Death by IEP / Why formal assessments do NOT work for CVI children or other children with sensory loss

I posted recently on my frustration with the “formal” assessments therapists and educators have tried to use on my daughter over the years.  (The long winded post, Death by IEP / Assessments and Access, has great quotes from experts in the field about the problems with assessments geared toward children with typical vision and hearing.) 

I learned early on in Eliza’s life to politely tell evaluators where they could put their assessments and the grim column of zeroes or checkmarked boxes of “No” or “Cannot do,” that would inevitably result.  ….  Right back in their briefcases, of course.  Ahem.

The grim column of zeroes represents the failure of formal assessments to accurately gauge the abilities of children with sensory loss.  It does not reflect their capacity to learn.   It literally means nothing. 

This has been a topic of conversation for CVI moms on Facebook recently.  Probably because it is IEP season and we are all hunting resources for appropriate IEP goals for our kids.  I am personally working on IEP goals that have higher expectations for my non-verbal kid who will wrap you around her finger with her cuteness, a method of sailing through life that has served her well so far.

IMG_0834Image:  A girl smiling broadly swings at the park.

By asking around about the problem of assessments, it was suggested to me that I look into the work of Dr. Jan van Dijk.  I thought I would pass along what I found.

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From Perkins eLearning: In the early 1960s, Dr. Jan van Dijk of the Netherlands was asked to assess children with sensory impairments and multiple disabilities.

He found that existing assessment tools were not useful because they assumed that the children had been exposed to typical experiences; and he felt that children with sensory impairments and multiple disabilities, due to the very nature of their impairments, had not had the opportunity to experience the world in a typical manner.

Dr. van Dijk dedicated his 50-year career to helping children who have multiple disabilities in addition to deafblindness. His child-guided strategies are recognized and used throughout the world.

What is child-guided assessment?

Child-guided assessment is a procedure to bring the best of the child to the surface.
Children with multiple disabilities live in a fragmented world, often full of stress and anxiety.
The assessor wants to meet the child within this very peculiar world, to discover how learning in its broadest sense takes place. He tries to resonate with the child’s behavior by following the child’s lead.
When the child feels that he is controlling the situation, it is likely that he will open up and will follow the assessor’s suggestions for finding undiscovered paths for learning and emotional stability.

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I watched one of Dr. van Dijk’s webcasts yesterday.

http://www.perkinselearning.org/videos/webcast/child-guided-assessment

In my humble opinion, this is 29 minutes CVI moms need to watch to better understand why formal assessments don’t work and how to explain this to IEP teams.  Dr. Jan van Dijk (who died last year) was an expert on working with children with multiple disabilities.  And, as one CVI mom said to me recently, “CVI doesn’t stand alone.”

I felt as though I understood my complicated kid better after watching it.  It’s important information and gives a glimpse into the way to reach our children.

Also, it’s fun to listen to Dr. van Dijk’s accent.  (I am easily amused.) 

If you get a chance to check it out, let me know what you think.  I’d love to know if you found this information helpful and if it helps you make progress with your child’s team.

Thank you!

 

 

 

 

 

Death by IEP / Assessments and Access

There are no tests of potential (different from achievement) that are free from inherent bias for individuals with CVI. The items are often based on content that is linked to visual learning and therefore, the scores will skew low

….and they certainly do.
Dr. Christine Roman-Lantzy

Cognitive assessment is typically based on how a child learns information including rate of learning, problem solving, and accuracy. For children with vision impairment, they have not had access to basic information.

How can you learn, let alone be judged on, information that either you cannot access or others have not given you access?

Dr. Sandra Newcomb

Hello fellow families of beautiful children with CVI,

Since it’s IEP season, I’ve been thinking about assessment tests recently.  As a parent of a child with special needs, I have watched my daughter go through a gauntlet of physical, developmental and cognitive testing from her earliest days.  It can be hard to watch.  It can be hard to hear the results.  Whatever the results, I want them to be accurate.

As the parent of child with CVI, I have learned that there is a lot to be aware of when someone says they want to assess your child.

