Early Intervention Guidelines for Infants and Toddlers
with Visual Impairment
Fiscal Host:
Zumbro Education District
801 Frontage Rd NW
Byron, MN 55920
Contacts:
Christian Wernau
507.775.2037
Kim Lucht
507.251.7925
Table of Contents
INTRODUCTION
3
WHO ARE CHILDREN WITH VISUAL IMPAIRMENT
4
APPROPRIATE EVALUATIONS AND ASSESSMENTS
7
WHO CAN PROVIDE VISION SERVICES
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WHAT ARE VISION SERVICES
11
RESOURCES
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MNAPVI (MINNESOTA ASSOCIATION FOR PARENTS OF CHILDREN WITH VISUAL IMPAIRMENTS)
MINNESOTA STATE ACADEMY FOR THE BLIND (MSAB)
AMERICAN FOUNDATION FOR THE BLIND (NEW YORK, NEW YORK)
BLIND BABIES FOUNDATION
HADLEY SCHOOL FOR THE BLIND:
THE PERKINS SCHOOL FOR THE BLIND
NATIONAL BRAILLE PRESS
TEXAS SCHOOL FOR THE BLIND AND VISUALLY IMPAIRED
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APPENDIX A - ROLES AND RESPONSIBILITIES
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SCREENING TOOLS
17
NEW MEXICO VISION SCREENING TOOL
FAMILY INFANT TODDLER PROGRAM
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APPENDIX B - TOOLS
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SPECIAL EDUCATION SERVICES
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APPENDIX C - MEDICAL TERMS TO LOOK FOR
40
APPENDIX D - CURRICULUM LETTERS
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APPENDIX E LETTER REFERENCES
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
INTRODUCTION
Minnesota Teachers of the Blind and Visually Impaired from Region 10, in implementing the Individuals with
Disabilities Education Act (IDEA), Part C, is committed to providing quality early intervention services for infants
and toddlers, ages birth to three, with disabilities and/or delays, including those with visual impairment.
Toward that goal, and using the position paper of the Division of Visual Impairments, Council for Exceptional
Children, titled: “Family-Centered Practices for Infants and Young Children with Visual Impairments” (2003) as
a basis, we recommend the following guidelines:
1. Early intervention service providers have ongoing professional development to prepare
them to screen for and identify risk factors or behavioral indicators of potential visual
impairments.
2. When a medical doctor has identified a child, a Functional Vision Assessment may be
conducted by a TBVI to identify educational needs and appropriate services for each
eligible child, according to Part C requirements.
3. Vision services are delivered by, or with input from a Licensed Teacher of the Blind
and Visually Impaired (TBVI).
4. Each local lead agency has a consulting relationship with a TBVI who participates on the
IFSP team.
Infants and toddlers with visual impairment have unique developmental needs. The following principles are
infused throughout these guidelines for services that address these unique needs, and recognize that “vision
services” must follow Part C criteria, policies, and procedures. (See helpmegrow)
These guidelines are designed to assist families, local lead agencies, and early intervention service providers in
providing services to infants and toddlers with a vision impairment. They describe children who qualify for
services for students with vision impairments, describe evaluations and assessments that are appropriate for
infants and toddlers with visual impairment, define what vision services are and who can deliver them, and
assist early intervention teams in accessing those services.
Table 1
Principles of Early Intervention for Infants and Toddlers with Vision Impairment
1. Early identification and diagnosis of vision impairment are essential.
2. Qualified professionals conduct ongoing vision evaluation, functional vision assessments,
orientation and mobility evaluation, and early intervention.
3. Infants and toddlers with vision impairments and their families receive specialized early
intervention services integrated into a program that promotes independence for the child within
the context of family-centered, community-based activities.
4. The IFSP team assists the family in learning about the nature of their child’s vision impairment
and its potential impact on their child’s development.
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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WHO ARE CHILDREN WITH VISUAL IMPAIRMENT
The Minnesota State Department of Health reported 70,617 births in 2009.
http://www.health.state.mn.us/divs/chs/annsum/09annsum/index.html. Based on the national prevalence of
visual impairment (1.5 per 1,000 live births), the estimated number of infants with visual impairment born in
Minnesota in the year 2009 alone is 105.
Students meet Criteria in MN for BVI according the criteria in MN Statutes:
https://www.revisor.leg.state.mn.us/rules/?id=3525.1345
It is also important to note that not all visual conditions qualify a child for early intervention (EI) services from a
Teacher of the Blind and Visually Impaired (TBVI). Table 2 describes several visual problems that are often
dealt with by medical procedures or therapies rather than through TBVI services.
Table 3 lists the most common visual disorders that generally qualify an infant or toddler for EI services that
may include consultation or direct vision services from a Teacher of the Blind and Visually Impaired
(TBVI). This is not an exhaustive list. The need for vision services must be assessed on an
individualized and ongoing basis.
Please contact your TBVI to Discuss specific student needs.
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
Table 2
Visual Problems Treated Medically
Note: These visual problems alone may not qualify an infant or toddler for early intervention services. However, EI service providers
should be alert for these types of visual issues in infants and toddlers who are enrolled in early intervention for other developmental
concerns. There are exceptionalities in individual cases. Contact your TBVI for more information.
Visual Problem
Description
Treatment/Comments
Strabismus
Eyes turn inward, outward, or cross
as a result of lack of muscle
coordination or imbalance.
If left untreated the weaker eye may
develop suppression in order to
avoid double vision, and amblyopia
may result.
Treatment may involve patching, eyeglasses,
or surgery. In some cases optometric vision
therapy may be an option.
For infants and toddlers enrolled in EI for
other concerns, the role of the early
interventionist is to use good observation
skills to alert parents of the need for
evaluation and possible medical intervention.
Refractive Errors: •
Myopia • Hyperopia •
Astigmatism
Near sightedness - Far sightedness
- Blurred vision is caused by an
irregular curvature of the surface of
the cornea or the internal focusing
structures.
Treatment is provided optically (with glasses).
Again, for infants and toddlers enrolled in EI
for other concerns, the role of the EI provider
is to observe for possible refractive problems
and alert the parents of the need for an eye
evaluation.
Eye Infections
Eyes appear red, matted, and/or
“gooey.”
Symptoms may indicate infection or clogged
tear duct and must be treated
medically. Good hygiene is necessary to
prevent spread of infection to other
children. This is a short-term time-limited
condition.
Ptosis
Eyelid droops.
The child must be evaluated by an
ophthalmologist. If the eyelid droops below
the pupil, the child’s vision will be at least
partially occluded. Ptosis may be a sign of
more significant cranial nerve issues.
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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Table 3
Common Visual Disorders that Generally Qualify an Infant or Toddler for Vision Services
Note: EI service providers should be alert for these terms in a child’s medical history or during interviews with
parents and caregivers. (See the glossary for definitions.) If EI personnel encounter these terms or references
they should contact their TBVI.
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Visual acuity of 20/60 or worse in the better
eye
Visual field loss reducing combined visual
fields to 20° or less
Albinism
Aniridia
Anophthalmia
Aphakia
Cataracts
Cortical Vision Impairment (CVI)
Familial Exudative Vitreo-retinopathy (FEVR)
Glaucoma
Leber’s amaurosis
Microphthalmia
Optic atrophy
Optic nerve hypoplasia
Papilledema
Persistent Hyperplastic Primary Vitreous
(PHPV)
Phthisis bulbi
Retinal detachment
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Retinopathy of prematurity (ROP), Grade 4 or 5
Septo-optic dysplasia
CHARGE association (when accompanied by
significant colobomas)
Cytomegalovirus (CMV), if it results in vision
loss
Coloboma
Delayed development of vision
DeMorsier’s syndrome
Down syndrome (with high myopia)
Duane’s syndrome
Nystagmus
Ptosis
Retinoblastoma
Retinopathy of prematurity (ROP)
Neurological Trauma, especially when an MRI
indicates brain damage to the occipital lobe CVI
Cortical Visual Impairment Periventricular
Leukomalacia (PVL)
If you have questions about whether a particular infant or toddler qualifies for vision services, ensure that
referral is made to Help Me Grow
*Pogrund, R., & Fazzi, D. (Eds.) (2002).
Early focus: Working with young children who are blind or visually impaired and their families (2nd Ed.). NY: AFB Press, p. 14.
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
APPROPRIATE EVALUATIONS AND ASSESSMENTS
What Are Appropriate Evaluations and Assessments for Infants and Toddlers with Visual Impairments?
Infants and toddlers with visual impairment who have been referred to early intervention services need a
comprehensive approach to evaluating and assessing their developmental needs, with input from a licensed
TBVI. This approach must ensure that:
a. Each developmental area is evaluated, i.e., cognition, physical (including vision, hearing, fine or gross
motor), social-emotional, adaptive, and communication/ language, with appropriate adaptations
made for specific items on the assessment tools that require vision to perform; and,
b. A complete picture of the child’s visual status is gained in order to provide the information needed
for development of the Individualized Family Service Plan (IFSP) and program planning.
A complete evaluation or assessment for an infant or toddler with a visual impairment will address both of the
above. It should include results of a functional vision assessment (FVA) and orientation and mobility
evaluation, if appropriate, as well as the results of the medical/ophthalmologic evaluation that preceded them.
Below are brief descriptions of five different procedures that are typically carried out with infants and toddlers
prior to and following diagnosis of a visual impairment. These are: 1) medical ophthalmologic evaluation 2)
functional vision assessment, 3) learning media assessment, 4) orientation and mobility evaluation, and 5)
developmental evaluation and assessment.
1) Medical Ophthalmologic and Pediatric Optometric Evaluation
The goal of the ophthalmologic evaluation is to diagnose and determine a treatment plan to preserve and
enhance vision. This examination takes place in the ophthalmologist’s office.
In its 2007 Policy Statement, the American Academy of Ophthalmology and the American Association for
Pediatric Ophthalmology and Strabismus recommend an ophthalmological examination be performed whenever
questions arise about the health of the visual system of a child of any age.
*See Document at the end
Important: Because of a higher incidence of vision impairments in children who are deaf or hard of hearing,
infants and toddlers who have been diagnosed with a hearing loss should have a vision evaluation.
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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Pediatric Optometric Evaluation
A pediatric optometric evaluation refers to the examination of children’s eyes by optometrists who are trained in
evaluating and treating visual disorders in children. The vision examination by the pediatric optometrist includes
evaluation of the child’s eye muscle movements, focusing skills, eye tracking and fixation skills, the ability of the
eyes to aim, move and work together, visual behavior, and dilation of the eyes. The dilation of the eye allows
the doctor to determine if there is a need for glasses even if the child is nonverbal. The dilation also allows the
doctor to view the structures inside the eye to look for abnormalities of the retina or optic nerve.
2) Functional Vision Assessment
Once an infant or toddler has been diagnosed with a visual impairment, completion of a functional vision
assessment (FVA) is one of the primary roles of the teacher of the blind and visually impaired (TBVI). Medical
documentation is required. The goal of the functional vision assessment, done in collaboration with the IFSP
team, is to determine what and how the child sees, and what can be done to best facilitate learning through the
visual sense. This assessment is accomplished in the child’s home, childcare facility, and/or other community
setting and typically requires several visits over a period of time. During the child’s first years, functional vision
assessments need to be reviewed several times.
