Essentials of Assessing Students with Visual Impairments for School Psychologists Handout

Webinar Recording

Essentials of Assessing Students with Visual Impairments for School Psychologists webinar recording from January 26, 2024. 

Learning Objectives

After this webinar, participants will be able to:

• Identify whom to consult with and the necessary steps to prepare for the evaluation.
• Describe best practices for evaluating students with visual impairments.
• List tests and other assessment tools that may be utilized with students with visual impairments and possible adaptations.

VI Basics & Intro to Evaluations

This intermediate-level webinar is for school psychologists with introductory knowledge about visual impairments; other evaluators are welcome to join. If you are new to the field of visual impairment, consider reviewing the following resources.

• Tips for Inclusive Interactions from the American Printing House (APH, 2022) - APH article
• More Than Meets the Eye: Working With Students With Visual Impairments (McKerracher & Green, 2020) - recorded presentation
• Comprehensive Evaluations of Individuals With Visual Impairments (Engle et al., 2024) - update to APH’s Intelligence Testing of Individuals Who Are Blind or Visually Impaired (Goodman et al., 2011).

• Evaluators are highly recommended to review the updated guidelines before evaluations.

• Psychoeducational Evaluations of Students With Visual Impairments (Nguyen et al., 2021) - recorded webinar

Collaborating Throughout the Process (Topic 1)

Evaluating a student with visual impairments with a transdisciplinary approach is crucial.

• Teachers of Students with Visual Impairments (TSVIs) are experts on

• what the student can access visually,
• how to adapt activities and environments,
• what is the student’s learning media,
• and assistive technology.

• Orientation & Mobility Specialists evaluate a student’s current O&M skills including:

• self-protective techniques,
• guide techniques,
• and spatial concept development.

• Other specialists who may need to be involved in the evaluation include SLP, OT, PT, APE, AT, behavioral specialists, inclusion specialists, and more.
• TSVI may be present during testing in addition to the school psychologist to assist with assistive technology and braille.
• “Best practices dictate that a team of professionals including a school psychologist, visual impairment professional, and a speech pathologist evaluate the individual” per Guideline 4 of Intelligence Testing of Individuals Who Are Blind or Visually Impaired (Goodman et al., 2011, Issue 4: Collaboration section, para. 1).
• Evaluators must collaborate with a TSVI during planning, administration, and interpretation. The TSVI may be present during testing in addition to the school psychologist/SLP to assist with assistive technology and braille. The evaluation often will take much more time since the following are needed.

• Consultation with the TSVI about optimal positioning of materials, lighting, and assistive technology.
• Planning for appropriate accommodations and testing measures.
• Error analysis with consideration of the individual learner’s profile.

Ecological Validity & the RIOT Model (Topic 2)

Using various assessment methods and information sources is crucial for ecological validity. Ecological validity refers to how well test results reflect real-world behaviors and functioning. It's important for all assessments.

• RIOT/ICEL: Records review, Interviews, Observations, Testing; Instruction, Curriculum, Environment, Learning.

• Using a RIOT/ICEL problem-solving approach to evaluation is recommended. This comprehensive approach brings social justice practices into evaluations and shifts the focus beyond the learner and standardized assessments. We need to look beyond the numbers for meaningful data!
• Review The RIOT/ICEL Matrix: Organizing Data to Answer Questions About Student Academic Performance & Behavior from Intervention Central for more information.
• Psychoeducational Evaluations of Students with Visual Impairments is a recorded webinar that includes information about using RIOT/ICEL for evaluating a student with VI (Nguyen et al., 2021).

• Key record to review: Comprehensive Vision Assessment

• The TSVI completes the Comprehensive Vision Assessment and provides information about a student’s functional vision, learning media, assistive technology, and expanded core curriculum needs.
• It is essential to review information about the student’s functional vision and learning media assessment BEFORE starting the psychoeducational assessment; this data informs which testing tools and adaptations may be appropriate or needed.

• Interview and observe skills related to the Expanded Core Curriculum (ECC).

• Both TSVIs and O&M specialists provide evaluation of the Expanded Core Curriculum (ECC), which includes:

• compensatory access,
• social interaction,
• orientation and mobility,
• independent living,
• recreation and leisure,
• career education,
• assistive technology,
• sensory efficiency,
• and self-determination (Allman & Lewis, 2014).

• Watch the recorded webinar called Expanded Core Curriculum (ECC): An Educational and Legal Requirement (Brown et al., 2021) to learn more.
• ECC areas where school psychologists and the TSVIs may overlap include:

• social interaction,
• career education,
• independent living skills,
• self-determination,
• and recreation and leisure.

Impact of VI on Development (Topic 3)

VI impacts more than visual access.

• Visual impairment impacts many areas, such as incidental learning, concept development, language development, cognitive processing, mental health, social skills, sensory processing, motor skills, independent living skills, employment, and sleep.
• To gauge the impact of visual impairment on a particular student, consider the etiology, age of onset, prognosis, and functional use of vision.

