Texas School for the Blind and Visually Impaired
Outreach Programs
www.tsbvi.edu |512-454-8631 | 1100 W. 45th St. | Austin, Texas 78756
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
rcmtracker@aol.com
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
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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).
A Multidisciplinary Approach to Preschool Children with ONH & SOD, Mendiola, 2012 – 2012 Texas Focus
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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
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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:
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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:
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Absence of septum pellucidum
Corpus callosum hypoplasia
Delayed neurological development
Sensory Integration dysfunction
Hormone Dysfunction
A Multidisciplinary Approach to Preschool Children with ONH & SOD, Mendiola, 2012 – 2012 Texas Focus
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SPECTRUM DISORDER
Figure 2: Seven photographs of children who are interacting in various activities.
Early intervention multidisciplinary approach
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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.
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Child
Parents
Grandparents
Siblings
Extended family
Caretakers
A Multidisciplinary Approach to Preschool Children with ONH & SOD, Mendiola, 2012 – 2012 Texas Focus
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Early Intervention: The Medical Team
Figure 4: A child in a wheelchair looks straight ahead.
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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.
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Regional Center
CCS
Feeding clinic
Sleep clinic
A Multidisciplinary Approach to Preschool Children with ONH & SOD, Mendiola, 2012 – 2012 Texas Focus
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Early Intervention: The Educational Team
Figure 6: A child is sitting on the floor and is surrounded by large pumpkins.
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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.
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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
A Multidisciplinary Approach to Preschool Children with ONH & SOD, Mendiola, 2012 – 2012 Texas Focus
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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.
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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.
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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.
A Multidisciplinary Approach to Preschool Children with ONH & SOD, Mendiola, 2012 – 2012 Texas Focus
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Teaching strategies
Figure 10: A child reads from a book.
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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.
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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.
A Multidisciplinary Approach to Preschool Children with ONH & SOD, Mendiola, 2012 – 2012 Texas Focus
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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
A Multidisciplinary Approach to Preschool Children with ONH & SOD, Mendiola, 2012 – 2012 Texas Focus
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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
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Fluid retention
Muscle and joint aches
Thyroid hormone
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Headache
Sleep problems
Feeling nervous or irritable
Appetite changes
Weight changes
Antidiuretic hormone
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Head ache
Nose bleeds
Dry mouth
Constipation
Cortisol hormone
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High or increased blood pressure
Fluid retention
Build up of fat in different areas of the body
Bruise easily
Prone to infections
A Multidisciplinary Approach to Preschool Children with ONH & SOD, Mendiola, 2012 – 2012 Texas Focus
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Recommended websites
http:// www.aapos.org/
http://blindbabies.org/
http://www.blindchildrenscenter.org/
http://brailleinstitute.org/
http://www.csb-cde.ca.gov/
http:// www.focusfamilies.org/
http://www.hadley.edu/
http:// www.magicfoundation.org/
http:// www.onesmallvoicefoundation.org/
http://www.onhconsulting.com/
http:// www.thevisioncenteratchla.org/
http://www.tsbvi.edu/
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 Focus
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ACKNOWLEDGEMENTS
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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 at Rcmtracker@aol.com
A Multidisciplinary Approach to Educating Preschool Children with ONH and SOD – Mendiola, 2012 – 2012-13 Texas Focus
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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 Focus
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