The information that is gathered from a FVA often is quite different from what is gathered from a clinical vision
evaluation at a doctor’s office, in that it is not diagnosis or treatment oriented. The goal of a FVA is to
determine the child’s visual strengths and needs, and to develop strategies for optimizing and/or promoting the
use of visual and non-visual information in the broader developmental sense.
The TBVI relies on the eye doctor’s findings to help determine adaptations that are indicated based on a child’s
diagnosis. Appropriate team recommendations for early intervention services cannot be made without the
information derived from the functional vision assessment.
3. Learning Media Assessment
Formal learning media assessments typically are not done during the birth-to-three years; however, the process
begins via observation of the infant/toddler’s preferred sensory mode (i.e., auditory, visual, tactual) and
developing visual skills. By the time a child enters preschool, the team usually has a fair idea of how to support
a child’s developing literacy.
The following describes prerequisite skills for emergent Braille literacy in infants and toddlers with visual
impairment. A similar skill area description exists for emergent print literacy skills for infants and toddlers who
will read using large print or other accommodations.
“Supporting early literacy development in early childhood settings such as the home and childcare;
teaching early literacy skills and modeling techniques for fostering development of those skills in the
home and childcare, such as reading aloud to the child, developing book concepts, encouraging early
reading and writing skills (e.g., pretend reading, scribbling); working with parents and others to expand
child’s experiential base and general concepts; developing hand/finger skills; helping parents and
others acquire books, labels, and other materials in accessible media; helping parents acquire
knowledge of Braille and resources for learning the Braille code; assuring models of proficient Braille
readers; bridging emergent literacy to early formal Braille literacy.”
Project SLATE (2003)
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
For children with visual impairment age three years and older, the decision on whether they will read print,
Braille, or both is based on a systematic assessment process called a “learning media assessment” and is
required by the Individuals with Disabilities Education Act (IDEA). It assumes that educational teams will
provide for instruction in Braille literacy skills for a child who is blind or visually impaired unless a learning media
assessment shows that Braille is not appropriate for the child.
*From Project SLATE Research (2003).
4. Orientation and Mobility Evaluation
The evaluation is done by a certified orientation and mobility specialist (COMS)(see Section IV). For infants
and toddlers, the concept of orientation represents a developmental process of becoming aware of oneself as
a separate being, where one is and wants to move in space, and how to get to that place. Mobility refers to
general gross motor development, including the normal integration of reflexes, acquisition of motor milestones,
refinement of quality-of-movement skills, and purposeful, self-initiated movement. For this age group,
orientation and mobility is also a gradual process through which the basic concepts and skills of safe movement
develop.
An orientation and mobility evaluation is performed by interviewing the parents, collaborating with the team’s
physical and occupational therapists, and directly observing and interacting with the child. In addition to overall
developmental information, the O&M specialist is concerned with the child’s level of functional vision, hearing,
tactile skills, and specific mobility skills. He or she also considers the natural learning opportunities presented
to the child within the conditions of the assessment and their possible influence on the child’s observed
performance.
The scenario below describes how an orientation and mobility specialist might work with an early intervention
team.
*Pogrund, R., & Fazzi, D. (Eds.) (2002). Early focus: Working with young children who are blind or visually impaired and their families
(2nd Ed.). NY: AFB Press, p. 395.
5. Developmental Evaluation and Assessment
Collaboration between the early intervention service provider and the teacher of the visually impaired (TBVI) is
important throughout the evaluation and assessment process. The TBVI can participate in two ways: (a) as a
direct participant by assessing in his/her particular area of expertise, or (b) as a facilitator or consultant by
observing testing to point out when the vision impairment affects the testing items or scoring, and to
recommend modifications for the visual impairment.
Evaluation and assessment tools usually are not designed for a child with a visual impairment. Children with
visual impairments need special accommodations for assessment and evaluation. The use of standardized
measures to determine a young child’s present level of functioning may not result in valid scores for the infant
or toddler with a visual impairment.
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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WHO CAN PROVIDE VISION SERVICES
When a vision impairment has been diagnosed in an infant or toddler, two kinds of specialists with expertise in
the area of vision impairment may be included on the team: (a) a certified teacher of children with visual
impairments (Teacher of the Blind and Visually Impaired or TBVI), and (b) a Certified Orientation and Mobility
Specialist (COMS). Either of these specialists brings a unique perspective for supporting families with children
with vision impairments.
Early intervention service providers must seek out these services and, at a minimum, establish consulting
relationships with TBVIs and COMS in their communities or through state agencies, in order to complete
individualized evaluations and assessments. The Individualized Family Service Plan (IFSP) must address each
child’s identified developmental needs and, in this case, the child’s need for vision services.
Descriptions of specialized service providers for infants and toddlers with visual impairments, both
educational/developmental and medical, are provided in Table 4 on the following page.
Table 4
Descriptions of Specialized Vision Service Providers
Teacher of the Blind
and Visually Impaired
(TBVI)
A licensed teacher of the visually impaired (TBVI) provides “vision services” to
children aged birth through twenty-one years of age. The training of TBVI’s is
specific to children diagnosed with vision impairment. TBVI’s provide early
intervention vision services specific to the needs of infants and toddlers, i.e.,
functional vision assessments, pre-Braille, evaluating the need for adaptive
equipment, and enhancing development of compensatory skills.
Certified Orientation &
Mobility Specialist
A Certified Orientation and Mobility Specialist (COMS) is a professional instructor
who teaches a person with a visual impairment how to move safely and efficiently in
a variety of environments. This specialist can help the family of an infant or toddler
modify the environment and learn strategies to promote movement and safe
exploration, for example.
Pediatric
Ophthalmologist
A pediatric ophthalmologist is a physician specifically trained to diagnose and treat
infants and toddlers with eye diseases. As a medical doctor, he/she is able to
prescribe medication and perform surgery when necessary.
Optometrist
Optometrists may screen for common eye problems and prescribe corrective lenses
when necessary.
Pediatric Optometrist
A pediatric optometrist has specialized training and experience to work with young
children with eye problems in need of corrective lenses.
Low Vision
Optometrist
These optometrists specialize in evaluating and prescribing special low vision
devices for patients with vision impairments.
Optician
Opticians provide the aids (e.g., glasses) prescribed by ophthalmologists and
optometrists.
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
WHAT ARE VISION SERVICES
Components of Early Intervention for Infants and Toddlers with Visual Impairment
The following vision service components may be considered in developing a child’s IFSP.
1. Development of attachment and meaningful social relationships and communication skills (listening,
turn-taking, personal expression, nonverbal communication, emergent literacy)
2. Assessment of sensory capabilities and preferences in order to facilitate the effective use of all senses,
including the use of low vision devices if appropriate
3. Adaptation of environments, toys, and learning materials to make them more accessible
4. Use of compensatory skills to accommodate for vision loss (e.g., strategies for accomplishing tasks
using touch rather than vision; learning to use all senses as effectively as possible)
5. Cognitive development opportunities that are experienced based and designed to teach concepts that
are acquired primarily through vision (basic concepts, problem-solving skills)
6. Facilitation of emergent literacy including pre-literacy for potential Braille and print readers through
collaboration with families and other professionals
7. Gross and fine motor development (as well as the development of physical control and stamina) with
special attention to prerequisite skills required for age appropriate orientation and mobility, and Braille,
print reading and writing if appropriate
8. Development of age appropriate orientation and mobility instruction (self-directed, independent
movement in the environment)
9. Instruction in daily living skills typically acquired through incidental visual learning that must be taught
using hands-on, step-by-step procedures to infants and toddlers with visual impairments in order for
them to function independently within natural environments (e.g., self-care skills, ability to do household
chores)
10. Comprehensive family support that includes emotional support and access to information and
resources that will help families become life-long advocates for their children
11. Thorough understanding of medical and visual conditions and their implications for early intervention
and education services
12. Recreational opportunities that enhance creativity and enjoyment
*Note: This table is not intended to be a “menu of services” for infants and toddlers with visual impairment. Adapted from the 2003
Policy Statement of the Division of Visual Impairment, Council for Exceptional Children.
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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Role and Function of Vision Professionals Consulting with Early Intervention Service Providers
1. Participate in the multidisciplinary evaluation and assessment of infants and toddlers with visual
impairment:
a. Perform functional vision assessments.
b. Perform orientation and mobility assessments (Certified Orientation and Mobility Specialist
(COMS)).
c. Obtain and interpret all ophthalmologic, optometric, and functional vision reports for families and
other IFSP team members.
d. Assist with comprehensive developmental evaluation/assessment of infant or toddler, providing
input on adaptations of assessment tool items as necessary for visual impairment and assisting
with interpretation of results.
e. Assist with communication skill assessments in pre-reading and listening.
f. Help to address the infant or toddler’s need for assistive technology.
g. Recommend assessment by other vision specialists as needed (e.g., orientation and mobility).
h. Assist families in assessing their concerns, priorities and resources regarding their infant or
toddlers’ visual development.
2. Participate in the development of the Individualized Family Service Plan:
a. Contribute to the infant’s or toddler’s present levels of performance by discussing how performance
is affected by the visual impairment and by providing information on the child’s learning style, use
of visual information, and other strengths unique to individual infants or toddlers.
b. Identify outcomes related to the visual and orientation and mobility needs of the infant or toddler
and their family.
c. Identify frequency, intensity, method, location, and services for meeting
3. IFSP outcomes.
4. Address development of pre-literacy skills and, by age three, recommend appropriate reading and writing
media.
For further information, TBVIs are directed to: “Infant Teacher of the Visually Impaired: Roles and
http://tsbvi.edu/infants/3231-infant-teacher
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
RESOURCES
NAPVI (National Association for Parents of Children with Visual Impairments) maintains a Parent Directory,
sponsors conferences, and has publications, and suggests useful links on its website: www.spedex.com/napvi/
MNAPVI (Minnesota Association for
Parents of Children with Visual
Impairments)
Contact: Info@mnapvi.org
Phone: 612/486-2784
Website: www.mnapvi.org/Minnesota_NAPVI/Welc
ome.html
Minnesota State Academy for the Blind
(MSAB)
Phone: 800-657-3634
Address: 400 SE 6th Ave
Faribault, MN 55021
Web site: www.msab.state.mn.us
Minnesota Braille and Talking Book
Library (MBTBL)
Phone: 507-333-4828
Address: 400 SE 6th Ave
Faribault, MN 55021
Web site: www.msab.state.mn.us
American Foundation for the Blind (New
York, New York)
Phone: 800/232-5463
Web Site: www.afb.org
Email: afbinfo@afb.net
Browse their pull-down menu of topics
relevant to infants and families.
Assorted informational brochures and fact
sheets for parents and service providers
Hadley School for the Blind:
Parent/Child Program
Contact: Ask for a parent/child instructor
Phone: 800/323-4238
Web site: www.hadley.edu
Address: 700 Elm Street
Winnetka, IL 60093
Free distance education courses for
parents and grandparents of blind children
The Perkins School for the Blind
Phone: 617/924-3434
Web site: www.perkins.org
Email: Info@Perkins.org
National Braille Press
Phone: 888/965-8965
Web site: www.nbp.org/ic/nbp/readbooks
Free packet of Braille books for birth-to-five
year olds.