• Since students with visual impairments do not receive the same information about the world around them as their peers, they need explicit instruction and experiential learning opportunities to gain a meaningful understanding of concepts.
• Incidental learning challenges may contribute to errors rather than the construct being assessed.
• Delays in functioning and performance could suggest the existence of conditions other than visual impairment if appropriate instruction and learning media have been provided by qualified personnel and accommodations have been consistently provided.

Impacts on Executive Functioning and Adaptive Skills

• Students with visual impairments often develop a sense of learned helplessness and overly rely on adult support.
• Causes of learned helplessness

• People are unaware that a child with a visual impairment is capable
• A fear of the child getting hurt or failing
• Interest of time
• Habits are hard to break

• Impacts of learned helplessness

• Executive Functioning

• Students are not given the opportunity to learn and develop skills in planning, organizing, initiating, carrying out, monitoring, and reviewing behaviors, tasks, work, and more.
• Passivity and lack of initiation

• Students who wait for explicit step-by-step instructions
• Limited exploration of the world around them
• Poor problem-solving skills

• Academics

• Students rely on an adult to manage their homework, their school materials, and AT devices
• Students can’t independently navigate technology

• Social impacts

• Students rely on their IA and become more and more distant from their peers
• Other students are less likely to try and form close friendships when an adult is constantly beside the blind student

• Adaptive behaviors

• Students may rely on adults to assist with clothing management and meal preparation when they have the capability to learn the skills to do so themselves.

• Avoiding learned helplessness

• Allow the “Dignity of Risk”

• “Dignity of risk is “the principle of allowing an individual the dignity afforded by risk-taking, with subsequent enhancement of personal growth and quality of life” (Ibrahim & Davis 2012)
• Allowing students to choose their own risks increases self-esteem while eliminating choices diminishes dignity.

• Encourage staff to step back and allow the student the opportunity to fail, and thus, learn.
• Encourage aids to reduce the option of being the social partner, so the student needs to reach out to peers instead.
• See the APH article on preventing learned helplessness
• See the Camp Abilities post on Dignity of Risk

Considerations for Social, Emotional, and Behavioral Functioning

Include social, emotional, and behavioral functioning in your evaluation. Students with visual impairment may need explicit instruction and support to facilitate social interactions and relationships and mental wellness.

Social Interactions

• Many social rules are learned at a young age by visually observing the world. Some of these skills typically sighted students expect one another to have, but our students with blindness or low vision may struggle in these areas, such as the following.

• Eye gaze frequently establishes turn-taking in a conversation.
• Posture, body language, and facial expressions can all indicate a peer’s interest level in a conversation.
• Smiles and eye contact demonstrate an interest in social engagement.
• VI children may miss the opportunity to visually observe social group rules, such as how a specific game is played.
• Students with VI may engage in inappropriate movement, as they don’t have the visual experience to notice that others around them are not engaging in similar movements, or, because they are unaware that others can see them clearly.

• Students with VI may experience the following (Sacks et al., 1992):

• Social integration challenges, feeling isolated
• Fears or lack of practice with joining groups of peers
• Pressure to fit in

• "Given the high rate of social skills difficulties reported in this population and the effect of these difficulties on all stages of development, it seems particularly relevant for practitioners to integrate social skills assessment and explicit teaching into intervention programs." (Caron et al., 2023, p. 128)
• Resources for intervention:

• Sarcasm Detectives (APH Hive course): Check out this course to observe a lesson and learn how to guide students to understand sarcasm through focused social language activities.
• Getting to Know You: A Social Skills and Ability Awareness Curriculum (Crow & Herlich, 2012) from the American Printing House for the Blind is for children with and without visual impairments that promotes understanding of how individuals with blindness or low vision develop social skills. The curriculum includes lessons for kindergarten through second grade and third through fifth grade.
• Empowered - Activity-Based Self-Determination Curriculum (Cleveland et al., 2007) from the Texas School for the Blind and Visually Impaired has 23 units that cover topics, such as self-awareness, identification of strengths and challenges, stress management, self-acceptance, coping and compensatory strategies, self-assessment process, personal control, communication basics, communication types (passive, aggressive, passive/aggressive, and assertive), self-advocacy, decision making, values, future planning, goal setting, problem-solving, conflict resolution, and rights and responsibilities.
• The PEERS Curriculum for School-Based Professionals Social Skills Training for Adolescents with Autism Spectrum Disorder (Laugheson, 2014) was not created for students with visual impairments; however, the structured, explicit lessons are helpful for students with social challenges. Staff at CSB have adapted some lessons with tactile and large print materials. Topics covered include starting, joining, and exiting conversations, communicating electronically, choosing appropriate friends, using humor, having sportsmanship, and handling arguments, teasing, embarrassing feedback, physical bullying, and cyber bullying.

