11. THE VISUALLY HANDICAPPED CHILD All educational procedures rely heavily on the sense of vision, and when this sense is in any way impaired, learning efficacy is seriously limited. The insensitive educator must only walk around blindfolded for even a brief period of time to appreciate life behind "a cloud" and sense some of the restrictions and limited perceptions visually impaired or handicapped individuals face. Visually handicapped children are classified on the basis of (1) the physical measurements of visual acuity and narrowness of the visual field, (2) the use that is made of the visual sense modality for learning, and (3) the degree to which vision must be corrected to be considered, at least, not legally blind. It is interesting to note that in the 1920's through the 1940's it was believed by the educational establishment that limited vision of the child should be conserved by as little use as possible and that the child should use his vision only when an object or the print was large. The entire educational approach was designed to avoid straining the eyes. Classes for children who were classified as partially blind were called "sight saving" classes. Current opinion holds that the eyes are very rarely damaged through use, and that the child should learn to use whatever vision he has in as many situations as possible (Kirk, 1979, p. 293). The National Society for the Prevention of Blindness (1966) defined blindness as visual acuity for distance vision of 20/200 or less in the better eye, with best correction; or visual acuity of more than 20/200 if the widest diameter of field of vision subtends an angle no greater than 20 degrees. The partially seeing are defined as persons with a visual acuity greater than 20/200 but not greater than 20/70 in the better eye with correction (p. 10). The current terminology for educational purposes when referring to the visually handicapped child are: 1. The visually impaired which refers to those who can learn to read large print; 2. The blind, who cannot learn to read print, but who need instruction in braille. This change evolved as a result of research findings which demonstrated that there is not a one-to-one correspondence between ophthalmic measurements and educational performance. Children with the same degree of a given visual defect on clinical tests may have very different visual abilities in terms of learning. Jones (1961) illustrated the difficulties in classification for educational purposes by using clinical acuity tests to determine whether a child should read print or should be taught braille. He studied 14,125 legally blind children registered with the American Printing House for the Blind. He found: 1. Thirty-one percent of children in local and residential schools for the visually handicapped were classified as legally blind with 20/200 vision. Yet 82 percent of them read print, and only 12 percent read braille. Six percent read both. Of those who could only recognize hand movements at close distance, seven percent learned print. 2. Of the total, 24 percent were educationally blind and read braille only. Seventy-six percent of the legally blind had some residual vision, and a large proportion of these read print. Nolan (1965) replicated the 1960 Jones study. He found that from among 2,536 children on the registry of the American Printing House for the Blind, the number of braille readers had decreased by 5 percent, and that those listed as print readers had increased by 5 percent. In a later study, Nolan (1967) found that the residential enrollment increased by 15 percent. He stated that "there appeared to be a consistent trend in all school systems toward a greater use of residual vision." Kirk (1979) concluded that these studies indicated clearly that the designation of legal blindness by means of visual acuity measures does not determine the mode of education the child is capable of using. He noted that the work of Jones and Nolan caused a significant trend toward: 1. Using the residual vision of legally blind children; 2. Increasing the organization of educational programs needs to be considered. The importance of an adequate vision screening program and systematic observations of visual behavior in school cannot be overestimated. Among pre-school and school children the following should be observed and noted as possible indications of visual difficulty: 1. Strabismus; nystagmus. 2. How the child uses his eyes; tilting his head, holding objects close to his eyes, rubbing his eyes, squinting, displaying sensitivity to bright lights, and rolling his eyes. 3. Inattention to visual objects or visual tasks such as looking at pictures or reading. 4. Awkwardness in games requiring eye-hand coordination. 5. Avoidance of tasks that require close eye work. 6. Affinity to tasks that require distance vision. 