Dr. Sharp: [00:00:00] Hello, everyone. Welcome to the Testing Psychologist Podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.
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Hey everyone. I am so fortunate to bring you part one of a 2-part series on assessment with visually impaired kids. I have no less than 5 experts who are collaborating on these next two podcasts with me. [00:01:00] They are incredible. They have done so much across their lifespans to work with kids with visual impairments and they bring such a wide range of expertise to these interviews. It’s quite amazing.
So these two episodes are very information-heavy. You will certainly want to read the transcripts or listen multiple times. And just know that we’re really just getting started and doing an introduction to many of these topics. The hope is that you might walk away feeling a little more comfortable working with kids with visual impairment. You might have a better idea of what to do, who to consult with, and how to provide the best support for these kids if they show up in your practice.
I will briefly introduce the 5 of them. They have lengthy bios. I think we could take 20 minutes to read [00:02:00] the biographies of all of them. They will introduce themselves on the podcast as well. You can check out their full biographies in the show notes.
To get started, Dr. Carol Anne Evans is a retired school psychologist and former teacher of students with visual impairments. She’s a consultant for the project TVISP at the University of Utah. She co-authored the chapter on visual impairments in Dr. Jerome Sadler’s 5th and 6th editions of Foundations of Behavioral, Social, and Clinical Assessment of Children. And she co-authored the guidance document, Intelligence Testing of Individuals Who Are Blind or Visually Impaired. She also consulted on the braille adaptation of the Woodcock-Johnson III.
Dr. Marnee Loftin is a retired school psychologist who previously served the Texas School for the Blind and Visually Impaired for nearly 30 years. She also co-authored the guidance document Intelligence Testing of Individuals Who Are Blind or Visually Impaired. She published a book Making Evaluations Meaningful, which addresses the identification and development of IPS for students who are blind or visually impaired. A new edition of her book is coming out in 2022.
Dr. Terese Pawletko is currently a pediatric psychologist. She started as a teacher of the visually impaired then moved on to be a school and clinical psychologist. After completing her postdoc fellowship at the University of North Carolina at Chapel Hill, she consulted with the UNC School of Medicine working with kids with chronic illnesses, kids and adults with autism and their parents, and related service providers. While at the Maryland School for the Blind, she developed the first program in the country for kids with visual impairment and autism. Since 2001, she’s been in private practice evaluating kids with [00:04:00] autism, visual impairments, and other learning and developmental challenges.
May Nguyen is a licensed educational psychologist and nationally certified school psychologist serving the California School for the Blind Assessment Center. She is an adjunct faculty member for the school psychology program at California State University East Bay. She’s co-founder and CEO of the Resilient Minds Collective, a network of educational psychologists, school neuropsychologists, and marriage and family therapists who strive to support individuals of diverse strengths and challenges to see them achieve their goals.
Stephanie Herlich has been a teacher of students with visual impairments and an orientation and mobility specialist for over 20 years. She is currently in the assessment center. Sorry, she is the Assessment Center Coordinator for the California School for the Blind in Fremont, California, and an educational consultant for exceptional teaching in Livermore, [00:05:00] California. Stephanie created the Beginning Braille six-part webinars series available on YouTube. She’s also the author of the Mangled Braille Program. Co-author of Getting to Know You, a social skills curriculum for students who are visually impaired and their sighted peers and contributing author of ECC Essentials Teaching, the expanded core curriculum to students with visual impairments.
So as you can see, there is so much knowledge in these interviews and there’s so much to take away. So without further ado, let me bring you this very informative part 1 of my conversation with these fantastic women on assessment with visually impaired kids.[00:06:05] Well, hello everyone. Welcome to the podcast. As I said in the introduction, this is a first for me having so many amazing people on the podcast at once. So we have 5 of y’all. I’m going to attempt to do a little introduction of each of you here so that people can get oriented to your voices. So May, can you jump in and tell us a little about yourself?
May: Yes, and thanks so much for having us all on, Jeremy. My name is May Nguyen. I’m a Licensed Educational Psychologist at the California School for the Blind Assessment Center Team. We provide assessments for children throughout the state of California. I’m also an adjunct faculty member at California State University East Bay and CEO of Resilient Minds Collective.
Dr. Sharp: Awesome. Thanks. Stephanie.
Stephanie: Hi everyone. I’m Stephanie Herlich. [00:07:00] I am also at California School for the Blind. I’m an Assessment Center Coordinator, a teacher of the visually impaired, and an orientation and mobility specialist.
Dr. Sharp: Cool. Carol.
Dr. Carol: I am a former teacher of the visually impaired, and then I really specialized in school psychology in middle age because the teachers in my area were complaining about the lack of valid testing for their students. And I said, well, what has to happen is somebody that knows vision needs to become a school psychologist. And everybody looked at me. So that’s why I became a school psychologist. I am retired from the practice of school psychology at this point, and a consult on a grant at the University of Utah to train school [00:08:00] psychology students and TVI students to collaborate with each other.
Dr. Sharp: Nice. Thanks for being here. Terese.
Dr. Terese: Hi, I’m Dr. Teresa Pawletko and I also am a former teacher of the visually impaired. I did that for five years before going to graduate school for school psychology and then on to post-doc and pediatric psychology. I’m currently a private practitioner based in Maine, but I track all over the US doing evaluations on kids with vision impairments and consult on autism and vision impairments.
Dr. Sharp: Very cool. All right. Marnee.
Marnee: Hi, I’m Marnee Loftin, and I’m a very happily retired psychologist. My training was not in vision. I did not have any experience at all, and I kind of wandered into the field and ended up enjoying it so much that I stayed for almost 30 years at the Texas School for the Blind.
Dr. Sharp: That’s great. I knew that, but I had forgotten that. [00:09:00] I don’t know if I’ve ever mentioned. I have a really good friend who’s a teacher at Texas School for the Blind.
Marnee: Oh, let’s compare notes later.
Dr. Sharp: We should. Yeah, definitely.
Well, I am thrilled to have all of y’all here. I think I originally contacted May and asked if she’d be interested and then all of a sudden we have 5 people who are interested and willing to do this. And as we were talking, I think this is going to shake out really nicely. We have a 2-part series on assessing visually impaired kids. That’s a topic that we’ve needed to talk about for a long time. I’m glad that we’re doing it right now that we’re finally doing it.
So I want to jump in. In this first episode, we’re really going to focus on the background and definitions. We’re going to talk about collaboration and we’re going to lay some groundwork for just planning our evaluations. So I want to jump into it. I know we have a lot [00:10:00] to cover.
