Understanding the Individual Needs of
Visually Impaired Students:
Integration of a Neuroscience-Based Clinical Model Into A
Specialized Educational Institute
Paul B. Yellin, MD, Erin O’Reilly, MS, Kimberly Ross, MS,
and Patricia Glyptis, MS
New York Institute for Special Education
Yellin Center for Mind, Brain And Education
© 2011 Paul B. Yellin, MD
Background


Increasingly, research in neuroscience is
demonstrating that there is a wide range of
variation in the learning needs of even
“typical learners.”
These variations can be described in terms of
individual profiles of strengths and
weaknesses, much like fingerprints or DNA.
Background


To date, policy and practice in the education
of visually impaired students has largely
focused on the many complex challenges that
they share.
In 2008, the leadership of the New York
Institute for Special Education (NYISE)
identified a pressing need for deepening their
understanding of the specific learning needs
of individual, visually-impaired learners.
Background



Specifically, they decided to integrate a
neurodevelopmental model into diagnostic
practice, counseling, and instruction.
They identified the Yellin Center for Mind,
Brain, and Education as the best partner to
support them in accomplishing this goal.
The purpose of this presentation is to share
our early experience in this collaboration.
A private, 501(c)(3) nonprofit, nonsectarian
educational facility which provides quality
programs for children who are blind or visually
disabled, emotionally and learning disabled and
preschoolers who are developmentally delayed.
Founded in 1831 as the New York Institution for
the Blind as one of the first schools in the US to
provide an educational program for children
who were blind and visually impaired
Schermerhorn Program
Schermerhorn Program




Children 5-21 years old who are legally blind
IEP’s based on traditional psycho-educational
assessments
Instruction follows NYS Curricula leading to
elementary and high school diplomas
Educational support, life skills, career skills,
and transition to post-secondary education
Founded by Dr. Paul Yellin, former National
Director of Clinical Programs at the All Kinds of
Minds Institute, a national nonprofit institute
dedicated to improving outcomes of struggling
students through programs linking emerging
neuroscience to educational practice.
Extends and updates the interdisciplinary,
dynamic model developed at All Kinds of Minds,
while integrating emerging neuroscience and
evolving policy and practice
Neuroscience and Education

A conceptual framework and vocabulary for an
interdisciplinary conversation about learning,
mental productivity, and specific brain activities.

Task analysis of academic functions.

Linkage to 8 neurodevelopmental constructs.

Neurodevelopmental profiles
An example of a skill and its
component sub-skills

Reading, a skill, is composed of several sub-skills:





Remembering how sounds and letters are related
Understanding word meanings
Remembering what your just read while reading what
you’re reading now
Identifying the “main ideas” and “salient details”
Making connections to prior knowledge and experience
Neurodevelopmental FunctionsEight Constructs








Attention
Higher Order Cognition
Language
Memory
Neuromotor Function
Social Cognition
Spatial Ordering
Temporal-Sequential Ordering
Neurodevelopmental Profiles


Every student, indeed, every human has
some strong functions and some weak ones
(dysfunctions).
It is possible to describe each individual’s
unique mix of strengths and weaknesses (i.e.
neurodevelopmental profile).
Neuroplasticity
“Re-wiring our brains”
Brodman’s 52 Regions
I. Franz, “Variations in Distribution
of Motor Centers.” Psychological
Review, Monograph Suppl 19
(1915):80-162.
Merzenich’s Monkeys
Re-zoning of sensory input
Neuroscience. 1983;10:639-65.
“Functional relevance of crossmodal plasticity in blind humans.”
The visual cortex responds to sensory
input from the Braille reading digit and
contributes to perception of Braille
letters.
Nature 1997, 48:344-348
“Early but not late-blindness leads
to enhanced auditory perception”
“We showed that the performance of
blind participants was better than that of
sighted participants on a range of
auditory perception tasks.”
Neuropsychologia 2010, 48:344-348
Normalization of Dyslexia-Specific
Brain Activation Profile

“These findings suggest that the deficit in functional
brain organization underlying dyslexia can be
reversed….are consistent with current proposals that
reading difficulties in many children represent a
variation of normal development that can be altered
by intensive intervention.”