7. Any complaints about inability to see. 8. Lack of normal curiosity in regard to visually appealing objects (Kirk, 1979, p. 295). The major causes of blindness are listed in broad categories including: infectious diseases, accidents and injuries, poisonings tumors, general diseases, and prenatal influences (including heredity). The National Society for the Prevention of Blindness (1966) reported that rubella, heredity, etc. accounted for 47.7 percent of legally blind children. Retrolental fibroplasia (categorized as "poisonings") accounted for 33.3 percent of legal blindness among school-age children, and infectious diseases together with neoplasms accounted for 7 to 8 percent. Injuries, including accidents, accounted for little over 2 percent, a substantial drop from earlier figures. The United States Office of Education estimated that approximately 0.1 percent of school children have visual handicaps serious enough even after correction to warrant special educational provisions. Ashcroft (1963) stated that there are 1 in 500 who are partially sighted (visual acuity 20/70 to 20/200), and that there are 1 in 3,000 who are legally blind (20/200 and less). The various groups of exceptional children, including the blind, have been surveyed extensively with respect to their physical, social, mental, and educational development. Among the visually handicapped, concentration on research has been primarily with the legally blind, and little has been done with partially seeing children. Lowenfeld (1955) suggested that this paucity of research may be due to the fact that the partially sighted child is "for all practical purposes a seeing child, and his handicap, if it is one, does not affect him in any way different way from other children who slightly deviate from the 'normal'" (p. 273). Bateman (1963) studied the effects of visual handicaps on the reading and psycholinguistic abilities of 131 children enrolled in classes for the partially sighted in public school classes in Illinois. She found that: 1. The IQ's of the Binet and WISC were normally distributed with an average IQ; 2. On the Illinois Test of Psycholinguistic Abilities, these children (a) did not differ from the standardization norms in the auditory-vocal channel subtests, but (b) performed significantly less well on visual reception, motor expression, visual sequential memory, and visual association; 3. Children with mild visual defects (visual acuity more than 20/70) were slightly lower in IQ and also lower on the subtests of the ITPA than those with moderate vision; 4. The visual-motor channel deficits were most marked in the severely defective group (those with visual acuity less than 20/200). Tilman (1967) compared 100 sighted with 100 blind children on the Wechsler Intelligence Scale for Children. An item comparison showed that the blind scored the same as the sighted on arithmetic, information, and vocabulary. The blind were inferior in items of comprehension and similarities. Tisdall, Blackhurst, and Marks (1967) compared residential and day-school blind children with seeing children on tests of divergent thinking ability and found no significant differences between the blind and seeing children or between residential and day-school blind children. Birch et al (1966) surveyed the school achievement of 903 fifth- and sixth grade partially seeing children to determine their level of educational achievement, and to establish the appropriateness of type size. They found that although these children were of average intelligence, they were over age for grade and 2.5 years retarded in academic achievement. They also concluded that no one type size could be considered superior. Nolan and Ashcroft (1959) found that the average reading speed of 264 partially seeing children (grades 4 to 12) to be about 100 words per minute, which is less than half the speed of seeing children. Lowenfeld, Abel, and Hatlen (1967) studied in considerable detail the blind programs throughout the United States. By means of a questionnaire they concentrated on blind students in the fourth and eighth grades. Their findings showed: 1. Braille reading starts in the first grade. 2 Eighty-five percent of the teachers try to teach the children to use both hands in learning braille. 3. Almost all the teachers taught braille writing with reading and used a braille writer. 4. Two-thirds of the teachers emphasized whole word reading. 5. In comparison with seeing children reading large print, the reading comprehension scores on reading tests showed that fourth-grade blind children were equal in braille-reading ability to seeing children, while the eighth graders were superior to seeing eighth-grade children. Kirk (1979) noted that some of the studies indicated that the visually handicapped have relatively normal educational development. Even the blind are equal to the seeing child in comprehension of reading when given more time to read the tests. In a review of the research on multiple disabilities with visual impairments, Wolf and Anderson (1969) discuss the following categories: 1. The Deaf-Blind Child. In 1960 it was estimated that there were 372 deaf-blind children in the United States. In 1970 the U.S. Office of Education estimated that there were 2,641 deaf blind children. 