A child with Aniridia in school and kindergarten

JILL ANN NERBY AND JESSICA J. OTIS in the book " Aniridia and WAGR sindrom" describe in detail what teachers should pay special attention, if their class (group) has a child with aniridia:

• Introduce and address the student with aniridia by name as you would any student. Questions will certainly arise from other children and adults. Encourage the child to answer these questions for him/herself.
• Include the student with aniridia in all activities (physical education, home economics, industrial arts, etc.). The VI teacher can offer suggestions about methods and special equipment or aids that may be helpful in some activities.
• At times all children like to be the center of attention (team captain, line leader, etc.). Encourage the student with aniridia to take leadership positions just like other children do.
• The same disciplinary rules that apply to the rest of the class should apply to the student with aniridia.
• Encourage the child with aniridia to move about the classroom to obtain his materials or visual information. He will know his own needs and method of compensating, and will soon become part of classroom routine.
• The child with aniridia may not be aware of and therefore may not become interested in events occurring at a distance from her, since she may not notice them. Some examples are a facial expression, a nod, and arm or hand movements. All of these could be used to invite a person to come over to you, to respond to a question, or to get an item. However, for a child with aniridia, you will need to use verbal cues. For example: “Jane, on top of the computer in the back of the room, there is a green folder, could you get it for me?”
• If necessary, provide additional work, desk, or locker space as needed to accommodate special materials (bulky large print books, reading stands, or other adaptive aids).
• As you and others get to know the student with aniridia, the other students may become interested in topics related to vision and visual impairment. You may wish to incorporate this into class lessons. If the child with aniridia feels comfortable about this information, he may want to participate in the presentation of the lesson.
• All children are sensitive to peer criticism. Your own acceptance of the child with aniridia will serve as a positive role model for the class. It is very important to educate students and staff members in the school about matters concerning visual disability in order to better manage the behaviors of student “bullies” or negative comments. These comments can have a detrimental impact upon the self-esteem of the child with aniridia and may cause depression in some. Possibly a classroom teacher could implement a “Character Education” program to help students develop positive attitudes towards people with disabilities. A heightened level of knowledge will lead to an increased degree of understanding and to valuing individual differences.
• The student with aniridia may bring adaptive aids into the classroom. Encourage her to use the aids as needed, and to answer any questions that others have about the aids as they arise.
• Because some visually impaired children prefer not to bring attention to their disability, they will use special aids and assistance from others only when absolutely necessary. In general, you should respect the child’s wishes, but if you suspect he really needs more aids or assistance than he is using, you may wish to consult with the VI teacher about this matter.
• A child with aniridia will learn to avoid obstacles in the classroom and school corridors. The VI teacher will alert you if there are any specific problems (stairs, outside playground, unmarked curbs, dimly lighted areas, etc.) and how to help the child maneuver these areas safely.
• For the safety of the student with aniridia as well as for all other children, doors and cupboards should be all the way open or all the way shut. She should also be told of any changes in the position of classroom furniture.
Some children with aniridia may need only a few adaptive materials while others require a combination of several devices. A partial list is below.
Non-optical aids—These are devices that are not individually prescribed, and may or may not be designed specifically for a person with a visual disability.
Visual Aids
• Bookstands may help reduce postural fatigue by bringing the work closer to the reader’s eyes. When a bookstand is not available, one may be improvised by placing other books beneath the book the child is reading.
• Felt-tip or dark writing pens provide a darker letter or drawing, and black ink is usually preferred. Using different colored markers or highlighters will often help a student to emphasize sections of their notes when scanning would otherwise be quite difficult.
• Acetate or transparency sheets/clear see-through tinted sheets. A general preference is yellow. Tinted transparencies placed over the printed page will tend to darken the print as well as heighten its contrast with the background of the paper, which lessens the glare.
• Large-print books may provide comfort for those who cannot read regular print at a close distance even with an optical aid. Its quality or typeface is as important to legibility as its size. Spacing between letters and lines is also important.
• There is a type of paper available for those with visual impairments. This paper has dark, bold lines and is helpful to children who find it difficult to see the lines on regular writing paper. Bold lines are available in various formats, such as graph paper and large-print staves for music notation.
• Page markers and reading windows may be helpful to a child who finds it difficult to focus on a word or line of print.
• Since a person with aniridia is sensitive to light and glare, sun visors and other shields may be used in certain situations to block out some of the light and glare. Outside it is normally done with sunglasses and/or brimmed hats.