Simos, et al, Neurology, 58:1023 (2002)
Understanding & Educating All Children
Diversity is the Norm




There are no “perfect brains”
Profiles of academic and cognitive strengths
and weaknesses at a particular point in time
vs. fixed labels
Wide range of normal variation in brain
development
We are “re-wiring” our brains throughout
our lives
Implications for
Diagnosis and
Treatment
“Differential Diagnosis”
Getting to the root cause of
symptoms or problems
Academic Assessment
The power of error analysis and search for recurring
themes across subjects, tasks, settings.
Neurodevelopment Assessment
Dynamic assessment using both quantitative and
qualitative methodologies.
Making Linkages
academic skills & subskills
neurodevelopmental functions
“Allyson’s difficulty with reading/decoding
stems from weak phonologic processing (i.e. a
part of receptive language).”
Neurodevelopmental
profile
An individual’s unique mix of
strengths and weaknesses.
Demystification

Label the weak function
“I know what I need to work on”
 “It has boundaries”




Destigmatization
Alliance Formation
Infusion of Optimism
A Comprehensive
Learning Plan
Interventions at
breakdown points
Segregate troublesome step as
separate activity or stage
Bypass Strategies
Techniques designed to work
around a student’s area of
weakness.
Leveraging strengths
Using context to help compensate for
weak decoding. Having a weak reader
read about a topic that they know well.
Don’t forget affinities
A student who struggles with
reading, but loves football should
practice reading about football.
Collaboration-Phase 1
Initial Training-Spring 2011



Involved core team of 2 School Psychologist s and 1
Educational Evaluator over 18 days
Assessment of NYISE students in tandem with Yellin
Center Clinicians
Outcomes





Fund of Knowledge
Value of profiles vs. labels
Value of trans-disciplinary collaboration
Practical experience
Not ready for prime time
Collaboration-Phase 2
Building Independence and Sustainability-Late 2011






Continued core team training while including classroom
teacher and other members of the NYISE team over 12 days.
Professional development sessions for classroom teachers
and other members of the team
Classroom teachers met with core team to discuss students
to be assessed and priorities for assessment
Core team assessed students with YC support
Core team led “demystification” sessions with students and
parents
Core team and classroom teachers collaborated in learning
plan development
Collaboration-Phase 3
Supporting Sustainability, Continuing
Development and Building Capacity
Case Study
CM
Referral Concerns


CM is an 11.1 y/o 5th grader with
oculocutaneous albinism, photophobia,
nystagmus (bilateral), and hyperopic
astigmatism. Visual acuities are 20/400 O.D.
and 20/400 O.S.
He was referred by his teacher for specific
strategies for reading comprehension, oral
expression, and written output
Other Relevant Background



Difficulty processing information, particularly
verbal information.
Needs time to answer questions
Struggles with independent writing:
Generating ideas
 Elaborating


Generally quiet, shy, and reserved with
difficulty expressing thoughts and feelings
Overview of Assessment



Team worked with CM on a series of series of
academic and neurodevelopmental tasks
Assessment included subtests of standardized
neuropsychological batteries and additional
tasks
Assessment instruments selected specifically
to isolate and assess CM’s
neurodevelopmental functions and their
relationships to learning and academic output
Relevant Strengths







Higher order cognition
Short-term memory
Mental work stamina
Active working memory
Spatial ordering
Fine motor function
Graphomotor function
Relevant Challenges



Creativity and brainstorming
Sentence comprehension
Discourse production
Strategies-Nurturing Affinities



CM has expressed an interest in becoming a video
game designer when he grows up.
CM can build convergent thinking by cataloging facts
or details about video games or about a video game
he would like to create.
His teacher could also set aside special times during
each day for high motivational reading that focuses
on topics in which he has great interest and some
prior knowledge.
Front-loading Strategy

Prior to reading grade level text:
He should be given a thorough introduction to the
reading material before he attempts to read it.
 He should be given a short list of questions to
review before he attempts to read the text.
 Reading simpler texts on the same subject prior to
reading grade level material would also activate
prior knowledge.

