Visual Impairments

Sharon Bradley-Johnson and Ruth Ekstrom

ompared with many impairments such as mental retardation and learning disabilities, visual impairment appears infrequently, with only 0.4% of students between the ages of 6 and 21 years receiving special education services because of a visual impairment ( U S . Department of Education, 1992). The majority of visually impaired individuals are adults; only 9% are younger than 45 years (Vander Kolk, 1981). In 1879 the federal Act to Promote the Education of the Blind was passed. Under this act, the American Printing House for the Blind (APH) conducts the Federal Quota Registration annually to determine the number of students enrolled in schools and agencies so that funds can be allocated for procuring books and educational materials A F H produces (Poppe, 1996). As ofJanuary 1995, there were 54,763 students registered. About 15% were in programs for adults, 32% in primary through secondary grades, 3% in kindergarten, 11% in preschools, 8% in programs for infants, and 28% were other. The mean age of the adult group was 40 years, consisting of those enrolled in rehabilitation programs, in programs for people with multiple handicaps, and in residential schools. Other registrants usually had handicaps in addition to visual loss, and many were in nonacademic multihandicapped programs. The majority of students (84%) were enrolled in state department of education programs, 8% were in residential schools, 5% were in rehabilitation programs, and 3% were in multihandicapped programs. The mean age of students in primary through secondary grades tended to be approximately 2 years older than the expected mean age

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of sighted students, ranging &om 8 years 6 months in Grade 1 to 19 years 7 months in Grade 12 (Poppe, 1996).

Definitions
Numerous terms are used to describe the various types of severe visual loss. The terms visually impaired and visually handicapped refer to individuals who require more than corrective lenses to function adequately. Those who are partially sighted as well as those who are blind fall into these categories. Individuals who are functionally blind must rely primarily on senses other than sight to learn. They use auditory (e.g., readers and tape recorders) and tactile means (e.g., braille) to acquire information. The term legally blind is used in determining eligibility for government benefits. The term applies to those with central visual acuity of 20/200 or less in the better eye with correction or to those with visual acuity of greater than 20/200 but who have a defect of the visual field for which the widest diameter is 20 or less. This classification does not necessarily mean that an individual is totally blind because more than 75% of people classified as legally blind have some usable vision (American Foundation for the Blind, n.d.; Vander Kolk, 1981). For planning instructional programs, this classification is not helpful because many legally blind individuals can use visual materials. Some organizations describe individuals who mustrely on nonprint materials, such as audiotapes and braille, as print disabled. Terms used to describe visually impaired individuals who are not functionally blind include l o w vision, limited vision, and partially sighted. For these individuals, vision is used for learning, but more than corrective lenses is needed to do so. In this chapter, we use the term low vision. These individuals may use regular or large-type material, some may require magnifiers, and some may need auditory and tactile material as well. In the educational system, definitions for eligibility for special education services because of a visual impairment are based on federal regulations, but they vary somewhat from state to state. According to the Individuals With Disabilities Education Act (IDEA, 1990), a visual impairment is one that, even with correction, adversely affects a childs educational performance. The definition for a particular state can be

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obtained from either a state department of education or a local education agency.

Etiology and Types of Visual Impairment

The etiology of severe visual losses may be a result of either congenital or adventitious factors. Congenital factors involve inherited conditions, prenatal damage, or trauma at birth. Examples include congenital cataracts, which can be associated with problems such as photophobia (ie., abnormal sensitivity to light), strabismus (Le., muscle imbalance that results in failure of the eyes to gaze at the same object simultaneously), and nystagmus (i.e., rapid, involuntary movement of the eyeball); retinitis pigmentosa, which involves a gradual deterioration of the receptor cells in the eyes that can result in total blindness or a restricted visual field; anophthalmos, which is the absence of the eyeball; and optic nerve hypoplasia, a condition occurring in utero involving the underdevelopment of the optic nerve. Adventitious factors causing visual loss involve accidents or diseases. An example is optic atrophy resulting from head trauma or tumors of the brain or eye. This condition may result in a loss of the peripheral field, a decrease in acuity, and photophobia. Corneal disease involves scarring of the cornea due to injury, allergies, or infections. Diseases such as diabetes, hydrocephalus, and multiple sclerosis may also cause visual loss. For a more detailed discussion of types of visual loss, see Happe and Koenig (1987). There is considerable heterogeneity in terms of the types of visual loss. Hazekamp and Huebner (1989) noted that there is a continuum of visual impairment ranging from mild losses to functional blindness. Furthermore, a visual loss may be stable, fluctuating, improving, or slowly or rapidly deteriorating. Thus, an individuals instructional needs will be affected by the cause of the condition and the type of loss. Besides etiology and type of loss, age at onset also affects functioning and instructional needs. Individuals who lose their vision after the age of 5 usually retain visual memories. These memories can facilitate the acquisition of certain language concepts, especially concepts that are difficult to teach to those who have never had vision. For example, the concepts of castle, cow, and color are difficult to comprehend without visual images. Individuals who d o not have a complete understanding of these concepts may still use them correctly at times

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because they have learned the concepts by rote. Thus, when assessing individuals whose visual loss occurred before the age of 5, it is important to probe questionable responses to determine whether the individual understands the concepts adequately. Also, an emphasis on assessment of vocabulary for young children with a visual loss is advisable so that misconceptions or inadequate concept development can be remediated as soon as possible. Many visually impaired individuals have other impairments in addition to visual loss. Kirchner (1983) suggested that 30-50% of visually impaired children have one or more additional impairments. Silberman (1981) estimated that more than 60% of visually impaired students have additional impairments resulting in delays in gross motor, fine motor, perceptual, language, cognitive, and self-help skills.