Mental Health

• “Assessment of emotional status should be a component of every assessment of a student who is blind or visually impaired” (Russo, 2003, p. 169).  
• Routine assessment of mental health is recommended for individuals with visual impairment (Demmin & Silverstein, 2020), specifically screening for anxiety and depression (Lundeen et al., 2022).
• Research “suggest[s] that a substantial proportion of students with visual impairments may experience more emotional and behavioral difficulties than the average youth while lacking the adaptive skills to manage their conduct adequately” (Sims et al., 2021, p. 310).
• Per “Visual Impairment and Mental Health Needs and Treatment Options” (Demmin & Silverstein, 2020),

• “[t]reatment of mental health problems in visually impaired populations may be lacking for numerous reasons, but one issue may be the tendency of both patients and providers to focus on the physical aspects of vision loss, or the need to re-learn practical skills, rather than the psychological and emotional impact, perhaps based on the misguided assumption that mood will necessarily improve after new skills are learned. Another contributor to lack of mental health treatment is that people who experience vision loss may be more inclined to rely on personal resources (ie, to attempt to maintain their independence), rather than to seek help.” (p. 4236)

• Visual Impairment and Mental Health Handout (Nguyen et al., 2024) includes information on the impact of visual impairment on development, current data on mental health outcomes, and practical strategies and resources to support the mental health of youth with visual impairments.

Testing Selection & Administration (Topic 4)

• There is no one-size-fits-all assessment battery.

• Test using the student’s learning media (e.g., braille, auditory, large print, tactile graphics, dual media learners) identified by a TSVI.
• Psychoeducational Evaluations of Students with Visual Impairments -  What tests can I use with a student who is blind or visually impaired? is a link to an appendix listing standardized and non-standardized tools within a more extensive document about psychoeducational evaluations of students with visual impairments.
• Include visual-spatial skills in the assessment if the student uses vision effectively for some learning.
• Cognitive functioning related to auditory learning skills (e.g., short-term memory, working memory, and listening comprehension) is crucial to assess.

• Evaluators must collaborate with a TSVI during planning, administration, and interpretation. The evaluation often will take much more time since the following are needed.

• Consultation with the TSVI about optimal positioning of materials, lighting, and assistive technology.
• Planning for appropriate accommodations and testing measures.
• Error analysis with consideration of the individual learner’s profile.

• Standardized testing considerations

• The few tests created specifically for individuals with visual impairments often have problematic psychometric properties or outdated norms.
• It is permissible to use tests normed on sighted individuals; however, remember that most tests are inappropriate to use exactly as they were standardized since the tests were developed to be used with sighted individuals.
• Document any breaks from standardized procedures, and consider whether qualitative interpretation would be more meaningful and appropriate.
• Standard scores, scale scores, percentiles, and age and grade equivalents may mask a student’s actual skills and abilities.
• Increase the emphasis on observation to supplement test results, including response to frustration, task attention, and general problem-solving approach.
• Consider item content and potential impacts of VI during interpretation.
• Reflect on whether the intended ability is being measured or if access to learning materials and the environment is being measured.  
• “[F]or individuals with sensory impairments, best practice may involve de-emphasizing the prominence of standardized intellectual and achievement testing in the psychoeducational evaluation” (Lund et al., 2014, p. 143).

Braille and Tactile Graphics (Topic 5)

• Braille is complex (e.g., uncontracted vs. contracted UEB, Nemeth vs. UEB for math and science, and double-sided [interpoint] or single-sided).

• Do not transcribe standardized tests to braille.
• Team administration with TSVI is advised if the student is using braille.

• Tactile adaptations (e.g., tactile graphics) may not increase accessibility for those who are not accustomed to gathering information through that sense.

Use of Visual Stimuli

• Use test materials with visuals if the student uses vision for learning; however, It is important to remember that students' visual acuity does not "tell the whole story" of what they can see.
• Refer to the Functional Vision Assessment and Learning Media Assessment results, and consult the TSVI.
• Tests involving visuals may need to be interpreted qualitatively, instead of quantitatively.

Adaptations & Modifications

Adaptations/Accommodations

• Accommodations: changes that provide access that does not alter the concepts being tested or the level of difficulty
• Examples include masking items and using bold line paper, dark marker, slant board, brailler, or abacus.
• Accommodating tests and tasks to make them visually accessible does not account for all the differences that learners with VI may have.
• Results from adapted tests may be reported quantitatively.

Modifications

• Modifications: changes that affect the concepts tested.
• Some examples to carefully consider and potentially avoid (or administer and interpret qualitatively only) are:

• extra time to respond to timed tasks,
• extra time to look at stimuli on memory tasks,
• enlargement on speeded tasks,
• enlargement on visual-perceptual tasks,
• typing/dictating instead of writing by hand on timed tasks,
• text-to-speech for reading comprehension,
• and giving verbal descriptions (outside of what is typically allowed) on visual tasks.

• Do not report results from modified tests quantitatively.

Enlargement

• “Large Print” materials may not be sufficiently enlarged for every student with low vision.
• When using magnification, ensure the entire page can be seen on one screen.
• Consider whether enlargement is accommodating or modifying the task.

• Larger response booklets may lower the difficulty of visual motor integration and control tasks.
• Scanning a wider field may increase the difficulty of a task and impact the student’s performance, such as on tasks measuring processing speed and visual memory.
• If enlargement impacts the level of difficulty, do not report scores.

