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There is much confusion in many school districts about the assessment of visual processing disorders and appropriate remedies for needs that arise from visual processing disorders in special education students.
Many school districts do not provide expert assessment in visual processing at all, mostly because they don’t understand when expert assessment becomes necessary in order to render a FAPE. But, there is also an underlying fear that is sometimes very overt and other times left unspoken out of shame and guilt; it is the fear of the costs of any services that expert assessment may reveal is necessary for a given student.
Under certain circumstances, vision therapy – still a controversial subject in special education after over a decade of ongoing debate – may be recommended as educationally necessary for some students. Generally speaking, in my experience, vision therapy is recommended as a related service when the child has a neurological disorder that interferes with the integration of the images from both eyes and/or making sense of the images the eyes have seen. The intent of the therapy is to strengthen the neurological connections that are weak and develop compensation strategies for those areas of weakness that cannot be therapeutically overcome.
Visual processing problems are a serious thing. They interfere with a child’s ability to make sense of what is going on around him at any given moment. One child with a severe visual processing disorder whom I represented had absolutely no perception of three-dimensional space. Everything looked flat to him. Looking at the open garage door on the front of his house, he just saw a giant, flat rectangle. He couldn’t perceive that the garage had depth as well. His depth perception was practically non-existent.
There was no way for a deficit that severe to not compromise his receipt of an education. He couldn’t navigate a flight of steps without taking it one step at a time with each foot – that is, he would step up on one foot then bring up the other foot to the step before embarking upon the next step up, and follow the same process going down the stairs. And he clutched to the handrail the whole time.
He couldn’t copy things from the board very easily because shifting from far point to near point was extremely tedious and difficult for him. By the time he reoriented his eyes to the page on his desk, he’d forget what he was supposed to write down, then would have to reorient to the board to visually retrieve the information, then reorient back to the page … it was very frustrating for him and he would often refuse to do pencil/paper tasks because of the visual challenges they presented.
So, it’s fair to say that visual processing disorders do occur for which specialized instruction and related services are necessary. Whether or not vision therapy is necessary is an IEP team decision that has to be based on the negative educational impact the visual processing disorder is having and whether vision therapy can be reasonably expected to remedy or significantly decrease that need.
Education agencies are only obligated to pay for interventions meant to specifically address educational needs. A child can theoretically have a handicapping condition that doesn’t negatively impact him enough in the school setting to warrant special education. Some children do find themselves in limbo between failing in the general education program but not having a qualifying condition to qualify for additional services and supports. Somebody is always going to fall in the shades of gray. That’s always a hard thing to live with for those families who find themselves in this place.
But, not every parent who finds themselves in this place is there because this is where their children belong. Sometimes school districts relegate children with educationally relevant visual processing needs to the same category as children who have disabilities but cannot demonstrate negative educational impact caused by those disabilities. These education agencies engage in this practice out of fear over the possible costs for services that children with educationally relevant visual processing needs may require.
In other words, they are so terrified that they’re going to have to pay for vision therapy that they deliberately fail to assess in that area of need. The last thing they want is evidence on the record that the child needs something that they’re not willing to pay for. But, now they’ve committed a procedural violation that results in substantive harm. Federal law requires assessment in all areas related to the suspected disabilities that the child may have. So, they can’t fail to assess in those areas or they could get nailed in due process and have to pay for vision therapy as a compensatory remedy.
This is, I believe, why many school districts have now chosen to address visual processing disorders with certain visual-motor and visual perceptual tests administered by school psychologists and occupational therapists (“OTs”). There are certain aspects of visual processing that school psychologists and OTs can assess, and for what that data is worth, there’s nothing wrong with having them conduct those assessments.
But, people have to realize that neither school psychologists or OTs specialize in visual processing and that how certain aspects of visual processing should be assessed is one of those things that you do on an individualized basis just like how any other aspect of special education is supposed to be handled. Assessment is supposed to be tailored according to the areas of suspected disability.
If the types of tests that a school psychologist and/or OT can administer are not going to get at all the aspects of visual processing that are cause for concern, then expert assessment is required. In many instances, this requires someone like a developmental optometrist, though the choice of the assessor is critical.
The school system is justifiably freaked out about vision therapy. There are plenty of optometrists hawking themselves as visual processing specialists who give away free eye exams, including visual processing assessment, and then magically discover that every kid who walks through their door needs at least $5000 worth of vision therapy, if not more. A few bad apples in the barrel has given the anti-vision therapy movement (which is really the anti-paying for anything if there’s any way to get out of it movement) ammunition to sway the opinions of their colleagues, who don’t really follow this sort of thing and don’t really give it much thought, into arguing against paying for vision therapy.
By claiming that all developmental optometrists are quacks, they assert the position that vision therapy itself is nothing but quackery. They refuse parent requests for visual processing assessments, pointing to the tests done by their school psychologists and OTs as sufficient, and utterly fail to identify and serve educationally relevant needs. A fraction of them get taken to due process by parents, but most of them get away with it because the parents decide they’d rather pay for therapy than for a lawyer. Many school districts count on most parents throwing in the towel, which is why they make the process so difficult.
I know what really goes on. I see it all the time. But, it would be unfair to say that this is what goes on all the time, in every instance, in every school district. There are plenty of school districts that realize what is really quackery and what isn’t, that understand the significance of a visual processing disorder, and pull in the experts when they need to.
The most valuable aspect of having a properly qualified expert as part of the assessment team is getting specific recommendations to address the educational needs caused by the handicapping conditions. A good assessor of visual processing for the special education process is going to be looking at the demands being placed on the vision system in the school setting – scanning the lunchroom for an empty seat, copying from the board, shifting from near point to far point and vice versa, producing properly formatted written work, etc. – and attempt to relate the child’s present levels of performance in the area of visual processing to those demands.
