Child: care, health and development 1978,4,291-303
DEVELOPMENTAL PATTERNS OF VISUALLY HANDICAPPED CHILDREN
JOAN REYNELL Senior Lecturer in Educational Psychology, The Wolfson Centre, Mecklenburgh Square, London WCl Accepted for publication 2 May 1978
Summary This article reports a comparative study of the developmental patterns of blind, partially sighted and fully sighted children during the first few years of life. Using the (previous reported) ReynellZinkin developmental scale for visually handicapped children, the groups were compared in the five developmental areas of (a) social adaptation, (b) sensori-motor understanding, (c) exploration of environment, (d) verbal comprehension and (e) expressive language. It was found that 10 to 12 months was the age at which the sighted group began to outstrip the visually handicapped children in most of the developmental areas. This divergence increased until towards the upper end of scale (4 to 5 years for the visually handicapped) when more abstract thought processes began to develop. The effect of visual handicap was also seen in the greater advantage of the partially sighted over the blind children. The patterns of development varied somewhat in the five different areas. The reasons for this are discussed. The findings point to the need for intensive help for visually handicapped children from the earliest months of life.
INTRODUCTION
In 1975 Reynell & Zinkin described some new assessment procedures for young visually handicapped children. The developmental scales which were described allowed for the separate assessment of 'motor' and 'mental' development, with further sub-scales under each of these headings. Each sub-scale was arranged in developmental stages from 0 to 5 years, following the developmental pattern of visually handicapped children. A larger sample of visually handicapped children has now been followed up, using the Reynell-Zinkin Mental Development Scale, This 0305-1862/78/1000-O291$02.00 ©1978 Blackwell Scientific Publications
291
292
Joan Reynell
scale is divided into the following five sub-scales which have been fully described in the original article, (1) social adaptation, (2) sensori-motor understanding (performance), (3) exploration of environment (orientation), (4) response to sound and verbal comprehension, (5) vocalization and expressive language. AIM OF PRESENT STUDY
The aim of the study reported here is two-fold. First, to estabUsh more reliable age levels for the different stages of development in visually handicapped children; and second, to compare the development of blind, partially sighted and fully sighted children in the five areas listed above and so leam more about the effect of visual handicaps on different aspects of intellectual development. DESCRIPTION OF SAMPLE
The original study was based on the findings from 116 recordings, including many children with severe associated handicaps. This follow-up study is based on 203 recordings, and a 'cleaner' sample, in that many of the children with severe associated handicaps have been eliminated. These 203 recordings were obtained from 109 children. For those children recorded more than once the time intervals between assessments ranged from 3 months with very young children, to a year with the older children. The distribution in terms of the number of recordings per child is shown in Table 1. TABLE 1. Showing distribution in terms of number of recordings per child No. of recordings per child
I 2 3 4
5 6 7
No. of children
tiS 16 12 9 3 2 1
Total no. of recordings
m it m
3iS IS 12 7
Visually handicapped children
VISUAL HANDICAPS
293
1
The children were divided into 'blind' and 'partially sighted' groups on the basis of the presence or absence of visually-directed reaching, as in the original study. Table 2 shows that there were approximately equal numbers of blind and partially sighted children evenly distributed throughout the age range, with a small number of borderline children labelled blind/partially sighted. In calculating the means, the scores of these borderline children were added to both groups. TABLE 2. Showing the age distribution of blind and partially sighted children
Age range in years O-I 1-2 2-3 3-4
4-5+ Total
Number of recordings: partially blind sighted 21 29 21 17 9 97
18 30 19
blind/partially sighted
Total
0
39
0
59 51 35 19 203
14
11 4
5 86
20
5
Range of associated handicaps Most of the children with severe degrees of cerebral palsy, hearing impairment and mental retardation have been excluded from this sample. It has been impossible to exclude all associated handicaps completely as a visual handicap rarely occurs without some degree of associated handicaps. The present sample of 109 children includes 17 with mild degrees of cerebral palsy and 8 with hearing impairment. One of the hearing impaired children had only a minimal hearing handicap, and the other 7 were excluded from the language sections. There is a wide range of intellectual ability, including some quite retarded children, but this variable has been eliminated by using the Maxfield Buchholz (1957) ages instead of chronological ages, as in the original study. There were twice as many children with cerebral palsy in the partially sighted group as in the blind group and all the hearing impaired children were in the partially sighted group. This suggests that the differential ability which was found to favour the partially sighted group
294
Joan Reynell