Adapted Tests Available in Braille and Large Print

Woodcock-Johnson IV (WJ IV): Adapted for Braille Readers

• Age range: 2 - 90+
• The Woodcock-Johnson IV (Cognitive, Achievement, and Oral Language) has adapted versions for large print and braille (UEB with Nemeth, UEB Math/Science).
• To use the large print and braille versions, the user must have the original WJ IV kit (Schrank et al., 2014).
• The braille adaptation of the WJ IV must be administered and interpreted by an examiner team that includes a qualified primary examiner who is competent in administering the WJ IV… "the examiners should have completed at least two practice administrations with individuals who are blind before administering the WJ IV-Braille for the purpose of using the scores and interpreting the results" (Jaffe, 2017, p. 8).
• The adapted versions of the tests use the general normative sample; however, "scoring tables and scoring software were developed specifically for the WJ IV - Braille, factoring in new clusters and item deletions and substitutions" (Jaffe, 2017, p. 27). Use the scoring software provided on the USB stick in the Braille Adaptation kit.
• Review the webinar Using a Team Approach in Evaluating Students w/ Visual Impairments Using  WJ IV Braille Adaptation (Jaffe, 2022a) and accompanying handout (Jaffe, 2022b).

Boehm-3

• Boehm-3 Preschool Tactile Edition and Big Picture Kits are available on APH and measure 26 basic concepts relevant to the preschool and early childhood curriculum. The Boehm-3 Preschool has two age levels:

• 3 years 0 months to 3 years 11 months
• 4 years 0 months to 5 years 11 months

• Boehm-3: Test of Basic Concepts, Third Edition: K-2 Tactile Edition and Big Picture Kit are also available for students in kindergarten to 2nd grade and assess the student’s understanding of 50 basic concepts identified as key elements for instruction and needed for problem-solving, classroom routines, and activities.
• The Boehm-3 K-2 Big Picture, Boehm-3 K-2 Tactile, and Boehm-3 Preschool Big Picture protocols include English and Spanish instructions while the Boehm-3 Preschool Tactile protocols are in English.
• Consider whether the student is familiar with tactile graphics.

Brigance Comprehensive Inventory of Basic Skills II (CIBS II)

• APH released the adapted criterion-referenced versions of the Brigance CIBS II in Uncontracted Braille, Contracted Braille, and Large Print in 2022.
• “This product is a widely used academic assessment that has been adapted for the use of learners with limited or no vision. The assessment has a series of subtests that capture a learner’s ability to complete math and reading/English Language Arts (ELA) exercises. It is intended for use as a standalone, one-time assessment to measure the learner’s abilities on a given day, or as a progress monitoring assessment to track the learner’s growth over time” (APH, 2022).
• For grade levels K - 9
• The original Brigance CIBS II (Green) was created in 2010, including a criterion-referenced version and a standardized, norm-referenced version. Curriculum Associates stopped selling the standardized version in 2020 due to its age.
• The standard version of the Brigance CIBS II is needed and can be purchased from Curriculum Associates. The CIBS II examiner’s manual will no longer be available for purchase once they sell out their limited inventory.

WRAT5 Student Braille (UEB and Nemeth) Books

• A standard Wide Range Achievement Test, Fifth Edition kit is needed as all the materials needed for administration are not included in the Student Braille Books.
• WRAT5 - Large Print: Similarly, a standard WRAT5 kit is needed for administration along with the large print student books.
• Ages 5 - 85+
• The blue and green forms are available in the adapted kits for the WRAT5.
• The WRAT5 has not been normed to the VI population.

Aprenda: La Prueba de Logros en Español, Tercera edición (Aprenda 3)

• Per the Aprenda 3 website, this is an academic achievement test for Spanish-speaking students in K-12 assessing language, reading, math, science, and social studies.
• We have not used this test; however, the website notes under product details that braille and large-print versions are available.
• This test was not adapted by APH.

For other tests, Psychoeducational Evaluations of Students with Visual Impairments - Tests Available in Braille and/or Large Print.

Criterion-Referenced Tests and Informal Tools Developed Specifically for VI (not norm-referenced)

The Oregon Project for Preschool Children who Are Blind or Visually Impaired, 7th Edition (2024)

• The Oregon Project Skills Inventory is a criterion-referenced assessment tool with behavioral statements in developmental sequence from birth to 6 years in the areas of cognition, language, social, vision, compensatory, self-help, fine motor, and gross motor.
• The 7th edition is on an online platform with printable skill checklists and teaching activities.
• Teacher accounts are free, but student accounts need to be purchased to access the Oregon Project materials. Licenses are $65 per student.
• It does not give a score in developmental months but shows the acquisition of specific skills.

2024 INSITE Checklist Instructional Manual: Assessment of Developmental Skills for Children with Sensory Impairments and Additional Disabilities

• The INSITE Checklist assesses gross motor, fine motor, self-help, cognition, social, emotional, communication, vision, auditory, and tactile development (Dennison & Watkins, 2024).

