Early Intervention: Targeted Instruction to Address the Needs of Typically Developing Infants with Visual Impairments 

January 30, 2013Ann Rash, Outreach Infant Coordinator

Chrissy Cowan, Outreach Mentor Coordinator

Infant Development

Developmental Checklists for typically developing infants

Determining sensory channel use

• Watch this video as you complete the Use of Sensory Channels sheet

• http://rickackerly.com/2012/10/24/baby-begins-to-search-the-orld/#more-3933 

Impact of Vision Loss on Development

Developmental Guidelines for Infants with Visual Impairments (APH)

Sharing information with other service providers 

Infant Brain DevelopmentWhy this matters for TVIs and COMS

The Infinite Array

• The brain and nervous system contain billions of interconnected neurons.

• Neurons form trillions of connections and the pathways.

• The number and organization of these connections influence everything, from the ability to recognize letters to the maintenance of relationships.

Making Connections• Neurons develop rapidly before birth. • At birth, infants have all, or most, of the brain cells they will ever

have.• Connections or "wiring" between these cells is incomplete -

connections have to be built.• Between birth and 8 months synapses form rapidly.• One neuron can connect with 15,000 other neurons.• In the first 3 months of life, the synapses multiply more than 20

times. • At 3 months, the baby has more than 1,000 trillion synapses. • http://developingchild.harvard.edu/resources/multimedia/videos/three

_core_concepts/serve_and_return/ 

Brain Plasticity in Early Childhood• Connections are made permanent from early

infancy to early childhood • As we mature, the brain physically changes due

to outside experiences.• The first three years see the most rapid changes

due to the bombardment of experience (everything is new!).

• At this time, the brain is most flexible and prepared to learn. (plasticity)

Pruning• Connections that are not used are

removed by "pruning" • After the first birthday, pruning occurs

more quickly. • A 3-year-old child has twice as many

connections as an adult.  • By 10 years, a child has nearly 500

trillion synapses, which is the same as the average adult.

Experience Builds Connections

• Early childhood experiences physically determine how the brain is "wired."

• Early sensory experiences create new synapses.

• Repetition of experiences strengthen them.• The number of connections can go up or

down by 25 % or more, depending on the enrichment of the environment.

• Those synapses that aren't used are pruned. • http://developingchild.harvard.edu/resources

/multimedia/videos/three_core_concepts/brain_architecture/

Genetics & Environment Interact

• There is mounting evidence that early experiences can dramatically alter the way genes are expressed in the developing brain.

Sensory Stimulation

• Touch, sound, sight, taste, smell, all build connections

• Some researchers, believe "the number of words an infant hears each day is the single most important predictor of later intelligence, school success, and social competence."

• Touch also is key to brain development– Research on infant massage suggests that in

preemies, massage causes faster growth and development.

Security• The most fundamental task of an infant is to learn

how to meet his needs• If adults respond predictably to his cries and provide

for his needs, the infant feels secure – He then focuses his attention on exploring, allowing his

brain to develop• If his needs are met only sporadically, the infant will

focus his energies on meeting his needs – He will have more and more difficulty interacting with

people and objects in his environment – His brain will shut out the stimulation it needs to develop

healthy cognitive and social skills• http://developingchild.harvard.edu/resources/multime

dia/videos/brain_hero/

The Basis of Learning

• The past decade has seen a massive amount of research on infant brain development & learning

• Babies know more than we once thought

A Summary of Infant Skills• 2-day-old infants recognize their mother's

voice and prefer it over other sounds. • 3-month-olds can discriminate primary colors,

& prefer red & yellow over blue & green. • 6-month-olds recognize a mobile 2 weeks after

being exposed to it for 2, 15-min. intervals. • 7-month-olds can match angry or happy facial

expressions with the corresponding vocal expression.

• 9-month-olds will imitate simple actions which they see being performed on objects, one week later.

Play

The Child’s Work and Your Intervention Strategy 

Great resource for teaching ideas

• Oregon Project–Skills Inventory–Binder of teaching activities

The goal of play:

• Have fun• Enjoy others• Experiment and make mistakes• Practice skills in a natural way• Practice problem solving

Play is not:

• Rigid structured therapy– Beware of developmental toys (stacking rings, shape sorters, puzzles)

• Adult directed lesson with predetermined outcome

How long will he stay interested in this?

Play + Real Objects = Learning Media

•  Social Emotional• Objects • Fine and Gross Motor• Language• Cognition

• Resource for Strategies:  Developmental Guidelines, pages with “Opportunities for Learning”

TVI as Facilitator of Emergent Literacy

4I

Emergent Literacy Begins at Birth 

• Emergent literacy is the developmental process that begins at birth whereby children acquire the foundation for reading and writing. 

• “The term ‘emergent literacy’ is used to denote the idea that the acquisition of literacy is best conceptualized as a developmental continuum, with its origins early in the life of a child, rather than as an all-or-none phenomenon that begins when children start school” (p. 848).

Whitehurst & Lonigan, 1998

4TT

Concepts About the World

Gaining concepts about the world (schemas) helps children understand concepts in books.Helping put up toys, getting something out of the refrigerator, helping put on shoes. A book about “clean-up” will be enjoyed moreif children have previous experiences with the concepts.Rosenkoetter & Barton, 2002

4WW

Conventions of Print/Braille Books • are generally made of paper, but can be made of other materials; 

• have pages to be turned; • may contain words or pictures; and • have pictures that represent familiar objects. 

Harley, Truan, & Sanford, 1997

What do we mean by “books”

• May be marketed books– May have to carefully selected to reduce “clutter” on page

– May have to be supplemented with objects mentioned in story

– There should be books that reflect the child’s experiences/interests (going to the store, going to bed, taking a bath, etc.)