may be greater in a sample of children showing a more even distribution of associated handicaps. In other words, the effect of the visual handicap on intellectual development may be even more marked than the findings reported here indicate. Establishment of age levels The mean raw scores were calculated separately for the blind and partially sighted groups, for each of the five sub-scales. For the purpose of establishing these means, ages were divided into intervals of three months from 0 to 5 years as follows: 0-3 months, 4-6 months, 7-9 months etc. The mean score for each age group was then plotted on a graph and the curves smoothed statistically. In this way developmental trends could be plotted for each sub-scale, comparing blind and partially sighted children. These graphs proved to be very close to those obtained in the original study which were calculated from a smaller and less *clean' sample, so the indications are that the new graphs reflect developmental trends reasonably well, despite the difficulties of getting any sort of uniformity in the sample. Age levels for sighted children were estimated from standardized scales for sighted children using similar items or equivalent developmental stages, and were checked by testing a small sample (43 children) of fully sighted children on the Reynell-Zinkin Scales. Developmental trends Social adaptation This scale is concerned with social response to people, and with the development of self help skills. Figure 1 shows the developmental trends for the three groups of children. The difference between blind and partially sighted children was negligible for this aspect of development, although the difference when compared to sighted children was very great, particularly in the IV2 to 2Vi. year range. The earliest items, concerned with response to people and voice recognition, do not show a great deal of difference, but the difference becomes evident when the items include self help such as cooperation in dressing and feeding. By about 3 years, most sighted children have achieved a degree of social independence not reached by the visually handicapped until 4^/2 to 5 years. The lack of difference between blind and partially sighted children is hard to explain. This is the only one of the five scales on which it occurred. It is possible that both
Visually handicapped children
B and PS
7 6 5 4 3 2 1 -
1
2
3 4 Chronological Age in yrs
5
FIGURE 1. Social adaptation (S; sighted, B: bHnd, PS: partially sighted).
295
296
Joan Reynell
groups tend to be 'babied' by their parents for longer than they need be, just because they are visually handicapped, and because the early stages of learning self help are necessarily more messy and clumsy than with sighted children. Many parents did, in fact, confess that they found it hard to tolerate this rate long drawn out and messy stage. If this is a contributory cause of delay in this aspect of development, it is a clear indication of the need for early guidance from the age of about 10 months, which is when the real divergence in ability between sighted and visually handicapped children begins. Sensori-motor understanding (performance) This scale is concerned with the understanding of concrete objects and their relationships with one another. Figure 2 shows the developmental trends for the three groups of children. 24 22 20 18 16 14 12
10 8
1
2
3 4 Chronological Age in yrs
FIGURE 2. Sensori-motor understanding (performance).
Visually handicapped children
297
In normal development, early sensory co-ordination, understanding of the permanence of objects, and the relationship of object to object is very dependent on visual perception for co-ordinating the different aspects of learning. It is not surprising, therefore, to see the very considerable effect of a visual handicap shown in Figure 2. There is a continuous and consistent difference in favour of partially sighted as compared to blind children. The difference between visually handicapped and sighted children is very marked indeed. The divergence begins soon after the normal age of understanding the permanence of objects, and increases with early understanding of object relationships such as fitting one object onto or into another. The difference becomes less marked as children move from perceptually dominated understanding to an understanding of more generalized concepts, including abstractions such as size and shape. This sort of understanding is demonstrated by sorting tasks, such as sorting bricks into big and small. This trend is also seen in the less marked difference between the partially sighted and blind groups at the upper end of the scale. These findings suggest that those visually handicapped children who can achieve more abstract levels of thinking begin to use intellectual means to transcend the visual limitations. The findings also point to the need for intensive help from the age of about 10 months to prevent some of the lag in perceptual learning upon which the later conceptual learning depends. Exploration of environment This scale is concerned with the child's ability to understand his orientation within a room, and his ability to use this in relation to fixed objects such as doors, pegs and large furniture. Figure 3 shows the developmental trends for the three groups of children in this aspect of learning. The trends are very similar to those in Figure 2, showing once again that early spatial understanding is visually dominated, and it is not until 3-4 years of age (for visually handicapped children) that an intellectual understanding can begin to take the place of visual perceptual learning. Verbal comprehension The early items of this scale are concerned with response to sound, including location and recognition. This moves through the early stages of recognizing familiar phrase patterns, to the understanding of words as object labels, and then to increasingly complex verbal directions. The difference between the blind and partially sighted begins to show
298
Joan Reynell
3 21 -
1
2
3 4 Chronological Age in vr^
5
6
FIGURE 3. Exploration of environment (orientation)
at the stage of understanding object labels, increases at the stage of relating two named objects (e.g. 'put the brush in the box'), and then begins to decrease at the more conceptual stage of thinking, when longer verbal directions, including shape, size and position are reached. When understanding reaches this later stage of abstract concepts (e.g. *put the small pencil in the biggest cup'), the difference between the two visually handicapped groups becomes negligible. Sighted children are ahead from the beginning, with a steady increase in advantage, particularly from the stage of relating two named objects. The findings point to the need for intensive help at the stage of understanding object labels. This is particularly important, as verbal comprehension is one of the main learning assets for visually handicapped children.