Assessment of Visual Impairment: Eye Specialists Reports

To understand an individuals visual loss, information from the eye specialists report is necessary. This report may include information relevant to planning assessment as well as intervention. Hence, this report should be considered before administering psychological tests. There are several types of eye specialists. Ophthalmologists are medical doctors who diagnose and treat eye defects and diseases. They also prescribe medication and lenses as well as perform surgery and other medical treatments. Optometrists are licensed nonmedical specialists who prescribe lenses and measure refractive errors and muscle disturbances. Opticians grind lenses according to prescriptions and adjust eyeglass frames, for example. Ophthalmologists or optometrists reports usually contain information related to the etiology of vision loss, age at onset, prognosis, required medical interventions and prescriptions, and restrictions on activities or use of the eyes. Information regarding the etiology of visual loss may help in understanding what, if any, useful vision the individual may have. For example, as noted previously, the age at onset has implications for concept development. The prognosis can have implications for instruction. If the prognosis indicates a changing condition, for example, there may be a need for supportive counseling to help the individual understand and adjust to the changes in vision. If the prognosis is for a gradual deterioration, it may be beneficial to begin braille in-

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struction while the individual still has some useful vision to aid instruction. Because eye conditions can change rapidly, the report from eye specialists should be up to date. To be useful, the visual assessment should have been completed within the past year. The following abbreviation information should help in interpreting results of eye specialists reports. Visual acuity and field of vision are measured separately for each eye. The abbreviation OD stands for ocular dexter (Latin for right eye), 0s stands for ocular sinister (Latin for left eye), and OU stands for oculi unitis or both eyes. Visual acuity refers to the sharpness of vision. Acuity is measured with and without correction (lenses) and for both near and distant vision. It is measured with a Snellen chart, in which 20/20 indicates normal vision. If acuity is described as 20/200, this means that the individual can see at 20 ft what a person with normal vision can see at 200 ft. If the loss is so severe that it cannot be measured with a Snellen chart (greater than 20/400), it may be measured in terms of the ability to count fingers held at varying distances. This result is abbreviated CF for counts fingers. If the loss is such that the individual cannot count fingers, then acuity may be measured in terms of ability to see hand movements at varying distances. This is abbreviated HM. The abbreviation NLP indicates that an individual has no awareness of external light (no light perception), whereas awareness of light is abbreviated as LP (light perception). If acuity is within normal limits, it is abbreviated WNL. Some individuals may have good central vision but poor peripheral vision. This loss of visual field can occur in one or both eyes. The eye report will illustrate the degree of loss and where the fields are restricted. This information has implications for the most useful direction of gaze. Individuals with a significant loss of visual field must be attentive to auditory input and learn to move their head and eyes to explore their environment.

Assessment of Visual Impairment: Functional Vision Assessment

Because clinic conditions used by eye specialists are not the same as those in other settings, recommendations in eye specialists reports may or may not apply to a classroom or work situation. Thus, a functional visual assessment may be carried out to ensure that appropriate envi-

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ronmental accommodations are made. This assessment typically is completed in the classroom or work setting by a teacher of the visually impaired or an orientation and mobility (O&M) specialist. Such assessments are not required in all states. Results from a functional vision assessment describe how individuals use their vision. Because of the heterogeneity in the population of visually impaired individuals, two visually impaired individuals with the same visual acuity may vary greatly in ability to use their vision. Different visual problems, such as different visual fields or the presence or absence of nystagmus or photophobia, is one variable responsible for differences in the ability to use residual vision. A second factor is individual differences in motivation to use vision (Blind Childrens Center, 1993). Results from a functional vision assessment can provide important information for planning both assessments and interventions. For example, the reports may indicate the type of lighting needed to optimize the use of vision, the appropriate size print, the best posture (for those with a limited visual field), the optimal distance for viewing material, and recommendations for using low-vision equipment. An environmental assessment (i.e., the assessment of the compatibility of the environment with an individuals capabilities) also may be included (Kelley, Davidson, & Sanspree, 1993). Because of the important implications of this information for the administration of psychological tests, results from functional vision assessments should be sought before beginning a psychological assessment.

Preparing for an Assessment

Organizing Background Information
A comprehensive, useful psychological assessment of an individual with
a visual impairment requires considerable planning before the administration of tests. Because of the quantity of different types of information involved, it is usually more timeconsuming to gather, organize, and interpret background information than it is for sighted individuals. To assist examiners working in school systems, Bradley-Johnson (1994) provided information organizing checklists for this purpose. One checklist is for use with infants or preschoolers, and another is designed for school-age students who are visually impaired. Besides obtaining information from school and clinic records and from interviews with others who know the individual well, input from

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several specialists is needed to plan a psychological assessment. Clearly, a multidisciplinary effort is critical if test results and recommendations are to be useful for visually impaired individuals. Because individuals with severe visual losses must rely to a considerable extent on auditory input, the report from a recent hearing evaluation should be obtained along with the eye specialists report. If these reports are not current, the psychological assessment may need to be postponed until such information is available. The report from a functional vision assessment, if available, also should be reviewed. If relevant, a report from a qualified O&M specialist also should be obtained. An O&M evaluation can be carried out even for infants. Assessment and intervention for O&M is critical for those with little or no vision to enable them to move about the environment independently. Examples of skills taught include the use of public transportation; safe travel within the home, school, and work environments; and appropriate walking stride and gait. Information describing other handicaps or health issues also will require consideration in planning a psychological assessment.