Texas School for the Blind and Visually
Impaired
Website: www.tsbvi.edu/Education
Phone: 800-872-5273
See Early Childhood Instruction (ECI) –
Infants & Toddlers with Visual
Impairments.
Blind Babies Foundation
Phone: 510/446-2229
Web Site: www.blindbabies.orgEmail
bbfinfo@blindbabies.org
Address: 1814 Franklin Street, 11th Floor
Oakland, CA 94612
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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APPENDIX A - Roles and Responsibilities
Infant Teacher Of The Visually Impaired: Roles And Responsibilities
Infants: Below are additional roles and responsibilities that the VI teacher assumes for infants.
Acquire and expand information about impact of visual impairment on child's development, working with
families, current research, resources, etc.
 Acquire information and follow all IDEA Part H (ECI) timelines and requirements.
 Administer Functional Vision Assessments for identified infants. (On-going; update for progress
reports)
 Administer Learning Media Assessments for identified infants. (On-going)
 Consult with Early Childhood Intervention staff and parents concerning assessments (INSITE, E-LAP,
Hawaii, Oregon, etc.) and evaluations, modifications, strategies, impact of vision loss, vision screening.
 Develop IFSP with team. Attend IFSP meetings.
 Provide services to visually impaired infants and parent training as outlined on the IFSP. Areas may
include:
 Learning Media--ensure the child has opportunities to have toys and activities to use all sensory
modalities.
 Enhance bonding between family members
 Motor--Gross, Fine, and O&M/Early Movement
 Self-Help--Eating and Drinking, Dressing and Undressing, Toileting, Personal Hygiene, Sleeping
Patterns
 Cognition--Body Concepts, Object Exploration and Manipulation, Experience-Based Early Concept
Development, Problem-Solving
 Social-Emotional
 Communication--Receptive and Expressive
 Sensory--Vision (Low Vision Efficiency Training, Large Print/Pictures/Books, Optical Devices),
Auditory/Listening Skills, Tactual (Pre-Braille/Tactile Symbols), Vestibular, Sensory Integration
 Family Needs
 Adaptive Devices
 Act as consultant to day care providers, extended family members, Early Childhood Intervention staff,
Related Service Staff, etc. when needed.
 Order adaptive and tactual aids.
 Monitor identified visually impaired students.
 Act as a liaison and consultant with the following persons/staff:
o Commission for the Blind
o Case workers
o Doctors
o Ophthalmologists
o Neurologists
o Parents and other caregivers
o District support personnel
o Orientation and mobility specialist
o Occupational therapist
o Physical therapist
o Speech therapist
o Education Service Center staff
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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o Early Childhood Intervention staff
Provide information and materials to help ensure the VI infant's home is an appropriate learning
environment (lighting needs, wide variety of objects/toys to explore and manipulate, Little Room, light
box, etc.)
Ensure that parents have opportunities to meet and obtain information about visual impairment issues
at parent meetings, workshops, conferences, etc. These can be held locally or regionally.
Participate in transition planning.
Perform other duties as required for Special Education such as:
o Attend IFSPs.
o Update Cumulative (CUM) folders
o Follow IDEA Part H timelines and requirements
o Complete paperwork for re-evaluation
o Maintain materials inventory
*Developed by TSBVI Outreach Texas school for the Blind. Modified by Region 10 Low incidence MN
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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Certified orientation and mobility specialists (COMS) have many roles, including:
Assessment and Evaluation
 Conducting the functional vision evaluation.
 Conducting the orientation and mobility evaluation.
 Evaluating student progress and providing progress notes as per district policy.
Direct Instruction in the Expanded Core Curriculum
 Encouraging purposeful movement, exploration of immediate surroundings and motor development for
infants with visual impairments.
 Teaching spatial and environmental concepts and use of information received by the senses (such as
sound, temperature and vibrations) to establish, maintain, or regain orientation and line of travel (e.g.,
using traffic sounds at an intersection to cross the street).
 Providing support to the student to facilitate development of self-esteem, self-determination and social
acceptance.
 Orienting students to unfamiliar environments.
 Instructing in efficient use of low vision for movement.
 Teaching efficient use of low vision devices.
 Teaching use of mobility tools, including the long cane and adaptive mobility devices, for safely
negotiating the environment.
 Providing travel experiences in the community, including residential and business environments and
public transportation systems.
Supporting Educational Teams
 Supporting families of young children in developing gross and fine motor skills, sensory skills, basic
concepts and other developmental milestones.
 Ensuring continuity from early childhood intervention services to school-aged programs.
 Ensuring that appropriate vision-specific supports are in place and the necessary skills attained for
transitioning from school to adult life.
 Modifying the environment to accommodate specific mobility needs.
 Modeling appropriate O&M techniques for other team members.
 Providing, creating and acquiring adapted materials such as tactual maps and mobility devices.
 Providing in-service training and consultation to other team members in home, school and community
settings.
 Recommending orientation and mobility strategies for access to the general curriculum such as
physical education class, and participation in school and community extracurricular activities.
Administrative/Record Keeping Duties
 Maintaining records on all evaluations, IFSP/IEPs, and progress reports.
 Attending IFSP and ARD meetings.
 Ordering and providing adapted materials from the American Printing House for the Blind through the
Federal Quota program and from other resources.
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
Screening Tools
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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NEW MEXICO VISION SCREENING TOOL
FAMILY INFANT TODDLER PROGRAM
NEW MEXICO SCHOOL FOR THE BLIND AND VISUALLY IMPAIRED
(NMSBVI)
“An accurate understanding of the status of a child’s vision and hearing is necessary when determining his/her
developmental status. Vision and hearing are integral to overall development. This provides information that
assists in the assessment of a child’s development abilities in areas such as communications, cognition,
gross/fine motor, social or emotional, and adaptive behavior. Further, vision and hearing screening help early
intervention personnel and parents identify which children need additional assessment by professionals who
specialize in these areas of development”. NM Family Infant Toddler Program, Technical Assistance
Document, Evaluation and Assessment, February 2006.
The New Mexico FIT program requires that every child entering the Family Infant Toddler Program receive a
vision screening. The New Mexico vision Screening Tool was designed to help programs have a consistent
method of screening vision for children in New Mexico. The screening tool includes parent interview, as it is
important to ask parents if they have noticed any vision problems.
1) Medical history is often related to vision problems and is included in the screening tool to help you think
about medical history, which might be related to vision issues. Exposures during pregnancy are
included as certain exposures can also increase the possibility of vision problems. Family history is
included because some vision issues in immediate family may be genetic.
2) Appearance of Eyes: Sometimes-visual problems can be noted by observation of the appearance of
the eyes and this area indicates some of the observations that can be important.
3) Behaviors That Are Often Associated with Visual Impairment: Children often demonstrate behaviors,
which can indicate that they are having some difficulty with their vision. This checklist area is a
reminder for the evaluator of some of these behaviors, which can be related to vision problems.
4) Development Vision Screening: vision develops in a sequential, predictable sequence similar to other
areas of development. This page is included to remind you of what typical visual skills you might
expect for certain ages. Many of these items are related to your other developmental assessment
tools.
5) The summary area of the vision screening tools is to discuss your observations about vision with the
parent and to obtain permission to make a referral to NMSBVI for further vision assessment if needed.
Professional judgment within the team is a strong component of the decision-making process about whether to
refer the child for further vision assessment. Because of the important role of vision in the early developmental
sequence, NMSBVI would prefer “over” referrals to a “wait and see” approach.
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
NEW MEXICO VISION SCREENING TOOL
Referred to NMSBVI
Yes
No Date:
FAMILY INFANT TODDLER PROGRAM
Referred to Ophthalmologist & NMSBVI
Yes
No Date:
Copies to family for Ophthalmologist
Yes
No Date:
Child’s Name:
Parent’s name/Phone:
Chronological Age:
Signature (person doing screening):
Eye Care Specialist:
DOB:
Adjusted Age:
Date:
Date of last exam:
PARENT INTERVIEW
Results of parent interview; describe any concerns:
I. HISTORY: (check all that apply)
A. Child’s History
Low birth weight <3.5lbs.
Hydrocephaly/microcephaly
PVL (periventricular leukomalacia)
Prematurity w/oxygen <32 wks
Syndrome
Shaken Baby Syndrome
Small for gestational age
Cerebral hemorrhage
Significant illness:
Meningitis/encephalitis
No Concerns
Hypoxia, anoxia, low apgars
Hearing loss
Head trauma/tumor
Neurological disorder
Sepsis
Medications:
SeizuresRetinopathy
Intraventricular hemorrhage (IVH)
Vacuum Extraction
Cerebral Palsy
B. Exposures during pregnancy
Rubella
Toxoplasmosis
Cytomegalovirus (CMV)
Significant illness
Herpes
Alcohol/drugs
Shaken Baby Syndrome
C. Immediate family history of childhood vision loss
Strabismus/Amblyopia
Retinal Dystrophy/degeneration
Systemic syndromes w/ ocular manifestations
Congenital Cataracts
Glasses in early childhood
Retinoblastoma
Congenital Glaucoma
Sickle cell disease
Other:
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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II. APPEARANCE OF THE EYE (S): (check all that apply)
Cloudy or milky appearance
Abnormal constriction or dilation of pupil(s)
Keyhole pupil
Difference between eyes (size, shape, etc.)
Sustained eye turn inward or outward? (after 4-6
months)
No Concerns
Excessive tearing
Droopy eyelids
Jerky eye movements (nystagmus)
Absence of eyes moving together
III. BEHAVIORS THAT ARE OFTEN ASSOCIATED WITH VISUAL IMPAIRMENT:
No Concerns
Tilt or hold head in unusual position?
Seem to look beside, under, or above and
Visually inattentive/uninterested?
object
Hold objects close to eyes or bend close to
High sensitivity to room light or sunlight?
look?