Let’s start with the background. I think Marnee, you’re going to kick us off and tell us a little about the developmental course and some of the things we need to know generally about visually impaired kids.
Marnee: Okay. Terrific. One of the things that I was fascinated by when I started at the school for the blind is it is such a complex population. As I said, I didn’t have any background at all. So my idea of visual impairment was what I’ve learned from reading a Little House on the Prairie. I had the idea that everyone was totally blind and they were all braille readers. And so what I’ve found is that there’s a tremendous variation in terms of the degree of vision loss, in terms of when it occurred, et cetera. And all of those variables are going to impact the developmental course of these [00:11:00] students.
We’ll talk about some of those variables as we go through this first part, but I think what’s important to recognize is that all of them are going to have some differences in the developmental sequence based upon their impaired vision. As psychologists, it’s really important for us to understand what those are so that we’ll be able to interpret the data correctly.
There are several great books and they’re referenced in here about what are the specific developmental, but I wanted to hit just two of them. I think the lack of vision results in some difficulty in achieving motor milestones, that if a child has normal vision, you might look at them and say that that is a child who really has developmental delays if they’re not walking if they’re not sitting up, et cetera, but most kids with a severe vision loss are [00:12:00] going to be a little bit delayed in those areas simply because they don’t have the visual impetus to move. It’s hard to get excited about moving your body if you don’t know what you’re moving toward. So they tend to be delayed in that area along with some other things that we can talk about another time.
Socially, you also see an egocentric approach to the world and to the people in it. They have a difficult time understanding the viewpoint of others in taking the perspective. You’ll see that within their language as well.
When I first went to the School for the Blind, I was pretty convinced that I was surrounded by a whole campus of children with autism because a lot of the early language looks very much like children with autism. You have the accolade like speech, you have the confusion of [00:13:00] pronouns. And for some reason, I never figured out in my course of working with the visually impaired. It clears up with most children. I think as they get the concepts to go along with the language, it doesn’t remain a problem.
Terese can talk about that and break the tail as well as Carol, but it’s important to know that those things vary. You’ll see, in terms of behavior or some passivity oftentimes with kids with severe visual impairment some increase in self-stand behavior, which again, convinced me that I was surrounded by children with autism. So those are some of the general things that you will see.
I think when you’re looking at the difficulty in determining the difference, let me back up, sometimes it’s hard because there can be other conditions that affect the [00:14:00] developmental milestones. So you have to be able to determine what part of the vision may be affecting that. So it’s always going to be critical to look at the age of onset, the basics of the etiology, the age at which it occurred, and then the interventions that the child has had. Those are the most critical in terms of correctly interpreting the differences in presentations. So that’s a very nutshell version.
Dr. Sharp: Sure. Well, I know that we’re going to dive a little deeper here as we go along. So I think that’s a nice kickoff. I’m going to switch it up a little bit, at least from our outline, and go a little out of order in a way that I hope makes more sense. Stephanie, I’m wondering if you might be able to jump in and talk about the different types, for lack of a better word, of visual impairments. And we’ll take it from there [00:15:00] before we go to medical complexity.
Stephanie: So we often use the terms congenital versus acquired or adventitious blind students, congenital meaning that they are blind from birth or no visual memory, and then acquired, they lost vision later.
And there’s a real difference that we see in students who are congenitally blind I think in terms of… my perspective often comes from the educational impacts is what I’m looking at. And so, really a little bit of what Marnee touched on is that we really need to bring the environment to students. And it’s all about in the early ages of experiential learning because they’re not gaining that information from the environment around them.
And then the other piece of this, which I think you were alluding to, Jeremy is we have a whole continuum [00:16:00] of students in terms of students with low vision all the way to students who are functionally blind. And then we also have students with additional disabilities along that continuum- students with additional disabilities who have low vision, and students with additional disabilities through functionally blind. And so, there are no two students that are alike.
The legal definition of legal blindness is different than what we are working with in the school. In the schools, we talk about the educational impact. If a student is educationally impacted by their visual impairment, if there’s this suspicion of that, then we would evaluate that and possibly bring them onto our caseloads. And so that’s something to really be aware of is that legal definition is [00:17:00] different from the educational definition.
It is the teacher of the visually impaired that usually determines whether or not a student is going to be a braille reader, and that’s based on our assessment that’s called the learning media assessment. And so not all students with a visual impairment are going to be braille readers. We would have students using large print technology, dual media, and braille readers.
Dr. Sharp: I get you. Just as we get into this, there are so many layers and nuances to think about. Carol, do you want to elaborate a little bit? We have this topic of ocular versus brain-based. I wonder if you might be able to jump in and talk about that a [00:18:00] bit.
Dr. Carol: I’d be happy to, and thank you very much for inviting me. We tend to sometimes think that the etiology of vision loss is either originating in the eye itself or based on insult neurologically, but you can have both. I’ll give you a few examples of some eye-based. I’m looking at my file on eye conditions here which I’d be happy to share with anyone who would like it. But other than refractive errors like nearsightedness, farsightedness, astigmatism, we have a whole range of things that can be caused by defects in the eye and the surrounding [00:19:00] organs of vision.
We have congenital cataracts and that tends to be hereditary. It runs in families. It used to be that they wouldn’t remove cataracts for six months or a year and people went around their whole lives with low vision because of that. And now they take cataracts off typically as soon as they are developed, as soon as they’re noticed, excuse me, as long as the child is healthy enough for surgery because the retina undergoes physical development because of exposure to light. And so, you can have a really serious delay in the development of vision if you don’t remove those early.
Then we have early diabetic retinopathy. [00:20:00] There are children born or very early in life diagnosed with diabetes. And then they have to really watch out for indications of vision problems. I knew an adult who was diagnosed with diabetes based on his eye exam. The doctor noticed changes in the retina and he didn’t even know he was diabetic.
Then we have Retinitis pigmentosa which is a deterioration of the retina. And that tends to typically start in the periphery and gradually encroaches on the central part of the visual field. And there’s no cure, but treatment may slow progression.
We also have juvenile macular degeneration which is a loss of vision in the [00:21:00] central field typically. And they have decent peripheral vision, which is really good for travel but eventually, you have reduced acuity in the peripheral part of the visual field.
And then we have a traumatic brain injury. Here’s where we get into neurological causes of visual impairment. Traumatic brain injury can also include stroke and sometimes babies have strokes in utero. They are born having had a stroke and so they can have many different kinds of field deficits depending on the location of the stroke within the brain. We talk about [00:22:00] the visual cortex in the posterior part of the brain, but the whole brain sees, so the visual pathways travel through the whole brain and a stroke or some kind of traumatic brain injury can depend on which part of the brain is injured and how severely. So there’s tremendous variability in the qualitative aspects of vision.
