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RULE OUT OTHER EXPLANATIONS Physiological: Is the child ill or in pain? How can she tell you? Is she struggling to hear directions or see the task?
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F O C U S C O N F E R E N C E : J A N U A R Y 2 0 1 2
Hearing and Vision in Young Children: Is He Trying to Tell Us Something?
WHAT IF THAT “PROBLEM BEHAVIOR …”
• Loud voice inside• Pushing, hitting, biting• Refusing to participate in circle time
• Won’t sit still for directions• Gets “in other kids’ faces” • Bangs his head on the table
…is really a medical or communication issue!
RULE OUT OTHER EXPLANATIONS
• Physiological: Is the child ill or in pain? • How can she tell you? • Is she struggling to hear
directions or see the task?
FOR MORE ON CHALLENGING BEHAVIORS
Flint Simonsen, Ph.D. “Thinking Functionally about Behavior” • Physiological• Communication• Role of Environment• Change in
Relationships
•Webinar on WSDS website: http://tinyurl.com/wsdsflint
WHAT ARE THE KEY ISSUES FOR EARLY CHILDHOOD SPECIAL EDUCATORS?
• IDENTIFICATION of infants & toddlers w/sensory loss• REFERRAL to early intervention • DETERMINING appropriate services and supports• FINDING service providers with specialized training and
expertise needed to support families• WORKING with families in natural environments to
address sensory loss through functional daily routines
WHAT WILL WE COVER TODAY?
• IDEA, Part C – What does the law say?• Impact of sensory loss on development: Overview• Identification of hearing loss, vision impairment, and
combined hearing and vision loss• Best practices for hearing and vision screening• Three-Pronged Approach
• Resources! Programs, People, and Curricula
WHAT DOES “IDEA” SAY?IDEA, PART C (NEW REGULATIONS - OCT. 2011)
§303.13 EARLY INTERVENTION SERVICES
(1) Assistive technology(2) Audiology(3) Family training, counseling, home visits(4) Health services(5) Medical services(6) Nursing services(7) Nutrition services(8) Occupational therapy(9) Physical therapy
(10) Psychological services(11) Service coordination(12) Sign language, cued language services(13) Social work services(14) Special instruction(15) Speech-language path.(16) Transportation and related costs(17) Vision services
(i) Identification of children with auditory impairments, using at-risk criteria and appropriate audiologic screening techniques; (ii) Determination of the range, nature, and degree of hearing loss and communication functions, by use of audiological evaluation procedures; (iii) Referral for medical and other services necessary for the habilitation or rehabilitation of an infant or toddler with a disability who has an auditory impairment; (iv) Provision of auditory training, aural rehabilitation, speech reading and listening devices, orientation and training, and other services; (v) Provision of services for prevention of hearing loss; and (vi) Determination of the child's individual amplification, including selecting, fitting, and dispensing appropriate listening and vibrotactile devices, and evaluating the effectiveness of those devices.
(2) Audiology services include--
§303.13 EARLY INTERVENTION SERVICES
. . .include teaching sign language, cued language, auditory/oral language, providing oral transliteration services (such as amplification), and providing sign and cued language interpretation.
(12) Sign language and cued language services
§303.13 EARLY INTERVENTION SERVICES
(i) Evaluation and assessment of visual functioning, including the diagnosis and appraisal of specific visual disorders, delays, and abilities that affect early childhood development; (ii) Referral for medical or other professional services necessary for the habilitation or rehabilita-tion of visual functioning disorders, or both; and (iii) Communication skills training, orientation and mobility training for all environments, visual training, and additional training necessary to activate visual motor abilities.
(17) Vision services mean--
§303.13 EARLY INTERVENTION SERVICES
(1) Is experiencing a developmental delay, as measured by appropriate diagnostic instruments and procedures, in one or more of the following areas: (i) Cognitive development. (ii) Physical development, including vision and hearing. (iii) Communication development; (iv) Social or emotional development; (v) Adaptive development; or. . .
(a) Infant or toddler with a disability means an individual under three years of age who needs early inter-vention services because the individual--
§303.21 INFANT OR TODDLER WITH A DISABILITY
(2) Has a diagnosed physical or mental condition that-- (i) Has a high probability of resulting in developmental delay; and (ii) Includes conditions such as chromosomal abnormalities; genetic or congenital disorders; sensory impairments; inborn errors of metabolism; disorders reflecting disturbance of the development of the nervous system; congenital infections; severe attachment disorders; and disorders secondary to exposure to toxic substances, including fetal alcohol syndrome.
(a) Infant or toddler with a disability means an individual under three years of age who needs early inter-vention services because the individual--
§303.21 INFANT OR TODDLER WITH A DISABILITY
WHAT ARE THE POTENTIAL IMPACTS OF SENSORY LOSS ON DEVELOPMENT?