• Intended for use with children with sensory impairments and additional disabilities ages 0-6.
• The 2024 INSITE Developmental Checklist – Individual Test Booklet includes the INSITE Checklist itself, quick instructions for use, and scoring and reporting forms. A downloadable version is available.

Independent Living Skills (ILS) Checklist 

• The ILS Checklist from the Michigan Department of Education Low Incidence Outreach (2018) is an excellent tool for gathering information collaboratively that was created specifically for students with visual impairments.
• Their grade-level guides are also helpful in considering what adaptive behaviors the student can perform.

• Preschool [PDF]
• 2nd Grade [PDF]
• 4th Grade [PDF]
• Elementary School [PDF]
• Middle School [PDF]
• 10th Grade [PDF]
• 12th Grade [PDF]

Total Life Learning: Preparing for Transition. A Curriculum for All Students with Sensory Impairments

• The Total Life Learning curriculum from Perkins School for the Blind was developed for students ages 3 to 22 who are visually impaired, including those students who have additional disabilities or are deafblind (Bridgeo et al., 2014).
• The curriculum assessment tool includes work, organizational, self-advocacy, personal/daily life skills, employment, and post-secondary education.

Social Skills Assessment Tool for Children with Visual Impairments Revised (SSAT-VI:R) 

• The SSAT-VI:R is in Teaching Social Skills to Students with Visual Impairments: From Theory to Practice (Wolffe & Sacks, 2006). Chapter 9: Social Skills Assessment includes best practices, development by school age, and checklists.

Observation of Autism spectrum disorder in people with Sensory and Intellectual Disabilities (OASID) 

• OASID is a semi-structured assessment tool that can help diagnose ASD in people with a moderate to profound intellectual disability combined with visual impairments or deafblindness.
• The manual (de Vaan et al., 2019) is freely available.
• Visit Creative Commons to see a copy of the license.

Making Evaluation Meaningful: Determining Additional Eligibilities and Appropriate Instructional Strategies and Visual Impairment, 2nd Edition 

• Making Evaluation Meaningful: Determining Additional Eligibilities and Appropriate Instructional Strategies and Visual Impairment, 2nd Edition (Loftin, 2022) is available in hard copy and electronic file.
• The book gives information and advice regarding evaluations for students with visual impairments. For example, the book includes observational guidelines and an observational checklist for students with multiple disabilities.

Sample Validity Statements

Example 1

The results of many norm-referenced tests standardized on sighted individuals are conservative indicators of the characteristics being measured. Scores on these tests can also be influenced by the individual’s motivation, attention, interests, and opportunities for learning. All assessment procedures measure a limited sample of an individual’s total repertoire, a snapshot of their skills and development. STUDENT’s visual challenges were taken into account in the selection of all assessment measures and the interpretation of results. The examiner used caution in the interpretation of the results in the context of STUDENT’s visual impairment and limitations of the test(s) due to this sensory disability.

Example 2: Other report writing samples

Example 3: Sample Letter for ID & VI 

VI Eligibility

When assessing students with visual impairments, eligibility is often already established, and the focus of the evaluation shifts to what will help the student to become competent and independent. While eligibility may seem clear-cut in most cases, sometimes there are questions regarding what kinds of visual impairments qualify for special education services.

Per California Code of Regulations, Title 5, Division 1, Chapter 3, Subchapter 1, Article 3.1, § 3030. Eligibility Criteria, “[v]isual impairment including blindness means an impairment in vision that, even with correction, adversely affects a child's educational performance. The term includes both partial sight and blindness.” Students do not need to be legally blind, which is more of a legal term than a functional or educational term. Students with low vision are included within the eligibility criteria. Low vision indicates a loss of vision that is uncorrectable.

The Guidelines for Programs Serving Students With Visual Impairments, 2014 Revised Edition created by the California Department of Education workgroups and committees indicated that “students with neurological visual impairments who are functionally blind or who have low vision, even with best correction” (2014, p. 7) are included in the students who are eligible for special education under the category of visual impairment. Students with cerebral or cortical visual impairment may qualify for special education if the impairment adversely affects their educational functioning, including academic performance, behavior, and social-emotional functioning. The guidelines further clarify that students with learning disabilities who present with differences in their visual processing abilities are not eligible under visual impairment, which is classified as a low-incidence disability (California Department of Education, 2014).

Review Visual Impairment Guidance (recorded webinar and slides) from the OSEP National TA Call on November 17, 2022, for more information about visual impairment eligibility. OSERS clarifies that states must not narrow the IDEA definitions (OSERS, 2022).

• “Definitions and criteria for visual impairment, including blindness, must include any impairment in vision, regardless of significance or severity, that even with correction, impacts a child’s educational performance. Functional assessments should be conducted to determine how a child’s vision impairment impacts their educational performance” (OSERS, 2022, slide 4).