And then some eye disorders also have nystagmus as one of the features. And that’s a rapid involuntary movement of the eyes. It can be either horizontal or vertical or it can be circular. I’ve seen it. And if a child has a usable vision for schoolwork, [00:23:00] for reading, then you have issues of great differences from child to child depending upon what part of the field is affected.
Sometimes, that’s treated with eye muscle surgery to reduce the extent of the movement and no point training, which means to train the gaze in the direction that reduces the extent of the movement and postural changes. And another thing that can be done is the use of magnification or bringing material closer to enlarge the image. Typically, nystagmus slows down the speed at which children can read because the image is moving.
Dr. Sharp: Right, thank you. [00:24:00] Just as you talk, a reflection, of course, this is obvious to all of you, I’m sure, but just echoing that idea that visual impairment is not just a monolith. There are so many different varieties. I’m really glad that we’re going to be able to dig in and just get more information on how each of these might manifest and what we might do. So that might be a nice segue, May, to talk about how this plays into the classroom. I love this difference between visual processing versus visual impairment. So could you speak to that a little bit?
May: Yeah. And I know there’s so much we want to try to cover in a short amount of time, so I’ll try to keep it brief. So a lot of times school psychologists might not have many children with [00:25:00] visual impairments on their caseload since it is a low incidence disability. And so, when they get their first child who has a visual impairment, it might be the first time they’ve encountered a teacher of students with visual impairments, like Stephanie, an orientation and mobility specialist.
And so they might assume like I did the first time I had my first VI case that the teacher of students with visual impairments would take care of all the academic assessment and take over the role of the RSP resource specialist or special education teacher on my assessment team. And I know some psychologists, they do the academic testing as well and might think, oh, the TVI would help with that because I don’t read braille. I’m not saying that everyone needs to learn how to read braille to assess students with visual impairments, but you need to work very closely [00:26:00] with a teacher of students with visual impairments. I’m going to shorten it to TVI to make it a little bit more efficient.
But when we’re looking at what a TVI assesses, we’re usually looking at visual functioning and learning media. So how the student will best access their academic material. And when you’re starting to suspect a learning disability when you’re looking maybe at potential challenges with various processing areas, that’s when you might want to bring on other members to the team if you’re a school-based practitioner such as you’re a resource specialist or special education teacher or the psychologist doing additional testing, looking at processing and academics and you would collaborate with the TVI on how to best provide access to those different tests.
We’ll go deep into that more [00:27:00] probably in a little bit, but one thing for psychologists to understand is that most TVI graduate training programs do not include training in standardized assessments. Many of the tools that TVI use are informal or criterion-referenced. So, we need to help them to understand how we need to provide the tests or how tests are interpreted, and they can help us to understand when is it better to interpret tests more qualitatively rather than quantitatively and help us to understand how we can try to test the limits when we’re looking at different modalities.
Dr. Sharp: Can I ask you a question real quick? Are there, this is open to anyone, are there graduate programs out there that specialize in the evaluation and test? I’m thinking of psychological programs, but it could be SLP or any other field, but are there programs [00:28:00] out there that specialize in the assessment of visually impaired kids?
Dr. Carol: I’m glad you asked that question, Jeremy. Yes, I am consulting currently with a program at the University of Utah that has a cohort. Well, it’s a 5-year grant. I’ll be 80 when it’s complete. So I’m there to pass on what I know before I forget it all. What they are doing is you have a group of students teaching the visually impaired and a group that are students in school psychology, it’s a graduate program, and they are learning. They are cross-training taking parts of some courses together so that they can learn this collaborative model of assessment.
And it’s the [00:29:00] first one that I know about. I know that there have been programs where students are required to take a course in visual impairment in the course of their school psychology training, but this is the first program that I know of. And it would be wonderful if it would spring up all over the country. And then we would get a generation of people who know how to collaborate.
Dr. Sharp: Sure. I was just thinking about how we didn’t get any training in grad school on assessing visually impaired kids. And like you said, it’s a low incidence disability but in children. So it’s still important though. And it’s just one of those areas. So, thanks for answering that. [00:30:00] Let’s go on, Stephanie.
Stephanie: Oh, I was just going to say one thing real quick, just because I know most people listening now are school psychologists. And just to let you know that… I’m coming from California and every state operates a little bit differently. I do think the majority of states that a teacher of the visually impaired, in order to get that credential, is a graduate credential. And within the program, a big piece of it is assessment.
Teachers of the visually impaired, like May said, do the functional vision assessment and a learning media assessment. But then also we see our role as TVIs, it’s collaboration. And I know this is a theme in our assessment program, and we will probably talk about it a lot through this podcast is so key because it is a low incidence population.
We know [00:31:00] that all the specialties out there working with students who are visually impaired aren’t necessarily familiar, whether it’s a psychologist or a speech-language pathologist, or a physical therapist, or any other specialists. So our role is to really be there to help you understand, you being psychologists or whatever other specialty you are, the implications of visual impairment in assessment or how to work with our students. So that’s such a key message. It is like, talk to the TVI about how to best assess students so that they are as valid as can be.
Dr. Terese: In addition, many TVIs have had lifelong relationships with the children that you are going to be evaluating. So some of the teachers, TVIs have been seeing these children since they were preschool or younger. So the wealth of information and experience [00:32:00] is beyond.
Dr. Sharp: Sure. Marnee, I see you trying to jump in. What’s up?
Marnee: I keep waving my hand like a purse trader. Texas is frequently very behind in terms of progress et cetera, but they really have done some great things in terms of assessment of this population. Texas has a fairly unique professional called an educational diagnostician. They do most of the testing in schools. And so two universities have really facilitated people becoming a master’s level TVI along with the diagnostician. So it’s really coming along in that area.
The other thing that I thought was really cool, we have a statewide certification and licensure program in Texas where you have to take, I think it’s up to [00:33:00] 40 hours a year and a part of the training that you have to have it’s three hours in cultural competency. And they have added sensory impairment to that as an option for people. So again, I think it may not be an immediate fix, but it’s a step in the right direction.
Dr. Sharp: Sure. That’s great to hear. Goodness. Before we totally move to collaboration and all the ways that that can and should happen, I wonder if we might backtrack, I mean, could any of you speak to just basic statistics around visual impairment and like how many… I know this is going to differ, but what percentage of kids in public schools versus…
Marnee: Yeah, I just finished a workshop. So I tracked that down in terms of the number of children in the US who are special [00:34:00] Ed and served under VI is less than 1%. And it’s like 0.4%, incredibly small number.
