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Special Needs

Visual Impairment in the Young


Sight is an ability that allows us not only to perform many of our functions of daily living, but it is also a sense that allows us to enjoy the things we do. For children who are unable to see, or who have limited sight, performing daily living functions, and growing up as a healthy, happy child may seem like daunting tasks. However, a visually impaired child can lead a productive, joyful life with the help of parents, educators and health professionals who understand the special needs of such a child.

If you think your child may have a visual impairment, or if your child has recently been diagnosed with a visual impairment, the following information will help you understand visual impairment in children and to link you with other sources of information and support.

The Eye

The visual system, including the eye, that provides for sight is a complex grouping of nerves, muscles, tissue and fluid. Because this system is so complex, any defect or injury to the eye itself, the muscles that support the eye, or the nerves surrounding the eye, including the optic nerve, can result in visual impairment A complete illustration of the eye can be found at NEI. The eye itself is made up of the:

  • cornea: transparent, outer layer of eye through which light passes and is the chief refractive medium for the eye, focusing light rays onto the retina
  • anterior chamber: space in front of pupil and lens, through which light also passes
  • pupil: hole in front of the lens which serves to control the amount of light that passes into the eye
  • lens: refracts light, and can vary its shape depending on the amount of light
  • iris: pigmented area surrounding pupil
  • vitreous humor: fluid that fills the eye ball, or globe, 99% water, functions to refract light
  • retina: located in the back lining of the eye ball, is made up of photoreceptor cells that transform images seen to nerve impulses carried by the optic nerve to the brain; the center of the retina holds the region of greatest visual acuity of form and color
  • optic nerve: located at the back of the eye ball, connects to the visual center of the brain.
  • sclera: white, rubber-like protective globe, what makes up the white eye ball


Common Causes of Visual Impairment

There are varying degrees of visual impairment, from low vision to blindness. As described, the eye and its system is so complex that any interference or dysfunction in the process could result in a visual impairment. Some common causes of a visual impairment include:

  • injuries to eye, optic nerve, or visual area of brain
  • illness or infection that affects the visual system
  • metabolic disorders (e.g. diabetes)
  • inherited genetic defects or syndromes
  • congenital abnormalities
  • exposure to infection prenatally

Types of Visual Impairments

There are many types of visual impairments that affect different parts of the eye or visual system. A comprehensive list of various conditions associated with visual impairment can be found at NYISE, or for comprehensive information on childhood visual impairments and links regarding specific diseases, go to Growing Strong.

  • Anophthalmia/Microphthalmia (A/M): A/M is the absence of, or remnant of the globe and ocular tissue from the orbit; A/M may affect one eye with the other eye being normal, or both eyes, resulting in blindness. A/M can be congenital or acquired after birth. The causes of A/Mmay include inherited genetic defects, chromosomal abnormalities, trauma or exposure to toxins prenatally.
  • Cataracts: condition affecting the lens of the eye where clouding occurs preventing light from passing through; may be present at birth or develop later.
  • Retinopathy of Prematurity(POM): condition of premature infants who require extensive oxygen therapy after birth, where the retina becomes damaged and cannot respond appropriately to light.
  • Retinitis Pigmentosa: condition affecting retina where an abnormal accumulation of pigmentation occurs impairing vision, results in a progressive loss of peripheral vision.
  • Retinoblastoma: a tumor of the eye which often requires removal of the entire eye resulting in total blindness. It may also occur only in one eye, leaving the person with normal vision in the other eye.
  • Leber’s Congenital Amaurosis:LCA is a degenerative condition of the retina. Many children with LCA have some vision; others are totally blind.
  • Imbalance of eye muscles or nerves associated with the eye
  • Strabismus: condition of uncoordinated eye movements including esotropia, or “crossed-eyes”, exotropia, or “wall-eyes,” and amblyopia, or “lazy eye”
  • Nystagmus: condition of atypical eye movements or jerks
  • Myopia (Near-sightedness):difficulty seeing things in the distance
  • Hyperopia (far-sightedness):difficulty seeing things very close

Developmental Considerations for the Visually Impaired Child

Your visually impaired child may need direct teaching various skills and experiences to maximize his or her growth and development. The following is a list of developmental considerations for your visually impaired child. For a comprehensive listing of this information, along with resources and suggestions for each consideration go to SASKED.