Stare at lights, ceiling fans? (after 3 months or
Inconsistent visual behavior?
age)
Difficulty sustaining eye contact
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
IV. DEVELOPMENTAL VISION SCREENING (Check each item observed)
YES
NO
Comments:
YES
NO
Comments:
YES
NO
away
Comments:
YES
NO
BIRTH:
Responds to movement or light with a
blink reflex
Pupil responds to light on/off
Makes momentary eye contact
Uses locomotion to seek or avoid
Comments:
YES
NO
BY 1-2 MONTHS:
Looks at objects, follows visually
Looks at adult; responds to voice
Follow person with eyes
Observes movement in room
indicates
BY 2-4 MONTHS
Holds and looks at rattle
Social smile
Shows interests by reaching
Scans visual environment or turns
Comments:
BY 4-7 MONTHS
Reaches and grasps for toys
Retrieves lost pacifier or bottle
Initiates social contact
Facial mimic
Creates social contact (reaches)
YES
NO
self
Comments:
YES
NO
Comments:
YES
forth
NO
BY 7-10- MONTHS
Works to obtain out of reach toy
Uncovers toy
Matches cubes
Reacts to strangers
Shows distinct stranger reaction
Plays peekaboo, pat a cake, so-big
Comments:
YES
NO
BY 13-18 MONTHS
Walks well alone
Places pellet in bottle
Builds tower of two cubes builds tower
of 3-4 cubes
Finds toy under cup
Explores drawers and cabinets
needs by pointing
Identifies one body part
Plays “where is your eye?” etc
Looks for hidden objects
Begins to detour around obstacles
Points or asks for desired object
BY 18-24 MONTHS
Walks upstairs, holding rail
Kicks large ball after demonstration
Runs well
Dumps pellets
Builds tower of 5-6 cubes
Places forms in formboard with help
Names on picture
Identifies 5 objects or pictures feeds
well with spoon
Imitates adult activities (use of tools,
housekeeping, etc)
BY 18-36 MONTHS
Tries to do things for self
Begins to play cooperatively with
peers
Comments:
BY 10-13 MONTHS
Tries to build a cube tower
Imitates scribble
Explores toys
Puts one object inside another
Finds toy behind solid screen
Uses object in imitation of an adults
Hanks toy or other object back and
Rolls ball to another
Imitates actions
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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YES
NO
BY 24-30 MONTHS
Walks upstairs, alternating feet
Holds crayon with fingers (adult
grasp)
Builds tower of 9 cubes
Imitates vertical and horizontal
strokes
Knows use of 3 objects
Uses objects in play to represent
others
Places forms in form board without
help
Names 5 objects or pictures
Identifies 7 pictures
Helps with dressing
YES
NO
Comments:
YES
NO
cube
Comments:
YES
NO
Comments:
BY 24-36 MONTHS
Helps parents
Begins cooperative play
Understands taking turns
children
Comments:
BY 30-36 MONTHS
Strings small beads
Builds 3-cube structure
Imitates cross
Imitates 3-cube structure
Builds tower of 10 cubes
Copies circle
Solves formboard (rotates)
Tells use of 3 objects
Puts shoes on
Feeds self competently
BY 36-42 MONTHS
Cuts paper with scissors builds 3structure from model
Names 10 pictures
Washes and dries hands and face
Does simple errands and chores
Plays cooperatively with other
SUMMARY OF VISUAL CONCERNS:
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
NEW MEXICO VISION SCREENING TOOL FAMILY INFANT TODDLER PROGRAM NMSBVI
SUMMARY FORM
Child’s Name:
Birth Date:
Parent/Caregiver:
Phone:
Parents Address:
City:
State:
Referring Agency:
Contact Person:
Phone:
Date:
Zip Code:
SUMMARY
We have no concerns regarding this child’s vision at this time; based on the parent interview child/family
medical history and developmental screening:
Caregiver Signature: _________________________________________ Date: __________________
We have identified risk factors/signs/observations, as noted in the vision screening. I authorize you to refer
my child to an optometrist or a pediatric ophthalmologist for follow up.
Caregiver Signature: _________________________________________ Date: __________________
We have identified risk factors/signs/observations, as noted in the vision screening. I authorize you to
release my child’s information to the district teacher of the blind/visually MN Help Me Grow Program impaired
for follow-up. If necessary, provide a summary of concerns:
Caregiver Signature: _________________________________________ Date: __________________
REFERRAL INFORMATION
Phone: 1-866-693-GROW (4769)
Online: Help Me Grow
http://www.parentsknow.state.mn.us/parentsknow/age1_2/HelpMeGrow_SpecialNeeds/ReferChild/index.html
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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APPENDIX B - Tools
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
Special Education Services
NAME OF DISTRICT
Education District #DISTRICT NUMBER
ADDRESS, CITY, STATE ZIP
To The Doctor: An eye report can help teachers to understand more thoroughly the educational needs of
children with a degree of eye difficulty. It may be appropriate for a teacher of the visually impaired to provide
consultative and/or direct services to this learner, or review the nature of present services. Medical information
is needed to determine appropriate service.
Medical entrance criteria for programming is based on an acuity of 20/60 or worse in the best eye with
correction, and/or a visual field of 20 degrees or less, and/or a congenital, degenerative or progressive eye
condition. If you find you are unable to get an accurate acuity we request you estimate it to the best of your
ability. MN Rule 3525.134 reference:
(a) estimation of acuity is acceptable for difficult-to-test pupils; and
(b) for pupils not yet enrolled in kindergarten, measured acuity must
be significantly deviant from what is developmentally age-appropriate”
Thank you very much for your assistance,
This information is required by federal and state laws to ensure special education services including the use of
federal quota monies to provide equipment from American Printing House for the Blind, including but not limited
to reading stands, Braillers, equipment to read specially formatted electronic books, electronic magnifiers, wide
line notebooks and many other items available through American Printing House for the Blind
ENTER YOUR NAME, Teacher for the Blind/Visually Impaired
CELL:
FAX:
APLICANTS NAME:
SEX
M
F
BIRTHDATE:
Ophthalmological Information
Eye condition primarily responsible for visual loss:
Secondary condition, if any: _________________________Right Eye? __________Left Eye? _________
Etiological factor for primary eye condition: _____________________________
Family members with visual loss: _____________________________
Describe the appearance of eye, including fundi:
_______________________________________________________________________________________
Central Visual Acuity With Best Correction
Evaluation tool used to determine
Distance (20’)
Acuity readings - Right Eye
Acuity readings –Left Eye
Acuity readings – Both Eyes
Near (14”)
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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If unable to determine the “visual acuity with best correction”, give estimation.
Refraction: Should child wear glasses? __________________________Contacts?
__________________________
What is the purpose of the glasses? __________________________
Are low vision aids likely to be of assistance to him/her? __________________________
Does the child have color vision deficiencies and for what colors? __________________________
Is this vision condition progressive and/or degenerative? __________________________
What is the prognosis of the condition? __________________________
Is there any limitation in the field of vision? __________________________
Right Eye? __________________________
Left Eye? __________________________
What is the widest diameter in Degree of remaining visual field? (attach perimetric chart if significant)
Right Eye? __________________________
Left Eye? __________________________
Please comment on other factors that may affect the child’s visual functioning:
****************************************************************************************
Date of examination: _______________________________
Date of report:_________________________
________________________________________________________________________________________
Signature of Eye Specialist
________________________________________________________________________________________
Type of Eye Specialist
________________________________________________________________________________________
Address
Please return the form to:
NAME
ADDRESS
CITY, STATE ZIP
FAX
EMAIL
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
FOUNDATIONS OF ORIENTATION AND MOBILITY: BIRTH TO THREE YEARS
BIRTH TO SIX MONTHS
Concurrent Motor Skills




In prone holds head up
Brings hands together
Rolls over
Grasps object intentionally




Sits with support
Reaches for objects
Brings hands to mouth
Shakes and plays with rattle
Sensation
Expose to indoor and outdoor sounds and sound toys; isolate each sound if possible—follow by
touching/holding.
Begin basic vision stimulation; incorporate with reaching, tactual stimulation and auditory cues; keep visually
attractive sound-producing objects within reach at all times.
Provide daily tactual stimulation by massage and stroking; use variety of textures and substances; during play
times, give interesting textures to hold and mouth - including fabric, household objects, toys, food in various
forms, etc.
Environmental Concepts
Expose to household activities on a daily basis with child as close to activity as possible (e.g., front carrier); give
object associated with the activity to child to hold and explore; provide simple description during activity.
Begin including infant in errands and community activities as soon as possible; position child close to the action
and arrange for maximum involvement, hopefully hands-on.
Body Language
Provide daily movement stimulation in the form of bouncing, swinging in prone, gentle spinning, rolling, and
gentle roughhousing.
Include all body parts and areas in tactual stimulation with emphasis on hands and feet; proceed slowly if this
appears to be aversive; consult with OT or PT.
Susan Shier Lowry
Governor Morehead Preschool
319 W. Margaret Lane
Hillsborough, NC 27278
919-732-6462
susan.lowry@ncmail.net
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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Space/Time Relationships
Establish predictable daily routine, i.e., the same events in the same order each day.
Arrange a “defined space” in child’s crib and/or playpen: place a solid row of attractive toys, household objects,
textures, and other materials around the infant. These should form a perimeter located just slightly beyond
infant’s reach. Any random movement should result in contact with an object, preferably a noisy one. Move
this perimeter of objects further away as child begins to scoot or roll. Also hang object near chest from
above. Place in defined space several times each day (not just at nap times) for 15-20 minutes each.
For the low vision child, begin encouraging reaching to an object viewed; use sound of object as necessary;
begin with most familiar objects.
For the blind child, begin preparing for reaching to a sounding object; use objects that have great meaning for
infant such as bottle, favorite rattle, etc.; have infant handle and explore tactually just prior to expecting him to
reach for it; initially sound it while in contact with hid body, later sound it on tray of high chair in front of infant.
Gross Motor
Encourage developmentally appropriate motor skills; position in variety of ways throughout the day—prone,
supine, side-laying, sitting supported, infant seat, front carrier; emphasize infant getting accustomed to prone
while awake.
Concurrent Motor Skills






Sits up with support
Transfers objects
Grasps with thumb and
forefinger
Crawls
Pulls to
standing
Finger feeds
SIX TO TWELVE MONTHS





Builds tower of cubes (2-3)
Creeps
Stands
alone
Places cube in cup
Walking emerging
Sensation
Continue exposure to variety of sounds; provide direct experience; repeat exposure often.
Continue incorporating vision stimulation and massage, but also encourage more active exploration of textures;
increase variety of textures, shapes, temperatures, and consistencies; encourage play with semi-wet
substances.
Expose to novel smells, tastes, and textures by routinely introducing new foods or new textures and/or forms of
familiar food; repeat as often as necessary to achieve acceptance.
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
Environmental Concepts
Encourage exploration of furniture, appliances, household products, foods, and household activities; give
consistent names to all objects but emphasize action words, i.e., use simple words to describe how the infant is
acting upon the object.
Continue including in errands and community activities; provide for more and more direct involvement as motor
skills progress.
Supervise frequent direct experience with sand, soil, mud, gravel, grass, leaves; exposure to trees, shrubs,
sidewalks, streets, vehicles, etc., as much as possible; emphasize what the child is doing with object or
substance.
Arrange a “defined space” in child’s crib and/or playpen: place a solid row of attractive toys, household objects,
textures, and other materials around the infant. These should form a perimeter located just slightly beyond
infant’s reach. Any random movement should result in contact with an object, preferably a noisy one. Move
this perimeter of objects further away as infant begins to scoot or roll. Also hang objects near chest from
above. Place a defined space several times each day (not just at nap time) for 15-20 minutes each.
For the low vision child, begin encouraging reaching to an object viewed, use sound of object as necessary,
and use most familiar objects.
For the blind child, begin preparing for reaching to a sounding object; use objects that have great meaning for
infant such as bottle, favorite rattle, etc.; have infant handle and explore tactually just prior to expecting him to
reach for it; initially sound it while in contact with their body, later sound it on tray of high chair in front of infant.
Gross Motor
Encourage developmentally appropriate motor skills; position in variety of ways throughout the day—prone,
supine, side-lying, sitting supported, infant seat, front carrier; emphasize infant getting accustomed to prone
while awake.
Body Image
Continue to provide daily movement stimulation, in addition to what infant can provide for himself.
