2012-13 Texas Focus

A Multidisciplinary Approach to Educating Preschool Children with Optic Nerve Hypoplasia and Septo Optic Hypoplasia

March 31, 2012

8:30-10:00 AM

Presented by:

Rosalinda Mendiola, TVI

Blind Children’s Center, Los Angeles, CA

Developed for

Texas School for the Blind & Visually Impaired

Outreach Programs

Optic Nerve Hypoplasia A Unique Way of Learning

A Multidisciplinary Approach to

Educating Preschool Children with ONH and SOD

Rosalina Mendiola, TVI, Blind Children’s Center, Los Angeles, CA

Figure 1: A child is looking down and to the right.

History of Optic Nerve Hypoplasia

1970s

It was once considered to be a rare and isolated ocular anomaly characterized by small, pale optic nerves and blindness.

1990s

It was later described in association with other congenital defects primarily of the midline brain structures, the septum pellucidum and pituitary.

2012

Now, it is the leading cause of blindness in young children, and it is associated with severe grossmotor delays, autistic like characteristics, sleep disorders and other neurological deficits.

Optic Nerve Hypoplasia

  • Optic Nerve Hypoplasia (ONH) refers to the underdevelopment of the optic nerve during pregnancy. The dying back of optic nerve fibers as the child develops in utero is a natural process, and ONH may be an exaggeration of that process. The effects of ONH have a broad range, from little or no visual impairment to near-total blindness.
  • As soon as a child is diagnosed with ONH they need to undergo a number of evaluations and brain function tests.
  • A neurologist can look at the brain structure through the use of MRI (magnetic resonance imaging).
  • Early diagnosis of brain malformation and hormone deficiencies can lead to better outcomes for the child with ONH.

Vision outcomes in children with Optic Nerve Hypoplasia

  • May have a lack of detailed vision and depth perception
  • May be unilateral or bilateral
  • Amblyopia
  • Nystagmus
  • Photophobia
  • Strabismus
  • ONH is a stable condition
  • Color vision is usually normal
  • Vision can range from moderate to no light perception

Critical Areas Of Development effected by ONH

The areas that can be affected other than vision include:

  • gross and fine motor skills disorders
  • cognition
  • speech and language
  • social interactions.
  • Brain abnormalities associated with ONH can in some cases cause seizures.
  • The development of the pituitary gland can also be affected in children with ONH.

Brain malformation:

  • Absence of septum pellucidum
  • Corpus callosum hypoplasia
  • Delayed neurological development
  • Sensory Integration dysfunction
  • Hormone Dysfunction

SPECTRUM DISORDER

Figure 2: Seven photographs of children who are interacting in various activities.

Early intervention multidisciplinary approach

  • The family
  • The medical team
  • The support team
  • The educational team

Early Intervention: The Family

Figure 3: A mother helps her daughter during an art activity.

  • Child
  • Parents
  • Grandparents
  • Siblings
  • Extended family
  • Caretakers

Early Intervention: The Medical Team

Figure 4: A child in a wheelchair looks straight ahead.

  • Endocrinologist
  • Neurologist
  • Nurse
  • Ocularist
  • Ophthalmologist
  • Optician
  • Optometrist
  • Pediatrician
  • Pharmacist

Early Intervention: The Support Team

Figure 5: A child touches a leaf during an art activity.

  • Regional Center
  • CCS
  • Feeding clinic
  • Sleep clinic

Early Intervention: The Educational Team

Figure 6: A child is sitting on the floor and is surrounded by large pumpkins.

  • Occupational Therapist
  • Physical Therapist
  • Teacher of the Visually Impaired
  • Orientation and Mobility Specialist
  • Speech and Language Specialist
  • Classroom teacher
  • Behavior Specialist
  • Licensed Psychologist
  • Social Worker

Teaching Strategies

Figure 7: A child is spreading a semi-liquid substance in a flat pan with his fingers.

  • Build rapport with the student.
  • Expose to sensory activities daily.
  • Follow the child’s lead.
  • Assess the child to find out where they are developmentally.
  • Patience, Patience, Patience
  • Incorporate music as much is possible children with ONH respond positively to music while learning concepts.

Teaching Strategies

Figure 8: A child is lying on his back with his leg up and crossed.

  • Build in sensory breaks during the day so that the student gets to release some of the energy they have or to take a break if they are becoming over stimulated.
  • Pair a new activity with a preferred activity (while introducing play dough have the child sit on a swing or rocking chair) if needed.
  • Initially use hand under hand technique versus hand over hand technique when guiding the child to explore.