Visually handicapped children
34 32 30 28 26 24 22 20 18
14 12 10 8 6 4
1
2
3 4 Chronological Age in yre
FIGURE 4. Response to sound and Verbal comprehension.
299
300
Joan Reynell
Expressive language (a) language structure: The early stages of this scale are concerned with the production of pre-speech sounds, leading on to the ability to say words, to put words together, and to the use of increasingly mature sentence forms. This is a more superficial aspect of expressive language than that assessed in section (b). As this scale is concerned with the more superficial aspects of language production, it is not surprising that the difference between the three groups is less marked than in the more intellectually loaded scales. There are, however, some interesting trends. The three groups are similar up to and including the stage of double-syllable babble. When words begin, the sighted group go ahead and stay a little ahead, but without increasing the gap. They have a 6 to 8 month advantage all the way. The interesting pattern is between the two visually handicapped groups. At the stage of jargon and 2 to 4 'sltuational' words, the blind
22 -
^ ^ ^
PS
20 •
18 -
16 -
14
8 12 5 to DC 10
8 6
-
/X
r
.••'
4
2
1 1
2
3 4 Chronological Age in yrs
FIGURE 5. Expressive language, (a) language structure.
1
Visually handicapped children
301
children are actually ahead of the partially sighted group. After that, when words begin to be true object labels, the partially sighted group go ahead and stay ahead until the stage of past and future tenses is reached. At this stage, once again, thinking transcends the immediately perceptual, and so is less dependent on vision. The findings indicate the need for intensive help at the 12 month stage of early object labels, when vision normally plays so large a part. Expressive language (b) language content: This scale begins with the naming of familiar objects and continues through the ability to tell the use and position of objects, to the ability to construct sentences about ongoing events. Sighted children start labelling objects 18 months before visually handicapped children and this advantage is maintained throughout the scale. This emphasizes the enormous part played by vision in making this association between objects and the verbal labels, and the ability to relate language meaningfully to reality situations. 1 The blind and partially sighted children are similar until part way
18 16 14 12 a> O
^ 10 5 "
8 6
1
2
3 4 Chronological Age in yrs
FIGURE 6. Expressive language, (b)language content.