Classroom and Workplace Observations

Observing the individual functioning in a natural environment before administering tests can be highly informative. For examiners with little or no experience working with visually impaired individuals, this observation should help prepare them for what to expect during testing. Valuable information can be obtained from this observation for planning realistic and relevant intervention as well. Such observation is particularly important for school-age students. The more systematic the observational method, however, the more likely the data are to be o b jective. Procedures for systematic direct observation are described by Alessi and Kaye (1983) and Gelfand and Hartman (1984). One aspect of functioning that is especially useful to note when observing in the natural environment is the individuals organizational skills. Individuals who have little usable vision and poor organizational skills have a difficult time functioning efficiently and independently. Much time is wasted searching for lost items and requesting help from others when materials are not well organized and not returned to their original location when no longer needed. Unnecessary and frustrating searches can be avoided if visually impaired individuals are taught or-

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ganizational skills early in life. Teaching organizational habits to young children can begin by having a specific place where toys are stored and requiring children to return toys to their storage spot when children have finished playing with them. If organization is a problem, this is an important area to target for intervention.

Test Selection: Areas to Consider

Because most tests normed on individuals who are visually impaired are dated, lack technical adequacy, and have little instructional relevance, use of additional information sources is important, including records review, interviews, systematic observation, rating scales, and individually or groupadministered tests. Different types of tests should be considered, including norm- and criterion-referenced measures and curriculum-based measurement, to obtain enough data to support conclusions. Furthermore, a comprehensive assessment is needed to provide a well-integrated picture of an individuals functioning in various areas of development. It is not wise to base conclusions on assessment of only one or two areas, especially when technically adequate measures are limited. Areas to consider for assessment include daily living skills, play skills for young children, social skills, intellectual development, behavior and emotions, vocational skills, language skills, and other areas of achievement. Adaptive behavior measures that consist of numerous items requiring vision will penalize individuals who are visually impaired and should be avoided when possible. A n example of a measure that requires little if any adjustment for visually impaired school-age students is the Adaptive Behavior Inventory (L. Brown 8c Leigh, 1986).If a visually impaired individual uses adaptive devices to complete daily living activities, such as a braille watch or a slicing guide, the individual should be given credit on an adaptive behavior scale for performing these skills independentlyBecause of their contribution to all areas of development, play skills are important to assess for visually impaired infants and preschoolers. For descriptions of tests for this purpose and special considerations for intervention in this area, see Bradley-Johnson (1994). Social skills are particularly important to assess for visually impaired preschoolers through adults: Appropriate social interaction is the logical prerequisite to social acceptance (Raver-Lampman, 1990, p. 70).

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Many visually impaired individuals have difficulty in this area because they do not have the opportunity to learn some of the social skills that their sighted peers learn through observation of others behavior. Examples of difficulties include lack of certain gestures and not orienting to a speaker. Furthermore, the emotions of individuals with visual impairments may be misunderstood because these individuals do not use the type of nonverbal communication used by their sighted peers. Although observation in the natural environment and interviews with others may provide useful information on social skills, more comprehensive assessment is often warranted. Students with disabilitieswere included in the norm sample for the Social Skills Rating Scale (Gresham & Elliott, 1990), and the items on this rating scale do not penalize students with a visual loss. The age range for the scale is from preschool through high school. Assessment of receptive and expressive language also should be considered. Visually impaired preschoolers may be delayed in concept development, and individuals without visual memories may not have a complete understanding of some concepts. Some visually impaired students use words in a meaningful way in one context but not in another context, suggesting an incomplete understanding of the concepts (Higgins, 1973). Thus, results from verbal tests should be interpreted cautiously, especially for young children. Questionable verbal responses from visually impaired individuals of any age should be probed to ensure valid results. When vision is severely impaired, reliance on verbal directions is more often necessary. Thus, a good understanding of concepts describ ing position and relationships such as down, over; and Tight is important. Such concepts aid 08cM training and enable more independent functioning. Some of these concepts are especially difficult to learn for individuals with little or no useful vision and take longer to acquire. An emphasis on these concepts in assessment, especially with young children, seems appropriate. Listening skills are especially useful when vision is limited. Results from observation of the individual functioning in the natural environment as well as during the assessment should provide useful information on the development of listening skills. For individuals with difficulties in this area, however, an assessment of receptive vocabulary and syntax, attending behavior, hearing, motivation to perform requested tasks, and memory may be needed to determine which areas require intervention.

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Test Selection: Issues To Consider

When selecting norm-referenced measures, timed tests should be avoided whenever possible. If an individual reads braille, additional time will be required because braille reading takes longer than regular-size print. Duckworth and Caton (1986) suggested that braille requires about Z1/2 times longer to read than regular print, but this time varies as a function of the readers experience with braille and on the use of additional materials such as audiotapes to augment braille text. Reading large print takes more time also. In addition, the use of limited vision is tiring. If timed tests are used, a visually impaired individual may be penalized because of the additional time necessitated by the visual loss. Also, if frequent breaks are not used during testing, the individual may become more fatigued than sighted individuals, resulting in an underestimate of performance. To circumvent a visual impairment, if only a portion of a test is used, such as the Verbal section of a Wechsler scale, this restricts the range of skills assessed. Results would be based on a limited sample of skills and should be interpreted accordingly. Every effort should be made to use multiple measures for each area tested, especially when only portions of tests are given. Tests in the appropriate medium for the individual being tested will be needed. If an individuals primary reading medium is braille, then braille materials will be required for testing. Large print or magnifiers will be needed by individuals who use primarily large print. Other individuals may need audiotapes or speech synthesizers. Many individually administered and group administered tests have been transcribed into braille and are available through the APH (P.O. Box 6085, Louisville, KY 40206). Large-print and audio materials also are available through the APH. There are few tests normed on a visually impaired sample, and few have been published within the past 15 years. Although the response requirements in these tests should be appropriate, the visually impaired norm sample may or may not be an appropriate comparison group. Because of the many factors affecting visual loss and its manifestation, such as age at onset, type of loss, and amount of usable vision, this population is highly heterogeneous. A relatively large norm sample would be required to ensure adequate representation of the many types of visual loss. Simeonsson (1986) noted that when tests have some norms specific to visually impaired individuals, this may involve small, biased samples (eg., students in residential institutions) , or the infor-