Although reviewing a recent ophthalmological or optometrist report is highly recommended and considered best practice for determining service delivery, federal and state eligibility regulations for special education do not require medical documentation. If a district states that it is mandatory, then the district is financially responsible. Please refer to OSEP 17-05 Policy Letter - Eligibility Determinations for Children Suspected of Having a Visual Impairment Including Blindness under the Individuals with Disabilities Education Act.

“There is nothing in the IDEA or the Part B regulations that would prevent a public agency from obtaining a medical diagnosis prior to determining whether the child has a particular disability, and the educational needs of the child. Also, there is nothing in the IDEA or the Part B regulations that would prohibit a State from requiring that a medical diagnosis be obtained for purposes of determining whether a child has a particular disability, provided the medical diagnosis is obtained at public expense and at no cost to the parents, and is not used as the sole criterion for determining an appropriate educational program for the child. Further, if a State requires a medical diagnosis consistent with the above criteria, such a requirement exceeds the requirements of Part B of the IDEA. Under 34 CFR §300.199(a)(2), the State would be required to identify in writing to the LEAs located in the State, and to the Secretary, that such rule, regulation, or policy is a State-imposed requirement that is not required by Part B of the IDEA and Federal regulations” (Ryder, 2017, pp. 3-4).

Students with visual impairments may have additional challenges with learning that have manifested for reasons beyond or were not primarily caused by their visual impairment, including specific learning disorder, speech language disorders, autism spectrum disorder, and intellectual disability. “Research with young children (birth to five years) who are visually impaired indicates that up to 70% of these children have additional disabilities” (Chen, 2001, p. 8).

Evaluating Co-Occurring Conditions (Topic 8)

ASD and VI

Autism and VI overlapping behaviors.

• Repetitive, sensory-seeking behaviors (e.g., eye pressing, rocking, head shaking, spinning, etc.)

• Behaviors associated with certain causes of visual impairment are listed in “Manneristic Behaviors of Visually Impaired Children” (Molloy & Rowe, 2011).

• Difficulty making friends; a preference for adult interactions due to predictability and ease of interaction relative to interactions with peers.
• Limited and perseverative topics and interests
• Repeated questioning, echolalia, and other repetitive language
• Body awareness/proximity difficulties
• Difficulty with facial expressions and body language
• Atypical posture

Considerations for the differential diagnosis of ASD in medically complicated pediatric populations (Ludwig et al., 2022)  

• This is a handy resource with a table (Table 1) with considerations of behaviors that may be seen in typically developing children with visual impairments, presentation of symptoms of autism in individuals with visual impairments, and special considerations. Ludwig and colleagues provide great recommendations for assessing children with visual impairment or hearing impairment for autism. The full text is available for free.

Autism Spectrum Disorders and Visual Impairment: Meeting Students’ Learning Needs 

• Google Book’s preview feature allows viewing 75 pages of the book Autism Spectrum Disorders and Visual Impairment: Meeting Students’ Learning Needs (Gense & Gense, 2005).
• Chapter 4 on assessment contains evaluation recommendations, informal checklists, observation data collection sheets, and rating scales.  

Observation of Autism spectrum disorder in people with Sensory and Intellectual Disabilities (OASID) 

• OASID is a semi-structured assessment tool that can help diagnose ASD in people with a moderate to profound intellectual disability combined with visual impairments or deafblindness.
• The manual (de Vaan et al., 2019) is freely available.
• Visit Creative Commons to see a copy of the license.

Modification and Validation of an Autism Observational Assessment Including ADOS-2® for Use with Children with Visual Impairment (Dale et al., 2024)

• This is an open-access article about the modification of ADOS-2 Module 3 for children with VI.
• “The modified ADOS-2® (Module 3) provides a potentially valid and reliable assessment tool, with its new scientifically derived diagnostic algorithm and threshold cut-off for identifying children at ‘High risk for ASD’ in this age range. It appears scientifically ‘fit for purpose’ for next stage clinical feasibility testing of the assessment methods. This will potentially lead to an internationally accepted diagnostic ASD assessment methodology for children with VI, in line with those who are typically sighted.” (Dale et al., 2024, Summary section)

Deafblindness

• A student with deafblindness may have additional needs that are beyond the needs of a student with only visual impairments or hearing impairments.
• An American Sign Language (ASL) interpreter or deafblind intervener may be needed to facilitate communication.
• Review guidance for deafblind evaluations.