302
Joan Reynell
through the object naming stage, when partially sighted children go ahead. This advantage is maintained until the stage of positional concepts and the creative use of language is reached, such as describing an ongoing activity. Again, with intellectual aspects transcending the perceptual, the difference between the two groups disappears. The findings stress the need for early help in relating language to concrete situations. DISCUSSION AND CONCLUSIONS
There is a common thread running through these results in each of the aspects of intellectual development assessed by the Reynell-Zinkin Scales. That is, that nearly all the early stages of learning are visually dominated, and lay the foundation for many of the higher intellectual processes. When visually handicapped children are able to use intellectual means to transcend the perceptual learning, they can, to some, extent, find ways around the visual difficulties, but by this time they are already 1 to 2 years behind their sighted peers in most aspects of learning. The visual component is most evident, as would be expected, in aspects of learning concerned directly with the concrete environment, such as in early mobility and orientation and in handling and relating concrete objects. The findings also indicate a very considerable visual component in both aspects of language devlopment. This does not apply to the superficial repetitive chatter demonstrated by some blind children, which accounts for the artificial spurt seen in Figure 5, but it does apply to true meaningful and reality-based language. This is evident from the findings of the verbal comprehension scale, and expressive language scale (b). ! The early co-ordinating function of vision is such an enormous learning asset that it is unlikely any teaching can completely make up for its loss, but it is at least possible that appropriate and intensive early teaching could go a long way to help. The teaching would need to be directed towards this very co-ordinating function, such as linking object to object, and word to object, using whatever sensory modalities are available to the child. For example, instead of just talking about a 'brush' the child needs to handle it, use it and hear the label 'brush* at the same time. This should be repeated at every appropriate time during daily living activities. Parents of visually handicapped children need regular professional guidance for this sort of daily living help to their
Visually handicapped children
303
children from the age of 10 months. Work with language-handicapped children (Cooper et al. 1978) has shown that this sort of daily living teaching, using parents as teachers under professional guidance, is effective if there is a professional visit once in six weeks. It is suggested that this might also be a suitable interval for visually handicapped children. The six-weekly interval allows enough time for some progress to be made, so that this can be built upon at the next session. It is also a realistic aim in terms of deployment of the teachers' time. The RNIB has provided an early home teaching service for many years, and some local authorities are now also providing specialist teachers for this work. It is encouraging that the early learning needs of the children are becoming more widely recognized and better understood, and it is to be hoped that this will be followed by provision of enough suitably trained people to meet the need.
REFERENCES Cooper J., Moodley M. &. Reynell J. (1978) Helping Language Development. Edward Arnold, London Maxfield K.E. & Buchholtz S. (1951) A Social Maturity Scale for Blind Pre-School Children. The American Foundation for the Blind Inc., New York Reynell J. & Zinkin P. (1975) New Procedures for the Developmental Assessment of Young Children with Severe Visual Handicaps. Child Care, Health and Development 1, 61-69
DEVELOPMENTAL PATTERNS OF VISUALLY HANDICAPPED CHILDREN
JOAN REYNELL Senior Lecturer in Educational Psychology, The Wolfson Centre, Mecklenburgh Square, London WCl Accepted for publication 2 May 1978
Summary This article reports a comparative study of the developmental patterns of blind, partially sighted and fully sighted children during the first few years of life. Using the (previous reported) ReynellZinkin developmental scale for visually handicapped children, the groups were compared in the five developmental areas of (a) social adaptation, (b) sensori-motor understanding, (c) exploration of environment, (d) verbal comprehension and (e) expressive language. It was found that 10 to 12 months was the age at which the sighted group began to outstrip the visually handicapped children in most of the developmental areas. This divergence increased until towards the upper end of scale (4 to 5 years for the visually handicapped) when more abstract thought processes began to develop. The effect of visual handicap was also seen in the greater advantage of the partially sighted over the blind children. The patterns of development varied somewhat in the five different areas. The reasons for this are discussed. The findings point to the need for intensive help for visually handicapped children from the earliest months of life.