Teaching strategies

Figure 9: A child glues a paper strip on a balloon.

  • Ongoing assessment is very important to make sure the student is making progress.
  • Visual task must be presented using the correct size and contrast needed by the student.
  • It is important to address the child’s sensory need in the classroom and at home.
  • Use a variety of mediums to introduce concepts.

Teaching strategies

Figure 10: A child reads from a book.

  • Teach communication and social competence by modeling the behaviors for the child.
  • Provide opportunities for independence.
  • Make sure the student can generalized skills learned in the classroom to other areas of their day.
  • Incorporate Individual Education Plan goals in the curriculum.

Teaching strategies

Figure 11: A child stares at large columns of light located in front of him.

  • Accommodate for the child’s visual, motor, and sensory needs.
  • Pre-teach and re-teach activities until they become part of the repertoire of activities the child can do independently.
  • Give the child plenty of time to process and respond to requests.
  • Communication between the family, the classroom teacher, and the specialists is very important.

Medications

Figure 12: A child has his arms up with hands on top of his head.

Children with ONH may have a deficiency in one or more of the following hormones.

  • Growth hormone
  • Thyroid hormone
  • Antidiuretic hormone
  • Cortisol hormone

Possible Side Effects of Medications

The following is not an all-inclusive list of all the possible side effect, but the side effects that may impact the child’s performance in the classroom setting.

Growth hormone

  • Fluid retention
  • Muscle and joint aches

Thyroid hormone

  • Headache
  • Sleep problems
  • Feeling nervous or irritable
  • Appetite changes
  • Weight changes

Antidiuretic hormone

  • Head ache
  • Nose bleeds
  • Dry mouth
  • Constipation

Cortisol hormone

  • High or increased blood pressure
  • Fluid retention
  • Build up of fat in different areas of the body
  • Bruise easily
  • Prone to infections

Recommended websites

References

Borchert M, Garcia-Filion P. The Syndrome of optic nerve hypoplasia: Neuro-ophthalmology. 2008;148 (1):395– 403

Garcia-Filion P, Epport K, Nelseon M, Azen C, Geffner ME., Fink C & Borchert M (2008): Neuroradiographic, endocrinologic, and ophthalmic correlates of adverse developmental outcomes in children with optic nerve hypoplasia: a prospective study. Pediatrics 121 ch53-ch59

Ma S, Fink C, Geffner ME. & Borchert M (2010): Evolving Central Hypothyroidism in Children with Optic Nerve Hypoplasia. Journal of Pediatric Endocrinology & Metabolism, 23, 53-58.

A Multidisciplinary Approach to Preschool Children with ONH & SOD, Mendiola, 2012 – 2012 Texas Focus1

ACKNOWLEDGEMENTS

  • I would like to thank the families of the Blind Children’s Center for allowing me to use pictures of their children for this presentation.
  • I also want to thank Texas School for the Blind and Visually Impaired for giving me the opportunity to present on a subject which continues to evolve as we speak.
  • Finally, I would like to thank the support team at the Blind Childrens Center who gave me permission to go into their classrooms.

References

Borchert M, Garcia-Filion P. The Syndrome of optic nerve hypoplasia: Neuro-ophthalmology. 2008;148 (1):395– 403

Garcia-Filion P, Epport K, Nelseon M, Azen C, Geffner ME., Fink C & Borchert M (2008): Neuroradiographic, endocrinologic, and ophthalmic correlates of adverse developmental outcomes in children with optic nerve hypoplasia: a prospective study. Pediatrics 121 ch53-ch59.

Ma S, Fink C, Geffner ME. & Borchert M (2010): Evolving Central Hypothyroidism in Children with Optic Nerve Hypoplasia. Journal of Pediatric Endocrinology & Metabolism, 23, 53-58.

THANK YOU

If you have any questions or comments feel free to email me

Texas School for the Blind & Visually Impaired

Outreach Programs

Figure 13 TSBVI logo.

"This project is supported by the U.S. Department of Education, Office of Special Education Programs (OSEP). Opinions expressed herein are those of the authors and do not necessarily represent the position of the U.S. Department of Education.

Figure 14 IDEA logo

A Multidisciplinary Approach to Educating Preschool Children with ONH and SOD – Mendiola, 2012 – 2012-13 Texas Focus1