MC’s Teacher’s Observations





He appears more confident and less fearful .
He is better able to express his thoughts and
feelings.
Due to the strategies that were recommended, CM is
better able to express his thoughts in writing even
handling open ended topics.
CM is more assertive, beginning to advocate for his
needs with selected staff members.
He was the first member of the class to memorize
the song for the Awards Ceremony.
Positive Signs

The implementation of the clinical model has led to
increasing collaboration across disciplines at the
earliest stage of assessment.

The participating clinicians found the initiative
empowering, each commenting that it confirmed
their core belief that “there had to be a better way”
of assessing and understanding their students
Positive Signs

When presented with their individual list of
strengths and challenges, virtually every student
commented that they had not previously realized
that they had any strengths.

They seemed empowered by the opportunity to
reframe their experience in terms of strengths and
weaknesses, which everyone has, rather than
defining themselves solely through their disability
Positive Signs

Teachers have commented that having the ability to
refer students to the list of their specific strengths
has been particularly valuable when they encounter
inevitable setbacks.

Clinicians and teachers have found that the
identification of specific breakdowns (e.g., weak
phonemic awareness) rather than broad labels (e.g.,
reading disability) has enabled them to select
specific interventions.
Positive Signs

There has been a broad recognition that even
students who share a disability have individual
needs and abilities. As one student
eloquently stated, “That’s what I’ve been
trying to say for years. It isn’t just that I’m
blind, I have a reading problem!!!!”
Challenges

At first, it was difficult for clinicians to move beyond
traditional “testing” paradigms to gain comfort with
more dynamic, qualitative approaches to
assessment.

Conversations across disciplines can be challenging.
For example, the assessment model required
psychologists and learning specialists to review each
other’s findings and collaborate in synthesis,
formulation, and diagnosis.
Challenges

Even as clinicians grew to prefer the new
assessment paradigm, without broader
process change across the Institute, there
were limitations in their ability to apply their
new knowledge.
Lessons Learned




It was critical to move slowly, communicate
frequently, provide staff opportunities to express
their concerns and objections.
Skepticism and resistance is inevitable.
It is unlikely that everyone will ever be enthusiastic
about this or any change.
Having clear, unequivocal support from the
Executive Director, Governing Board, principals, and
key thought leaders has been critical.
Final Thoughts from the Core
Team



“Overall the team found this process to be
enlightening, allowing us to discover strengths
when assessing, rather than just seeing
weaknesses”
“We can now view students through a
different lens and have a new perspective.”
“In identifying affinities, teachers can now
incorporate a student’s affinities into their
teaching.”
Final Thoughts from the Core
Team

“The demystification process, which allows
children to understand their strengths and
challenges, has made a tremendous impact in
the lives of our students and how they view
themselves.”
Final Thoughts from the Core
Team


“Our teachers proudly supported the children,
by displaying the student’s personalized “My
Kind of Mind” sheet.”
“The teachers have appreciated the learning
plan they’ve been provided with, as they now
have a road map of how to address their
student’s learning needs.”
Final Thought from the NYISE
Team
“We feel that we are still in the early stages of
synthesizing and implementing the
neurodevelopmental process. We are excited
about the next phase of this professional
development process.”
Conclusions


Reframing the learning needs of visually
impaired children in terms of individual
profiles of specific strengths and weaknesses
has been empowering to the students and
staff at NYISE.
Despite the fact that the program is in its
infancy, we are optimistic about its long-term
potential not just for the students and staff at
NYISE, but for the broader community of
visually impaired learners.