INTRODUCTION
In 1975 Reynell & Zinkin described some new assessment procedures for young visually handicapped children. The developmental scales which were described allowed for the separate assessment of 'motor' and 'mental' development, with further sub-scales under each of these headings. Each sub-scale was arranged in developmental stages from 0 to 5 years, following the developmental pattern of visually handicapped children. A larger sample of visually handicapped children has now been followed up, using the Reynell-Zinkin Mental Development Scale, This 0305-1862/78/1000-O291$02.00 ©1978 Blackwell Scientific Publications
291
292
Joan Reynell
scale is divided into the following five sub-scales which have been fully described in the original article, (1) social adaptation, (2) sensori-motor understanding (performance), (3) exploration of environment (orientation), (4) response to sound and verbal comprehension, (5) vocalization and expressive language. AIM OF PRESENT STUDY
The aim of the study reported here is two-fold. First, to estabUsh more reliable age levels for the different stages of development in visually handicapped children; and second, to compare the development of blind, partially sighted and fully sighted children in the five areas listed above and so leam more about the effect of visual handicaps on different aspects of intellectual development. DESCRIPTION OF SAMPLE
The original study was based on the findings from 116 recordings, including many children with severe associated handicaps. This follow-up study is based on 203 recordings, and a 'cleaner' sample, in that many of the children with severe associated handicaps have been eliminated. These 203 recordings were obtained from 109 children. For those children recorded more than once the time intervals between assessments ranged from 3 months with very young children, to a year with the older children. The distribution in terms of the number of recordings per child is shown in Table 1. TABLE 1. Showing distribution in terms of number of recordings per child No. of recordings per child
I 2 3 4
5 6 7
No. of children
tiS 16 12 9 3 2 1
Total no. of recordings
m it m
3iS IS 12 7
Visually handicapped children
VISUAL HANDICAPS
293
1
The children were divided into 'blind' and 'partially sighted' groups on the basis of the presence or absence of visually-directed reaching, as in the original study. Table 2 shows that there were approximately equal numbers of blind and partially sighted children evenly distributed throughout the age range, with a small number of borderline children labelled blind/partially sighted. In calculating the means, the scores of these borderline children were added to both groups. TABLE 2. Showing the age distribution of blind and partially sighted children
Age range in years O-I 1-2 2-3 3-4
4-5+ Total
Number of recordings: partially blind sighted 21 29 21 17 9 97
18 30 19
blind/partially sighted
Total
0
39
0
59 51 35 19 203
14
11 4
5 86
20
5
Range of associated handicaps Most of the children with severe degrees of cerebral palsy, hearing impairment and mental retardation have been excluded from this sample. It has been impossible to exclude all associated handicaps completely as a visual handicap rarely occurs without some degree of associated handicaps. The present sample of 109 children includes 17 with mild degrees of cerebral palsy and 8 with hearing impairment. One of the hearing impaired children had only a minimal hearing handicap, and the other 7 were excluded from the language sections. There is a wide range of intellectual ability, including some quite retarded children, but this variable has been eliminated by using the Maxfield Buchholz (1957) ages instead of chronological ages, as in the original study. There were twice as many children with cerebral palsy in the partially sighted group as in the blind group and all the hearing impaired children were in the partially sighted group. This suggests that the differential ability which was found to favour the partially sighted group
294
Joan Reynell
may be greater in a sample of children showing a more even distribution of associated handicaps. In other words, the effect of the visual handicap on intellectual development may be even more marked than the findings reported here indicate. Establishment of age levels The mean raw scores were calculated separately for the blind and partially sighted groups, for each of the five sub-scales. For the purpose of establishing these means, ages were divided into intervals of three months from 0 to 5 years as follows: 0-3 months, 4-6 months, 7-9 months etc. The mean score for each age group was then plotted on a graph and the curves smoothed statistically. In this way developmental trends could be plotted for each sub-scale, comparing blind and partially sighted children. These graphs proved to be very close to those obtained in the original study which were calculated from a smaller and less *clean' sample, so the indications are that the new graphs reflect developmental trends reasonably well, despite the difficulties of getting any sort of uniformity in the sample. Age levels for sighted children were estimated from standardized scales for sighted children using similar items or equivalent developmental stages, and were checked by testing a small sample (43 children) of fully sighted children on the Reynell-Zinkin Scales. Developmental trends Social adaptation This scale is concerned with social response to people, and with the development of self help skills. Figure 1 shows the developmental trends for the three groups of children. The difference between blind and partially sighted children was negligible for this aspect of development, although the difference when compared to sighted children was very great, particularly in the IV2 to 2Vi. year range. The earliest items, concerned with response to people and voice recognition, do not show a great deal of difference, but the difference becomes evident when the items include self help such as cooperation in dressing and feeding. By about 3 years, most sighted children have achieved a degree of social independence not reached by the visually handicapped until 4^/2 to 5 years. The lack of difference between blind and partially sighted children is hard to explain. This is the only one of the five scales on which it occurred. It is possible that both
Visually handicapped children
B and PS
7 6 5 4 3 2 1 -
1
2
3 4 Chronological Age in yrs
5
FIGURE 1. Social adaptation (S; sighted, B: bHnd, PS: partially sighted).