Dr. Sharp: Sure. I might be getting too much in the weeds here. Just let me know if that’s the case. What percentage of those kids are in public school versus like a Texas School for the Blind or a school specifically for kids with visual impairment?
Dr. Carol: The majority of the kids… Go ahead, Marnee.
Marnee: I was just going to say for a while, we had yearly conferences with psychologists at the different schools, but I think the whole movement in the states has been children remaining in their public school and being [..]. And I think all of us have tried to come up with special programs. Like at Texas, they have summer programs, they have various things like a space camp, a different advanced placement type classes. And I think [00:35:00] the commitment in most places is that kids need to be with their families. And we’re hoping that the outreach department and all of the schools are growing like crazy for that reason to provide support to local schools.
Dr. Sharp: That’s great.
May: And to provide a little bit of clarity, not every state has a school for the blind, but there are quite a number of states that have a public or a state-sponsored school for the blind or a school for the deaf or a school for blind and deaf. And there are also private educational organizations that serve the sensory impaired population. So there’s quite a variety of programs but when we’re talking about the Texas School for the Blind and the California School for the Blind who are public state agencies, so students and families do not pay to attend these [00:36:00] kinds of institutions.
Dr. Sharp: I got you. Thanks for making that distinction. That’s important. Well, I know that we touched on the importance of collaboration just a few minutes ago. Let’s dive into that. Stephanie, do you want to start us off?
Stephanie: Sure. I guess I jumped the gun a little bit. I talked about it a bit before, but in previous presentations we’ve done in the past, we talk about the steps to assessment and the TVI being super integral throughout and collaborating.
We highly recommend that before anyone else has started in our assessment, the TVI needs to jump in and begin with the functional vision assessment and learning media assessment and share that [00:37:00] with all of the other colleagues because you certainly wouldn’t want to do a test in large print when that student is a braille reader or do it with the incorrect style of magnification. There are so many different things that could happen there.
So there’s the process of getting that assessment started, but it’s really important to know it’s unusual. And then I think in a lot of other IEP teams, everyone works individually and they’re all in a little bubble and then they bring it to the table, whereas with a student with a visual impairment, it’s so all-encompassing to everything that they’re doing that the collaboration is just key.
And so in areas that a TVI can assist is [00:38:00] really with the classroom well, or anything having to do with learning media, but also don’t forget about technology. These days, everything leads back to assistive technology. So some areas have an AT specialist who may jump in and provide that assessment, but I would always encourage that again, the TVI be part of that because the equipment used by our students is so specialized.
And then the other thing I want to make sure to mention here is we talk a lot about the expanded core curriculum. And so, I think it’s important that in this collaboration that everyone understands, that all the specialists understand that piece.
There are these nine areas that have been identified as the expanded core curriculum. And these are the things that students with visual impairments aren’t going to get just [00:39:00] generally, but where other students with sight would. For example compensatory learning which is braille and sensory needs, and then there’s assistive technology, there’s orientation and mobility. Social skills is a big one where there’s some fabulous overlap with the testing that a psychologist would do.
So again, it’s really important to collaborate to make sure we don’t want to double test a student but we can work together to cover those skills. And I know that even May and I often in our assessments we’ll work together on some of these things because we’re both doing them. So self-determination is another one that I know psychologists touch on. So that’s why this career education, all of these are overlap and we want to work together on.
Dr. Sharp: Nice. As we were prepping for the interview, I know that we’ve talked about how there are so many folks that could be involved in this process. [00:40:00] You touched on two. What other specialties or people might jump into this process here?
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May: There could be a lot of people and we hope that many different specialists would be involved to share their knowledge. So another position that we mentioned a little bit earlier is orientation and mobility. Orientation and mobility specialists help with many different aspects of the ECC or expanded core curriculum that Stephanie just mentioned, not just navigating their environment but helping them to figure out how to navigate their independent living skills, which is big for our students with visual impairments.
We want them to be as independent as possible. Many times for children with visual impairments, it’s so easy for adults to do things for them and try to be helpful but unfortunately, being overly helpful to the point where our students tend to become passive and not engaging [00:42:00] actively with their environment and with the daily routines that other students might learn how to do through incidental learning or just learning that happens through observation and practice. Stephanie, do you want to add anything about O and M?
Stephanie: No. I think that they’re definitely a key person that is part of that assessment, and just others. Oftentimes we see APE missing from the group. And that’s a really important piece for our students. Certainly, speech and language pathologists. Oftentimes, I think when students early on are tested, this visual impairment piece, for whatever reason, things get attributed to the visual impairment rather than recognizing that there’s going to be the same incidents of [00:43:00] other needs and disabilities within the visually impaired population as in any other population.
So SLP is often a huge person on the caseload. PT, OT, any of these providers. AT I mentioned. And that’s one that you definitely want to collaborate with because our needs are so great. And then even just a deaf and hard of hearing teacher and knowing that if a student… and this is an important piece because we see this missing a lot. I might be going a little off, but I want to throw it in that, if a student has a visual impairment and a hearing impairment, you want to be sure to classify them as deaf-blind because once you’ve got two sensory impairments going, there are now even more things that we need to look at. We’re talking even low vision or mild sensory loss. I’ve worked with a lot of teams that are [00:44:00] reluctant to or don’t understand that, and they feel like they’re not going to put that DHOH designation because they’re not totally deaf or completely blind, but even just some mild of either one, that’s a big consideration.
Dr. Sharp: Sure.
May: Sorry, I just want to add a little bit to the deaf-blind comment is exactly what Stephanie was saying. It’s not just the addition of visual impairment plus having a hearing impairment. It’s better to conceptualize it as a multiplication type of challenge where there are all these other challenges that might present for a student who has multiple sensory impairments.
I know that we talked a little bit about having OT. OTs can be really important for our students because they might be sensory seeking or get overwhelmed. And I know that Terese, you probably have a lot of experience working with these [00:45:00] children who are identified as BI and autism. But students who are identified strictly as having a visual impairment have many different accommodations that they might benefit from that might not be as apparent as a student who might be very externalizing in their sensory behaviors.
The same with speech-language pathologists in districts who might think, oh, they scored average for a receptive and expressive language, their articulation is fine, their fluency is fine, but that pragmatic language component and applying pragmatic linguist skills can be really challenging for our students. They might be able to answer a question on a test and know what the right answer is for a social scenario but to actually apply it, that’s like a whole other story.