mation may be confounded by individuals with varying amounts of useful vision. Using tests normed on a sighted sample also is problematic. If the individual has the enabling behaviors required to respond to the test items, and if comparison to sighted peers is desirable, such a test might be useful. Using such a measure assumes, however, that the individual has had experiences similar to those of the sighted sample. This cannot be the case because of the visual loss. If, for example, the visually impaired woman had attended a residential school and was overprotected by her parents because of the handicap, then her background would be much different from that of the sighted norm group. To help address problems with appropriate norm groups, conclusions about visually impaired individuals should be based on multiple sources of information, assessment of various areas of development, and periodic reevaluation. An extensive list of measures, and discussion of their technical characteristics, for use with infants through adolescents was provided in Bradley-Johnson (1994). Tobin (1994) provided similar information, along with information on the assessment of blind and visually impaired adults, based on practices in Great Britain. The importance of using multiple sources of information when selecting college students was also addressed in the Rehabilitation Act of 1973. It stated that a college would not be out of compliance in requiring the submission of test scores even though there is a strong possibility that these tests do not reflect a handicapped applicants ability. However, . . . the institution must guarantee that admissions decisions take into account other factors such as high school grades, recommendations, etc. (p. 22). Appropriate norm groups are not an issue with criterion-referenced tests. Furthermore, flexible administration procedures and various materials can be used. For braille readers, the APH has tactile supplements for both the Revised Brigance Diagnostic Inventory of Early Development (Brigance, 1991), covering skills typically learned between birth and 7 years of age, and the Brigance Diagnostic Comprehensive Inventory of Basic Skills (Brigance, 1983), covering skills typically taught from kindergarten to 10th grade. These criterion-referenced tests are extensive and cover areas such as daily living, language, play, reading, mathematics, written language, and general knowledge. Valuable information for instructional planning can be obtained with these measures. For monitoring progress in braille reading, a modification of the curriculum-based measurement procedure described by Shinn ( 1989)

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was examined by Morgan and Bradley-Johnson (1995). Because braille takes longer to read than regular print, a 2-min sample (rather than 1 min) was used, and 6 s (rather than 3 s) were allowed for error correction. Morgan and Bradley-Johnson found that the reliability and validity of this modified procedure for braille readers was highly similar to that of the original procedure used with sighted individuals. The curriculumbased measurement procedure can be used to monitor individual progress in braille reading frequently and efficiently and to compare an individuals performance with peers at any grade level.

Appropriate Accommodations: Special Equipment and Materials

Tests are standardized to ensure that identical conditions are provided for everyone taking a particular test. The purpose of standardization is to ensure fair testing of all participants and aid in the interpretation of test scores. However, the use of many standardized testing conditions for individuals with visual impairments is often impossible. To ensure that tests are fair for these individuals, various comparable testing conditions, referred to as accommodations, are used. For visually impaired individuals, these accommodations could include (a) provision of special lighting; (b) changes in test scheduling such as allowing extra time or administering the test over several days; (c) revision of test directions such as reading print directions aloud; (d) revision of test format such as use of braille, large print, or an audiotape; and (e) revision of response methods such as dictating answers or using low-vision aids such as magnification devices, tactile graphs, an abacus, or a computer. A p propriate accommodations may be described in a functional vision report. Individuals with low vision may read regular or large-type materials. Some require low-vision equipment. If this is the case, arrangements to use this equipment during testing will be necessary. Examiners should become familiar with the use of this equipment before an assessment. There is a wide variety of low-vision equipment, including magnifiers mounted on a headband, on glasses, or on a stand, or some may be hand held. Book stands are often used to decrease fatigue caused by holding reading materials close to the eyes. Some individuals with little or no functional vision use computer systems to scan printed materials to produce braille or speech output. They also may use computers to produce written output. A device similar to a typewriter, a braille writer, can also be used to produce braille.

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The slowest method for writing braille is to use a hand-held slate and stylus. The slate holds the paper and the stylus is used to press braille dots into the paper. Equipment that enables individuals to respond easily and efficiently in the school or work environment should be used during testing as well. Talking calculators, however, may be an exception. Even though these calculators are used in the school or work environment, they would invalidate test results on norm-referenced arithmetic or mathematics tests. Examples of other equipment that would be appropriate for use during testing include a braille watch or clock, a braille ruler, an abacus for calculations, and a signature guide (i.e., a metal plate with a space within which individuals write their name). Some individuals will need to use bold-line or raised-line paper to make a written response. According to the Federal Quota Registration for the APH, 26% of visually impaired students were visual readers, 10% braille readers, 8% auditory readers, 24% prereaders, and 32% nonreaders (i.e., they lacked a functional reading mode; Poppe, 1996).

During Assessment
Fairness in testing includes ensuring that the individuals are comfortable in the testing situation and familiar with the setting. Whenever individuals with disabilities are assessed, accessibility of the testing site should be considered. Stress can negatively affect the ability of some visually impaired individuals to use their residual vision. A tense examiner may miss important observations and nonverbal messages from the examinees. Hence, establishing adequate rapport is important. To assist examiners in making visually impaired individuals and themselves cornfortable, Eyde, Nester, Heaton, and Nelson (1994) offered the following suggestions:
a. Speak directly to the person. Identify yourself and let the person know you are speaking to him or her. When you are leaving the person who is blind, say so. b. Do not avoid using works like look or see. There are not any reasonable substitutes. Briefly describe the physical layout of the examining room, especially the furniture arrangement. c. Do not pet o r otherwise distract a guide dog without permission. The dog is responsible for the safety of the blind person and is not a pet.