295
296
Joan Reynell
groups tend to be 'babied' by their parents for longer than they need be, just because they are visually handicapped, and because the early stages of learning self help are necessarily more messy and clumsy than with sighted children. Many parents did, in fact, confess that they found it hard to tolerate this rate long drawn out and messy stage. If this is a contributory cause of delay in this aspect of development, it is a clear indication of the need for early guidance from the age of about 10 months, which is when the real divergence in ability between sighted and visually handicapped children begins. Sensori-motor understanding (performance) This scale is concerned with the understanding of concrete objects and their relationships with one another. Figure 2 shows the developmental trends for the three groups of children. 24 22 20 18 16 14 12
10 8
1
2
3 4 Chronological Age in yrs
FIGURE 2. Sensori-motor understanding (performance).
Visually handicapped children
297
In normal development, early sensory co-ordination, understanding of the permanence of objects, and the relationship of object to object is very dependent on visual perception for co-ordinating the different aspects of learning. It is not surprising, therefore, to see the very considerable effect of a visual handicap shown in Figure 2. There is a continuous and consistent difference in favour of partially sighted as compared to blind children. The difference between visually handicapped and sighted children is very marked indeed. The divergence begins soon after the normal age of understanding the permanence of objects, and increases with early understanding of object relationships such as fitting one object onto or into another. The difference becomes less marked as children move from perceptually dominated understanding to an understanding of more generalized concepts, including abstractions such as size and shape. This sort of understanding is demonstrated by sorting tasks, such as sorting bricks into big and small. This trend is also seen in the less marked difference between the partially sighted and blind groups at the upper end of the scale. These findings suggest that those visually handicapped children who can achieve more abstract levels of thinking begin to use intellectual means to transcend the visual limitations. The findings also point to the need for intensive help from the age of about 10 months to prevent some of the lag in perceptual learning upon which the later conceptual learning depends. Exploration of environment This scale is concerned with the child's ability to understand his orientation within a room, and his ability to use this in relation to fixed objects such as doors, pegs and large furniture. Figure 3 shows the developmental trends for the three groups of children in this aspect of learning. The trends are very similar to those in Figure 2, showing once again that early spatial understanding is visually dominated, and it is not until 3-4 years of age (for visually handicapped children) that an intellectual understanding can begin to take the place of visual perceptual learning. Verbal comprehension The early items of this scale are concerned with response to sound, including location and recognition. This moves through the early stages of recognizing familiar phrase patterns, to the understanding of words as object labels, and then to increasingly complex verbal directions. The difference between the blind and partially sighted begins to show
298
Joan Reynell
3 21 -
1
2
3 4 Chronological Age in vr^
5
6
FIGURE 3. Exploration of environment (orientation)
at the stage of understanding object labels, increases at the stage of relating two named objects (e.g. 'put the brush in the box'), and then begins to decrease at the more conceptual stage of thinking, when longer verbal directions, including shape, size and position are reached. When understanding reaches this later stage of abstract concepts (e.g. *put the small pencil in the biggest cup'), the difference between the two visually handicapped groups becomes negligible. Sighted children are ahead from the beginning, with a steady increase in advantage, particularly from the stage of relating two named objects. The findings point to the need for intensive help at the stage of understanding object labels. This is particularly important, as verbal comprehension is one of the main learning assets for visually handicapped children.
Visually handicapped children
34 32 30 28 26 24 22 20 18
14 12 10 8 6 4
1
2
3 4 Chronological Age in yre
FIGURE 4. Response to sound and Verbal comprehension.
299
300
Joan Reynell
Expressive language (a) language structure: The early stages of this scale are concerned with the production of pre-speech sounds, leading on to the ability to say words, to put words together, and to the use of increasingly mature sentence forms. This is a more superficial aspect of expressive language than that assessed in section (b). As this scale is concerned with the more superficial aspects of language production, it is not surprising that the difference between the three groups is less marked than in the more intellectually loaded scales. There are, however, some interesting trends. The three groups are similar up to and including the stage of double-syllable babble. When words begin, the sighted group go ahead and stay a little ahead, but without increasing the gap. They have a 6 to 8 month advantage all the way. The interesting pattern is between the two visually handicapped groups. At the stage of jargon and 2 to 4 'sltuational' words, the blind
22 -
^ ^ ^
PS
20 •
18 -
16 -
14
8 12 5 to DC 10
8 6
-
/X
r
.••'
4
2
1 1
2
3 4 Chronological Age in yrs
FIGURE 5. Expressive language, (a) language structure.