When Eliza was about a year old, a new occupational therapist wanted to assess her.

We were still wrapping our minds around the diagnoses that had quickly followed our girl into the world:  microcephaly, cerebral palsy, global developmental delay, cortical visual impairment.  The learning curve was less a curve than a straight 90 degree angle to climb with no climbing gear,  and occasional boulders of unforeseen complications – seizures, asthma attacks, severe GI issues, little sleep – raining down at any given time.  We were trying to find our way.

This was soon after our Neuro-Ophthalmologist had told us there was nothing we could do about CVI. “Take her home, treat her like a blind child, come back and see me in a year.”

This was soon after I had ordered Dr. Roman-Lantzy’s book and sought her out for the first time.  I was just at the beginning of understanding what Cortical Visual Impairment was.  The message that Eliza’s vision could improve, however, was loud and clear.

Dr. Roman-Lantzy’s work offered me a glimpse of hope, especially because many of her 10 CVI characteristics explained Eliza’s puzzling behaviors for the first time..

Eliza was a light gazer.  She stared at light coming in through windows, lamps, or any strong light source.  She stared at fans.  She reluctantly used her peripheral vision and only if she had to. There was a long latency period between the time she would glance sideways at an object and then reach for it (usually with her head turned away from the object).  If you did not know to wait, you would miss her processing and getting organized enough to reach for something she had seen 15, 20, 30 seconds earlier.

She would not look into faces.  Her head often hung down, especially in new environments.  The novelty of new places was too much sensory input, and often, caused her to have screaming fits.   She was in Phase I.  I was still learning what that meant, but it was a place to start.  It was a foot hold in my 90 degree upward climb.

The new occupational therapist wanted to assess Eliza’s fine motor skills to establish a baseline to measure future progress.  Made sense to me.  I knew we had to get used to doing this.  We had to let the experts do their thing. Their keen eyes and knowledge would help me read my girl who was in many ways still a puzzle to me.  Their assessments would give us a fuller picture of Eliza and what she could do.  Or would they?

This is what I remember from the first assessment 10 years ago.

It was called the Hawaii Early Learning Profile.  I remember because the acronym for this assessment is HELP.  That was very comforting.  Boy, did I need HELP.  And, why Hawaii?    What did Hawaii know that the rest of the United States did not?  Maybe, there would be poi and hula dancing involved.  (Remember, I was not sleeping and it gets very busy in my head even when I’m well rested).  The HELP would help.

Standing in the OT’s office with one-year-old Eliza on my hip, I read over the developmental charts in the HELP.  I noticed that a lot of what was assessed required that the child had typical vision.   I mentioned this to the therapist.  She agreed that was an issue.  HELP, like most developmental assessments, did not account for vision loss.  But, she would write a note that Eliza had CVI.

I continued reading the chart of developmental milestones.

Looks at picture” – Nope.

“Plays with hands, feet” – Hasn’t found them yet, so no.

“Looks at place where ball falls down” – Uh Uh.

“Plays Peek-A-Boo”  – Well, doesn’t look at faces, so pass.

“Searches with eyes for sound” – Can we substitute stares at light bulbs?

“Places cylinder in similarly shaped hole” – Okay, I don’t even know where to begin with this one.  Just no.

“She is technically legally blind,” I told the OT.  “She doesn’t look at pictures.  She doesn’t look at faces. New sounds startle her. Do you have a different assessment?”  

The OT assured me she would mention Eliza’s diagnosis of CVI in the notes section of the test.

“Wait, what?  The central challenge to her ability to interact with the world will be a footnote?” (Okay, I didn’t say anything that articulate.  The “Wait, what?” is more like it.) 

To begin, she wanted to test Eliza’s ability to track a ball and to reach for it.  She put a light colored tennis ball on a school desk and rolled it to where I was standing with Eliza in my arms.

“Get the ball, Eliza!”  the therapist prompted.  The ball rolled off the desk.  Eliza was oblivious.    The OT looked apologetic, picked up the ball and tried it again.  Eliza stared at the fluorescent lights above us.  I stared at the therapist in disbelief.