Dr. Sharp: Right. Well, that makes me think too, we should probably circle back to Terese to talk about some of the overlaps with medical complexity and other diagnoses. We [00:46:00] skipped over that part which is pretty important. Can you speak to that? You mentioned autism certainly, but I know there are other considerations as well.
Dr. Terese: There are quite a few. I mean, Carol alluded a little bit to the traumatic brain injury population. So if a child’s had a stroke and things. We have a number of children that are in the vision population that are ex preemies. And so that population may have had brain bleeds or abnormalities in terms of neurological development. There’s a particular eye condition called optic nerve hypoplasia and ONH is a brain-based visual impairment. So, even though it’s called optic nerve hypoplasia, it really goes beyond that. So they may be absent or within Corpus callosum, there’s often the pituitary and hypothalamus involved.
And so if we’re not making sure that the family and the child are connected with neurology and endocrinology and things because these kids [00:47:00] often have low growth or abnormal growth development in addition to diabetes insipidus, in addition to difficulties with their cortisol system, their adrenal system is off. And that’s just one example.
The complexity of children with vision impairments now is really magnified. We talk about, and this is not a derogatory statement but kind of vanilla blind where it was just blindness that was the characteristic of the population, but now many of the children that we’re servicing in the field of special education have multiple and competing and complex disabilities. It’s less often the case that it’s just a vision impairment at this point.
Dr. Sharp: Sure. Could you give any more detail around, I’m particularly interested in the overlap with autism and just because I work with a lot of those kids. It’s fairly common.[00:48:00] Dr. Terese: Well, there are at least 14 eye conditions that have a subgroup of kids with autism spectrum disorders in them. And so there’s a genetic component to that. So a number of children with optic nerve hypoplasia, if you take transparency of the brain of a child with optic nerve hypoplasia and the transparency of a child with an autistic brain and overlap them, there’s a tremendous amount of overlap with some of those kids. So that’s why the kids may look autistic-like but in fact, have autism spectrum disorders because of the abnormalities in the brain.
Some other eye conditions are anophthalmia or microphthalmia, children with albinism, which may be surprising, optic nerve hypoplasia, something called Leber congenital amaurosis, Apert syndrome. So those are just a few of the eye conditions that have at least a subgroup of kids with spectrum disorders on them.
And it’s really, I think one of the things Marnee was mentioning earlier in terms [00:49:00] of the Texas school, where the kids have echolalia or the kids had stereotypic behaviors, that by themselves does not autism make. It’s really, what’s the cluster and what’s the intervention that’s been provided, and what’s the developmental trajectory that those kids have had because even typically developing children go through a period of echolalia, but it’s protracted and it’s also the difficulties with transitions and change and rigidities and things like that. So it’s the whole package that people need to really take into account. I’ll talk more about that in our next session.
Dr. Sharp: Okay.
Dr. Terese: Does that help?
Dr. Sharp: Absolutely. I have so many questions, but I know we have a lot of content too, so we’ll say, I’ll try and keep track in case we don’t get to some of these. I will ask though specifically, and you tell me if this is jumping the gun and getting into our next episode, but I am particularly interested in the overlap with echolalia, and like you said, stereotype behaviors. [00:50:00] This is a naive question, but what’s the etiology of that in visually impaired kids if they’re not autistic as well? What accounts for that?
Dr. Terese: In terms of echolalia, it’s some of the language development where kids are really practicing and rehearsing and trying to get a sense of what the connection is with the real world. But I think in terms of the stereotypic behavior, some of the children if they’re not adequately stimulated or they have some cognitive and significant cognitive impairments, a lot of kids will engage in more repetitive kinds of behaviors. So I think you have to look at what some of the basis is and are they getting adequate stimulation from their environment and from the people in their environment too.
The other thing I always think about Jeremy is, are we teaching these children how to use their hands? Because if we’re not teaching them how to use their hands and how to explore things systematically, then what they’re going to do [00:51:00] is a repetitive action. So I never assume a child knows what to do with their hands unless I’ve deliberately taught them what to do with them, how to engage with materials, and how to explore their environment effectively. So I think it’s really incumbent on us to rule that out as another possibility.
Dr. Sharp: Sure. That’s a great point. Thank you.
Dr. Terese: You’re welcome.
Dr. Sharp: So before we close the loop one collaboration, was there anything else to say, any other folks, or anything to highlight in the collaborative realm for us to be aware of before we move to actually plan these evaluations?
May: I just wanted to add that families are so resilient to the whole collaboration process too. Sometimes we might just focus on who is in the educational environment, but our families might see one view or snapshot of a child in the school setting and have a completely different child, either more or less independent [00:52:00] at home. So it’s really so important to have the parents be active members of the evaluation process and to do if available observations of students within the school setting and if possible home and community setting. I know for orientation and mobility specialists, that is one part of their evaluation is to see them in multiple settings.
Dr. Terese: Absolutely. Jeremy, I travel around to do evaluations on children with vision impairments. And before I see a child, I ask families and schools to send me video clips because it’s really incredibly powerful to get a sense of what the child is doing before I ever show up outside. And I have the luxury of going to wherever the children are located as opposed to having an office-based practice. So it’s really invaluable to get a variety of video clips of the child’s family.
Stephanie: We pretty much do the [00:53:00] same whenever we do a field assessment. Now, our assessments are outside of the IEP process but we do, do a home visit and sometimes we see a completely different child at home than we do at school. 100% that is super important.
Dr. Sharp: Right. Well, it sounds like there’s a parallel there with typically developing children we see. That happens, right? Terese, I’m going to ask you one very practical question. I’m imagining listeners might be curious about this. Are you traveling to different states to do these evaluations?
Dr. Terese: Yes.
Dr. Sharp: And so are you just licensed in a lot of states or how does that work?
Dr. Terese: I’m licensed in Maine and in New Hampshire and certified in Maine, New Hampshire, and Connecticut. So I have multiple certifications and I’m trucking mostly in New England. But what I’ve done is I’ve also checked the licensing boards in other locations to see, [00:54:00] like, in Massachusetts, I can work 12 calendar days without being licensed or certified so long as I’m licensed somewhere else. So I’ve checked those kinds of things. It also took me to Ireland, which was really exciting and I didn’t need to worry about licensing there.
Dr. Sharp: Oh, yeah. That’s great. Well, thanks for indulging that question. Like I said, I think some people are probably interested in the logistics of how you might do something like that.