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d. When assisting the person to a chair, simply guide his or her hand to the back or arm of the chair for location. e. Do not push or pull the person. Let the person take your arm and walk about half a step ahead of him or her. Identify stairs, curbs, or other obstacles as you approach them. (p. 15)

The following suggestions also may be useful: (a) Before handing materials to the person, indicate that you will be doing so and place the material so that it touches his or her hand; (b) when you are recording responses or arranging materials, explain what you are doing so that the person does not wonder what is happening if you are not administering test items; and (c) be sensitive to fatigue, using several testing sessions and frequent breaks.

After Assessment: Interpretation Issues

To provide a comprehensive picture of an individuals abilities and difficulties, results from testing should be integrated with information obtained from interviews, records review, and direct observation. Furthermore, the validity of information from norm-referenced tests should be evaluated in light of results obtained from criterion-referenced and curriculum-based assessment when possible. Because of the limitations of norm-referenced tests for visually impaired individuals, conclusions should be based on an integration of information from the assessment of various areas important for development including social skills, adaptive behavior, play skills for young children, emotions and behavior, intellectual development, vocational skills for older individuals, language development, and skills in other academic areas. Finally, repeated assessment of progress over time is a better basis for conclusions than a single assessment.

Assessment for Special Education Eligibility

The mandates of the IDEA (1990) apply to assessment for eligibility for special education services. Among other requirements, the IDEA requires a multidisciplinary team and use of tests and other evaluation materials besides those designed to provide only a general IQ score. With regard to test selection, the IDEA (1990) requires that

measure, rather than reflecting the childs impaired sensory, manual, or speaking skills (except where those skills are the factors which the test purports to measure). (p.42496)

tests are selected and administered so as best to ensure that when a test is administered to a child with impaired sensory, manual, or speaking skills, the test results accurately reflect the childs aptitude or achievement level or whatever other factors the test purports to

Monitoring Student Progress

To enhance accountability in education, the National Assessment of Educational Progress (NAEP) and many state programs attempt to document what typical students at various grade levels are able to do. The IDEA (1990) requires that most students with disabilities be included in district, state, and national assessments. Despite this requirement, many students with disabilities have been excluded from these testing programs. In 1994, for example, the NAEP included only 50% of 4thgrade students, 38% of 8th-grade students, and 36% of 12th-grade students identified as having an individualized education plan (IEP) for special education services. The NAEP has recently implemented new procedures to include more students with disabilities. Under the old procedure, such students were excluded if they were mainstreamed less than 50% of the time in academic subjects or if the IEP team determined that the student was incapable of participating meaningfully in the assessment. Under new procedures, students with an IEP will be included unless the IEP team determines that the student cannot participate or if the students cognitive functioning is so severely impaired that he or she cannot participate even with accommodations (Olson & Goldstein, 1996). The National Center for Educational Outcomes has been pressing for the inclusion of students with disabilities in national and state accountability assessments. They stated that the ability to extract useful national and state policy-relevant information on the outcomes of students with disabilities from national and state data collection programs is seriously hampered by the extensive exclusion of portions of this population. . . . The categorical exclusion of students with disabilities perpetuates the myth of inherent differences. (McGrew, Thurlow, Shriner, & Spiegel, 1992, pp.
iii-iv)

Siskind (1993b) provided an extensive summary of the types of modifications made in 30 statewide criterion-referenced testing pro-

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grams to accommodate students with disabilities. All 30 states provided large-print versions of the test and permitted use of visual magnification devices; 28 states provided a braille transcription and permitted braille writers. Twenty-three states permitted devices to transform print into tactile form. Electronic readers, such as voice synthesizers, were permitted in 19 states, and the same number of states provided answer documents with enlarged type. Only 9 states provided audiocassette versions of the test. In a related article, Siskind (1993a) noted that statewide criterion-referenced tests administered to students who are visually impaired are not always instructionally valid. She urged that attempts be made to introduce additional accommodations so that no student is tested in an unfamiliar mode, especially when test results are part of promotion or graduation requirements. Siskind (1993~) surveyed 60 South Carolina classroom teachers knowledge of approved modifications for students with disabilities on state-mandated tests. She concluded that the teachers were not well informed on this issue and stated that
if teachers are unaware of the accommodations they can make when testing children, it is unlikely that allowable accommodations are employed. Hence, some students are not being tested in the most appropriate and valid manner, and perhaps more problematic, there is inequality in the treatment of students with disabilities. (p. 155)

Performance assessment is becoming a part of many state assessment programs. In 1994, 38 states were considering or using some form of performance assessment (Thurlow, 1995). Some issues regarding the inclusion of students with disabilities in performance assessments have been described by McLaughlin and Warren (1995):

1. Outcomes-based systems present special educators with a difficult conceptual switch from believing that each student with a disability should have individualized outcomes to accepting the notion of a common set of outcomes across students. 2. There is still ambiguity among assessment experts regarding how much accommodation should be provided within an assessment program. 3. When one set of scoring standards is defined for all students, with no modifications made for students with disabilities, students with disabilities may be denied diplomas or otherwise penalized. 4. When results are used for high stakes accountability, there may be greater pressure to exempt students with disabilities. Once

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the decision to exempt students with disabilities has been made, there may also be pressure to i d e n q more students as having disabilities in order to exempt more students from the assessment. (p. 3)