  • Sensory-motor skills (sitting, crawling, walking, balancing, developing fine and gross motor skills)
  • Concept development (body image, environment, sexuality, gender awareness, space, time, position)
  • Communication (exposure to braille books, learn name and pronounce, listening skills, language skills)
  • Orientation and mobility (body awareness, spatial awareness, auditory awareness, sighted guide techniques)
  • Daily living skills (dressing, cleaning, personal hygiene, using the telephone)
  • Self-concept and socialization (displaying appropriate behavior, communicating one’s needs, playing)
  • Knowledge of the eye condition (basic functions of the eye, name, cause and implications of eye condition, eye care)


Hearing Impairment in the Young


The sense of hearing is often taken for granted. There are no readily visible signs or symptoms for hearing loss in a young child. Approximately 5,000 children in the United States, however, are diagnosed with a significant hearing impairment every year. According to the American Academy of Otolaryngology, more than three million American children under the age of 18 years have varying degrees of hearing loss. As a parent or caretaker, recognizing and understanding hearing impairment is essential to your child’s development. And, because you spend the most time with your child, you will most likely be the first to suspect any hearing loss.

The Ear

The ear is composed of three parts

  • The outer ear consists of the soft, fleshy area that is readily visible to the naked eye and includes the auricle (collector of sound energy), the ear canal and the earlobe.
  • The middle ear is a small area consisting of three small bones, the malleus, stapes and incus, which amplify and conduct the sound energy they receive through the outer ear.
  • The inner ear is a much more intricate area composed of bony chambers and passageways and is connected to the nerves of the ear and skull.

hearing problems for kids

Types of Hearing Impairment

Types of hearing impairment can be described by the area of the ear that is affected, whether the loss is temporary or permanent, and if the child is born with the hearing loss (congenital) or acquires a hearing impairment after birth. Congenital hearing loss is attributed to a defect that the child is born with, either a through an inherited genetic defect or the result of a prenatally acquired condition. Hearing loss acquired after birth is most common, however, accounting for more than 75 percent of all cases of hearing impairment in children.

  • Conductive Hearing Impairment:
    Hearing impairment that occurs in the middle ear is called a conductive hearing loss and is usually temporary. Ear wax buildup, chronic or recurrent middle ear infections such as otitis media, or biological malformations are common causes of conductive hearing loss. Many children with these types of temporary hearing losses can regain their hearing through medical treatment or minor surgery.
  • Sensori-neural Hearing Impairment:
    Hearing impairment that occurs in the inner ear is called sensori-neural hearing loss because it involves nerve damage. This type of damage is usually permanent and may worsen over time. The most frequent cause of sensori-neural hearing loss is genetic/hereditary in nature.

Common Causes of Hearing Impairment:

The reason for a child’s hearing loss may not always be easy to identify. There are many possible implications for a child’s hearing impairment. If the hearing impairment is congenital, the cause may be different than if the hearing loss is acquired after birth. Common causes of congenital hearing loss include:

  • inherited syndromes (Treacher-Collins, Goldenhar’s, Alpert’s)
  • nonsyndromic inherited hearing loss
  • drug exposure in utero
  • prenatal infections

Common causes of hearing loss acquired after birth include:

  • recurrent ear infections with fluid present (otitis media)
  • infections (meningitis, mumps, measles, chicken pox, hepatitis, influenza)
  • hyperbilirubinemia (jaundice)
  • drugs (antibiotics given via needle through vein)
  • noise exposure
  • head trauma
  • birth complications

Risks Factors for Hearing Loss

If you think your child may be at risk for a hearing impairment, the following table provides a list of potential risk factors that may apply to you, your baby, or your family. The information found in the table was resourced from the American Academy of Otolarynology, and can be found along with other education information related to disorders of the ear, nose and throat at hearing loss.