She can’t see the ball,” I told the OT.  “It is too similar to the color of the desk.  Can I put a piece of black cloth on the desk to make it easier for her to see?”

“No. We have to maintain the protocol of the assessment.”

“If she could see it, she might reach for it.” 

“We can’t change how we do the assessment.”

So, the assessment will just be a series of zeroes then. It is going to look like she can’t do any of this if we don’t give her a chance to see what you expect her to do.  You’re not going to get an accurate idea of what she can do right now this way.  That’s like me asking you to run an obstacle course or do an algebra test in the dark. How would you score on that?”

“I’m sorry.  This is how we perform this assessment.”

“Well, it’s basically useless.  So, I think we are done here.” 

After watching the OT roll a ball my daughter could not see to her and then, scoring her as unable to track and complete the task, it dawned on me that the rules of this test were stacked against her.  Her development was going to chart a different path, a path this test did not accurately measure.

This was a new and strange idea.  I was slowly getting used to the fact that Eliza didn’t fit in anyone else’s boxes – not the pediatrician’s typical development questionnaires, not the stupid head circumference charts, and now, not even in the assessment for a child with developmental delays.

We were in unchartered territory.  We needed people who would think (and assess) outside of the box.  If the test did not apply to her, then the rules didn’t either.   I thanked the OT for her time, told her we would not be working with her, and took Eliza home.

I am not an expert in developmental assessments, but I have sat through many of them over the years both as an observer and an interviewee.  Eliza is far too capable and far too challenging to be relegated to “notes in the margin.”

I have since seen gifted  interventionists and therapists work with Eliza’s sensory challenges – starting with a thorough reading of her scores on the CVI Range.  I have seen them observe her intently for long periods of time.  I have seen them use trial and error when necessary, but always respectfully.

The kid faces enough challenges as it is.  She at least deserves to be evaluated in a way that reflects her true ability and potential.

And, the HELP was no help at all.  (Sorry.  It was right there.  Someone HAD to say it.) 


Fast forward about 10 years to a week ago, when I was sitting in a meeting with our IEP team at Eliza’s school.

Our search for FAPE in our CVI saga is a long and complicated tale. There have been successes and setbacks.  In the CVI spectrum, Eliza is on the complicated side.  She is non-verbal and has had a series of lackluster school placements.

Yes, she has delays in her physical and cognitive development.  Yes, she can learn.  Yes, these two sentences can co-exist.  You would be surprised how many people you have to convince of this basic fact.

This year we have had slow, steady success with communication.  On the other hand, she has also developed some behaviors that get her out of doing things she doesn’t want to do.  (That kind of cleverness doesn’t show up on cognitive tests.  And, will give me more grey hair than I already have.)

In this recent IEP meeting, a school psychologist confidently presented her assessment of Eliza’s behaviors and introduced the Behavior Intervention Plan that would shape them right up.  There would be a token system of bright yellow stars that Eliza would learn to associate with immediate rewards.  Eliza will comply!  Eliza will be rewarded!

Eliza is currently in mid to upper Phase II now.  With private consultation and work at home, she has begun showing more visual curiosity.  We have worked on teaching actual objects in her environment first and then moving to 2D representations of these objects.  Recent research from CTVI Matt Tietjen has revealed that children with CVI struggle the most with symbolic representations of objects – cartoon drawings, illustrations, etc…   They need to learn the actual objects and then learn the pictures of the objects.  (Check out his class, “What’s the Complexity Framework” offered through Perkins elearning.  Seriously.)

This is what was going through my mind when the psychologist started explaining her token system to us.  They were proposing stars (symbols)  to represent a reward for a child who does not have a lot of external motivators. (I never said she was easy.)  I wondered if the psychologist had actually met my girl.

I wanted to clarify about needing to use actual objects and then move to 2D pictures.

I interjected, “You realize she has a visual impairment right?  She has Cortical Visual Impairment, so we have to —” 

I know, I know.  High contrast.  We have to make the stars high contrast.”  The psychologist cut me off mid-sentence and began explaining her token system again.

I was reminded of something CVI Teacher Ellen Mazel said at a recent conference.