Begin passive differentiated movement of body parts accompanied by simple labeling of body parts and action,
begin simple hand games and finger-plays that incorporate body parts; accompany with tactual
stroking/massage; emphasize eyes, nose, mouth, arm, hand, leg, foot, stomach.
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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Space/Time Relationships
Begin changing daily routine occasionally, but allow enough time to thoroughly adjust before introducing yet
another change.
Expand infant’s defined space to correspond with their gross motor skills, i.e., to playpen, then later to small
corner of room; position one large toy, object or texture on each side of child’s space—each should be very
different from the other—fasten them permanently—continue to use loose toys and objects around perimeter in
addition to the permanent landmarks.
When able to sit up, use defined space idea by providing tray attached to seating; tray should have edge to
prevent toys/objects from “disappearing”; allow free play time with several objects on tray; also, when giving
toys, food or bottle to infant, place on tray and help infant reach for it instead of placing in infant’s hand.
For low vision child, begin incorporating reaching for toy/object viewed with vision stimulation activities; give
intermittent tactual and auditory cues to reinforce looking; incorporate with feeding, i.e., have infant reach for
spoon, jar, bowl, box, etc.
For the blind child, continue reaching to sound but place object on tray in front of child while sounding; continue
intermittent tactual input and always permit tactual exploration before; begin encouraging localization by headturn as reaching becomes consistent; begin decreasing auditory input to intermittent; later provide initial sound
only.
When reaching to sound is well established, begin object permanence activities; again, use meaningful and
highly desirable objects; permit brief tactual exploration or play before requiring pursuit; begin by placing screen
(cloth) over object as infant is holding it; later, proceed to containers over object (plastic tub, square cake pan,
shoe box); use immediate physical prompting initially; also initially, have infant help place object under cover.
Begin using “defined spaces” in feeding by using tray with edge; consistently position dish, cup, spoon and/or
bottle even if infant is not independently using these items.
Gross Motor
Continue to encourage developmentally appropriate gross motor skills; do so within familiar defined spaces
(e.g., playpen) and also in open space; from very beginning encourage to walk from a specific location
(landmark) to another location within 2-3 feet; encourage cruising by arranging furniture close together for ease
of transfer.
For the low vision child, begin incorporating motor planning with vision stimulation by having child detour
around obstacle and crawling under to retrieve a desire object.
Provide daily opportunity for free movement and exploration; keep furniture in predictable arrangement; use a
constant low-volume sound source for each room or area (fan, ticking clock, radio, etc.); avoid constant or even
frequent medium-to-high volume TV or radio; remove articles unsafe or breakable and replace with interesting
materials and household objects.
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
To prevent or discourage self-stimulation, arrange the child’s environment so they will contact interesting
materials, toys and objects almost constantly; also provide one-on-one sessions daily that encourage
interaction with a variety of objects; keep infant busy.
TWELVE TO TWENTY-FOUR MONTHS
Concurrent Motor skills
 Scribbles spontaneously
 Places several cubes in cup
 Walks steadily
 Runs
 Crawls up steps and down
 Turns pages of book singly
 Climbs into adult chair
 Throws ball
 Walks up stairs with assistance
 Completes circle, square, triangle formboard
 Jumps in place
Sensation
Expose to variety of sounds; provide direct experience; help child produce the sound themselves; give simple
names for sounds they hear that have meaning for them; repeat experiences often.
Continue incorporating vision stimulation with reaching and other fine motor tasks, but begin more advanced
skills; incorporate use of vision with loco-motor tasks (ball play, hid and seek, egg hunt, etc.); continue use of
distance vision outdoors; give simple names for objects viewed; repeat experiences often.
Continue tactual exposure by continually increasing child’s involvement in many household and outdoor events;
use textures to mark personal possessions, furniture, storage bin, etc; continue play with variety of dry and
semi-wet substances; encourage exploration and manipulation of object parts; through physical modeling
increase child’s repertoire of hand and finger movements (e.g., with Playdoh); demonstrate effort of movement
(e.g., gentle, hard, lightly, firmly); begin matching grossly different textures.
Expose to new and familiar smells with and without food; begin giving simple names for distinct and meaningful
smells (bacon, bubble bath, mother’s cologne, pet, medicine, etc.); later begin asking to identify these smells
with aid of other naturally occurring clues; teach how to sniff.
Environmental Concepts
Continue exploration of furniture, appliances, and household products; give name of each object and describe
action on it (e.g., “Bill closed the door”); increase direct involvement in various household activities as motor
abilities increase (e.g., have child help with different phase of dinner each night—setting table, putting
vegetables in pan, pouring drinks, or cracking eggs); if child cannot do it, have child feel it being done.
Continue errands and community activities; increase direct involvement; begin having child select grocery item
and give money to cashier; point out sights, sounds, smell, and let child touch and explore if possible.
Expand outdoor experiences and sensations (see 6-12 months) and provide frequent mediation; give labels for
and demonstrate new actions with objects and substances; begin experiences with sidewalk, driveways, curbs,
streets, corners, vehicles; vehicle-behavior, and weather; simple labeling of object and action associated with it;
incorporate with use of distance vision.
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
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Body Image
Provide daily movement stimulation; teach how to use motor equipment that will provide high level of activity on
child’s own.
Continue hand games that incorporate body parts; try hide and seek game in which child searches for small
object (raisin) attached to named body part; label facial features, hair, head, neck, fingers, stomach, elbow,
knee, toes, bottom, back, etc.; ask child to point to these parts; later should be able to name when asked.
Space/Time Relationships
Continue predictable daily routine with frequent minor and occasional major changes.
Expand child’s defined space by using small room or corner of a larger room; continue to use landmarks within
these spaces; set up define spaces all over the house (or classroom), for example, play corner in bedroom,
corner in living room, cabinet beside refrigerator that holds child’s own pots and pans; be sure to set up favorite
toys and objects that are stored in each of these areas.
Continue to use tray on high chair (see 6-12 months); later use place mat on table to define child’s space.
Practices reaching to sound using only initial and intermittent sound; return to continual sound to encourage
greater head turn (localization); begin presenting object in space (as opposed to on body or tray) and at
increasing variety of angles; continue intermittent play and tactual exploration.
Encourage child to walk to a continual sound source with 12-18 inches; as in reaching, use much initial and
intermittent tactual exploration and play; later have child localize sound, “face” it, and walk to it; gradually
increase distance and angles.
Continue conventional object permanence activities and increase in difficulty; fade use of sound but reintroduce
whenever new task appears too difficult; use defined spaces widely and assist child in replacing toys stored in
each of these spaces; provide physical assistance to immediately retrieve dropped or thrown object and fade
assistance; show child where household objects are kept (accessible) and help child obtain and replace them
when helping with that activity (cutlery, soap/washcloth, paper bags for trash can, own clothes/diapers, etc.).
Define child’s feeding space with place mat or, later, cafeteria tray; begin requiring child to find and replace cup,
for/spoon, and napkin in proper position by themselves; while scooping, encourage child to use “resting hand”
as a point of reference by holding bowl with it while scooping towards it with the other.
Enhance concept of vertical space by encouraging climbing, sliding, and beginning jumping; teach filling and
emptying vertical containers; stack large-to-medium interesting objects (shoe boxes, small pillows, coffee cans,
etc.).
Encourage child to climb on and crawl under and in various familiar and novel equipment/furniture; emphasize
these spatial terms; later ask child to follow these same simple directions; work with variety of objects and
containers (varying in size, shape and texture) to emphasize in, out, empty, and full.
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
Gross Motor
Encourage appropriate gross motor skills; provide regular opportunities to try emerging running skills in familiar
open space (yard, tennis court, gym, large garage, large open living area).
Begin encouraging goal-directed movement, i.e., encourage child to move to a goal in mind rather than wander;
if child is wandering, spinning, etc., persist in making sure child has plenty of opportunities for appropriate motor
expression (rocking horse, sit’n spin, swing, trampoline, bouncing toy, etc.); initiate goal-directed movement by
guiding child to familiar landmark then having child walk to child’s goal very close (by 3 ft); gradually increase
these distances; later, introduce obstacles.
Teach simple routes, 3 to 5 feet in length; only teach routes to a goal (landmark) that represents a familiar and
desirable activity (bath tub, trampoline, refrigerator, record play, snack table, etc.); initially assure that child gets
to participate in at least part of that activity upon completing the route, give enough physical assistance to move
quickly in order to maintain time and space perception.
Encourage beginning motor planning by assisting with the following:
 Opening cabinets
 Shutting drawers
 Crawling under furniture and into tight places
 Crawling over obstacles
 Later, demonstrates using stool, box, etc. to reach desired object; always reward motor exploration by
discovery of desired and/or meaningful object.
Formal Techniques
Teach child to search for dropped object immediately; co-actively model accurate reach accompanied by quick
sweeping motion; model with each hand alone; later encourage child to sweep farther and persist longer.
Teach modified sighted guide by having child hold on to adult’s index finger; encourage firm grasp; work on
walking in rhythm and at a faster pace; discourage pulling back; with curb greatly exaggerate your body motion
and step; teach child to wait until you step first; give verbal reminders as necessary, fade.
Encourage very selective trailing; if child cannot use standard trailing try two-handed method or use sighted
guide with ont-trailing hand; give frequent verbal reminders to trail; use concrete language cues, e.g., “Hand on
wall”.
Teach a modified upper hand and forearm technique since laterality and midline concepts are not wellestablished; for example: both arms out in front, palms outward, hands on top of each other; use concrete
and/or simple language cues such as, “hands out” or “upper arm”.
Internalization
Use constant environmental stimulation to discourage mannerisms; arrange for child to come in contact with
interesting toys and objects often; expand repertoire of interactions with objects; provide movement stimulation
and regular opportunities for physical exhaustion; use mild physical prompting to discontinue mannerism
accompanied by one or two-word verbal reminder.
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
3
3
Discourage “spacing out” by intervening immediately—get child involved with motor equipment or toys and
materials.
Watch for “fiddling about”, i.e., sensory-motor preoccupation such as hitting surfaces, jiggling door knobs,
repeated opening and closing doors, etc.; a certain amount is normal initially, if a particular habit lasts for more
than 1-2 months, begin discouraging; physically model appropriate associated activity, e.g., opening and
closing cabinets; show child how to open, crawl in, empty contents, replace, and close door; do this each time
child begins the opening and closing; use non-punitive physical prompt with simple verbal reminder also, if
necessary.
TWENTY-FOUR TO THIRTY-SIX MONTHS
Concurrent Motor Skills
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Makes train of cubes
Jumps from chair
Tower of 8-10 cubes
Walks on line
Alternates feet on stairs
Walks on tiptoe
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Adapts to reversal of formboard
Unscrews lids
Two-dimensional shape discrimination
Hops of one foot
Imitates drawing vertical, horizontal and
circular line
Sensation
Continue to draw attention to environmental sounds; have simple and brief discussions of sound
descriptions: high, low, loud, soft, near, far, in front, behind, beside; identify sound sources, but only those that
child has had hands-on experience with: cat, dog, bird, cow, horse, car, truck, air conditioner, typewriter, TV,
washer/dryer, etc.; begin encouraging use of sound for traveling in home and classroom: initially expect to use
appropriate sound as a goal, later teach to turn self in relation to sound and move to silent goal.