A child with significant depth perception issues is probably going to need a lot of accommodations. Specific therapy may be helpful to improve the deficit areas, but teaching the child how to access and use his accommodations is going to be huge. Depending on the nature of the visual processing disorder, a child may require the accommodations of larger print, fewer items per page (to reduce the visual clutter of the page), eye exercises before reading, frequent breaks for eye fatigue while reading lengthy passages, a colored overlay for reading, note-taking assistance, and/or other accommodations.
Very often, for educational purposes, vision therapy simply isn’t warranted. An honest expert assessor is going to say so. But, parents have to be concerned that an expert assessor may say what he/she is being paid to say by the school district that contracted him/her to perform a visual processing assessment. If anything the district’s expert assessor says doesn’t ring true with you, and you think your child may suffer educational harm as a result, you may need to exercise your parental right to an independent educational evaluation (“IEE”) at public expense.
But, don’t jump the gun and assume that right away. Try to figure out what needs your child has that the assessments done haven’t identified or any needs that have been identified but for which no remedies have been recommended. If your child’s needs have all been identified and there’s something reasonably appropriate in place to address each one of your child’s identified needs, then you and your child have as much as you’re entitled to.
If, however, after careful analysis, you realize that there are gaping holes in the assessment data and/or there aren’t enough recommendations to address all your child’s needs that have been identified, then you probably need to ask for an IEE at public expense – or you can pay for it yourself and pursue reimbursement from the school district, but that’s usually perceived as adversarial and it’s good form to ask the district to pay for it first before resorting to paying for it yourself and seeking reimbursement. You need to give them the chance to do the right thing before resorting to doing it for them and holding them financially accountable.
You may find it necessary to have an outside expert take a look at the assessments conducted by the school district, listen to your descriptions of the problems you child appears to be having in school, then give you expert advice about the adequacy of the district’s assessments. That will most likely cost you some money, but not as much as a full-blown assessment.
If the expert says that the district’s data is sufficient to speak to the needs that you’ve identified in your discussions and all you really need are sound recommendations, he/she can probably give them to you right there, which you can then take back to the IEP team. Get them in writing from the expert and copy them to the district along with a request for an IEP meeting to discuss the recommendations of your expert and, if appropriate, incorporate them into the IEP.
If, however, the expert comes back and says that the district’s assessment data is insufficient, get something in writing that describes the additional types of assessments the expert believes needs to be done and why. Any recommendations for additional assessment should relate back to the areas of educational need that are not being served by the district’s assessment data. You can then use this information to substantiate your request for an IEE.
Having an expert recommendation for additional assessment by a qualified expert is by no means required in order to get an IEE. But, it’s one of those things that can make the process go a lot faster. If the record is clear that you have a sound, well-informed basis for your IEE request, the district has no valid reason to turn your request down. The only way a school district can decline to perform an IEE is to take the parent to due process and assert the appropriateness of its own assessments. If the district sees at the time that the request is made that the parent already has an expert who has made recommendations to which he/she would have to testify in hearing, and those recommendations are sound, it would be moronic for the district to argue over the IEE request.
The role of the OT in a visual processing assessment is to look at issues that might actually be fine-motor in nature. For example, when children have difficulties with producing written work, there are a number of things that could be causing them problems. Either they are having some type of problem with the neurology and/or physical construction of their arms, wrists, and hands that makes the fine motor movements required for writing difficult or impossible; they are having a hard time relating the visual images they are conceptualizing to their motor cortex so that their hands can produce the images they intend; or they do not fully comprehend what the image they are trying to produce actually looks like and can’t accurately interpret what they are writing looks like because of a visual processing disorder.
Because the function of the OT is to work on those fine motor skills, the purpose of assessing visual processing as part of an OT evaluation is to rule out the possibility that a problem is visual rather than motor. It is not to identify and serve a visual processing-related need. So, when school districts argue that they’ve assessed in visual processing because the OT did a VMI (visual-motor integration) test, understand that this data could easily be insufficient to identify all the needs arising from a visual processing disorder.
A school psychologist can administer a wide range of standardized tests that include subtests in components of processing of visual information. The problem is that even if the school psychologist administers all the right tests within his/her purview to administer, all that will tell anyone is whether there is a problem, not necessarily what to do about it. I firmly believe that all school psychologists should keep themselves very well abreast of the research being done in visual processing and what science knows about it to date. But, most do not.
Another critical consideration is that many of the tests administered by experts to measure visual processing include the use of expensive equipment that school districts simply do not possess and for which they have no qualified staff. In order to measure visual processing, many aspects of visual acuity have to also be known, which means all that funny hardware that you find in any eye doctors’ office plus whatever else is necessary to measure the processing components.
Relating the impact of certain problems in visual processing to the educational setting is not something that school psychologists have necessarily been trained to do. They are unlikely to know what best practices are when it comes to serving and accommodating all possible types of visual processing needs. This is why expert input is necessary, even if only on a consultation basis.
All of that said, just because you present a logical argument to your school district for an expert visual processing assessment, that doesn’t mean your school district is going to voluntarily give you one. Some school district administrators are still stuck in the political climate of special education in the late 1980’s through the 1990’s in their own minds, thinking of things within that context and panicking over things that stopped being an issue for everyone else a long time ago. They are responding emotionally to something that they don’t understand that frightens them.
Due process may become necessary just to get around all of the hysteria and have the outcome decided by an impartial judge who weighs the facts against what the regulations require and nothing more. Every situation is different. But, understanding the role that each member of the district’s assessment team plays in the assessment process is an important part of meaningful parent participation in the IEP process. The more you understand as a parent of how the system is supposed to work, the better informed you are as to whether the rules are being followed or not and what to do if they aren’t.
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