• Textbook publications may be available in electronic format from the publisher.
• Students with aniridia may benefit from an elevated slope for easier reading. This also helps them avoid poor posture while reading and writing. Ask the child’s VI teacher about it. Placing a book on the desk and then leaning the reading book up against it to create a slope can create a homemade version of the slope. This also helps with worksheets and tests.
Auditory Aids
• Cassette tape recorder—Students can use the recorder to take notes, listen to recorded texts, or formulate compositions or writing assignments.
• Cassette players/recorders and other recording programs—The Library of Congress and other organizations provide free library services to people with visual disabilities by offering a wide variety of texts and leisure reading on cassettes, and most recently, CDs. The speeds at which the cassettes and CDs are played differ from the speeds of commercially manufactured recordings; therefore, the Library of Congress lends special cassette players to eligible individuals. Some cassette players provide a variable speed component, which can be adjusted to suit the needs of the listener.
Assistive Technological Aids
• Talking calculator—This hand-held calculator speaks each entry and result. It is capable of performing all the necessary computations, and earphones are available.
• Closed-circuit television (CCTV)—The CCTV enlarges printed materials onto a computer-like monitor, and can also change polarity: black print on a white background on paper can be viewed as white print on a black background (which cuts out a lot of glare). Color contrasts and illumination can also be altered.
• Computerized assistive technology—There are software programs that are capable of enlarging print and graphics on the computer monitor, such as Zoomtext, Bigshot, and Window-Eyes. Ask the VI teacher how to get this technology for your student. There are also dictation programs that allow a person to speak into a microphone, and the computer types what the person says.
Optical Aids
• Glasses with special prescriptions may be prescribed for a child with aniridia if he or she will benefit from the lens correction.
• Tinted lenses—The child with aniridia generally needs to wear tinted glasses inside as well as darker tinted glasses outside.
• Magnifiers will increase the size of the image reaching the eye.
• Bioptic monocular (telescopic aid)—children can use a monocular (hand-held or placed in spectacle frames) to view the chalkboard and class demonstrations.
Chalkboard Notes
• When the chalk or marker board is located in the front of the classroom, the front row, center, is usually a good seat for a child with a visual disability. However, not all front-row seats will guarantee that the child with aniridia will be able to see everything written on the chalkboard. If demonstrations are given during class, the location of the demonstration should be taken into consideration when assigning permanent seats. A child with aniridia will experience glare in certain situations, which may cause her discomfort or inability to read, and she will prefer a seat away from the window or other bright light. It is helpful for the child with aniridia to sit with her back to the sun.
• If he’s using a marker board, ask the child with aniridia which color of marker he can see best. Some colors such as red and green are more difficult for some to see. Black or blue are usually preferred most.
• Assign a cooperative classmate to copy or read notes aloud in a low voice to the child with aniridia.
• Encourage the child with aniridia to walk up to or move his chair closer to the chalkboard, and help him to position himself so as not to block the view of other students.
• Lend the student with aniridia your copy of the notes you put on the board or the book from which you have taken them.
• Say the notes aloud as you are writing them on the board. The child with aniridia can take them down as dictation.
• Enlarge and darken your notes on a copy machine for the student with aniridia. This is especially helpful in a math class, where following step-by-step instructions is necessary.
Demonstrations in Class
• When you have a student with aniridia, it is best not to stand with your back to the window. Glare and light will silhouette your demonstration and will make it visually uncomfortable for the student with aniridia. Cutting down on glare will benefit the entire class.
• Allow the child with aniridia to stand next to or to the side of the demonstration. Consider allowing her to assist in doing the demonstration or to handle the materials before or after the observation period.
• A CCTV may be useful and permit magnification of the demonstration.
Maps and Charts
• The child with aniridia may wish to move closer to the chart or even sit on the floor (if appropriate). Permit him to do so as long as he does not block another child’s view.
• An enlarged copy of the chart or map may be given to the child. Ask the VI teacher if she is able to provide enlarged or otherwise modified available maps. Some maps or diagrams may need to be simplified for ease in viewing.
Movies, Projectors, Reading Machines, and PowerPoint Presentations
• If it is possible for the child with aniridia to preview a movie on a TV monitor, allow him to sit close enough to see it. If there are subtitles, request that another classmate read the titles aloud to the student or class.
