ERIC Identifier: ED473829
Publication Date: 2002-11-00
Author: Hatton, Deborah D. - McWilliam, R. A. - Winton, P. J.
Source: ERIC Clearinghouse on Disabilities and Gifted Education
Infants and Toddlers with Visual Impairments: Suggestions for
Early Interventionists. ERIC Digest.
The intervention needs of infants and toddlers differ considerably from those
of children with visual impairments (VI) and blindness who are kindergarten age
and older. Early intervention for infants and toddlers should be family-centered
while also addressing VI-specific needs. Because significant visual impairments
often result in developmental delays and make it difficult to access visual
learning environments, infants and toddlers typically qualify for special
education services. Exemplary services include the following strategies:
Establish reliable alliances (Turnbull & Turnbull, 2001) with families and
other service providers based upon family and child strengths, respect for
diversity and culture, and collaboration.
Collaborate with families and other professionals to complete the Individualized
Family Services Plan (IFSP) process.
Serve as an effective member of the early intervention team, help families and
other team members understand medical information, and be familiar with service
Approach early intervention from a support, rather than provision of services,
Make home visits that promote functional outcomes for both the child and family.
ISSUES SPECIFIC TO VISUAL IMPAIRMENTS
Because severe visual
impairments may be evident at birth or shortly thereafter, parents may learn
that their child has VI much earlier than do parents of children with other
disabilities. It is important for early interventionists to be aware of possible
depression in the parents of infants and toddlers with VI. All new mothers are
at risk for postpartum depression, and parents of children with disabilities are
known to be at greater risk for depression. (e.g., Schon, 1999)
Parental depression can interfere with the development of attachment that is
critical for social and emotional development. In addition, the VI might also
impede attachment. First, the infant may not be able to make the direct
eye-to-eye contact that is critical to the attachment process (Schore, 1994).
Second, the infant may display adaptive behaviors that are misinterpreted by
caregivers. Infants with VI may remain quiet in order to listen to sound cues.
Rather than smiling, cooing, and reaching for caregivers who approach the crib,
they may become very still as they listen for caregivers. By softly talking to
the baby as they approach, caregivers can provide alternative sensory cues to
elicit smiles and coos and make interactions more enjoyable. Effective early
interventionists help caregivers interpret their infants' behaviors as well as
help them learn to adapt to the environment so that the infant receives sensory
information as effectively as possible.
Because visual impairments involve medical diagnoses, the family may want to
know as much as possible about the infant's eye condition and prognosis.
Consequently, early interventionists must work with vision specialists on the
child's team and be knowledgeable about the child's condition and appropriate
resources in order to help interpret information, if needed. As with other
disabilities, parents often report negative experiences during diagnosis. Eye
specialists may not explain that children with legal blindness may have useful
vision and may even become print readers rather than Braille readers.
Additionally, parents may not understand that it is difficult to determine the
amount of useful vision an infant has and that visual function can improve over
For the past ten years, the leading causes of visual impairment in infants
and toddlers have included retinopathy or prematurity (ROP), cortical visual
impairment (CVI), and optic nerve hypoplasia (ONH) (Hatton & Model Registry
of Early Childhood Visual Impairment Collaborative Group, 2001). Infants who
have ROP are among the smallest and sickest and may be at risk for multiple
disabilities. Medical issues may be priorities for these families. Children with
CVI typically have other disabilities that have an impact on early development
and intervention. Finally, infants with ONH are at risk for associated
conditions such as diabetes and deficiencies of human growth hormone that may
impede both physical and mental development. These three most prevalent eye
conditions demonstrate the complex medical issues that may present challenges to
In addition to being knowledgeable about medical issues specific to infants
and toddlers with VI, early interventionists must understand the impact of
visual impairment on development. This knowledge can assist families in adapting
the environment and their interactions with their children to enhance sensory
information. A discussion of these issues is beyond the scope of this digest;
however, Chen (2001) provides a helpful discussion of these issues. For example,
VI can affect early cognitive and motor skills, with fine motor, object
manipulation, symbolic play, and other skills developing later.
STRATEGIES FOR PROVIDING EXEMPLARY SERVICES
Family-centered practices emphasize family strengths, empowerment of families
to make their own decisions, collaboration between the family and other
professionals, and a holistic view of the family. By establishing respectful
relationships with families and by understanding and honoring diversity, early
interventionists demonstrate family-centered practices. Providing support to the
family in natural environments and with sensitivity to the family ecology
enables parents to understand and enhance their child's abilities.
and service coordination.