Assessment for Admission to College, Graduate, or Professional School

Students with visual impairments face the same college and graduate school admissions tests as sighted students. Organizations administering these tests provide a variety of accommodations including braille transcriptions, large-print versions, and audiotapes. Before testing, students who wish to have an accommodation must identlfjr themselves to the testing organization, request an accommodation, and provide documentation of their disability. Arrangements can then be made for a p propriate accommodations. In a few circumstances, testing organizations are unable to provide a requested and preferred accommodation. Voice synthesizers, for example, currently are not commonly available. In such cases, an alternative accommodation must be used for the assessment; this may negatively affect the validity of the results. Bennett, Rock, Kaplan, and Jirele (1988) examined results on the Scholastic Aptitude Test (SAT; now known as the Scholastic Assessment Test) for three groups of visually impaired students: 203 using a braille transcription, 984 using a large-type version, and 398 using a regulartype version (in some cases with adaptive devices such as magnifiers). All groups were given extra time. The mean verbal scores for the three groups were essentially comparable to those of sighted students. Similar results were found for students using the large-print and regular-type versions for the mathematics test, but students using a braille transcrip tion scored lower. Certain mathematical item types were more difficult for students using the braille transcription. Differential item function techniques showed that these students had lower scores than would have been expected on the basis of their total mathematics test score on items containing graphics and on items intended to assess relatively novel content. Bennett et a1 recommended that caution be used in transcribing tests into braille and emphasized the importance of pilot testing braille items. Braun, Ragosta, and Kaplan (1988) examined the predictive validity of the SAT for 6,255 nondisabled students and 35 visually impaired

individuals who took a regular edition of the test and 171 individuals who took special versions such as braille transcriptions or large-print versions. The SAT results, combined with high school grade point averages, were used to predict standardized freshman-year averages. Correlations for visually impaired students who took the regular, and those who took the special versions, were both -37. The correlation for nondisabled students was .49. Low but positive residuals indicated that the visually impaired students performed slightly better than their predicted scores. The predictive validity of the Graduate Record Examination (GRE) was examined for 105 visually impaired individuals using special administration (Braun et al., 1988). The difference between actual first-year average in graduate education and the first-year average predicted from a combination of GRE results and undergraduate grade point average was greater for visually impaired students for whom higher grades were predicted and less for those for whom lower grades were predicted. Correlations between actual and predicted first-year averages were 2 9 for visually impaired students and -63 for nondisabled students. The construct validity of the GRE for visually impaired students was examined by Bennett et al. (1988). They concluded that the threefactor model (verbal, quantitative, and analytical) provided a moderately good fit for visually impaired students using regular type and a less adequate fit for visually impaired students taking the large-type, extended-time administrations. The analpcal factor behaved differently for visually impaired students taking the large-type version than for most other GRE examinees with the item types that compose it. Logical reasoning and analytical reasoning appeared to fit better as separate factors. In addition, the analytical scores of these students showed different relationships with other factors. There were considerably lower intercorrelations between the verbal and quantitative factors for visually impaired students who took the large-type version of the test. Bennett et al. emphasized the importance of using these two scores separately rather than as part of a composite. Willingham (1988) examined the college admissions process for students with visual disabilities. Compared with other applicants to the same colleges, visually impaired students were found to be slightly below average with respect to their academic qualifications. The selection process for visually impaired students and other students with disabilities was similar to that for other applicants. Overall admissions rates were slightly but not significantly lower than would be predicted from the

SAT and high school grade point average. In smaller institutions, however, this difference was significant, suggesting that students with disabilities [who] require special equipment or resources may be less likely to be admitted in smaller institutions that are perhaps less able to provide those resources (Willingham, 1988, p. 79). In advising students with visual disabilities who will be taking standardized tests for college or graduate school admission, it is important that they (a) learn about the test (e.g., what the test is designed to measure, what the test scores mean, and what kinds of testing accommodations are available) ; (b) register early for special administrations, making known their need for accommodations; (c) obtain information about the required documentation to support any accommodation they request; and (d) obtain practice materials from the testing company and use them to familiarize themselves with typical test items. An important issue in admissions testing is flagging of test scores to indicate that a test was given under nonstandard conditions. The policy is consistent with the Standards fm Educational and Psychological Testing (1985), as suggested by the American Educational Research Association, American Psychological Association, and National Council on Measurement in Education. Standard 15.4 reads as follows: In school situations involving admissions . . . any modification of standard test administration procedures or scoring should be described in the testing reports with appropriate cautions regarding the possible effects of such modifications on validity (pp. 83-84). In 1979 the Office of Civil Rights established an interim policy allowing the flagging of test scores in college admissions. Although this interim policy remained after the passage of the Americans With Disabilities Act (ADA) in 1990, there are increasing concerns about this practice because it may violate portions of the ADA. According to D. C. Brown (1996), most agree that admissions counselors and committees assume the individual has a disability when they see a flagged score (p. 16). A concern is that testing organizations often flag scores without providing information to assist in interpretation. Those who use test results need to know whether the accommodation affects the validity of the results. It is important to consider, however, that the examinee with a visual impairment or other disability probably will use the same accommodation for test taking as they will in their college or graduate school work. Thus, the test score should reflect how the individual will perform the kinds of tasks r e p resented by the test items. The decision regarding which accommodations to flag varies con-

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siderably not only between testing organizations but also within organizations and their various testing programs. Students with visual impairments may want to inquire about a testing organizations flagging policies when they register for admissions tests to determine which accommodations are and are not flagged. This information may influence their choice of testing accommodations. Although many with disabilities feel that flagging is a violation of privacy, there are circumstances in which flagging can be useful. This would be the case, for example, if an individual with a visual impairment took a test using a nonpreferred and less familiar accommodation. Under such circumstances, the flagging, with an appropriate explanation, might alert the recipient of the test results to the fact that the individual was placed at a disadvantage because the preferred and usual accommodation was not available and the result might therefore have been higher under the preferred conditions.