• Cognitive Assessment of Children Who Are Deafblind: Perspectives and Suggestions for Assessments (Nicholas, 2020) includes information on the limitations of standardized tests, assessment adaptations, and recommendations for evaluation. Nicholas shares about “multi-method, multi-informant assessment, ecological assessment, and dynamic assessment. The use of multiple assessment pathways is necessary to reveal the genuine cognitive abilities and potentials of a child with deafblindness” (para. 1).
• Chapter 3 in the Deafblindness Educational Service Guidelines (Riggio & McLetchie, 2008) reviews issues and practices for evaluating students with deafblindness, such as impact on learning, assessment approaches, authentic assessment, evaluation in natural environments, assessment of literacy and math skills, involvement of families, and planning and implementation of the individualized education program (IEP).
• An Assessment Procedure for Students Who Are Deafblind with Significant Additional Disabilities (Blaha & Hurst, 2023): This paper from the Texas Deafblind Project for TSBVI is intended for team working with children who are deafblind and have co-occurring disabilities (e.g., medically fragile or with orthopedic impairments) that impact their engagement in learning activities. An interview tool and developmental chart with possible impacts of deafblindness are included.
• Cognitive Evaluation for Students who are Deafblind: A Panel Discussion Regarding Best Practices (54-minute recorded webinar) was facilitated by the Texas School for the Blind on March 18, 2024, and included perspectives from a Deafblind Education Consultant, Educational Diagnostician, and Family Engagement Coordinator (Collins, Bennet, Ballah, & Brillhart).

Intellectual Disability & VI

• According to the DSM-5-TR (American Psychiatric Association, 2022), “IQ test scores are approximations of conceptual functioning but may be insufficient to assess reasoning in real-life situations and mastery of practical tasks” (p. 42).
• According to the chapter titled “Assessment of Students Who Have Visual Impairments and Multiple Disabilities” (Bruce et al., 2016),

• “Assessment of students with visual impairments and multiple disabilities will need to occur across multiple observation sessions and in multiple natural environments (those environments and locations in which the student typically participates in the activities being observed). It is important to note that when students with visual impairments and multiple disabilities are unfamiliar with the assessor (a school psychologist, teacher, or specialist) or the testing environment, they are less likely to perform to their maximum potential.” (p. 108)
• “Portfolio assessment is one of the most effective forms of assessment for students with visual impairments and multiple disabilities. In a portfolio assessment, the teacher collects a sampling of student work over time as evidence of the student’s level of performance in one or more areas of the curriculum.” (p. 116)
• “Rather than emphasize scores or grade equivalents, the assessment report needs to focus on what the student can do, is not yet doing, and what would be the most valuable to teach” (p. 134).

• Strategies for Assessing and Teaching Students with Visual and Multiple Disabilities (Smith, 2016) is a recorded webcast from Perkins School for the Blind that provides information about the sensorimotor phase of development and challenges that children with visual impairments and multiple disabilities experience.  

Specific Learning Disability & VI

• Having a visual impairment does not preclude eligibility under Specific Learning Disability additionally if the education code criteria are met.

• “Specific learning disabilities do not include learning problems that are primarily the result of visual, hearing, or motor disabilities, of intellectual disability, of emotional disturbance, or of environmental, cultural, or economic disadvantage” (California Code of Regulations, Title 5, Division 1, Chapter 3, Subchapter 1, Article 3.1, § 3030. Eligibility Criteria).
• Students with visual impairments may have additional challenges with learning that have manifested for reasons beyond or were not primarily caused by their visual impairment.

• Per Whittaker & Ortiz (2019) in their white paper “What a Specific Learning Disability is Not: Examining Exclusionary Factors” for the National Center for Learning Disabilities,

• “SLD can coexist with limited English proficiency as well disabilities such as sensory impairments, motor difficulties, emotional problems, and more. Any such factors may well be seen as contributory to the observed learning problems in the classroom and do not rule out a learning disability as long as they are not the primary reason for such difficulties.” (p. 6)

• Unfortunately, there is a common misconception that students with visual impairments cannot be considered for special education eligibility under the category of specific learning disabilities; the truth is that students with visual impairments can also have specific learning disabilities. The Texas Educational Agency (2022) provided guidance in Sensory Impairments and Specific Learning Disabilities, such as the following excerpt.

• “A common misconception is that the mere presence of a sensory impairment automatically rules out specific learning disability. This is not true. A sensory impairment can coexist with a specific learning disability (including dyslexia and related disorders). Admission, Review and Dismissal (ARD) committees need to consider this possibility, particularly when students’ academic skills are not progressing as expected despite receiving adequate instruction and appropriate supports and services to meet the needs that result from the sensory impairment. It may be that the sensory impairment does not fully explain the student’s current academic underachievement. For some students, the sensory impairment may be a contributing factor but is not what is primarily causing the observed academic underachievement. For these students, a specific learning disability may also be present.” (p.1)

• Effects of a learning disability can show up in braille literacy. It is important to tease out if the student has a learning disability or difficulty with the braille code due to other reasons, such as limited exposure to braille outside of VI sessions or limited frequency or duration of braille sessions with a qualified instructor (e.g., TSVI).
• Consider whether the student is experiencing significant educational needs despite appropriate access provided through accommodations for vision loss.
• Marnee Loftin (2021) recorded a great quick series of videos for the National Center on Improving Literacy, as sponsored by the US Office of Elementary and Secondary Education and the Office of Special Education. Check them out at Visual Impairment and Dyslexia Video Series | National Center on Improving Literacy. Topics covered include:

• Can students with visual impairments have dyslexia?
• How would someone evaluate for the presence of dyslexia in a student with visual impairment?
• What are some of the factors that impact the development of reading skills in students with visual impairments?
• What are some signs a student with visual impairment may need an evaluation for dyslexia?
• What types of intervention strategies are useful for students with visual impairments?