Ellen says that the most dangerous people she has ever met are

1. Teachers who have never heard about CVI

and

2. Teachers who have been to one workshop or read one article and think they are experts in CVI.

I knew I was sitting in this IEP meeting with someone who had read an article and decided she knew CVI.

She was going to continue using the assessments and the strategies she knew (for children with – I can only assume – typical vision) without taking into account how Eliza has access to her environment.
By the way, not having access to your environment, not understanding what is going on around you will affect your behavior.

This situation is still a work in progress.

I am shopping for an advocate and hoping to win the lottery.  To be continued….


What have I learned from these experiences?  What do I continue to learn?

When dealing with children identified with CVI, the CVI Range (Roman 2007) is the assessment that is the foundation of all other assessments.

When you are the parent of a child with CVI, be wary of the assessments used by your intervention or educational teams.  There are not many developmental assessments that take visual impairment into account.  Ask a lot of questions.

Ask them if they know what incidental learning is.  Our children are NOT incidental learners.  This fact should guide how therapists and teachers interact with them.

If you don’t feel comfortable with the answers, ask more questions until you do.  Or, ask for new providers.  You have every right to work with therapists and interventionists who have your child’s best interest at heart and who understand how to work with a child  with CVI.

Regarding other assessments for young children with sensory loss, I found interesting information here:

http://www.wonderbaby.org/articles/development-charts

and

http://www.perkinselearning.org/scout/assessment-young-children-visual-impairments

I am also aware of The Oregon Project for Preschool Children who are Blind or Visually Impaired. It is a comprehensive assessment and curriculum designed for use with children birth to six who are blind or visually impaired. It can be used by parents, teachers, vision specialists, or counselors in the home or in the classroom setting.

 

I am not recommending one assessment over another.  Each child with CVI is unique and requires a multi-disciplinary team approach of therapists, interventionists, teachers, and doctors.  Some of these team members must have a thorough understanding of CVI.

We, the parents, are team captains.  If your team proposes to assess your child with developmental tests that do not give your child access, you may need to discuss what other methods of assessments are available.

If no one on your team says you need to get a CVI Range completed for your child by a Perkins-Roman Endorsee, then, you need to lead the way.

Inaccurate results are not going to help your child.  Inaccurate results are not going to help your child’s therapists or educational team.

Even when it comes to assessments:

It is not extra

And, to all of those folks who want to test our children with tests that do not accommodate them…

To all of the therapists and teachers who have read one article or attended one workshop on CVI and then try to fit these kids in the margins or the footnotes, Eliza and I would like to respectfully say,

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Death by IEP / A New Category (Not a previously unpublished Agatha Christie novel…although wouldn’t THAT be cool? …but I digress.)

Hello fellow families of glorious children who happen to have Cortical Visual Impairment,

It’s IEP season at our house! 

That festive time of year parents of students with special needs eagerly anticipate with the kind of glee small children save for Santa.

Deck the halls with articles about neuroplasticity and webinars on Orientation and Mobility….Fa La La La and the CVI Range….. Ho Ho, ah phooey.

I can’t fool you.  I am not jolly.

Technically, it’s always IEP season at our house because I continue learning what I have to ask for and how to advocate for my complicated girl with a brain based vision impairment not currently acknowledged by the vast majority of school systems in the U.S.  More importantly, it is not acknowledged by, or regulated in, the current laws of Special Education.

Ho Ho – Holy Crud, this is hard. 

(To get us all on the same page, here’s a very basic definition of an IEP.

“IEP stands for Individualized Education Program.  An IEP is a written statement for a child with a disability  that is developed, reviewed, and revised in a meeting in keeping with certain requirements of law and regulations.

The IEP has two general purposes:

(1) to establish measurable annual goals for the child;

(2) to state the special education and related services and supplementary aids and services that the public agency will provide to, or on behalf of, the child.

When constructing an appropriate educational program for a child with disability, the IEP team broadly considers the child’s involvement and participation in three main areas of school life:

  • the general education curriculum
  • extracurricular activities
  • nonacademic activities”)
Source:  http://www.parentcenterhub.org

By the way, we parents are a critical part of the IEP team.

