Understanding the Individual Needs of Visually Impaired Students:

Integration of a Neuroscience-Based Clinical Model Into A Specialized Educational Institute

Paul B. Yellin, MD, Erin O’Reilly, MS, Kimberly Ross, MS, and Patricia Glyptis, MS

New York Institute for Special Education Yellin Center for Mind, Brain And Education

© 2011 Paul B. Yellin, MD

Background

Increasingly, research in neuroscience is demonstrating that there is a wide range of variation in the learning needs of even “typical learners.”

These variations can be described in terms of individual profiles of strengths and weaknesses, much like fingerprints or DNA.

Background

To date, policy and practice in the education of visually impaired students has largely focused on the many complex challenges that they share.

In 2008, the leadership of the New York Institute for Special Education (NYISE) identified a pressing need for deepening their understanding of the specific learning needs of individual, visually-impaired learners.

Background

Specifically, they decided to integrate a neurodevelopmental model into diagnostic practice, counseling, and instruction.

They identified the Yellin Center for Mind, Brain, and Education as the best partner to support them in accomplishing this goal.

The purpose of this presentation is to share our early experience in this collaboration.

A private, 501(c)(3) nonprofit, nonsectarian educational facility which provides

quality programs for children who are blind or visually disabled, emotionally and learning

disabled and preschoolers who are developmentally delayed.

Founded in 1831 as the New York Institution for the Blind as one of the first schools in the US to

provide an educational program for children who were blind and visually impaired

Schermerhorn Program

Schermerhorn Program

Children 5-21 years old who are legally blind IEP’s based on traditional psycho-educational

assessments Instruction follows NYS Curricula leading to

elementary and high school diplomas Educational support, life skills, career skills,

and transition to post-secondary education

Founded by Dr. Paul Yellin, former National Director of Clinical Programs at the All Kinds of Minds Institute, a national nonprofit institute

dedicated to improving outcomes of struggling students through programs linking emerging

neuroscience to educational practice.

Extends and updates the interdisciplinary, dynamic model developed at All Kinds of Minds,

while integrating emerging neuroscience and evolving policy and practice

Neuroscience and Education

A conceptual framework and vocabulary for an interdisciplinary conversation about learning, mental productivity, and specific brain activities.

Task analysis of academic functions.

Linkage to 8 neurodevelopmental constructs.

Neurodevelopmental profiles

An example of a skill and its component sub-skills

Reading, a skill, is composed of several sub-skills: Remembering how sounds and letters are related Understanding word meanings Remembering what your just read while reading what

you’re reading now Identifying the “main ideas” and “salient details” Making connections to prior knowledge and experience

Neurodevelopmental Functions-Eight Constructs

Attention Higher Order Cognition Language Memory Neuromotor Function Social Cognition Spatial Ordering Temporal-Sequential Ordering

Neurodevelopmental Profiles

Every student, indeed, every human has some strong functions and some weak ones (dysfunctions).

It is possible to describe each individual’s unique mix of strengths and weaknesses (i.e. neurodevelopmental profile).

Neuroplasticity

“Re-wiring our brains”

Brodman’s 52 Regions

I. Franz, “Variations in Distribution of Motor Centers.” Psychological

Review, Monograph Suppl 19 (1915):80-162.

Merzenich’s Monkeys

Re-zoning of sensory inputNeuroscience. 1983;10:639-65.

“Functional relevance of cross-modal plasticity in blind humans.”

The visual cortex responds to sensory input from the Braille reading digit and

contributes to perception of Braille letters.

Nature 1997, 48:344-348

“Early but not late-blindness leads to enhanced auditory perception”

“We showed that the performance of blind participants was better than that of

sighted participants on a range of auditory perception tasks.”