Assessment and Treatment:

If you think your child may be at risk for a hearing loss, or is exhibited some of the indicators for hearing loss, speak to your doctor about having your child’s hearing tested, preferably by a pediatric audiologist. There are many options to test your child’s hearing ability at any age. And, if no hearing loss is detected, the test will not have harmed your child in any way. If you need help locating a pediatric ear-nose-and-throat doctor or a pediatric audiologist, The American Speech Language and Hearing Association (1-800-638-8255) offers physician referral services for qualified speech and hearing health professionals in your area.

If your child does have any hearing impairment, however, early detection and treatment are the best ways to maximize your child’s hearing and speech development. Hearing can be improved with the use of hearing aids or other assistive devices. Additionally, appropriate speech and language therapy is available, as well as, specific educational programs designed for children with hearing impairments. The nonprofit organization Beginnings provides information and assistance to parents of children with hearing impairments including resources and support, treatment options, financial and government concerns, and educational opportunities.

Finally, it is important to remember that your child is still a normal, active child who will desire interaction with other children, want to learn and play, and be accepted.

Do you know what is dyspraxia?


I present you an article describing the nature of Dyspraxia and the way it effects children.  Useful to help understand the technical terms professionals use, as well as providing a list of things to look for.

What is Dyspraxia?

Dyspraxia is a brain immaturity; messages sent from the brain are not properly transmitted to the body. Most problems are with the organisation of movement, although there may also be difficulties with language, thought and perception. About 5% of the population are affected by Dyspraxia, 70% of whom are boys. Dyspraxia used to be called ‘clumsy child’ syndrome. It is a hidden disability, with all of the associated disadvantages. Other names used by special needs professionals may be:

  • Developmental Coordination Disorder (DCD)
  • Minimal Brain Dysfunction
  • Motor Learning Difficulty
  • Perceptuo – motor Dysfunction
  • Developmental Dyspraxia

Most problems for those with Dyspraxia are associated with the organisation of movement, although there may also be difficulties with language, thought and perception. It is a disorder that can also be found in children with ADD (Attention Deficit Disorder) or ADHD (Attention Deficit with Hyperactivity Disorder). (See article on this site by same author)

What are the features of dyspraxia? 

All children are individuals, and so may not exhibit all of the characteristics noted below. However, if your child has some of these indicators it is worth talking to his class teacher who will liase with the SENCO (SPecial Needs COordinator) to help your child. If your child is not yet at school, talk to your Health Visitor who will be able to give you access to the appropriate professionals.

Child Successfully Ties Shoes

Some problems linked with dyspraxia

  • clumsiness, uncoordinated movement, constantly bumping into things
  • poor posture, hunched shoulders etc.
  • walks awkwardly
  • inability to decide which hand to favour, showing confusion over which hand to use. This may lead to your child having difficulty with hand-eye coordination, unable to throw or catch a ball.
  • sensitivity to touch. He may not like the feel of certain fabrics next to his skin and find particular items of clothing uncomfortable. He may also find that plasters are too uncomfortable, he is too sensitive for these against his skin as well.
  • poor short-term memory. Dyspraxics have difficulty in recalling tasks from the previous day. He may not remember the skills he seemed to have mastered previously. He may seem to be ‘slow’ as he finds it difficult to perform routine tasks that his peers find easy and automatic.
  • reading/writing difficulties. The dyspraxic child finds holding a pencil uncomfortable and may not remember how to form his letters correctly. His work may be generally untidy and badly organised. Writing on lines in schoolbooks will require a supreme effort, and may still look messy.
  • by the time your child has started school, most of his classmates will have learnt to pedal a bicycle, hop and skip. These motor skills are hard for the child with dyspraxia to learn and retain.
  • most children on entering school can easily dress themselves ready for the day ahead. However, the dyspraxic child finds this task difficult to learn, and may also have great trouble feeding themselves properly and efficiently. This can have an alienating effect with his peers who find his feeding habits repulsive.
  • language difficulties. When questioned directly your child may not give the correct response, even when he knows the answer.
  • your child may have speech problems. These can be manifested by your child being slow at learning to speak, or the sounds they make are unintelligible as sentences with meaning.
  • your child may exhibit phobias, or show obsessive behaviour. He may be impatient, not liking his teeth or hair brushing, or his hair or nails cut.