Continue use of distance vision with loco-motor games, etc.; include negotiation of uneven surfaces, obstacles,
steps; begin simple analysis and identification of objects followed by tactual confirmation; encourage child to
use simple description.
Continue play with novel textures and substances; teach more advanced tactual matching; begin tactual
discrimination of common textures using feet and hands—ask child to name.
Expose to more smells and their sources; take on regular field trips and teach beginning associations of smells
with locations: grocery store, doctors, cafeteria, bakery, zoo, gas station, etc.
Environmental Concepts
Continue child’s involvement in household activities but expand extent of each task and number tasks; have
child carry out at least one task from beginning to end as soon as child is capable 9e.g., undressing—including
putting clothes in hamper); expand number of tasks child can do with complete independence.
Expose to unfamiliar errands and community events as well as continue familiar ones; expand involvement in
the latter; begin teaching independent travel in small, familiar store; more advanced participation in purchasing;
more in depth discussion of sights, sounds, smells, landmarks, etc.
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
Continue exposure to residential concepts and landmarks, have child name familiar landmarks; guide child
through beginning street crossing; listen to traffic, discuss when to cross, use sighted guide to cross at
appropriate time, help child note textures, sounds and landmarks during crossing.
Body Image
Continue providing opportunity for daily movement stimulation and physical exhaustion through:
 Dancing
 Climbing
 Use of obstacle courses
 Trampolines
 Pools
 Jumping
 Running
 Swings
 Tricycles
 Continually introduce and teach novel
equipment and games.
 Playground equipment
Continue games involving naming body parts; introduce more advanced naming: wrist, waist, hips, shoulders,
ankles, etc.; incorporate with comprehension of spatial prepositions (in, out, behind, in front, under, etc.) by
having child place body parts in relation to own body and environmental objects; have child imitate your body
position or action by doing it.
Space/Time Relationships
Continue using defined spaces set up all over house and at school; may be able to achieve total orientation in a
small room now, although one may have to frequently encourage goal-directed movement and verbally and
physically remind child of location of objects in relation to landmarks; arrange defined space in corner of yard
adjacent to door; if appropriate, set up another area that includes favorite tree, swing set, etc.
Continue to expect child to maintain consistent spacial relationships with all utensils during independent eating
times.
Use verbal and physical (if necessary) reminders to encourage child to replace toys/objects, clothes, etc.;
continue building on object permanence by asking child to retrieve named objects within known location in large
room, then later from adjacent room; introduce systematic search patterns of child’s immediate space and also
perimeter of a room; encourage child to pursue beeper ball, jingle ball and bouncing (regular) ball.
Continue concept of vertical space by providing more complex climbing equipment and teaching new skills;
have child stack, build and connect increasingly small objects.
Expand child’s understanding of spatial prepositions: in, out, under, on top, above, below, behind, in front,
between; begin naming object-to-object relationships after child has considerable experience manipulating the
objects; initially ask child to place objects as you describe, later have child tell you about how to the objects are
positioned.
Begin stressing activities that emphasize the sides of the body and spatial terms that reflect laterality (side-toside, side step, beside, sideways, etc.); encourage distinction between the two sides of the body; do not expect
left/right labeling yet, but do refer to left and right in your description.
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
3
5
Teach one-quarter and one-half turn in relation to wall; use simple, concrete language cues, such as, “Side to
wall” or Back to wall; use prop to enable tactual confirmation of alignment; later stress head, body and feet
alignment; make lesions brief and within context of daily routine; use appropriate reward for age level.
Teach pointing to continual distant sound source; initially use stationary source and vary angles (encourage
head turn); later have child point to approaching sound source (mechanical toy, beeper ball, car, etc.) and track
across midline; use physical modeling as necessary).
Gross Motor
Support and encourage advancing gross motor skills; devise adaptations as necessary to teach these skills;
assure that child has opportunity to utilize on daily basis at home and school.
Continue expecting goal0directed movement; may need t use additional sound cue at goal occasionally, but
encourage using more landmarks, direction taking, straight-line walking and indirect auditory clues.
Continue more advanced motor planning activities.
Build child’s repertoire of body movements by physical modeling of adults and peers: dance movements,
swaying, spinning, twisting, duck-walking, crab-walk, walking backwards, tumbling; no action is too
meaningless to teach; teach how to move major body parts in isolation (shoulders, arms, rib cage, hips, feet,
knees, head, etc.); build into child the desire to imitate peers.
Continue stressing effort of movement; incorporate with dance; teach child to use appropriate effort of
movement according to type of music (rock, classical, etc.).
Begin stressing straight-line travel using squaring-off (“Back to wall”)’ initially use very short distances and
physical assistance to maintain direction and gait; use meaningful and valued object at goal and initially pair
with auditory clues; later use landmarks or large tactual aids at goal.
Formal Techniques
Introduce individualized modification of formal dropped objects technique; use favorite familiar objects;
incorporate into game. Allow play with the objects; demand immediate searching, encourage persistence and
teach soliciting assistance after thorough search.
Continue sighted guide techniques, have variety of unfamiliar indoor settings in which trailing is appropriate;
have child use conventional one-handed trailing; initially may need auditory goal to distract from extra tactual
input; expect only very brief trailing to locate a specific object within familiar settings.
Introduce narrow passage technique; use simple language; initially offer simple verbal description of situation,
then fade.
Introduce beginning sighted guide door technique; if possible, have child on the side closest to door, open door
so that child will easily contact it, have child help hold it, then close the door; introduce concepts such as pull,
push, toward, and away.
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
Continue modified upper hand and forearm; teach one-handed, cross body position when laterality/midline
concepts are established; consult with OT or PT if possible.
Begin teaching simple perimeter search of small room; include much simple discussion of each landmark
encountered and the activities associated with each one; repeat no less than once/week initially, later review
periodically; assure that child has frequent opportunities within the classroom routine to move to all landmarks
in the room (e.g., to retrieve a necessary item for the teacher, to place something in the trash, to turn on the
record play, to open the window, etc.).
Introduce short, functional routes within the classroom routine and at home: utilize simple direction-taking,
selective trailing, landmarks, and auditory clues; child may continue to require verbal and physical reminders for
some time; only require use of route travel in situations where child cannot maintain orientation or adequate
speed and efficiency; discontinue if and when child is able to use direct, free space movement toward the
objective; do not require long or complex routes that involve a great deal of trailing.
Introduce a protective device when child is demonstrating good orientation and has the occasion to travel a
long, clear route (hallway, walkway, sidewalk, etc.) on a daily basis; use doll stroller, toy lawn mower, toy
grocery cart, hula hoop, or modified pre-cane device; allow child to tactually explore obstacles encountered until
child has become familiar with the route; emphasize accurate correction away from the obstacle and
maintaining mental image of goal (must use meaningful location/activity as the goal, not just drill); may need to
use additional auditory goals initially; later see if child can name obstacle encountered without tactual
confirmation; evaluate on the use of the long cane—
Consider the following:
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Ability to maintain grip
Ability to keep tip in front
Ability to use safely
Ability to respond to obstacles
Need
Availability of adults to reinforce techniques and frequency of use…
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
37
Oregon Project B-7 Vision Screening Tool By Month
The Oregon Project, Sixth Edition has several significant changes and additions:
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More than 200 skills have been added
Newly designed recordkeeping with the ability to use a computer to graph the child's developmental
profile
New teaching activities for every skill
An expanded resource section with glossaries and a comprehensive listing of beneficial educational
materials
Comprehensive list of agencies serving children who are blind or visually impaired
Instruction for making toys and teaching materials
For technical questions regarding The Oregon Project Curriculum and Skills Inventory, call (541) 245-5196 or
email or_project@soesd.k12.or.us.
For ordering questions regarding The Oregon Project Curriculum and Skills Inventory please see the "Ordering
Information" link on the right side of this page. If there are additional questions, call (541) 776-8580 or
email Suzanne_Vaughn@soesd.k12.or.us.
The Oregon Project for Preschool Children who are Blind or Visually Impaired (The OR Project) is a
comprehensive assessment and curriculum designed for use with children birth to six who are blind or visually
impaired. It can be used by parents, teachers, vision specialists, or counselors in the home or in the classroom
setting.
The sixth edition of the OR Project includes several significant changes. Approximately 200 additional skills
were added, totaling more than 800 distinct developmental skills, each with corresponding teaching activities.
This new edition provides computer graphing of an individual child's profile to clearly depict the child's strengths
and areas for instruction. The OR Project can be used with any child functioning at developmental levels
between birth and six years.
The Oregon Project consists of a:
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Manual
Teaching Activities
Reference Section
Skills Inventory
The MANUAL contains instructions and procedures, which will make best use of The OR Project materials. It
includes a philosophical overview of the education and teaching of preschool children who are blind or visually
impaired.
The TEACHING ACTIVITIES include ideas for each skill taught either in the home or classroom setting. They
are suggestions for the parent and teaching staff, not designed as step-by-step "recipes," but rather, as starting
points for instruction. The skills and activities can serve as frameworks for writing prescriptive programs to fulfill
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
IFSP/IEP objectives.
The REFERENCE SECTION includes a Glossary of educational and vision terms needed by those working
with children who are visually impaired, a list of references, resources for obtaining educational materials and
literature, things to make and do, articles on play and development, and blank copies of all the forms,
checklists, and informal evaluations which can be copied and used.
The SKILLS INVENTORY consists of more than 800 behavioral statements, organized in eight developmental
areas:
Cognitive
Language Compensatory
Vision
Self-Help
Social
Fine Motor
Gross Motor
Skills have been developmentally sequenced and arranged in age categories. All major skills needed by a child
who is blind or visually impaired are included. The Skills Inventory is a criterion-referenced assessment, and
enables educators to find the performance level, select long and short-term objectives, and record the
acquisition of information from a completed OR Project Skills Inventory.
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
39
APPENDIX C - Medical Terms to look for
This section contains words or terms commonly used in the identification, evaluation, assessment, and service
provision of children with significant vision loss or blindness.
ACCOMMODATION - The ability to change focus from a distance point to a near point and vice versa
ACUITY LOSS - The loss of the ability to discriminate detail and, thereby, the experience of blurred vision
ALBINISM - Full or partial lack of pigment; may affect eyes only or entire body; may cause abnormal visual
development depending on the severity of the condition because of abnormal development of the macula of the
eye
AMBLYOPIA - Reduction in acuity, especially that in which there is no apparent pathologic condition of the
eye. Amblyopia is often associated with strabismus
ANIRIDIA - Congenital, traumatic, or surgical total or partial absence of the iris
ANOPHTHALMIA - Absence of one or both eye globes
APHAKIA - Absence of the crystalline lens in the eye, most commonly due to surgery
ASTIGMATISM - A refractive error where blurred vision is caused by an irregular curvature of the surface of the
cornea or the internal focusing structures
BINOCULAR VISION - Coordinated use of the eyes to focus and align on one object and to fuse the two
separate images into one visual image
BLINK REFLEX - Spontaneous eyelid blinking, which occurs approximately every 5 10 seconds or is induced by sudden sounds or approaching objects
CATARACTS - A condition in which the lens of the eye becomes cloudy, resulting in a loss of acuity
CENTRAL SCOTOMA - Loss of perception of objects directly in the line of sight
COLOBOMA - Incomplete closure in development of certain parts of the lower eye such as the retina or iris
with frequent optic nerve involvement
CONGENITAL - Present at birth
CONJUNCTIVITIS - Inflammation of the membrane lining the eyelids and portions of the globe
CONVERGENCE - When the eyes turn inward to maintain the line of sight on a near object/word
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
CORTICAL VISUAL IMPAIRMENT (CVI) - Inability of the brain to understand and process visual information
regardless of eye health status (Also known as cerebral visual impairment)
DEPTH PERCEPTION - The ability to perceive the relative positions of objects in space
DETACHED RETINA - Separation of retina from the layers of the eye to which it is normally attached
DIAGNOSTIC VISION EVALUATION - Vision evaluation given by an ophthalmologist or an optometrist to treat
or diagnose the visual status of the patient
DIPLOPIA - Double vision.