1
Visually handicapped children
301
children are actually ahead of the partially sighted group. After that, when words begin to be true object labels, the partially sighted group go ahead and stay ahead until the stage of past and future tenses is reached. At this stage, once again, thinking transcends the immediately perceptual, and so is less dependent on vision. The findings indicate the need for intensive help at the 12 month stage of early object labels, when vision normally plays so large a part. Expressive language (b) language content: This scale begins with the naming of familiar objects and continues through the ability to tell the use and position of objects, to the ability to construct sentences about ongoing events. Sighted children start labelling objects 18 months before visually handicapped children and this advantage is maintained throughout the scale. This emphasizes the enormous part played by vision in making this association between objects and the verbal labels, and the ability to relate language meaningfully to reality situations. 1 The blind and partially sighted children are similar until part way
18 16 14 12 a> O
^ 10 5 "
8 6
1
2
3 4 Chronological Age in yrs
FIGURE 6. Expressive language, (b)language content.
302
Joan Reynell
through the object naming stage, when partially sighted children go ahead. This advantage is maintained until the stage of positional concepts and the creative use of language is reached, such as describing an ongoing activity. Again, with intellectual aspects transcending the perceptual, the difference between the two groups disappears. The findings stress the need for early help in relating language to concrete situations. DISCUSSION AND CONCLUSIONS
There is a common thread running through these results in each of the aspects of intellectual development assessed by the Reynell-Zinkin Scales. That is, that nearly all the early stages of learning are visually dominated, and lay the foundation for many of the higher intellectual processes. When visually handicapped children are able to use intellectual means to transcend the perceptual learning, they can, to some, extent, find ways around the visual difficulties, but by this time they are already 1 to 2 years behind their sighted peers in most aspects of learning. The visual component is most evident, as would be expected, in aspects of learning concerned directly with the concrete environment, such as in early mobility and orientation and in handling and relating concrete objects. The findings also indicate a very considerable visual component in both aspects of language devlopment. This does not apply to the superficial repetitive chatter demonstrated by some blind children, which accounts for the artificial spurt seen in Figure 5, but it does apply to true meaningful and reality-based language. This is evident from the findings of the verbal comprehension scale, and expressive language scale (b). ! The early co-ordinating function of vision is such an enormous learning asset that it is unlikely any teaching can completely make up for its loss, but it is at least possible that appropriate and intensive early teaching could go a long way to help. The teaching would need to be directed towards this very co-ordinating function, such as linking object to object, and word to object, using whatever sensory modalities are available to the child. For example, instead of just talking about a 'brush' the child needs to handle it, use it and hear the label 'brush* at the same time. This should be repeated at every appropriate time during daily living activities. Parents of visually handicapped children need regular professional guidance for this sort of daily living help to their
Visually handicapped children
303
children from the age of 10 months. Work with language-handicapped children (Cooper et al. 1978) has shown that this sort of daily living teaching, using parents as teachers under professional guidance, is effective if there is a professional visit once in six weeks. It is suggested that this might also be a suitable interval for visually handicapped children. The six-weekly interval allows enough time for some progress to be made, so that this can be built upon at the next session. It is also a realistic aim in terms of deployment of the teachers' time. The RNIB has provided an early home teaching service for many years, and some local authorities are now also providing specialist teachers for this work. It is encouraging that the early learning needs of the children are becoming more widely recognized and better understood, and it is to be hoped that this will be followed by provision of enough suitably trained people to meet the need.
REFERENCES Cooper J., Moodley M. &. Reynell J. (1978) Helping Language Development. Edward Arnold, London Maxfield K.E. & Buchholtz S. (1951) A Social Maturity Scale for Blind Pre-School Children. The American Foundation for the Blind Inc., New York Reynell J. & Zinkin P. (1975) New Procedures for the Developmental Assessment of Young Children with Severe Visual Handicaps. Child Care, Health and Development 1, 61-69