• Poor contrast or insufficient lighting with certain reading machines, such as microfiche, may present reading problems for the child with aniridia. Here are a couple of suggestions. Using a clear yellow overlay may help with contrast when she is reading microfiche. Another student with the same assignment could read the material aloud to her if the child with aniridia feels comfortable with it. However, the older the child gets, the more she will just want to “fit in” and not want to draw attention to herself in this way. The individual responsible for audio/visual materials in a school can be a resource for adaptive ideas and devices to be used in the classroom, as can the VI teacher.
Reproduced Materials, Tests, and Homework
Consult with the VI teacher as to the appropriate print size and clarity needed for the student with aniridia. The following suggestions may be helpful when children with visual disabilities find reprints unclear or difficult to read.
• Ask the VI teacher how to adapt or enlarge instructional materials on a copy machine. It is also helpful if you give the student with aniridia the assignments, particularly long-term projects and reports, as far in advance as possible. This will allow for any special ordering of materials or locating human readers.
• He will frequently need extra time to complete assignments and exams. Allowing time and a half is usually considered acceptable. When you are certain the child understands the work, it may be a good idea to shorten his assignments. For example, you may request that he do only the odd-numbered problems in the math homework.
• When making copies of tests or worksheets, be sure the print is large and dark enough for the child with aniridia to read. Black ink is usually easier to read. Do not use red, green, or blue.
• You may use separate answer sheets for students to use while taking a test; however, it is generally easier for a child with a visual disability to answer directly on the test.
Texts and Other Books
Many students with aniridia can use books with regular-size type, although they may have to bring the book closer to their eyes and use optical aids or reading stands. They may also require more time to complete assignments.
• If a child requires or feels more comfortable with large print or recordings, then these may be obtained by the VI teacher for her. If you are aware that you will have a child with aniridia, you may want to give titles of the books to be used to the VI teacher even before the student enters the class. Children who qualify as “legally blind” are entitled to receive from the federal government specialized equipment distributed through the American Printing House for the Blind in Louisville, Kentucky.
• As a child gets older and moves on to high school, more subjects will be offered, such as home economics. In such a class, when doing something like sewing, a visually impaired person may benefit from using contrasting thread colors, such as light thread on dark material or dark thread on light material. For more suggestions on how to help a visually impaired student in this type of class, please ask the student’s VI teacher.
• In the upper grades, students often request their own recorded or otherwise adapted texts through organizations such as Recording for the Blind.
A frequent concern of regular classroom teachers is the safety of a student with a visual disability. While certain precautions must sometimes be taken, it is important not to project your own fears onto the child with aniridia. The student’s needs for exploration and independence must be balanced with sound safety practices, which often should be enforced for all children. However, the child with a visual impairment should not be excluded from activities in the belief that she might hurt herself, unless restrictions are specified by her physician or ophthalmologist.
On the other hand, some children prefer not to participate in certain activities. A child with aniridia may find it very difficult to participate in ball games in which quick focusing, depth perception, and detail vision are necessary. Again, you may wish to consult with the VI teacher to provide suggestions as to how the student with aniridia may participate in sports in a meaningful way, such as assisting the team’s coach or taking score. It may be necessary to find other activities that he can do and get other students involved in a meaningful way. Some of the following suggestions may be helpful around the school, both inside and out. Individuals with aniridia may have good indoor and outdoor travel skills, but may have trouble with depth perception, such as unmarked steps, or unnoticeable small holes or dips on a playground.
• Fire drills—The child with aniridia should be instructed to walk with or take hold of a nearby classmate or adult, and quickly and quietly follow others. Assigning a sighted student is ineffective when the assigned student is absent or panics.
• Auditorium—The child may choose to sit closer to the stage and should be allowed to do so.
• Field trips—When visiting a theater, a museum, or other exhibits, you may want to notify someone on the staff that there is a visually impaired student in your class. If told in advance, they may allow the child with aniridia to go beyond museum barriers or touch some of the exhibits.
• Lunchroom—Initial orientation to the lunchroom may be necessary so that the child learns where the trays are located, where the line forms, etc.
• Listening skills—These skills enable the child with a visual disability to make efficient use of her hearing, and are particularly important for listening to recorded texts and obtaining information from teacher presentations and class discussions. Tuning in to sounds in the environment is also essential for the development of her orientation and mobility skills. Listening skills taught by the VI or mobility teacher can supplement those taught in the regular classroom.
