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##  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 coordination                          responsibilities. 
* Approach early intervention from a support,               rather than provision of services, perspective. 
* Make home visits            that promote functional outcomes for both the child and                         family. ISSUES SPECIFIC TO VISUAL IMPAIRMENTSBecause 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                  time. 
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 early interventionists. 
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 SERVICESFamily-Centered                                 Practices. 
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. 
Teams 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. 
Support-based                 early intervention. 
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 
-                         friendliness 
- sensitivity 
- 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 development. 
Developing functional                   outcomes. 
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 development. 
Effective home visits. 
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 ongoing                        priorities. REFERENCESChen, 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 http://clas.uiuc.edu/techreport/tech7.html#c2 
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, 95(7), 418-433. 
McWilliam, R. A., & Scott,                     S. (2001). A support approach to early intervention: A three-part               framework. Infants & Young Children, 13(4), 55-66. 
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 Associates. 
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. 
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ERIC Digests             are in the public domain and may be freely reproduced and                       disseminated, but please acknowledge your source. This digest was               prepared with funding from the Office of Educational Research and               Improvement (OERI), U.S. Department of Education, under Contract No.            ED-99-C0-0026. The opinions expressed in this publication do not                necessarily reflect the positions of OERI or the Department of                  Education.                                                                   **Title:** Infants and Toddlers with Visual Impairments: Suggestions for Early             Interventionists. ERIC Digest.                                               **Note:** Digest number E636.                                                          **Document Type:** Information Analyses---ERIC Information Analysis Products (IAPs) (071); Information Analyses---ERIC Digests (Selected) in Full Text (073); **Target Audience:** Practitioners                                                                **Available From:** ERIC Clearinghouse on Disabilities and Gifted Education, Council for            Exceptional Children, 1110 North Glebe Rd., Arlington, VA 22201.                Tel: 800-328-0272 (Toll Free); Fax: 703-620-4334; e-mail:                       [email protected]. For full text: http://www.ericec.org.                   **Descriptors:** Attachment Behavior,  Child Development, Delivery Systems,  Early               Intervention,  Family Needs, Individualized Family Service Plans,               Infants,  Integrated Services,  Interdisciplinary Approach,                     Preschool Education, Toddlers,  Visual Impairments                           **Identifiers:** ERIC Digests                                                                 
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