Employment Testing
The Guide for Administrating Written Employment Examinations to Persons With Disabilities (Eyde et al., 1994) is the key resource for assessment in this area. This guide contains a summary of legal requirements, physical accessibility issues, and advance preparation and detailed suggestions for testing job applicants who are visually impaired. Suggestions are also presented for interacting with people with disabilities. The ADA requires employers to provide accommodations when testing individuals with disabilities and to administer tests in accessible locations. The ADA forbids the use of employment tests or other hiring criteria that screen out individuals with disabilities unless the test or hiring criteria are shown to be job-related for the position under consideration. It is also required that tests be selected and administered to applicants with a disability in such a manner that the results reflect the skills or aptitude of the applicant rather than the impaired sensory skills, except when such skills are the factors the test purports to measure. The employment examination of visually impaired individuals begins with determining whether the applicant qualifies as an individual with a disability as defined in the Rehabilitation Act of 1973or the ADA. For applicants deemed disabled, the next step is to determine whether

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they can perform the essential job functions, either with or without reasonable accommodations as defined by law. This requirement may call into question the use of tests of general ability for employment screening purposes. Employers may be asked to demonstrate that general-ability instruments are relevant for specific job functions. Reasonable accommodations include adjusting or modrfjrlng examinations. Eyde et al. (1994) stated that testing accommodations should level the playing field for persons with a disability. Accommodations facilitate a persons capacities, usually through providing a mechanical or other kind of substitute for the disability (p. 2). Key considerations when testing individuals with visual impairments with written employment examinations are as follows: Provide individual testing to meet the necessary accessibility, procedural, and time requirements. Provide accessible materials such as braille transcriptions, large print, or audiotapes. In some cases the examiner may act as a reader. Eyde et al. (1994) provided suggestions about reading a test to a visually impaired examinee. Provide information in advance about permitted aids, such as a slate and stylus, braille writer, or tape recorder for taking notes, computational aids such as an abacus, and low-vision aids. Explain the method to be used to mark answers. Eyde et al. (1994) suggested that when visually impaired individuals use a braille writer to record answers or mark them directly in a largeprint test booklet, the answers should then be transferred to a regular answer sheet. Provide appropriate time limits. As previously noted, braille, for example, takes longer to read than regular print. Eyde et al. (1994) suggested giving nonspeeded (power) tests without any time limit. They noted that individuals with diabetes (a major cause of blindness in adults) may experience numbness in the fingers after an hour or so of reading braille and will need either a break or a change to another test format. They also noted that speeded tests are usually omitted for applicants with visual impairments. Performance tests for employment present additional problems. The best solution may be to determine the type of accommodation the job applicant would require to perform such tasks and administer the test using that accommodation. The law does not require employers to

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provide accommodations if this would cause the employer unusual hardship. The assessment of older adults presents special problems because many of them have not learned to use assistive devices, as many younger people have. Because many older people have experienced hearing losses that accompany aging, their use of audiotapes also may be limited. Older adults who are hard of hearing or deaf and who lose their vision also may no longer be able to use their lipreading or sign language skills. Furthermore, mental health problems in older people that may accompany loss of vision, hearing, or both may also require assessment.

Conclusion
A multidisciplinary effort is necessary to carry out a valid assessment of visually impaired individuals. Reports from other professions (e.g., eye specialists, O&M specialists) should be reviewed before psychological testing for implications regarding testing procedures. Interviews and observations in the natural environment are valuable, especially for examiners who are unfamiliar with visual impairment. Before assessment, the examiner must arrange for, and become familiar with, any special equipment and materials needed for testing. To ensure valid results, special procedures before and during assessment have been described. Issues regarding assessment for special education, monitoring student progress, college, graduate, or professional school admissions, and work assessment also are noted. Assessment is changing considerably, including introduction of computer-based testing and the use of alternatives to standardized tests, especially performance tests. Accommodations with the computer can sometimes be better for visually impaired individuals than with paperand-pencil tests, or they may make appropriate accommodations more difficult. Performance tests seem to be less problematic. They often provide a more representative work sample than a paper-and-pencil test. However, the tasks used may have to be adapted so that they can be performed by individuals with visual disabilities. Such adaptations raise questions of validity, similar to those posed for paper-and-pencil tests. Research is needed to determine whether performance tests and work samples have as good or better construct or predictive validity. Publishers of standardized tests, and organizations offering major

testing programs, should provide normative and interpretative information about examinees with visual impairments. Few currently provide this type of assistance. Part of the problem is small samples, in that the population of individuals with visual impairments is not homogeneous. There is wide variation in impairments and a wide range of accommodations used by visually impaired examinees. Providing normative information will require the accumulation of data over a period of several years, or across similar tests provided by different publishers. A related problem is the need for more consistent criteria from test publishers when flagging test scores. Professional organizations such as the American Psychological Association may have to take the lead in bringing measurement professionals together to consider whether a particular accommodation may affect the validity of a test and, if so, the kind of information about the score that should be provided to users of test results. Perhaps flagging should be eliminated in most assessments of individuals with visual impairments if the same type of accommodation is used to answer the test questions that will be used in college, graduate, or professional school examinations. As Frisby, Reynolds, and Wang (1996) noted, the actual practice of giving a person a test is in and of itself an equity issue. If equity in assessment is to be provided to individuals with visual impairments, much work is needed.