• Daily living skills—These are essential for the development of independence and a feeling of self-worth. They include the “how to’s” of daily living, from good grooming, to cooking a simple meal, to organizing and locating belongings.
• Orientation and travel skills—The child will be taught the basics of movement and travel skills as needed by a mobility teacher.
• Visual skills—The VI teacher will help a child with a visual disability to discover the conditions under which he can best use his vision, such as types of illumination, positioning of materials, type size, and so on.
• Materials—Special or adapted materials may be obtained for use in the classroom. The VI teacher will help your student to learn to care for the tools and equipment she uses.
• Concept development—The child who has been severely visually impaired since birth may need to be taught the body image and spatial concepts that the sighted child normally develops as a matter of course. For example, a child may need to learn such spatial concepts as “above,” “below,” and “next to” in relation to himself and others. Older students may have difficulty understanding the concepts of rotation and revolution. The child also needs to learn concrete educational experiences. By using real objects he can learn about the environment around him.
• Remedial academic assistance—The VI teacher may be able to help you locate tutors or otherwise provide for remediation if this should be necessary.
• Counseling and guidance—One of the most important jobs of a teacher is to provide an understanding atmosphere in which the child with a visual disability can express her physical disability. It is necessary to help the child cope with the attitudes of others. With you and other supportive staff, the student will learn to communicate their needs and concerns. The school’s guidance department also shares the responsibility of personal counseling and career education. A student with aniridia approaching the age of fourteen should also consult with a vocational counselor from the state agency or department concerned with the needs of the visually impaired. Students with a visual disability should become aware of their state’s programs for financial assistance in higher education and vocational planning.
• It is important to remember that a young child with aniridia, particularly if the child’s vision condition has been stable from birth, may not be aware that what he is seeing is any different from what other children see. A gradual visual loss is also difficult for a child with aniridia to detect and verbalize. For example, the child may not realize that there is increased glaucoma pressure in his eyes.
• It is extremely important that the regular classroom teacher, the VI teacher, parents, and other support service school staff maintain positive open communication for the benefit of the student’s success in school. Everyone must work towards helping the student with aniridia to reach their maximum potential in every aspect of life.
• One way to help the student excel and for you to stay connected with the child’s parents and VI teacher is to be involved with the child Individual Education Plan (IEP). Make sure the parents understand how important an IEP is and how it can help the child.
Some possible warning symptoms of deterioriating eyesight can be placed in one of the three major groupings listed below.
• Physical changes of or about the eyes and face—These include an eye that tends to wander or eyes that are bloodshot or show recurrent redness or watering. The child may complain that her eye hurts either at various times of the day or during specific tasks. Frequent rubbing of the eyes is another symptom of trouble. Facial distortions, frowning, or an abnormal amount of squinting or blinking are also possible signs of problems. A child may show preference for using only one eye, for viewing at close range, or bring objects unusually close to her eyes.
• Changes in vision—A child may complain that objects look blurry or that he is unable to see something at a relatively close distance. He may have an unusual tendency to hold his hand close to his eyes or move it in front of him. An inability to use vision in different types of situations or illumination should also be noted.
• Changes in behavior—A child may become irritable when doing deskwork or show a short attention span when watching an activity that takes place across the room.
• Glasses do not always help correct limited vision. While some visually limited children will be aided to an extent by corrective lenses, there are many for whom correction is not possible, and many who can benefit somewhat from correction but will still have very limited vision.
• Holding a book close to one’s eyes will not harm one’s vision. Individuals with aniridia often do this to help compensate for the size of the print.
• If a television is functioning properly, sitting close to the set will not harm the eyes.
• Sight cannot be conserved. Unless you have been informed otherwise, encourage a child to use their vision.
• Dim light will not harm the eyes. As a result of some eye conditions (aniridia, cataracts, albinism), a child may require dim lighting in order to visually feel more comfortable.
• Loss of vision in one eye does not reduce vision by 50%. While there is loss of vision on the affected side and a general loss of depth perception, it is not a loss of half the visual system.
For more information about aniridia, please visit the Aniridia Foundation International’s (AFI) Physicians and Professionals area by logging on to the website www.aniridia.net. In this area there is a special page for teachers. AFI adds new information on a continual basis, so go there often. If you have any helpful suggestions that have not been printed, please send them to teachers@ aniridia.net so that AFI may