To help blind children, you need to know how they feel about their disability. Karen Gold reports
Two blind brothers with an identical disability were part of a research study. One sat down and did nothing. The other went out, found training and got a job.
The needs of blind children depend on their personalities and circumstances, says Jean Howells, head of key services for the National Blind Children's Society. Some children are brighter than others. Some are more determined. And some children have additional learning or physical disabilities.
Only about 25,000 children in Britain - two per thousand - have serious sight problems that cannot be corrected by glasses, so teachers may encounter only a handful during their career.
The most common cause of blindness is cataracts, but visually impaired children come with a bewildering variety of medical labels, including nystagmus (rapid involuntary eye movement), glaucoma (pressure in the eye ball), various eye dystrophies (muscular weaknesses), retinitis pigmentosa (damaged retina), and eye tumours.
"It's often easier to understand and support a child who is totally blind, because that's unequivocal: we all perceive his need," says Jennifer Bowen, development director of the advocacy charity, Look.
Yet total blindness is rare. Most children have some perception of light and dark. Beyond that, the amount they see varies hugely. Some have distance vision but no near vision; others the reverse. Some have a narrow tunnel of central vision but no peripheral vision; others a central blur with more clarity around the edges.
More confusing still are the children whose sight fluctuates from day to day, not only in varying light - with a glare as difficult to see in as shadow - but because of their health, stress or for no obvious reason.
Some eye conditions, such as nystagmus, cause the eye to react slowly, so the child not only reads slowly but also struggles to focus on and pick up a dropped pencil from the floor. Other conditions cause the child's eyes to appear to wobble, or allow just one pinpoint of visual clarity, so children can only make eye contact or focus clearly when they tilt their heads at odd angles and look out of the corner of their eye.
ASSESS THE WHOLE CHILD
Since what each child sees varies so much, expert assessment, usually by a member of a local education authority's sensory impairment team, is essential.
An educational psychologist may also need to contribute: roughly half of all visually impaired children have another physical or learning difficulty, too; a third have profound and multiple disabilities.
The assessment must take into account the child's personality and psychological state. Some eye diseases are degenerative, a hard prospect for a child and a family to bear. And, like the brothers in the research study, some children approach their blindness as a challenge, others as a defeat.
"One child can need a classroom assistant almost full-time," says Jennifer Bowen. "Another child with the same eye condition but a different attitude, coming from a different family, won't want that sort of support and will simply want the work magnified. You can't fit the child into the service - the service has to be tailor-made for the child."
The support children need may change even when their eye condition is stable.
"In primary school a child is usually happy to accept any advice and support offered," says Jennifer Bowen. "Often, when they get into secondary school, they become self-conscious. They don't want to be different to their peers; they don't want to use low-vision aids in class."
If a child's sight is worsening, the difficulties are even greater, says Karen McLean, head of the visual impairment resource base at Plantsbrook school in Sutton Coldfield, who is herself registered blind.
McLean looks after 22 visually impaired children with statements, a handful of whom use braille. Only around 6 per cent of visually impaired children use braille. Many are in the handful of specialist schools for the blind; while some, along with most other visually impaired children, are supported in mainstream schools by specialist, often peripatetic, teachers for the blind.
"If you have a child coming all the way through with braille it's fine," McLean says. "But a lot of our children learn braille later, because their condition is degenerative. We have quite a few who should be using braille, but they hang on to print as long as they can. It's a very big step - you can't force them."
The children who need the most support are usually academically average, says Jennifer Bowen. "People know how to support the good kids, and the kids who are really behind. It's the ones in the middle, who can see enough to make a nuisance of themselves, who often don't have their needs met."
Worst off are those children who lose their central vision and their ability to see detail, so they can only see some print. They are unlikely to stand up and tell the teacher they can't see the board, or that their work hasn't been enlarged. "If someone isn't looking after them, they prefer to fool around," says Bowen.
TOUCH AND MOVEMENT
Preparation for the arrival of a blind child should start long before he or she sets foot in the classroom. Suzy McDonald, curriculum officer for the Royal National Institute of the Blind (RNIB), says: "I get what are almost panic phone calls in June or July saying, 'I've got a blind child coming in, what do I do?'"
McDonald refers these teachers to their local authority sensory support service and a mobility officer (though there are shortages of both).
Ideally, the mobility officer will tour the school twice. First, they come alone and point out steps and handrails to be marked with fluorescent tape, obstacles to be moved, and lighting or slippery surfaces to be changed.
They return with the child, to help plan and memorise routes.