Dyspraxia is not something that your child will ‘grow out of’, although most children with dyspraxia will be integrated into mainstream schools with ease. Early identification of dyspraxia is essential as school based programmes are extremely efficient at helping children cope with this disability.



Strategies to help in the classroom


Classroom strategies 

There is always the tendency for adults to finish off sentences for those who are finding difficulties in articulation. Give the child enough time to respond to questioning, as he may already have a problem in this area. Listen closely to all the child has to say. After a while you will be attuned to the child and able to easily interpret his response. Try to maintain eye contact, using short sentences and familiar language. As with hearing impairment, make sure the child is concentrating fully, watching your facial expressions as a clue to content.

Make sure that you use all available media to reinforce instructions, such as print, diagrams, symbols and the use of materials the child can feel and touch. Using visual aids to reinforce learning is also appropriate.

Use of open-ended questioning should be encouraged as it asks the child to reply in more than one word, using sentences. It is useful for the child to be part of the whole class, reading their work in the Literacy plenary as well as working in small groups to encourage integration. As some of these children may have a shorter attention span, it is important that the activities offered to them should be focused on strengthening auditory skills and reinforcing oral work.

Poor auditory skill – short-term memory and processing skills

The auditory short-term memory is the area of the memory that is used to ‘listen’ to what is being said in a conversation and then respond properly to it. The information is held, processed, understood and then assimilated for the length of time that it takes to respond. This deficit ion this area will affect the child’s ability to converse with his peers or answer direct questions from his teachers. It will be hard for them to follow verbal instructions or to remember the instructions accurately.

It is important that the child is given the time to respond to questions and that any instructions are kept to a minimum. If there is a whole class instruction, try and also repeat the information on a one to one basis with the child. If possible, allow for visual instructions by the teacher or any other adults involved with the child. Remember that children with Downs’s syndrome are more visual than auditory learners so concentrate on this aspect of their skills. Their listening skills are not as good as their visual skills.

Short concentration span 

Many Downs syndrome children are easily distracted and have a short concentration span. It is usual for the child to have a support worker in the class, and this means that the child may become more easily tired having to concentrate fully on one person speaking.
Make sure that the child is given short, focused tasks that are sensitively planned. It may be useful for there to be a set of activities kept in a small area of the classroom where the child and his support worker can go when they have finished the set tasks. The selection can include items such as jigsaws, books, cards and toys that have a link to the part of the curriculum being studied. This structured situation allows the child choice in a structured way. To encourage the Down’s child to integrate fully into the class, it may be possible to allow another child to be part of this activity, encouraging cooperative skills and friendships.

Learning and retaining new skills 

Down’s children in general have difficulties in transferring skills across the curriculum. The children take longer to learn and consolidate new skills. They also retain differing amounts of information from day to day. It is possible to help the Downs syndrome child by extra repetition, presentation of key skills in a variety of ways and use every opportunity to use visual stimuli. Make sure that all skills are built upon, and that the skills remain after new input.

open education week

Routine and structured timetabling 

Downs syndrome children do not like changes to routine, so it is advisable for you to have a coherent routine that the children can rely upon. Unstructured routines are not conducive to learning for them. Upon transition to new situations, allow the child to have enough time to adjust. Make sure that the child is conversant with his timetable, presenting it in a number of forms. It may be a good strategy to give him a pictorial representation of this for him to refer to, and his adult helper may help him to trace his progress throughout his school day. Try to keep to this routine as much as possible. If there is to be large-scale change to this timetable, allow time for the child to adjust and also give advance warning of these changes to his parents.