EARLY INTERVENTION SERVICES – http://www.health.state.mn.us/divs/fh/mcshn/ecip.htm
ESOTROPIA - Condition when one or both eyes turn in
EXOTROPIA - Condition when one or both of the eyes turn out
EYE TEAMING - Both eyes working together properly
FARSIGHTEDNESS - See hyperopia
FIELD LOSS - Inability to see in certain directions relative to the central line of sight
FIELD OF VISION - The area that can be seen while looking straight ahead
FIXATION - To direct a gaze and hold an object in view
FOVEA - Small depression in the macula of the retina; area of sharpest vision
FUNCTIONAL VISION EVALUATION - A vision evaluation administered by a vision teacher (TVI). The
purpose of the evaluation is to determine how the individual being tested is able to use his/her vision. This
helps to show what the individual can see in the everyday environment.
GAZE SHIFT - Process of looking from one object to another
GLAUCOMA - increased internal eye pressure with possible nerve damage and vision loss
HYPEROPIA - (farsightedness) a refractive error that is usually caused by the eyeball being too short front to
back or focusing power is too weak. With this condition, one can see objects at a distance using
accommodation. Close objects require even more accommodation.
HYPERTROPIA - Turning upward of one or both of the eyes
LEBER'S CONGENITAL AMAUROSIS - Genetic disease that causes a progressive loss of vision
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
41
LEBER'S OPTIC ATROPHY - Genetic rare disease resulting in progressive difficulty for the optic nerve to send
messages to the brain - Usually only in males and onset late in childhood
LEGAL BLINDNESS - Central visual acuity of 20/200 or less in the better seeing eye with corrective lenses or
a peripheral field loss in which the widest diameter of the field in the better eye is no greater than 20 degrees
(14" diameter at 1 meter).
LIGHT PERCEPTION - Ability to distinguish a light stimulus
LOW VISION - Vision that cannot be corrected to normal with conventional lenses, but is functional. People
with low vision can be prescribed low vision aids (optical and non-optical devices) to help maximize their visual
skills.
MACULA - The central area of the retina that surrounds the fovea and with the fovea comprises the area of
most acute vision.
MICROPHTHALMIA - Abnormally small eyeball, usually congenital
MYOPIA - (nearsightedness) A refractive error caused by the eyeball being too long or focusing power being
too strong. With this condition, one can see close objects, but objects at a distance appear out of focus.
NEARSIGHTEDNESS - See myopia.
NYSTAGMUS - A condition that involves small involuntary rapid movements of the eyes from side to side, in a
circular, jerky, or pendular motion, or in a combination of these. It may be secondary to poor visual acuity or
due to abnormality in brain function.
OPHTHALMOLOGIST - A physician who specializes in the diagnosis and treatment of the eye, performs
surgery, and prescribes glasses, medicine or therapy.
OPTIC ATROPHY - Reduced ability of the optic nerve to send nerve impulses from the retina to the brain
OPTIC NERVE - The cranial nerve that is responsible for carrying nerve impulses from the retina to the brain
OPTIC NERVE HYPOPLASIA (ONH) - Congenital underdevelopment of the optic nerve
OPTICIAN - An individual who specializes in fitting, adjusting and dispensing glasses and other optical devices
prescribed by the ophthalmologist or optometrist.
OPTOMETRIST - An individual who specializes in the diagnosis and treatment of the eyes and related
structures, and prescribes glasses, medicine, prisms, low vision-devices and therapy.
ORIENTATION AND MOBILITY (O&M) - A sequential process in which people with visual impairments are
taught to utilize their remaining senses to determine their position within the environment and to negotiate safe
movement from one place to another.
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
ORIENTATION AND MOBILITY SPECIALIST (COMS) - A certified professional trained to teach orientation
and mobility skills to people with visual impairment.
ORTHOPTIC TRAINING - Series of eye exercises for developing or restoring binocular vision
PEDIATRIC OPHTHALMOLOGIST - An ophthalmologist with fellowship training in pediatric ophthalmology
specializing in the diagnosis and treatment of the ocular problems in children, performs surgery, and prescribes
glasses, medicine or therapy.
PEDIATRIC OPTOMETRIST - An individual who works with the pediatric population and specializes in the
diagnosis and treatment of the eyes and related structures, and prescribes glasses, prisms, low vision devices
and therapy. This is an optometrist who has completed additional training in order to work with the pediatric
population.
PERIPHERAL FIELD - Vision allowing the perception of objects and movement outside of the direct line of
sight.
PHOTOPHOBIA - Abnormal sensitivity to light
PROSTHESIS - A substitute for a missing body part such as the eye
PTOSIS - A drooping of an eyelid
PUPILLARY RESPONSES - Contractions or dilations of the pupil due to various changes in brightness
REFRACTION - The measurement of the eye to determine refractive errors and the need for prescriptive
lenses
REFRACTIVE ERROR - A focusing error in the eye that prevents light rays from focusing accurately on the
retina
REHABILITATION TEACHER - Teachers trained to instruct persons with visual impairments in the use of
compensatory skills and assistive technology that will enable an individual to live a safe, productive, and
independent life.
RETINA - Innermost layer of the eye formed of light sensitive receptors and nerves that connect the retina
through the optic nerve to visual centers in the brain
RETINITIS PIGMENTOSA (RP) – A hereditary progressive degeneration, often hereditary, of the retina, which
leads to peripheral and eventually central field loss
RETINOBLASTOMA - The most common malignant intraocular tumor of childhood occurring prior to the age of
5 years.
RETINOPATHY OF PREMATURITY (ROP) - Condition resulting from complications of oxygen administration
after low birth weight which may lead to reduced visual acuity, visual impairment or total blindness.
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
43
SCANNING -the ability to accurately change fixation from one object in space to another by use of eye and
head movements.
SCATTERED SCOTOMAS - Patches of vision loss in visual field.
STRABISMUS - Eye muscle imbalance, e.g., esotropia (eye turning in), exotropia
(eye turning out), or hyper/hypotropia (eye turning up or down).
TEACHER OF THE VISUALLY IMPAIRED (TVI) - An individual who has completed a four-year teaching
degree (or a Master’s degree) in the special education field specific to visual impairments.
TRACKING - The ability to visually follow moving objects horizontally, vertically, or in an oblique plane
VISUAL ACUITY - Ability of the eye to perceive detail; sharpness of vision
VISUAL DISCRIMINATION - The ability to accurately compare and contrast visual images
VISION SPECIALISTS – A generic term that includes certified teachers of children with visual impairments,
orientation and mobility specialists, and Rehabilitation Teachers. Teachers of the visually impaired (TVIs)
typically have special education certification to teach children.
VISION THERAPY – A treatment regimen to correct or improve specific dysfunctions of the visual system
identified by standardized diagnostic criteria. This type of therapy must be prescribed and administered by an
optometrist. It is a medical therapy rather than a developmental or educational treatment.
VISUAL EFFICIENCY - Degree to which a child can use vision; a skill that needs to be developed with visually
impaired students.
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Appendix D - Curriculum Letters
Accessible Instructional Material Guidance
The 2004 reauthorization of the Individuals with Disabilities Education Act (IDEA) includes a requirement that
students who are visually impaired and students who are print disabled receive their textbooks and core
instructional materials in specialized formats at the same time as their non‐disabled peers.
The 2006 regulations implementing the 2004 IDEA includes guidance on how states and local districts are to
respond to this legislation. The two sections of this legislation are the National Instructional Materials
Accessibility Standards (NIMAS) and the National Instructional Materials Accessibility Center (NIMAC).
Providing accessible formats in a timely manner is not a new requirement, however, collaboration with the
NIMAC will improve this process for the students covered under these regulations.
The NIMAS are standards used by textbook publishers to prepare electronic files of textbooks, which can be
converted to specialized formats. Specialized formats means braille, audio, large print, digital or audio text,
which can be used by students who are blind, visually impaired, physically disabled, and reading disabled.
The NIMAC’s duties are to receive and maintain a catalog of these electronic files. Publishers, at the direction of
local school districts, send these files to NIMAC. When a student in a local school district requires one of these
specialized formats to have access to the general education curriculum, the local district will contact an
Authorized User (AU), designated by the State of Minnesota to obtain from the NIMAC the particular files for
core curricular and associated materials. The Authorized User assigns the electronic file to an Accessible Media
Producer (AMP) to convert the file into the specialized format. Once the specialized format has been converted,
the AMP will send the formatted file or hard copy to the local district that requested the materials. In some
cases, the AU and the AMP will be the same entity.
Current authorized users and accessible media producers for Minnesota are:
 State Services for the Blind Communication Center
 Bookshare.org
 Learning Ally
In addition, Joan Breslin Larson at the MDE is an authorized user and can assign files from the NIMAC to an
AMP.
EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
45
Students with Print Disabilities
IDEA refers to blind or other persons with a print disability as children who are served under the Act and who
qualify in accordance with the Library of Congress regulations for the Act to Provide Books for the Adult Blind of
1931 as Amended.
Persons who are blind or other persons with disabilities who have been certified by a competent authority as
unable to read or use standard printed materials because of:
 Blindness
 A visual impairment
 Physical limitations
 A reading disability due to an organic dysfunction
Certification of Eligibility
In cases of Blindness, Visual Impairment, or Physical disability, certifying authorities include doctors of
medicine or osteopathy, ophthalmologists, optometrists, registered nurses, nurse practitioners, physician
assistants, therapists, professional staff of hospitals, institutions, and public agencies (e.g., local education
agency related service personnel, teachers of the visually impaired, social workers, counselors, or
rehabilitation teachers). In the absence of any of these, certification may be made by professional librarians or
by any person whose competence under special circumstances is acceptable to the Library of Congress. In the
case of a Reading
Disability from an organic dysfunction, the certifying authority must be a doctor of medicine or osteopathy,
who may consult with colleagues in associated disciplines. A family member is not eligible to be the certifying
authority.
LEA Responsibilities
It is the responsibility of the LEA to provide curricular materials in alternate formats to students who need them
for access to FAPE. At the time of purchase of any curricular materials, LEAs should direct publishers to
submit an appropriately formatted file to the NIMAC.