Well, let’s talk about the evaluation process. It just makes me think as we get into this topic of the… I can only remember one individual in our practice who came in, who was visually impaired. I did end up consulting with my colleague at Texas School for the Blind, who consulted with some other folks down there. And I think we did our best, but it was admittedly not ideal. This was an adult. So, I’m curious [00:55:00] for those of us out there who might be trying to plan an evaluation, where do we even start? What’s important to know? Marnee, do you want to start us off?
Marnee: Yeah, I’m just thinking boy, in a break time, that’s tricky. I guess the first thing is to really reassure yourself that it is possible. I have people calling all the time and saying, I’ve got a student who’s visually impaired and we know it’s impossible because there are no instruments normed on kids who are visually impaired. And so I think starting out and talking about the issue of normative data and then talking about what are some of the resources will provide that level of reassurance.
It’s interesting because they have had multiple attempts to develop an instrument that is actually for children who are visually impaired. [00:56:00] They’ve all been unsuccessful for some of the reasons that we’ve talked about because it is such a complex, very different population. And so, the instruments that they have developed typically indicated that all children who are visually impaired are within the genius range because I’ve done such a good job of picking out things that kids who are visually impaired do well. I found one last night that came from England that I have in my files, it was done in 1945. And it was just as unsuccessful. It was commissioned by the Royal Institute of the Blind.
I think what is the common belief among people who work in the field of visually impaired is that you accommodate prior to the administration of the test according to the [00:57:00] guidelines that we’ll talk about in a bit, but what we want to do is to compare children to other individuals without a visual impairment because they’ll be participating in the world without those types of changes in normative data.
Right now, I don’t think there’s a huge move toward developing another test that’s normed upon students that are blind. Somebody in the group may disagree with me on that, and they may have information that I don’t. But I think all of us who’ve worked extensively have spent our time trying to talk about ways- how do you test to get the best information possible?
One of the things that are referenced on some of the materials that I think it’s important for anyone who’s going to be testing a child with a visual impairment is the position paper on guidelines for testing [00:58:00] children who are visually impaired. And it’s on the website of the American Printing House for the Blind. Carol and I were 2 of the 3 people that did it. And so, what we tried to put in there is everything that we know that will make your testing a more successful and representative snapshot of this child.
I think the other thing that we always caution about when we’re talking about whatever resource you use is that you need to realize number one is going to take a lot more time because you have to spend more time in observation and interviewing people who are familiar with the child, and then it’s going to be important that you interpret the data very cautiously. You’re not getting the same thing that you would get if you sat down with a child who’s 8 years old and who lives in the Midwest in the administered IQ test. But that’s the same with [00:59:00] a lot of kids that we test. When I test children at the Texas Valley, I’m getting a real different population. So it’s incumbent upon us to be sensitive to that.
So I would say before you start testing, check out the chapter that Carol will be talking about, check out the position paper on APH for your preparation. The other thing I would say is, be certain to check on the website for the American Printing House for the Blind. They do have a number of instruments that are available for purchase that has gone through a rigorous process of accommodation so that the publisher has cooperated, a vision specialist has cooperated, and there’s information on a number of tests that are available there. So be sure you know what your sources are.
And then [01:00:00] the next thing you need to do is to pay attention to all of the training that’s available both on this podcast, and some of the websites that are out there. They’ll give you a lot of information to do the best possible job.
Dr. Sharp: Fantastic.
Marnee: That’s sort of a complex subject.
Dr. Sharp: Absolutely. We’re off to a great start here. Thanks. So where should we hit next? Should we head to Carol with adapting the assessment process, or do we want to talk about measures first? What do you all think makes the most sense?
May: Probably measures.
Dr. Sharp: Okay. Let’s do measures.
Stephanie: So, May, you’re on choosing measures?
May: Okay. So we’re going to sound a little bit like a broken record but a lot of [01:01:00] it will depend on the particular student since there is so much variability in the standard presentation. And of course, like Stephanie was mentioning, we want to start with the functional vision assessment and learning media assessment results and seeing what media is their primary or secondary learning media so that when we’re looking at our stimulus that we’re presenting to students, we’re using the appropriate type because then you’re no longer testing what the test is intending to test if you’re using inappropriate media.
And when we’re looking at, like Marnee mentioned, APH- the American Printing House for the Blind, has different tasks that are already adapted in large print or braille. Some of those include the Boehm. The Boehm Preschool is available in a tactical [01:02:00] version and a large image version as well as the Boehm for kindergarten to 2nd grade. The Boehm is are getting updated. So that should be out at the end of this here or maybe early into next year, 2022, but they’re hoping to have the full Boehm comprehensive inventory of basic skills.
Dr. Sharp: May, can I jump in and ask you to backtrack one acronym to the Boehm. Can you spell that for people?
May: Oh, B-O-E-H-M. And this one might be one that a lot of early intervention or school psychologists or speech-language pathologists, working with the littles, the younger children might be more familiar with. There is on Pearson, the standard kit but you don’t need the standard kit to use the adaptive [01:03:00] versions, but for many of the other standard kits or standardized tests, you do need the standardized test kits in addition to the adaptive version. You cannot administer like the WJ Woodcock-Johnson IV has a large print in braille version. If you just buy the adaptive version from the American Printing House for the Blind, you will not be able to administer the whole thing. You need to have a standard kit too. So for those who are in private practice, this is an additional cost that you need to consider. And Terese I see you, I’m here, just go ahead.
Dr. Terese: I just wanted to jump in because I happened to be living in Maine and many of the states have regional or statewide lending libraries. And so, what the psychologist if they’re asked to evaluate a child with a vision impairment and they need to use the Woodcock-Johnson and they happened to own the print version of the Woodcock-Johnson, you can see if the TVI has access to one that they could [01:04:00] be loaning out. It will be shipped free matter for the blind. You can use it, and then you can return it back to the center where you’ve gotten the loaner from.
So before people start to go, oh my God, I can’t afford to spend $50 on a protocol and $300 on the test kit because I’ve already spent $1000 on the Woodcock-Johnson, backup and see whether the teacher of the visually impaired has access to a loaner kit through the resource library if they’re affiliated with a statewide lending library. So at least that’s what we’re doing in Maine.
Dr. Sharp: That’s great.
May: Another thing to consider is that it takes a long time to adapt these standardized tests to braille and print versus, and I know Carol was involved with the braille adaptation for the Woodcock-Johnson before. A lot of times when our tests come out with new additions, it takes quite a bit of [01:05:00] time, several years before an adaptive version is available. Because of copyright law, we are not able to just ask our IT guy, Hey, can you just make this in braille for me? It’s like, nope. Technically you cannot. So you do have to wait unless it’s informal. And Carol, I see your mouth moving. So do you want to add something?