2. The Blind-Speech-Defective Child. In reviewing the studies in this area, the authors reported the prevalence of speech problems among the blind as being between 6 percent an 33 percent. 3. The Mentally Retarded Blind Child. Such children are found in residential schools for the blind, in local day school, and in residential schools for the mentally retarded. These children often have more than the two underlying disabilities. In a study of these problems, the authors summarized the results as follows: Thirty-five percent of the mentally retarded children in special classes had two disabilities and sixty-five percent had three or more disabilities. Thirty-one percent had three disabilities, twenty percent had four disabilities, six percent had five disabilities, and five percent had six or more disabilities (p. 33). 4. Blind Children with Physical Disabilities. These include children with cerebral palsy, poliomyelitis, epilepsy, and any physical disability found among normal children. 5. Blind Children with Emotional Problems. As in other groups there exist among the blind a number of children with emotional problems who need treatment. From Wolf and Anderson's research, it is clear that a visual handicap can be associated with many other handicaps. Educational programs must be adapted to the individual needs of these children. Unless special strategies are implemented, these children will not receive the educational experience they need. The education of the visually handicapped has existed for many centuries, but the education of the visually impaired (partially sighted, or partially blind) is a twentieth-century development. In the United States the first class for the partially sighted was initiated in Boston in 1913. Other cities heard about these classes and one was opened in Cleveland the same year. Kirk (1972) noted that two major changes have occurred during the 1950's and 1960's which had a significant impact on the education of visually handicapped children. These trends and changes included (1) changes in enrollment in day and residential schools and (2) changes in types of services offered. A substantial increase in the total number of visually handicapped children enrolled in public and residential schools, increasing from 5,818 in 1949 to 21,333 in 1970. Another noticeable trend which occurred in the 1960's and 1970's was the increasing acceptance of children with other handicaps in programs for the visually handicapped. According to Jones and Collins (1966) 73 percent of the 353 local programs and 94 percent of the residential programs included children with multiple handicaps in their enrollment. Whereas resource rooms and itinerant teachers were few in number prior to 1946, after 1956 they were the most common. Furthermore, the full-time special class has shown a marked decline over the three periods studied. After 1960, the majority of visually handicapped children in local day schools were assigned to a regular grade according to their age and level of academic achievement. In this type of service, the aims and objectives of the regular grade become predominant, even though the techniques may be special. The general goals or objectives of education were the same for visually handicapped children as for seeing children, even though the procedures of attaining these goals are achieved by modification of instructional materials and special teaching procedures. If visually handicapped children were exposed only to the educational experiences and materials used with sighted children, they would not achieve the goals set for them. Thus special methods, materials, and equipment must be employed, utilizing the senses of hearing, touch, smell, residual vision, and even taste. The curriculum for the visually handicapped must include: (1) adaptations of the general curriculum, (2) some additional or specialized content, and (3) specialized materials and equipment. For teaching the visually impaired, Knowles (1969) suggested the following seventeen areas which correlate with success in relation to vocational rehabilitation: 1. Physical education. 2. Listening skills. 3. Reading and writing. 4. Arithmetic. 5. Social and living skills. 6. Specialized materials and equipment. 7. Movable and adjustable desks. 8. Chalkboards that are gray-green. 9. Pencils and papers that are cream color, unglazed and slightly rough. 10. Typewriters with larger than normal print. 11. Books and reading materials with large print. 12. Projection and magnifying equipment which can enlarge charts, maps and reading material. 13. Braille materials. 14. Audio aids to assist the child's quest for knowledge particularly in the upper elementary grades. 15. Talking books labeled in braille. 16. Arithmetic aids like arithmetic boards and an adaptation of the abacus. 17. Embossed and relief maps. Kirk (1979) suggested that the visually impaired child progress through school with a regular grade, but that special interventions occur in the first grade and continue throughout the 12 grades. As long as educators take into consideration the special needs of the child, he should be able to successfully matriculate through to graduation.