Part C of IDEA (1997) requires that a multidisciplinary team assess infants
and toddlers and develop the IFSP development so that at least two different
disciplines are involved. Input from many disciplines may be required to address
the family's priorities and the child's needs. The team for a child with VI
should include a vision specialist and an orientation and mobility specialist as
well as the early interventionist and other educators and diagnosticians.
Therefore, early interventionists must be able to work collaboratively with
parents and a variety of professionals on the early intervention team.
Part C also mandates that each family have a service coordinator who is
responsible for the development, implementation, and monitoring of the IFSP and
the transition to preschool. The transdisciplinary model of service delivery, in
which a primary service provider is the main contact between the early
intervention team and the family, is one model for meeting this requirement.
This primary service provider maintains close contact with all team members and
the family and helps integrate the recommendations of various disciplines into a
holistic plan that addresses the family's priorities. The early interventionist
should be prepared to take this role; however, a teacher of children with visual
impairments may also serve as the primary service provider.
Because the IFSP should focus on family and child strengths while also
addressing the family's priorities, early interventionists are increasingly
providing broad-based support rather than individual child-centered therapy.
McWilliam and Scott (2001) suggest that support provided by early
interventionists falls into the following categories:
Emotional support--includes the following characteristics or behaviors
(McWilliam, Tocci, & Harbin,1998):
- positiveness about the child and the family
- responsiveness, including taking action when appropriate
- orientation to the whole family, not just the child
- competence with and about children
- competence with and about communities.
Material support--resources to implement interventions that meet family
priorities: access to equipment, supplies, assistive technologies, and
information about financial resources, and food.
Informational support--information about child development (what comes next,
what are other children this age doing), the child's condition or disability,
resources and services, and activities that will enhance the child's
Functional outcomes are outcomes that make day-to-day life for both the
infant or toddler and family easier while also promoting the child's
development. Functional outcomes for young children with disabilities include:
Engagement--the amount of time a child spends interacting with the environment
in a developmentally and contextually appropriate manner.
Independence--functioning with as little assistance from others as possible.
Families differ in how independently they want their young children to do
things, and these differences are sometimes determined socioculturally.
Social relationships--the ability to communicate, get along with others, develop
trust, interact appropriately, play appropriately, and form friendships. Social
relationships change as the child ages, and they serve as the motivation and
foundation for learning and competence.
Ideally, routines-based assessment will be used prior to the development of
the IFSP to identify functional outcomes that are family priorities as well as
the daily routines within which they occur. Routines-based assessment involves
an informal interview in which the family discusses daily routines with the
early interventionist to identify priorities for early intervention that (a) are
functional, (b) enhance daily life for the family, and (c) promote the child's
Most early intervention is provided during weekly home visits that last about
one hour, often beginning with a discussion about current family concerns and
priorities. Early interventionists must collaborate closely with the family;
working with the child in isolation cannot be expected to have much, if any,
impact since infants and toddlers cannot generalize information. If early
interventionists focus on support to the family, they can provide intervention
that addresses the family's immediate concerns and priorities and can take
advantage of the "teachable moment" when families are most motivated to actually
implement recommendations. Skillful early interventionists realize this and are
flexible enough to adapt recommendations to meet the family's current and
Chen, D. (2001). Visual impairment in young
children: A Review of the literature with implications for working with families
of diverse cultural and linguistic backgrounds (Tech. Rep. No. 7). University of
Illinois at Urbana-Champaign, Early Childhood Research Institute on Culturally
and Linguistically Appropriate Services. Retrieved April 29, 2002 from
Hatton, D. D., & Model Registry of Early Childhood Visual Impairment
Collaborative Group. (2001). Model Registry of Early Childhood Visual
Impairment: First year results. Journal of Visual Impairment and Blindness,
McWilliam, R. A., & Scott, S. (2001). A support approach to early
intervention: A three-part framework. Infants & Young Children, 13(4),
McWilliam, R. A., Tocci, L., & Harbin, G. L. (1998). Family-centered
services: Service providers' discourse and behavior. Topics in Early Childhood
Special Education, 18, 206-221.
Schore, A. N. (1994). Affect regulation and the origin of the self: The
neurobiology of emotional development. Hillsdale, NJ: Lawrence Erlbaum
Shon, K. H. (Winter, 1999). Access to the World by Visually impaired
preschoodlers. Re:VIEW, 30(4).
Turnbull, A. P., & Turnbull, H. R. (2001). Building reliable alliances.
In A.P. Turnbull & H.R. Turnbull (Eds.), Families, professionals, and
exceptionality (pp. 56-82). Columbus, OH: Merrill Prentice Hall.