This language has been suggested for Textbook Adoption Contracts and LEA Purchase Orders: “By agreeing
to deliver the materials marked with "NIMAS" on this contract or purchase order, the publisher agrees to
prepare and submit, on or before ‐‐/‐‐/‐‐* a NIMAS fileset to the NIMAC that complies the terms and
procedures set forth by the NIMAC. Should the vendor be a distributor of the materials and not the publisher,
the distributor agrees to immediately notify the publisher of its obligation to submit NIMAS filesets of the
purchased products to the NIMAC. The files will be used for the production of specialized formats as permitted
under the law for students with print disabilities. Please note that the delivery of print versions should not be
delayed in cases where the NIMAS fileset has yet to be validated and cataloged by the NIMAC. For additional
information about NIMAS, please refer to aim.cast.org. For additional information about the NIMAC, refer to
nimac.us . We would also be interested in learning about accessible versions of your instructional materials that
may be available for purchase to support students with print disabilities who do not qualify for specialized
formats created with files available from the NIMAS
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
* Use a date that is timely, perhaps at the same time that delivery is expected of hard copy books. It must
allow for enough time for the NIMAC to receive a file, validate it, enter it into their data base, allow for it to
be converted to an appropriate format and delivered to the school so that the student receives their
alternative formatted text at the same time as their typically developing peer.
Identifying eligible students:
1. Follow all LEA special education eligibility standards and child find/evaluation procedures including the
policies and procedures for paying for a medical diagnosis.
2. Follow competent authority guidance
3. Identify eligibility for files from the NIMAC on the IEP form
Identifying Accessible formats:
Use appropriate assessments such as the Learning Media Assessment given by the Teachers of the Visually
Impaired
Assistive Technology Consultants or others with specific information should be involved and present at IEP
meetings. If they cannot be present, their reports need to be available to IEP team members.
Describe textbooks and related core materials to be provided in accessible formats on the IEP form. If an
assessment to determine the accessible format has been completed, results should be reported also.
Timely Manner Process:
Definition: “timely manner” language has been interpreted by OSEP as “at the same time as other children
receive instructional materials.” The regulation requires the Department to “ensure that all public agencies take
all reasonable steps to provide instructional materials in accessible formats to children with disabilities who
need those instructional materials at the same time as other children receive instructional materials.” 34 C.F.R.
§ 300.172(b)(4). OSEP’s commentary lists the following examples of reasonable steps:
Reasonable steps, for example, would include requiring publishers or other contractors to provide instructional
materials in accessible formats by the beginning of the school year for children whom the public agency has
reason to believe will be attending its schools. Reasonable steps might include having a means of acquiring
instructional materials in accessible formats as quickly as possible for children who might transfer into the
public agency in the middle of the year. Reasonable steps would not include withholding instructional materials
from other children until instructional materials in accessible formats are available.
Considering the need for Accessible Instructional Materials in the IEP:
An IEP team could consider adding language in the IEP such as
“Does the student require accessible, alternate‐format versions of printed textbooks and printed core
materials that are written and published primarily for use in elementary and secondary school instruction and
are required by an SEA or LEA for use by students in the classroom?”
A query of this kind is designed to prompt the IEP team to consider each print‐disabled student's
need for accessible, alternate‐format versions of print instructional materials.
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If a student with a print disability does need a specialized format, the IEP should specify the following:
 The specific format(s) to be provided (Braille, audio, digital text, large print, etc.)
 The services and/or assistive technology tools the student may need to access the
specialized format
 The individual or individuals responsible for providing the specialized format, and
 The training and supports for the student, staff and family to effectively use the accessible
materials and any related assistive technology
 What formats are required to be used in what setting in order for the student to receive a free
appropriate public education.
Suggested process for obtaining accessible formats in a timely manner:
IEP teams make the determination of need using competent authorities as defined in IDEA. Team
members also use data to make the decision about need and type of accessible format required by an
individual student.
The LEA representative on the IEP team will assume responsibility for following district procedure for
obtaining accessible formats. This might include having a specific district person designated as a Digital
Rights Manager (DRM). The contact between the LEA representative and the DRM will be identified on
the IEP services page as a linkage that needs to occur so all textbooks and related core materials can be
ordered in the accessible format required by students in a timely manner.
The DRM can contact an Authorized User to identify textbooks and related core materials needed, the type
of accessible format required, and to indicate any preference in the Accessible Media Producers (AMP) who
will generate the accessible materials.
If a student does not qualify to receive a file from the NIMAC, the LEA continues to have an obligation
under IDEA to provide accessible instructional materials in a timely manner to all students who require
them.
For additional information, contact: Joan Breslin Larson, Minnesota Department of Education, 651.582.1599
or joan.breslin‐larson@state.mn.us
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APPENDIX E LETTER REFERENCES
POLICY STATEMENT
Vision Screening for Infants and Children
A Joint Statement of the American Association for Pediatric Ophthalmology and Strabismus
and the American Academy of Ophthalmology
Policy:
The American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and
Strabismus recommend timely screening for the early detection and treatment of eye and vision problems in
America's children. This includes the institution of rigorous vision screening during the preschool years.
Early detection of treatable eye disease in infancy and childhood can have far-reaching implications for
vision and, in some cases, for general health.
Background:
Good vision is essential for proper physical development in growing children and educational progress. The
visual system of the young child is not fully mature. Equal input from both eyes is required for proper
development of the visual centers in the brain. If a growing child’s eye does not provide a clear, focused
image to the developing brain, irreversible loss of vision may result.
Early detection provides the best opportunity for effective treatment. The American Association for Pediatric
Ophthalmology and Strabismus, the American Academy of Ophthalmology, the American Academy of
Pediatrics, the American Academy of Family Physicians, and the American Association of Certified
Orthoptists recommend early vision screening.
Vision screening programs should provide widespread, effective testing of preschool and early school-age
children. Many school systems have regular vision screening programs that are carried out by volunteer
professionals, school nurses, and/or properly trained laypersons. Screening can be done quickly, accurately,
and with minimum expense by one of these individuals. The screener should not have a vested interest in
the screening outcome. As with all screening programs, vision screening should be performed in a fashion
that maximizes the rate of problem detection while minimizing unnecessary referrals and cost. Beginning in
the preschool years, those conditions that can be detected by vision screening using an acuity chart include
reduced vision in one or both eyes from amblyopia, uncorrected refractive errors or other eye defects and, in
most cases, misalignment of the eyes (strabismus).
Amblyopia is poor vision in an otherwise normal appearing eye that occurs when the brain does
not recognize the sight from that eye. Two common causes are strabismus (misaligned eyes) and a
difference in the refractive error (need for glasses) between the two eyes. If untreated, amblyopia
can cause irreversible visual loss. The best time for treatment is during the preschool years.
Improvement of vision in children over the age of ten is seldom achieved.
Strabismus is misalignment of the eyes in any direction. Amblyopia may develop when the eyes do
not align. If early detection of amblyopia secondary to strabismus is followed by effective treatment,
excellent vision may be restored. The eyes can be aligned in some cases with glasses and in others
with surgery. However, restoration of good alignment does not ensure elimination of amblyopia.
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Refractive errors cause decreased vision, visual discomfort (eye strain), and/or amblyopia. The
most common form is nearsightedness (poor distance vision). It is usually seen in school-age
children and is treated effectively, in most cases, with glasses. Farsightedness can cause
problems with focusing at near and may be treated with glasses. Astigmatism (imperfect curvature
of the front surfaces of the eye) also requires corrective lenses if it produces blurred vision or
discomfort. Uncorrected refractive errors can cause amblyopia, particularly if they are severe or
are different between the two eyes.
In addition to detecting vision problems, effective screening programs should also emphasize a mechanism
to inform parents of screening failures and attempt to ensure that proper follow-up care is received.
Recommendations:
The American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and
Strabismus recommend that an ophthalmological examination be performed whenever questions arise about
the health of the visual system of a child of any age. They recommend that infants and children be screened
for vision problems as follows and that any child who does not pass these screening tests have an
ophthalmological examination.
1. An ophthalmologist, pediatrician, family physician, or other properly trained health care provider
should examine a newborn's eyes for general eye health and perform a red reflex test in the
nursery. The baby with an abnormal red reflex requires urgent consultation. An ophthalmologist
should be asked to examine all high-risk infants, i.e., those at risk of developing retinopathy of
prematurity (ROP); those with a family history of retinoblastoma, glaucoma, or cataracts in
childhood; those with retinal dystrophy/degeneration or systemic diseases associated with eye
problems; or when any opacity of the ocular media or nystagmus (purposeless rhythmic
movement of the eyes) is seen. An ophthalmologist should also examine infants with neurodevelopmental delay.
2. All infants should be screened by six months to one year of age for ocular health. This should
include a red reflex test by an ophthalmologist, pediatrician, family physician, or other properly
trained health care provider during routine well-baby follow-up visits.
3. Vision screening should also be performed on children between 3 and 3 1/2 years of age. A
pediatrician, family practitioner, ophthalmologist, optometrist, orthoptist should assess vision and
alignment, or individual trained in vision assessment of preschool children. Emphasis should be
placed on checking visual acuity as soon as a child is cooperative enough to complete the
examination. Generally, this occurs between ages 2 ½ and 3 ½. A child who is uncooperative at a
second attempt at vision testing should be referred for a comprehensive pediatric medical eye
evaluation. It is essential that a formal testing of visual acuity be performed by the age of 5 years.
4. Some evidence currently exists to suggest that photo screening may be a valuable adjunct to
the traditional screening process, particularly in preliterate children.
5. Further screening examinations should be done at routine school checks or after the
appearance of symptoms. Routine comprehensive professional eye examination of the normal
asymptomatic child has no proven medical benefit.
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EARLY INTERVENTION GUIDELINES FOR INFANTS AND TODDLERS WITH VISUAL IMPAIRMENTS
6. Children with presumed or diagnosed learning disabilities such as dyslexia should undergo a
comprehensive pediatric medical eye examination so that any undiagnosed vision impairment can
be identified and treated. They should be referred for the appropriate medical, psychological, and
educational evaluation and treatment of the learning disability. There is not adequate scientific
evidence to suggest that “defective eye teaming” and “accommodative disorders” are common
causes of educational impairment. Hence, routine screening for these conditions is not
recommended.
Many serious ocular conditions, which can be found at screening, are treatable if identified during the
preschool and early school-aged years. Many of these conditions are associated with a positive family history.
Therefore, additional screening emphasis should be directed to high- risk infants and children, and screeners
should readily refer such children to an ophthalmologist for a comprehensive medical eye evaluation.
Approved by:
Revised and
Approved by:
Revised and
Approved by:
Revised and
Approved by:
American Association for Pediatric Ophthalmology and
Strabismus, May 1991
American Academy of Ophthalmology, Board of Directors
June 1991
American Association for Pediatric Ophthalmology and
Strabismus, September 1996
American Academy of Ophthalmology
Board of Trustees, September 1996
American Association for Pediatric Ophthalmology and
Strabismus, August 2001
American Academy of Ophthalmology, Board of Trustees
October 2001
American Association for Pediatric Ophthalmology and
Strabismus, October 2006
American Academy of Ophthalmology, Board of Trustees
March 2007
©2007American Academy of Ophthalmology®
P.O. Box 7424/ San Francisco, CA 94102/ 415.561.8500
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