Dr. Carol: There are people who do it. I was one of them years ago and adapted things on my own. I knew the braille and I knew the intent of the items which is really important having both perspectives as a TVI and a school psychologist. And we did it because that was a better test than what was available. And there are people doing it all over the country and sometimes doing it wrong. I remember borrowing an early privately done Woodcock-Johnson and [01:06:00] there were the visual, the published test had a picture of three fish. Well, how was that represented? They brailled the words fish, fish, fish. How many fish are they? Well, the child who didn’t know how to read fish.
May: Yeah, there’s a whole lot that goes into adapting materials and whether your student has been exposed to tactile graphics or where are they in learning braille? Is it contracted or uncontracted? There are all these various components.
Stephanie: And I was just going to throw in even one more wrench in the puzzle is that, and someone can give me the date, but we switched braille codes. We used to use what’s called the English Braille American Edition, EBAE, and [01:07:00] now 2016, is that right? I don’t know. I think so. We switched to UEB Unified English Braille, and there is a difference in the codes. So if you have old editions of Brailled Assessments, they are likely in EBAE which means that your younger students who have grown up with UEB are not going to be able to read those. So yet another reason.
I see Jeremy shaking his head. You should’ve seen when it first came out that you really need to talk to your TVIs about what edition, and even more so, one more runch would be when we start talking about math. And if you were assessing your students in math, there are two codes being used in the United States. There’s the Nemeth Braille Code and there’s UEB math code. And different states are doing different [01:08:00] things, different students within a state may be using a different code. So it’s really important that you’re talking to your TVI and using the right code. And if your young student doesn’t know all of the contractions yet, that is another thing you need to understand.
May: As you might have already gathered, all these different subtopics that we have talked about could be whole-day training. I know that Carol, Terese, and Marnee have done multiple-day training on each of these topics. So we’re giving a very brief glimpse into the world of assessing children with visual impairments but there’s so much complexity that’s involved. So you can see why it takes so much time to prepare for an evaluation, to administer an evaluation, and then later to interpret it.
Dr. Sharp: Oh, absolutely. I’m [01:09:00] again going to try to channel listeners and guess what they might be thinking, which is what if we see students or we have the possibility of seeing a kid or a student who is visually impaired, there are no other obvious resources to get this assessment done, what do we do? Is something better than nothing? Do we look for other reasons? Is the family somewhere else? How might a practitioner handle that?
May: And I think going back to Marnee about reading that APH- American Printing House for the Blind document, that guidance document that Carol and Marnee wrote along with another colleague, it really spells the best [01:10:00] practices of what you should do in certain scenarios because there’s not just one straight answer- this is the test that you should do for all kids with VI.
So, if your students have some level of functional vision and use their vision for learning, even though they have a visual impairment, they might be primarily visual learners. And so there’s a lot of different considerations.
I know that Carol and Marnee can probably give you more specific examples but I would say that is a great starting place for all practitioners. When you get a student who has visual impairments, review that document and that might already help to ease some anxieties and answer some questions and talk to the teacher of visual impairments to help give you an idea. What’s on paper about a visual impairment is one thing versus what the teacher can share, what the family can share will give you a much more meaningful picture of, okay, this is where I should direct my attention in this [01:11:00] evaluation. Carol and Marnee, I’ll hand it off to you.
Marnee: I’d say, just even go in and observe the child so that you demystify them because otherwise it’s just a child that has a vision impairment and that along can go, Ooh, what am I going to do? As supposed to, well, it may not be so difficult because look at how they’re functioning in the classroom and checking in with the TVI about all the particulars and the learning media assessment on the functional vision assessment and things that way. But just seeing the child function can demystify some of it.
Dr. Sharp: That’s great.
Stephanie: And I’ll just throw out to that one of the values of COVID and what we all just went through is there’s so much out there now in terms of webinars. So this group got together because we were all doing webinars on the same topic right around the same time. So just researching what’s out there. There are fabulous handouts. And these are kinds of webinars [01:12:00] that talked specifically about psychoeducational assessments for students with visual impairments.
Dr. Sharp: Sure. We have so many links in the show notes. There are going to be a lot of resources for folks to check out after these episodes.
May: And I really appreciate Terese mentioning observations. I think bringing it back to basics of what are best practices for evaluations in general, […], record review, interview, observation, then testing, it’s like, you really need to follow that process of evaluating procedure. It’s essential because if you just jump in and start assessing, a lot of times you are not going to be meaningful for the student.
So doing those record reviews thoroughly, interviewing family members and all service providers and teachers involved, and doing multiple observations of the student in various settings because a student [01:13:00] really might be able to navigate and interact with an environment in one learning classroom one way, and then if they’re like a high school or middle school or go to like the lab for chemistry or another class and be much less independent.
Dr. Sharp: Right. Well, I feel like we have covered a lot of ground and at the same time just scratched the surface. Anything before we start to wrap up this first part of the series? Anything else on prepping for the evaluation, things we need to consider?
Dr. Terese: Yeah, I think just the one standard thing which is true for any evaluation is before people are picking instruments, it’s like, what is the question that you want to be answered as a result of the evaluation? And that would be a guiding principle no matter who we have in front of us, whether it’s a child with a vision impairment or a child with a learning disability. That’s going to guide people in terms of selecting [01:14:00] instruments in addition to the functional vision assessment and the learning media assessments.
May: Carol, did you want to speak more about using non-standardized assessments or adapting assessments?
Dr. Carol: The adaptation. I started teaching the visually impaired in the early 70s. And my primary tool was a handful of flair pens for darkening dittos. Does anybody remember purple dittos? Marnee, of course, you would. And teachers were running dittos not on ordinary paper but on newsprint. And often you could better read the reverse side of the page backward than you could the front of the page because they were doing it on two sides of [01:15:00] newsprint because it was so much cheaper than an ordinary paper.
And so, I had a note come home from a teacher of one of my children saying, please have your child complete this math worksheet. And I said, when she comes home with a copy, either one of us can read, I’d be happy to do that. But then we got enlarging copiers in the schools and the first one was in my husband’s office and I went, oh yes. And so I would pay the company that he worked for a nickel a page for being able to enlarge on their copier. And then they started to show up in the schools. So yes, we were enlarging things.
