Lesson 2: Special Considerations

Questions to ask about the visual impairment and eye condition:

1.	What caused the child’s visual impairment?
2.	Is the eye condition hereditary?
3.	Will the child’s eye condition change?
4.	Where is the problem located?
5.	Do the child’s pupils react to light?
6.	What is the child’s tracking like?
7.	What is the child’s central vision like?
8.	What is the child’s field of vision like?
9.	What is the child’s best viewing distance?
10.How may this eye condition affect the child’s mobility?
11.Are the child’s eyes sensitive to light?
12.Does the child have light perception?
13.Does the child have light projection?
14.Would glasses or contact lenses help?
     15.Would low vision aids help:

Getting answers to these questions is just the beginning.  Observing how the child uses her vision is essential.					
	
Observing vision

1.	Does the child stare at lights or patches of sunlight?
2.	Does she watch or react as someone moves across the room, especially in front of a window?
3.	Does she respond to brightly coloured objects?
4.	Does she respond to black-and-white patterns or other strong contrasts like black and yellow, or yellow and navy?
5.	Does she respond to glittery or shiny objects? To twinkling lights?
6.	Does she attend to a toy close up?
7.	Does she look towards the centre or does she focus better to one side?
8.	Does she notice a toy or favourite object from across the room?
9.	Does she react to things such as mobiles bouncing, curtains in the breeze, or people entering a room?
    10.Does she respond more in dim light or in bright light?
    11.Does she tilt her head to look at an object?
12.Does she look at objects at eye level? Below? Above?
13.Does she recognise her mothers face? At what distance?
14.If she has nystagmus, when is it less apparent?

Observing responses in children with additional disabilities

1. Does she become very quiet and still?
2. Does she turn and hold her head a certain way?
3. Does her breathing pattern change?
4. Does her body become less tense?
5. Does she make sounds when she enjoys something?

Choosing appropriate toys
1.	Is the toy interesting to look at? To listen to? To touch? To smell?
2.	Is the toy easy to hold? Is it too heavy and cumbersome for her small hands?
3.	Is the toy rewarding and fun to interact with?  Is it interactive?
4. Does the toy surprise or frighten the child?

Assignment 2
1) How can a child demonstrate that she is seeing something?
A child can demonstrate they are seeing something by turning and facing it and talking about it. It is important to be sure that a child is not responding to auditory cues. She may say that she can see a ‘black’ dog as it walks past her, which gives indication of seeing it, not just hearing it. She may also look towards someone as they silently walk into the room or walk past her. Even a child with only light perception may visually notice someone walking past a window, creating a shadow. A child may reach out for something that they see which is not making a noise, such as a mobile above the cot or an object on the table. You can observe if a child is turning towards something and following it with her eyes. It is easier to determine what a child can see once they are able to talk because they can tell you what they see. They may initially need support in learning to look for things.
2) List 4 questions that you might want to ask an eye specialist
* Is my child’s eye condition stable? Is vision likely to increase/decrease?
* How will the eye drops affect her vision, will there be any side effects?
* Is there any treatment? Will it improve vision?
* Will glasses or low vision aids help?
3) Give 4 examples of compensatory behaviours that a child may exhibit when she is tired.
The child with low vision is always using their eyes under less than perfect conditions. When tired, she child may squint, cover or close one eye, tilt their head or look as if they are not looking directly at the object. 
4) List 4 possible side effects that medication can have on a child who is visually impaired.
Taking eye drops may blur the child’s vision or cause the child to be more sensitive to light. Other non-visual side effects may include, drowsiness or irritability. Children with additional medical conditions may be on other medications, which can also have side effects. Even over the counter medications are accompanied by possible side effects. Medication that affects muscle tone also affects the muscles controlling eye movements. Side effects can influence the child’s well-being, ability to pay attention, learn and develop. My daughter has been on lots of glaucoma drops and drops following surgery and they have affected her in many ways from physical discomfort to mental and emotional wellbeing. Sometimes we have been able to change medication so that it does not affect her so much.
5) Using an example, explain how hospitalisation can negatively affect the child’s development and ability to play.
My child has had several operations for her eye condition; glaucoma and this effected her most in the early days. As a baby she would lose skills she had just learnt such as making a new sound or movement after an operation. She was also irritable and frightened from all the medical intervention. Because of all the examinations and treatment, she became very sensitive to being touched and was untrusting of trying new things. This affected the amount and type of play we could introduce to her. As a toddler her behaviour was difficult for a while and her anxiety caused by her medical experiences left her anxious which effected her concentration and language skills. Luckily things are much easier now and she is managing to co-operate at hospital and is very interested in what is happening and knows what to expect. I do not feel that professionals in the visual impairment field took on board the effects of hospitalisation and the discomfort caused by her eye condition. She was considered delayed and demanding with inability to concentrate. Her TVI described her as being in a world of her own because she could not get my daughter to do 1:1 tasks. In fact my daughter was scared of being withdrawn into a separate room for fear she might be examined or hurt and wanted to join in with the other kids. Now that Harmony’s anxiety has reduced, she has been able to show that she is equal to her peers and has above average skills in many areas.
6) Explain how you can determine if a child with additional disabilities is enjoying a play activity.
If a child has additional disabilities then extra consideration will be necessary. The child may need more time to acquire a skill or may need other aids. If the child has limited movement, then the parents can create new ways for the child to interact with toys, this may include assisting the child to reach out and touch or varying the child’s position to prevent muscle fatigue.
Changes and progress may come more slowly but with the right approach the child can make progress and show positive responses to play. The child can show interest by becoming very quiet and still and can let you know she is having fun by making sounds and moving her arms and body. Her breathing pattern may also change.
The more one works with the child, the more they wil be able to pick up on the child's individual communication, personality and charachter. It is also important to liase with other adults caring for the child.