References
Alessi, G., & Kaye, J. (1983). Behavior assessmentfor school psychobgists. Silver Spring, MD: National Association of School Psychologists. American Foundation for the Blind. (n.d.) . Facts about blindness. New York: Author. Bennett, R. E., Rock, D. A., Kaplan, B. A., & Jirele, T. (1988). Psychometric characteristics. In W. W. Willingham, M. Ragosta, R. Bennett, H. Braun, D. A. Rock, & D. E. Powers (Eds.), Testing handicapped people (pp. 83-97). Needham Heights, MA: Allyn & Bacon. Blind Childrens Center. (1993). First steps. Los Angeles: Author. Bradley-Johnson, S. (1994). Psychoeducational assessment of students who are visually impaired 07 blind: Infan9 through high school (2nd ed.). Austin, TX Pro-Ed. Braun, H., Ragosta, M., & Kaplan, B. (1988). Predictive validity. In W. W. Willingham, M. Ragosta, R. Bennett, H. Braun, D. A. Rock, & D. E. Powers (Eds.), Testing handicapped people (pp. 109-132). Needham Heights, MA: Allyn & Bacon. Brigance A. ( 1983). Brigance Diagnostic ComprehemiueInventory of Basic Skills. North Billerica, MA: Curriculum Associates. Brigance, k (1991). Ratised BriganceDiagnostic Inventory ofEarly Development. North Billerica, MA: Curriculum Associates. Brown, D. C. (1996, July). Flagging test scores. The Score Newslettm pp. 16- 17. Brown, L., & Leigh, J. (1986). Adaptzue Behavim Inventmy. Austin, TX:Pro-Ed.

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Duckworth, B., & Caton, H. (1986). Bra& Reading Rate Scale. Louisville, Ky: American Printing House for the Blind. Eyde, L. D., Nester, M. A., Heaton, S. M., & Nelson, A. V. (1994). Guidefor adminisfaing unitten employment examinations to persons with disabilities (PRDG9411). Washington, D C U S . Office of Personnel Management, Personnel Research and Development Center. Frisby, C. L., Reynolds, M. C., & Wang, M. C. (1996, August). Equity issues in educational testing. Paper presented at the 104th Annual Convention of the American Psychological Association, Toronto, Ontario, Canada. Gelfand, D., & Hartman, D. P. (1984). Child behavior analysis and thmapy (2nd ed.). Elmsford, W. Pergamon Press. Gresham, F . M., & Elliott, S. N. (1990). Social Skills Rating Scak. Circle Pines, MN: American Guidance Service. Happe, D., & Koenig, A. (1987). Children and vision. In A. Thomas & J. Grimes (Eds.), Children 2 nee& (pp. 658-667). Washington, DC: National Association of School Psychologists. Hazekamp, J., & Huebner, K M. (1989). Program planning and evaluation for blind and visually impaired students: National guihlines fw educational excellence. New York: American Foundation for the Blind. Higgins, L. C. (1973). Chsifcation in the congenitally blind. New York American Foundation for the Blind. Individuals With Disabilities Education Act. (1990). Public Law 101476, $1401. Kelley, P., Davidson, R., & Sanspree, M. J. (1993). Vision and orientation and mobility consultation for children with severe multiple disabilities. Journal of Visual Zmp a i n n a t and Blindness, 87, 397-401. Kirchner, C. (1983). Special education for visually handicapped children: A critique of data on numbers served and costs (Statistical Brief #23). Journal of Visual Impairment and Blindness, 77, 217-223. McGrew, K S., Thurlow, M. L., Shriner, J. G., & Spiegel, A. N. (1992). Inclusion of students with disabilities i n national and state data collection programs (Tech. Rep. N o . 2). Minneapolis: MN: University of Minnesota, National Center on Educational Outcomes. McLaughlin, M. J., & Warren, S. H. (1995). U s i n g p m f m a n c e assessment i n outcomes-based accountability sysstemc. Reston, VA Council for Exceptional Children. Morgan, S., & Bradley-Johnson, S. (1995). Technical adequacy of curriculum-based measurement for braille readers. School Psychology Rev&, 24, 21- 103. Olson, J. G., & Goldstein, A. A. (1996). Increasing the inclusion of students with disabilities and limited English proficiency students in NAEP (NCES 96-894, monograph). Focus on N W 2( 1). f quota registrants in 1995: Program type, gradeplacement, Poppe, K J. (1996). Distribution o visual acuity, reading m d i u m , and age. Louisville, Ky: American Printing House for the Blind. Raver-Lampman, S. A. (1990). Effect of gaze direction on evaluation of visually impaired children by informed respondents. Journal of Visual Impairment and Blindness, 84, 64-70. Shinn, M. R. (1989). Curriculum-based measurement: Assessing special children. New York: Guilford Press. Silberman, R. K (1981). Assessment and evaluation of visually handicapped students. Jovrnal o f Visual Impairment and Blindness, 75, 109- 114. Simeonsson, R. J- (1986). Psychological and h e l o p m t a l assesmmt of special children. Boston: Allyn & Bacon.

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Siskind, T. G. (1993a). The instructional validity of statewide criterion-referenced tests for students who are visually impaired. Journal of Visual Impairment &Blindness, 87, 115-117. Siskind, T. G. ( 199315). Modifications in statewide criterion-referenced testing programs to accommodate students with disabilities. Diagnostique, 18, 232-249. Siskind, T. G. (1993~). Teachers' knowledge about test modification for students with disabilities. Diagnostique, 18, 145- 157. Standards for educational and psychological testing. (1985). Washington, DC: American Psychological Association. Thurlow, M. L. (1995). National and state perspectives on perfrmance assessment and students with disabilities. Reston, V A Council for Exceptional Children. Tobin, M. J. (1994). Assessing visually handicapped people: An introduction to test procedures. London: Fulton. U.S. Department of Education. (1992). Fourteenth Annual Report to Congress on the imf the Individuals With Disabilities Education Act. Washington, DC: Auphmntation o thor. Vander Kolk, C. J. (1981). Assessment and planning with the visually impaired. Baltimore: University Park Press. Willingham, W. W. (1988). Admission decisions. In W. W. Willingham, M. Ragosta, R. Bennett, H. Braun, D. A. Rock, & D. E. Powers (Eds.), Testing handicapped peopb (pp. 71-81). Needham Heights, MA: Allyn & Bacon.