Bad behaviour is not just a problem encountered by the teacher of children with Down’s syndrome, it is one faced by us all. Usually the Downs child’s behaviour is related to his immature development, but it is similar to children’s behaviour in a younger age group.

However, Down’s children have more problems to contend with than their peers, due to their problems as outlined above. They are more vulnerable to change, and are therefore more likely to be fretful and anxious. They also have good avoidance skills, being able to divert attention from their rigid attention to tasks by bad behaviour.

Strategies to help in the classroom 

It is imperative that the child knows the boundaries of behaviour expected in the classroom, and the child with Down’s syndrome should not be treated any differently to his peers in this respect. Try and make sure that all instructions given are short and explicit, avoiding the opportunity for the child to misinterpret the meaning of the instruction. Also, try to identify if the child is ‘unable’ or ‘unwilling’ to complete the task. If the child is unable this is no fault of his, if he is unwilling this behaviour should not be tolerated. Use of visual prompts again reinforces your expectations. Rewards systems can be in place for ‘good’ behaviour, whilst it is also acceptable to ignore the poor behaviour if it is not too disruptive to the rest of the class. Some tactics for avoidance behaviour can be sorted out between all professionals engaged in working with the child. Working with positive role models is a good strategy to encourage appropriate behaviour.

Classroom integration 

Most children with Down’s syndrome educated in mainstream classes will have been allocated additional support. Usually these are Learning Support Assistants (LSA) or Classroom Support Assistants (CSA). Not all of the work undertaken by the child should be on a one to one basis. It is important for the child’s integration and emotional development for them to also be taught in small groups and whole class situations. The children need to be accepted as part of the class, not just an appendage. This will also help the child acquire the skills of independence.

There must be regular contact by all professionals engaged in helping the child so that a common approach can be coordinated. All teachers, LSA’s etc should be aware of the work to be undertaken by the child and the differentiated tasks to be undertaken. Communication with parents is vital to ensure that there is continuity between school and home

Teaching all children with learning disabilities is a challenge. However, if undertaken with care, the Down’s syndrome child can be a joy to work with, as is the way with most children. Inclusion is important for all children to feel a part of their community and for them to enjoy local friendship groups.


How to integrate children  with Down’s Syndrome into the classroom


There has been a positive response to the Governments push for inclusion of children with disabilities into the mainstream classroom. Academic research has shown that children with disabilities perform better when included in an ‘ordinary’ class. It gives the child the chance to mix with children from their own locality and see them acting in an age-specific way. They also have good role models in their peers. Being in this school setting also includes the child in their local community. There is also the opportunity for non-disabled children to learn tolerance about children with Special Needs. The issue of inclusion is one for the whole school to approach, using an integrated policy. There is also the issue of staff development. There needs to be support for this idea throughout the whole of the school, and adequate resources provided.

What is Down’s syndrome?

The most common form of learning disability is Down’s syndrome. It affects one in every thousand children born each year. It is marked by the presence of an extra chromosome; each child has 47 instead of the usual 46. All Down’s syndrome children have a certain degree of learning difficulty, ranging across the spectrum between mild and severe. There is also a wide range in development between these children, just as in children without disabilities. However, children with Down’s syndrome develop more slowly, the gap between these children and their peers widening with age. Problems associated with Down’s syndrome

integrate children

All children have specific strengths and weaknesses, and children with Down’s syndrome are just the same. There are some ways in which these children can be helped, that will help them learn. The problems associated with Down’s may also be applicable to other children with disabilities, and some of the ways of dealing with them can be used across the mainstream school.