• Unlocking the Foundations of Reading for Students with Visual Impairments (APH Hive course) includes information on the process of teaching reading, examine how to strengthen reading skills for all students, and how to evaluate the impact of visual impairments on learning to read. Modules include setting the stage, science behind reading, essential components of reading, special considerations for reading achievement, developing skilled readers, factors that affect access to reading, impact of VI on reading skills, and assessment tied to literacy. Ohio Center for Autism & Low Incidence (OCALI) and California State University, Los Angeles developed this course.

Resources for Further Learning and Connection

Databases for Etiologies of Vision Loss

The etiologies of visual impairment are wide-ranging and include (but are not limited to) the following: achromatopsia, albinism, aniridia, anophthalmia/microphthalmia, cataracts, congenital optic nerve anomalies, optic nerve atrophy, optic nerve hypoplasia, septo-optic dysplasia, cortical/cerebral visual impairment, diabetic retinopathy, glaucoma, juvenile macular degeneration, retinitis pigmentosa, retinoblastoma, retinopathy of prematurity, and trauma (eye injury). Further information about these and other etiologies of vision loss can be found in the following databases.

• American Academy of Ophthalmology - EyeWiki 
• American Association for Pediatric Ophthalmology and Strabismus - Eye Terms & Conditions
• National Center for Biotechnology Information Bookshelf - StatPearls 
• National Institutes of Health: Genetic and Rare Diseases Information Center 
• National Eye Institute - Eye Conditions and Diseases 
• National Organization for Rare Disorders - List of Rare Diseases 

Assessment Resources

• Making Evaluation Meaningful is a book by Marnee Loftin (2022) intended to provide guidance to evaluation personnel, teachers of students who are visually impaired, and families in making the best possible decisions regarding student evaluation.
• Psycho-educational Assessment in Children with Visual Impairments is a free online course (registration required) designed for psychologists with expertise in the psycho-educational assessment of children and adolescents. This course has additional information for Teachers of Students with Visual Impairments who are supporting psychologists and may be useful to other assessment professionals.
• California School for the Blind Assessment Center has various resources that we created posted.

General Visual Impairment Resources

• Perkins eLearning Resources has extensive opportunities for online learning including podcasts, videos, and articles.  
• Texas School for the Blind has extensive resources and online learning opportunities.
• Paths to Literacy for students who are blind or visually impaired has many excellent resources for parents, educators, and assessors on reading, writing, and math.

Cortical/Cerebral Visual Impairment (CVI) Resources

• PaTTAN CVI Course is a series of webinars that progress from foundational information about children with CVI through assessment methods and interventions.
• CVI Self-Paced Short Course (registration with a Google account is required) is a free online course about CVI, including information about causes, characteristics, screening tools, assessments, and report writing. A Google account is required to access this course. Using an account with an @gmail.com email domain as a school or work email address with a different email domain may cause problems with accessing the course. Class code: 265c263
• Pediatric Epilepsy Surgery Alliance provides educational resources including, “Vision After Hemispherectomy, TPO Disconnection, and Occipital Lobectomy: An Introductory Guide” and “Helpful Educational Strategies For Children With Homonymous Hemianopsia.”

Connections with Colleagues

• Council of Schools & Services for the Blind includes links to schools and agencies that serve children who are blind or visually impaired in the United States.
• APH ConnectCenter Directory of Services contains information for organizations and agencies that serve people who are blind or visually impaired in the United States and Canada.
• BVIPsych Listserv is an email listserv connecting psychologists who assess and provide services to individuals with visual impairments.
• The NASP Interest Group, BVIPsych: School Psychology Services for Students Who Are Blind or Visually Impaired, is available for NASP members.

APH ConnectCenter's Directory of Services

APH ConnectCenter Directory of Services can help you find a variety of support.

The APH Directory of Services for Blind and Visually Impaired Persons is a free, searchable database containing contact information for over 2,000 organizations and agencies that serve people who are blind or visually impaired in the United States and Canada from the American Printing House for the Blind (APH).

To see all listings in your state, select your state from the drop-down menu and leave the other search options blank.

You can call APH's ConnectCenter as well. They have experienced representatives who can provide free information on virtually any topic related to blindness and low vision. Call toll-free (800) 232 - 5463 on Monday to Friday 8 AM – 8 PM Eastern, or e-mail them at connectcenter@aph.org.

Note that a listing in the Directory, which is based on information supplied by the organization itself, does not imply endorsement or evaluation by APH.

California School for the Blind Assessment Center Team

Stephanie Herlich, M.A., TSVI/O&M

(sherlich@csb-cde.ca.gov)

May Nguyen, MS, LEP, NCSP, ACUE

(mnguyen@csb-cde.ca.gov)

Shelby Zimmerman, MA, TSVI/COMS

(szimmerman@csb-cde.ca.gov)

Rebecka Henry, MS, CCC-SLP  

(rhenry@csb-cde.ca.gov)

References

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