The next stage is thinking about what is taught and how. Specialist organisations supply many tactile and auditory resources so children can use their fingers and ears instead of their eyes. There are liquid measures, designed for tea-making but just as good for water play, tactile and audio-described books, and even paintings and primary history resources, plus tactile globes.
Some solutions are simple: bright or braille stickers on the child's exercise book to differentiate it from 30 others. Some require practice: teaching assistants quickly become expert at enlarging worksheets and book excerpts once everybody knows that Child X needs 36 point print while Child Y can manage with 18 point if it is on a yellow background.
Many visually impaired children cannot read off a whiteboard; some gain increased access from a monitor linked to an interactive whiteboard, but for others the flicker and fast-moving image actually makes things worse.
Almost none can cope with an overhead projector.
Teachers can get into good habits, according to the charitable Nystagmus Network, which has just produced a schools' advisory pack, by always remembering to address children by their names, and by saying aloud anything they write on the board as they write it. It also notes that words such as "there" and "here" are useless to a blind child; "On the left, in the corner," is helpfully precise.
PLANS ARE VITAL
If teachers think ahead they can borrow braille textbooks from the National Library for the Blind, order made-to-measure enlarged copies of any fiction book from NBCS (see resources), even organise customised braille texts from their local prison, says Suzy McDonald.
If assistants have worksheets in advance they can reproduce them as necessary; some will invent resources, particularly for young children.
Blind children need real money to feel in maths, models (home-made are fine) of the body for science, and footballs with bells inside.
"We have two lads whose sight is poor and they can't catch a cricket ball, but they can throw one and they are demon bowlers," says Karen McLean.
Planned access to hammers, saws, cookers and javelins is also important so visually impaired children can be safe while following the same curriculum as everyone else.
As well as a curriculum-based magazine, RNIB has a network of support groups for teachers in various subjects, and offers telephone advice and visits, often from subject experts at its residential school, New College, Worcester. (Details are available from Suzy McDonald. See resources). It is also one of several organisations that offer advice on technological aids.
There is a huge range of these: enlarging software, screen readers, speech-recognition aids, talking calculators and mobile phones, braille notetakers, and the latest small closed-circuit televisions that act as magnifiers, enabling any book to be read at any size.
The drawback of these apparent riches is cost; the challenge is fitting the right machine to each individual, says Dan Mitchell, training manager of Blind in Business, a charity that runs free careers and technology courses for visually impaired 13-year-olds across the country.
"At 13, your teacher is still often making technology decisions for you, but you'll make them alone when you are older and we have found the decisions are always better when we make them ourselves," says Mitchell.
In many cases, Blind in Business - which encourages young people to see themselves alongside their sighted peers as teachers, lawyers and entrepreneurs - is pushing on an open door. Proportionately more blind 18-year-olds go into higher education than sighted ones. The kind of passionate determination shown by deaf and blind campaigner Helen Keller has always existed, says Karen McLean.
"I went through mainstream and into teaching with nothing but help from family, friends, teachers - while being extremely stubborn and awkward," she says.
But, adds Jennifer Bowen, getting on is difficult for blind children, and not all are resilient enough to make it.
"If there's one thing I would change it would be people's understanding of that. Some children don't concentrate, they are naughty and even disruptive, and it's not until years later that they say, 'I couldn't see what I was doing, and I wouldn't ask for help, so what was I to do?'"
* RNIB is at www.RNIB.org.uk. The site includes an online shop for vision aids. For maps and diagrams contact Sue King (tel: 01733 375000). Suzy McDonald (tel: 0870 042 9554) manages teacher networks
* Blind in Business (www.blindinbusiness.org.uk) offers careers advice and training
* Nystagmus teachers' pack, pound;15, www.nystagmusnet.org
* National Centre for Tactile Diagrams, University of Hertfordshire (tel: 01707 286348)
* Living Paintings Trust (www.livingpaintings.org) loans free touch and sound packs
* British Blind Sport (www.britishblindsport.org.uk) offers archery, athletics, football, judo and other sports
* Braille, large print and audio books, and literacy advice is available from www.revealweb.org.uk; ClearVision (tel: 0208 788 0107); www.listeningbooks.org.uk; National Library for the Blind (www.nlb-online.org); National Blind Children's Society (www.nbcs.org.uk)
* ICT advice sources include: Blind in Business; NBCS; RNIB; Victar (www.education.bham.ac.ukresearchvictar); Becta (www.becta.org.uk); AbilityNet (www.abilitynet.org.uk)
* Support for children and families is available from Look: the National Federation of Families with Visually Impaired Children (www.look-uk.org) and at the RNIB website for teenagers (www.sortit.org.uk)