The problems associated with Down’s are listed below:

1. Hearing impairment
2. Visual impairment
3. Problems with gross and fine motor skills
4. Speech and language problems
5. Auditory skills – poor short term memory and processing skills
6. Short concentration span
7. Learning and retaining new skills
8. Adherence to routine and structured timetabling
9. Behaviour
10. Classroom integration

1. Hearing impairment

Many children with Down’s syndrome suffer from some form of hearing loss. It is thought that approximately 20% have developmental ear defects and damaged auditory nerves. As Down’s children have smaller ear canals and sinuses, they are prone to recurrent chest infections. This may cause glue ear; untreated this can lead to hearing impairment. Have a hearing defect will also affect the child’s speech and language development. 

How can we overcome this problem?
There are a number of strategies that we can use in the classroom to overcome the problem of hearing loss. These strategies apply to all children, not just those affected by Down’s syndrome. 

The first and most obvious solution is to place the child at the front of the class where they can see and hear the teacher clearly. It is important for the teacher to be facing the child squarely so that the child has every chance to hear what is being said. Using gestures and good facial expressions is also helpful. Visual aids, photographs, pictures, artefacts, print all help the child with hearing problems. The noise of the classroom can be confusing, and it is good practice for the teacher to repeat answers to questions for the child to give him the opportunity to respond. The child will also respond to written material, and writing key, new vocabulary on the board is an important feature.

2. Visual impairment 

Children with Down syndrome tend to have good visual awareness, even though a high percentage, between 60-70%, has been prescribed glasses before the age of 7. However, it is important to understand that there needs to be specific strategies in place in the classroom to make the whole of the curriculum available to them. 

Overcoming the problems
The child needs to be placed at the front of the class so that he can easily read the work written on the blackboard. When you are producing work cards or printing prose for use in the class, make sure that the size of the font is accessible and that the type of font is not too fussy (fussy) as it could be difficult for the child to read. It is also important to make all presented materials clear and as simple as possible.

3. Gross and fine motor skills control 

Many children with Down syndrome have poor muscle tone and loose joints. This affects both gross and fine motor control, meaning that motor development can be delayed and also restricts experiences in the Early Years. Because of this, a child will find that he is affected when beginning to write, further restricting his development. 

How to overcome this
Give the child plenty of opportunities to practice this skill, sending home some work sheets for practice, where the parents can give extra support and help. All of the child’s motor skills will improve if he is given the chance to practice them. As the child may have loose joints, there is the need to provide strengthening exercises for his wrist and fingers. These can take the form of tracing, sorting, cutting, building etc. Most of these are an extension of activities usually provided in the Early Years settings and are easily copied by parents at home. Make sure that all of the activities you provide are relevant, yet enjoyable, so that the child has every chance to progress.

4. Speech and language problems 

By the time children have entered full-time compulsory education, their needs should have been assessed and the level of help to be provided by speech or language therapists should have been established. These professionals, who should be able to offer some support to you in your efforts to teach the Downs syndrome child, will see them regularly.


There are many reasons why the children with Down’s syndrome have difficulties with speech and language problems. Some of the problems are physical in nature, and some are due to perceptual and cognitive problems. Delays in understanding and learning will inevitably lead to cognitive delays. Any learning delay will mean that the child will have a restricted access to the schools’ curriculum. However, a child with Downs will be able to understand far more than they are able to express. This means that their cognitive skills may well be underestimated. 

The child may have a restricted vocabulary, unable to learn the complex rules of English grammar. As the child is able to learn words rather than the order of the words, this means that they have problems with social language. Language specific to subjects in the curriculum are difficult for these children to learn as they are infrequently used in daily life. They also have difficulties understanding instructions. 

Forming words is difficult as children with Downs’s syndrome as they have a smaller mouth cavity and the muscles in the tongue and mouth are weaker also.