Q U I C K OV E RV I E W
POSSIBLE IMPACT OF VISION IMPAIRMENT
• Lack of eye gaze impacts parent-child bonding
• Delayed development of body/spatial awareness
• Loss of vision as an integrating & distance sense
• Reduced motivation to grasp and move in space
• Pace is slower; requires more time to explore
• Impaired vision affects literacy skills
FACTOIDS ABOUT VISION IMPAIRMENT
• 10:1,000 babies born have vision “problems”• 1.5:1,000 have visual
impairment• ~75% of young children
with multiple disabilities have vision impairment• Top three VI diagnoses:• Cortical vision impairment• Optic nerve hypertrophy• Retinopathy of prematurity
POSSIBLE IMPACT OF HEARING LOSS
• Reduced vocal turn taking affects parent-child bonding• Reduced access to language• Reduced awareness of
auditory environment• “Hearing age” begins only
with amplification• Reduced access to language
and concepts impact literacy
FACTOIDS ABOUT HEARING LOSS
• Approximately 10 children per 1,000 are born with some level of hearing loss• 3:1,000 babies born have a
significant permanent sensorineural hearing loss• Even a mild or unilateral hearing
loss can have significant effects on speech & language development and on academic achievement
IMPACT OF COMBINED HEARING LOSS AND VISION IMPAIRMENT
• Often associated with complex medical needs Parent-child bonding affected• Establishing security/
trust is a challenge• Development of
communication is key
FACTOIDS ABOUT DEAF-BLINDNESS
• Terms used: combined hearing loss and visual impairment, or dual sensory loss• Prevalence: 2.37 per 1,000
infants & toddlers served by Part C • About 250 infants, children &
teens in Washington • Very few specialists are trained
to work with this population
IDENTIFICATION OF INFANTS & TODDLERS WITH HEARING & VISION CONCERNS
B E S T P R A C T I C E S
FOR HEARING:• Otoacoustic
Emissions (OAE) Screening
FOR VISION:• Pediavision• InfantSEE
SCREENING FOR HEARING AND VISION CONCERNS IN INFANTS & TODDLERS
OAE HEARING SCREENING
www.kidshearing.org
The Gold Standard
VISION SCREENING
www.InfantSee.org
Free eye exam between the ages of
6 and 12 months
The Gold Standard
Vision Problems:• Eyes turning inward, outward,
or crossed• Children with unidentified
refractive errors• Other visible eye conditions
(e.g., drooping eyelid, “gunky” eyes, cataracts
Vision Impairment:• Children with VI needing
services of a TVI or O&M specialist
WHAT VISION ISSUES ARE YOU MOST LIKELY TO SEE IN YOUR PROGRAMS?
Middle Ear Problems:• Fluid from allergies,
infections• Hearing may fluctuateMild, Moderate, Bilateral or Unilateral Sensorineural Loss:• Even these levels of hearing
loss can cause significant impact if not dealt with
Severe to Profound H.L.• Most severe impacts
WHAT HEARING ISSUES ARE YOU MOST LIKELY TO SEE IN YOUR PROGRAMS?
GENERAL STRATEGIES
• At time of intake, read all reports. Be alert for any mention of hearing loss or vision impairment.• Be alert for children with syndromes or risk factors associated
with sensory loss, e.g., Down syndrome, prenatal drug/ alcohol exposure, prematurity, cerebral palsy, etc. • Follow up with specialists in sensory losses.• If you serve young children in groups: Assume that on any given
day, about one-third may have reduced hearing. Design environment for auditory access.• For children with multiple disabilities, be aware of high risk for
sensory loss—even if that seems like “the least of his problems.”
SAMPLING OF RESOURCES
• Washington Sensory Disabilities Services (WSDS)
1-800-572-7000 425-917-7827www.wsdsonline.org• National Dissemination
Center for Children with Disabilities
http://nichcy.org/
DEAF/HARD OF HEARING
Statewide Center on Childhood Deafness & Hearing Loss (CDHL)www.wsd.wa.gov(CDHL website in development)• www.handsandvoices.org• www.babyhearing.org• www.kidshearing.org• www.agbell.orgSKI-HI Curriculum: Order from Hope, Inc.www.hopepubl.com
BLIND/VISUALLY IMPAIRED
• Dept. of Services for the Blind (DSB) – Janet George
(800) 552-7103 www.dsb.wa.gov• American Foundation for
the Blind: Family Connect www.familyconnect.org• WA State School for Blind
(WSSB) www.wssb.wa.gov
DEAF-BLIND
• National Consortium on Deaf-Blindness (NCDB)
www.nationaldb.org• Design to Learn www.designtolearn.com• National Family
Association for Deaf-Blind (NFADB)
www.nfadb.org