Don’t let anyone tell you otherwise.  Especially when it comes to CVI.  We have a long, bumpy road ahead of us, but we are the ones getting educated about CVI.  We are the ones seeking out experts, reading journals and books.

(Speaking of BOOKS, Dr. Roman-Lantzy’s NEW book, Cortical Visual Impairment: An Approach to Assessment and Intervention, 2nd Edition is out!!!!

Go to the AFB Store to check it out! 

https://www.afb.org/store/Pages/ShoppingCart/HomePage.aspx 

Then Celebrate!!)

We moms and dads are critical members of our children’s IEP teams.  We stay up late researching articles on CVI and our children’s other needs and diagnoses.  We print them out the night before.  We highlight and staple the articles filing them in manila folders with our children’s names written neatly on the tab.  This is our attempt to have some control over a situation in which we have nearly no control whatsoever. (Or maybe it’s just me.)

IMG_1947.JPG

Image:  A haggard woman in sunglasses holding stacks of research in each hand prior to an IEP meeting.

I am a perpetual optimist, much to the annoyance of my husband and some of my friends. Yet, despite my tendency to be ridiculously optimistic in the face of dire circumstances, I am worn down by years of IEP meetings that seem to go nowhere.


I have not learned the skill of successful IEP planning.  I am embarrassed to admit this. My daughter is now 11-years-old and I still feel inept and ineffective.  I feel as though I should be smarter than this.  

Googling “IEP assistance” brings up  many, many resources for IEP writing and advocacy.  I suppose I am in good, if frustrated, company.


 

In spite of plenty of effort and research, I  haven’t been particularly successful in articulating how Eliza needs to learn and how the school needs to put it in place. I’m worn down by giving each new school and each new teacher the benefit of the doubt for a few months,  then discovering that the implementation of what we put in the IEP was not carried out.  I’m worn down by insisting that she can learn more than the school thinks she can (“The downward spiral of low expectations.”).  I am worn down by seeing stacks of articles I printed out, untouched on someone’s desk.  Or, never seeing them again.

iep-hell.png

Image:  A dining room table covered in papers, low tech communication devices, pictures and binders in preparation for an IEP meeting

Every year I spend  hour after hour attempting to convince, cajole,  and then, demand that the school team learn about how CVI is an obstacle to my child’s ability to learn and WHAT TO DO ABOUT IT.  I have hired private consultants and therapists with money I do not have.  I have documented the progress we make at home to take to school to show what Eliza can accomplish with mutual goals, high expectations, and a common understanding of how to navigate Cortical Visual Impairment because it is an issue every waking second of her day – much like my typical vision is with me every waking second of my day.

Meetings are planned.  School staffs are polite and weary.  Meetings end.  Everyone needs to get back to their jobs.   We agree to disagree.  I refuse to sign the document, or sign in partial agreement with my handwritten list of concerns.

The NEXT IEP meeting is scheduled in a couple of weeks so we can all jump back into the ring and continue the match.

And, before I know it, another year has passed.  I have been humored and circumvented without even realizing it.

I drag myself home after another IEP  meeting to nowhere like the last contestant in a 24 hour dance marathon.  I’ll crawl into a quiet place to sit and stare vacantly for awhile.  (Sometimes I find myself mumbling, “The horror, the horror…”  Ok, that was a slight exaggeration.  Maybe, “the frustration, the lack of understanding…access…..it’s about access, dang it”  Yes, that’s more like it.)

One night as my husband was coolly observing what used to be the dining table (see above), but is now my Command Center For Changing Education As We Know It For Children with CVI  – (too much?) – he commented,

“It’s like Death by IEP.”

And, suddenly my world made a little more sense.

So, now CVI Momifesto has a new category for all of the fun, D-I-Y projects that are our children’s IEPs.   This category will be a place to tell the IEP stories and to share what works and what really doesn’t work.

Baloney

Image:  A post-it note with the words “This is baloney” written on it.  The post-it note is on a copy of an IEP.

To be continued…..