Books made by you or the family

• Experience boxes• Experience books w/ objects glued on page• Books illustrated by child• Experience books with actual photos 

Environmental Factors Emergent literacy is influenced by environmental factors, or the contexts ofchildren’s lives. 

Strategies and Interventions to Facilitate Emergent Literacy

Developmentally appropriate strategies andinterventions that promote functional outcomesinclude • play; • routines-based literacy;• responsive literacy environments;• shared storybook reading (especially dialogic reading, storybook preview, and storybook sounds);

• Storytelling• dialogue/conversation.

Examples of Active and Interactive Engagement 

Seventeen-month-oldAllysandra and her mothershare a storybook.

Here, at 22 months,Allysandra explores a book actively.

How do we help an infant develop literacy skills?

• Establish routines– http://www.pathstoliteracy.org/helping-young-children-develop-emergent-literacy-skills#routines 

• Experiential learning– http://www.pathstoliteracy.org/helping-young-children-develop-emergent-literacy-skills#experience

• Meaningful activities– http://www.pathstoliteracy.org/helping-young-children-develop-emergent-literacy-skills#meaningful

(continued)

• Read aloud– http://www.pathstoliteracy.org/helping-young-children-develop-emergent-literacy-skills#read

• Exposure to reading and writing– http://www.pathstoliteracy.org/helping-young-children-develop-emergent-literacy-skills#exposure

• Evidence-based recommended practices– http://www.pathstoliteracy.org/helping-young-children-develop-emergent-literacy-skills#evidence

What a home visit looks like

Home visits 101Tell us your stories

How is working in someone’s home different?

• Working w/ a family, not teachers/therapists• Family may be in shock from medical news• We have no control over the environment• We have to be aware of saying things that reflect a value or cultural system different from the family’s

• Be sensitive to all family members

Things to consider before the home visit

• What other disabilities are present—research these (ex., CP/motor issues that will affect positioning/mobility)

• Review history in your office—it may be painful for family to repeat it all over again

• Talk w/ ECI personnel to find out current home dynamics/therapy that is occurring

Planning intervention

• Group Activity:Fill in the Summary of Developmental Strengths and Intervention Concerns (from Developmental Guidelines for Infants with Visual Impairment)

Get your foot in the door

• Building trust:  active listening, which includes open-ended questions

• Find out what is most important to them (sometimes this is not vision!)

• Avoid acting like you know everything--be honest

• Give time, don’t rush—you are on “family” time, not “school” time

Strategies that empower 

• Acceptance vs. judgement & criticism• Sharing concerns in a direct way vs. avoiding difficult or touchy subjects

• Allow exploration of feelings vs. cutting off exploration of feelings (you may privately question some, but all feelings/thoughts during grieving process are normal)

Empowerment….

• Offering information related to stated need(s) vs. flooding with information

• Value contributions and ideas from family vs. insisting that other’s do what we want or advise-family’s ideas are the ones most likely to be embraced

Setting the Stage for future home visits….(following assessment and initial IFSP)

• Interact with the baby as you talk early in the visit (“Can I hold/play with ___?”  “What is the best way to pick him up?”  “What is his favorite object?”)

• Interact with siblings—if you bring in a bag of stuff, don’t be too picky about them exploring

• Ask the parent, “What questions do you have about what I’ll be doing with your baby?”

Programming Begins: 1st Home Visit

• “Tell me about your child.”  “Does he sleep/eat OK?”

• “What are your concerns about his vision?”• “Do you have any questions about what the eye doctor has told you?”

• Share your information:  phone/email• Set a schedule, realizing this will need to center around family and child’s bio-rhythms. 

2nd home visit• “Tell me about your week.”• Share information that relates to questions that were brought up in home visit #1

• “Play” with the baby.  Begin to note: visual behaviors, patterns of movement, how baby responds to stimuli.

• Gage child’s level of stamina

2nd home visit (cont.)• Explain what you are looking for as you play.• Leave time for questions, and close with positive comments about baby

• “Next time, I’m going to take notes on what happens in your child’s day—your daily routine, and how alert your child is during different parts of the day, so that we can plan the best opportunities for him to use his vision.”

3rd home visit• Begin the “Routine-Based Activity Planner” discussion.  Take notes.

• Explain why a daily routine is a nice vehicle for increasing visual behaviors

• Together, pick the time for one routine and outline a plan to try the routine (ex., bath time)

Bath TimeEatingBed TimePlay Time

A typical home visit may include:

• Greeting family members and catching up• Talking or playing with siblings• Sharing information about recent or upcoming medical or other appointments

• Reviewing developmental changes the parent has observed (“What’s new?”)

• Reviewing how suggested activities went• Discussing and modeling activities

Typical home visit (cont.)

• Listening to parent concerns and offering emotional support

• Sharing problem-solving strategies• Locating community resources• Scheduling the next home visit

now tell us your best home visit

Which hat will you wear?

• Confidant• Collaborator• Teacher (with child)• Coach (with parent)• Community liaison • Advocate

Some parting thoughts….

• Consider time together as an investment, not a cost

• Coach, not control• Supply quality resources—time to read is limited!

Resources

• WonderBaby http://www.wonderbaby.org/• LIAM Project http://www.liamsproject.org/ (resources 

to families of children with albinism to help make their transition easier after diagnosis) 

• Family Connect  http://www.familyconnect.org/parentsitehome.asp?SectionID=75 

• PAVII, APH Quota Funds• Blind Babies Foundation http://blindbabies.org/learn/resources/ 

Resources

• Washington Sensory Disabilities Service– http://www.wsdsonline.org/

• Infant/Toddler Link• Videos Link

Evaluations• Please fill these out and fax to:

Eric AdcockTSBVI OutreachFax: 512-206-9320