And sometimes that was in the student’s favor. I remember, anybody remembers the Stanford Binet-4 [01:16:00] Stanford Binet-4 was my go-to instrument at the time. Now it’s got a lot of confound between the visual and verbal. So the Stanford Binet-5 was not my favorite instrument. I remember that a student I was testing could not see the visual absurdities, the picture absurdities, and they had a picture of somebody eating peas on a knife. They had a picture of, what’s wrong with this picture? What’s silly about it? And the student could not answer the one that showed the saw being upside down and the teeth were up because he couldn’t see that the teeth were up. But when I took the test booklet over to the CCTV, the video magnifier, he could immediately answer that [01:17:00] and many more successive questions.
So that’s what I mean. And at the time, his reading group was sitting on the floor with an aide writing words on a whiteboard that was not close enough to any of the students for them to see it well. And so, the fact that he could answer questions on the visual absurdities, the picture absurdities led me to recommend that he receives his reading instruction using the video magnifier.
Dr. Sharp: Yeah, there are so many ways that you have to be flexible and pay attention to these environmental factors.
Dr. Carol: Yes.
Dr. Sharp: Speaking of that, I wonder, could we maybe talk just a little bit about setting up the room for an assessment with a visually impaired kid and things we might need to consider there?[01:18:00] Stephanie: Yeah. So some things to consider are lighting number one. And again, you’ll get a lot of this information from the functional vision assessment. Lighting can play a big part. It can help students out using reading stands, using what we often refer to as a CCTV which is an electronic magnifier, using bold line paper, felt pens. Ask your student to bring with them any devices that they may be using in the classroom.
One caution about even just a CCTV is you want to make sure that the student has experience using the device that you are presenting them with. So you don’t want to sit a student down at a brand new [01:19:00] device even though you think, oh, it’s a magnifier and they use a magnifier, but if they’ve never used that particular magnifier, they shouldn’t use it for the first time during an assessment. There are different levels of magnification. There are different styles of electronic magnifiers. So you want to make sure that they have familiarity with that. If a student does all of their work on a computer, make sure they bring their computer to be used.
In terms of enlarging materials, you want to make sure that you’re not just enlarging it. All students have different font sizes that they require. It could be anywhere from what’s often referred to as standard large print. I don’t think it’s called standard for our students with visual impairment because there is no standard. It could be anywhere from 24 points on that to 60 point font. I mean, if it’s that big, there’s no more discussion that would need to happen with a team [01:20:00] because we would say, well, the world is not written in 60 point font, but again, you want to use what the student is used to using and making sure to show the enlarged copy to the TVI.
Is this the correct size? Because I think there’s confusion sometimes between, oh I’m going to blow it up 150% on the copy machine, that doesn’t mean it’s getting to the right font size.
Clutter is another thing to look at. If a student is often being presented with materials with pieces of it being occluded, meaning blocked out, you’d want to present the material in that same way.
Color can be an issue. Oftentimes, students may not be able to see a yellow highlight or yellow writing. So if it’s testing that’s in color, you want to make sure that [01:21:00] that’s accessible to students. May brought up tactile graphics or even just graphics because learning to read tactile graphics is a process. And so you want to make sure your student understands how to read a tactile graphic. And all these little things may change standardization. And so it may affect scoring which the tester needs to realize but you also want to make sure you’re testing in a way that the student can access it.
One more thing would be not only clutter on the page but clutter in the student’s environment. So students with CVI, cortical visual impairment, or cerebral visual impairment are very sensitive to other stimuli around them. So even just if you’re testing within an environment with a really busy board, that can distract them from the material in [01:22:00] front of them. So being sure to test in a way that there are no external stimuli or auditory stimuli. If there’s a lot of noise going on outside of the classroom or within the room you’re testing, that can definitely affect the results that you’re seeing.
May: And looking at adaptations like, Stephanie, touched on. We want to make sure we’re not increasing the demands or decreasing demands with this adaptation and really think, are you still testing what the task was designed to test? Like when we’re looking at, I’ve gotten questions about the CTOPP and blowing up the stimulus pages for rapid number naming or rapid letter naming. If the student has to scroll across the screen, the whole stimulus isn’t visual of being able to be visible [01:23:00] on one screen, does that change the task because now they have to have the motor component of like scrolling or moving a knob to see? Or when you have answer options displayed where you have to move back and forth between different sides of the screen to see all of the different answer options for an item, now you’re increasing the working memory load of a task too.
So there are all these different components. So a lot of times when you’re using visuals, and I’ll let others chime in if they disagree, but when you’re using visuals with students with visual impairments, you’ve got to be very careful in considering whether it is more meaningful to use that information to inform what kind of accommodations or modifications they might need in their educational setting. And how meaningful that standardized number is. Is it a valid score to report or not? And a lot of times, like I know I would usually defer to reporting things [01:24:00] qualitatively when we’re using all these different…
Dr. Terese: I was just saying the modifications or adaptations. Yeah.
May: Yeah. And there are many different, we talked a little bit about when we’re using standardized measures and now due to copyright law, we can’t adopt them into different formats. Also, curriculum-based measurements and informal measurements can provide a lot of meaningful information as well. And there are many different writing skills and checklists that are made specifically for students with visual impairments that do not produce standard scores but still provide lots of meaningful information.
So I feel like a lot of psychologists who are new to the world of assessing students with VI might go and try to stick to the tried and true standardized assessment tools that they’re very familiar with when there are all these other ways of getting meaningful information that [01:25:00] like as Terese said, are you answering the referral question? What is the most important part? And a lot of times it’s like, how can we actively engage the student and help promote their independence?
Dr. Sharp: Yes. Well, I think you’re doing a great job of giving us a teaser for the next part of our series, and talking about how do we interpret the data and results and so forth. So in the interest of keeping people’s interest piqued, maybe this is a good place to wrap up. So next time we are going to dive more into interpreting the test results and different deep dives into specific presenting concerns and comorbidities with learning disorders and autism and so forth.
So this has been great. It felt like a whirlwind for me. And I appreciate y’all just sharing all this information with us. And hopefully, I [01:26:00] think we set the stage for a more in-depth discussion about some of these topics to come. So I appreciate y’all’s time. I look forward to talking again here pretty soon for the second part of our series. Thank you all.
May: Thank you.
Dr. Terese: Thank you.
Dr. Carol: Bye.
Dr. Sharp: All right, y’all, thanks as always for listening to the podcast. I hope you found this informative. Next time, like we mentioned in the recording, we’ll dive deeper into specific comorbidities and how to interpret data when we’re also evaluating for both visual impairment and learning disorders, autism, intellectual disability, and considerations for deaf-blind children as well. So there’s a lot to be had in the next one in addition to the material here. All right, I’ll leave you for now. Catch you next time.[01:27:00]
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