Neuropsychologia 2010, 48:344-348

“These findings suggest that the deficit in functional brain organization underlying dyslexia can be reversed….are consistent with current proposals that reading difficulties in many children represent a variation of normal development that can be altered by intensive intervention.” Simos, et al, Neurology, 58:1023 (2002)

Normalization of Dyslexia-Specific Brain Activation Profile

Understanding & Educating All ChildrenDiversity is the Norm

There are no “perfect brains” Profiles of academic and cognitive strengths

and weaknesses at a particular point in time vs. fixed labels

Wide range of normal variation in brain development

We are “re-wiring” our brains throughout our lives

Implications for Diagnosis and

Treatment

“Differential Diagnosis”

Getting to the root cause of symptoms or problems

Academic Assessment

The power of error analysis and search for recurring themes across subjects, tasks, settings.

Neurodevelopment Assessment

Dynamic assessment using both quantitative and qualitative methodologies.

Making Linkages

academic skills & subskills

neurodevelopmental functions

“Allyson’s difficulty with reading/decoding stems from weak phonologic processing (i.e. a part of receptive language).”

Neurodevelopmental profile

An individual’s unique mix of strengths and weaknesses.

Demystification

Label the weak function “I know what I need to work on” “It has boundaries”

Destigmatization Alliance Formation Infusion of Optimism

A Comprehensive Learning Plan

Interventions at breakdown pointsSegregate troublesome step as

separate activity or stage

Bypass Strategies

Techniques designed to work around a student’s area of weakness.

Leveraging strengths

Using context to help compensate for weak decoding. Having a weak reader

read about a topic that they know well.

Don’t forget affinities

A student who struggles with reading, but loves football should practice reading about football.

Collaboration-Phase 1Initial Training-Spring 2011

Involved core team of 2 School Psychologist s and 1 Educational Evaluator over 18 days

Assessment of NYISE students in tandem with Yellin Center Clinicians

Outcomes Fund of Knowledge Value of profiles vs. labels Value of trans-disciplinary collaboration Practical experience Not ready for prime time

Collaboration-Phase 2Building Independence and Sustainability-Late 2011

Continued core team training while including classroom teacher and other members of the NYISE team over 12 days.

Professional development sessions for classroom teachers and other members of the team

Classroom teachers met with core team to discuss students to be assessed and priorities for assessment

Core team assessed students with YC support Core team led “demystification” sessions with students and

parents Core team and classroom teachers collaborated in learning

plan development

Collaboration-Phase 3Supporting Sustainability, Continuing Development and Building Capacity

Case StudyCM

Referral Concerns

CM is an 11.1 y/o 5th grader with oculocutaneous albinism, photophobia, nystagmus (bilateral), and hyperopic astigmatism. Visual acuities are 20/400 O.D. and 20/400 O.S.

He was referred by his teacher for specific strategies for reading comprehension, oral expression, and written output

Other Relevant Background

Difficulty processing information, particularly verbal information.

Needs time to answer questions Struggles with independent writing:

Generating ideas Elaborating

Generally quiet, shy, and reserved with difficulty expressing thoughts and feelings

Overview of Assessment

Team worked with CM on a series of series of academic and neurodevelopmental tasks

Assessment included subtests of standardized neuropsychological batteries and additional tasks

Assessment instruments selected specifically to isolate and assess CM’s neurodevelopmental functions and their relationships to learning and academic output

Relevant Strengths

Higher order cognition Short-term memory Mental work stamina Active working memory Spatial ordering Fine motor function Graphomotor function

Relevant Challenges

Creativity and brainstorming Sentence comprehension Discourse production

Strategies-Nurturing Affinities

CM has expressed an interest in becoming a video game designer when he grows up.

CM can build convergent thinking by cataloging facts or details about video games or about a video game he would like to create.

His teacher could also set aside special times during each day for high motivational reading that focuses on topics in which he has great interest and some prior knowledge.

Front-loading Strategy

Prior to reading grade level text: He should be given a thorough introduction to the

reading material before he attempts to read it. He should be given a short list of questions to

review before he attempts to read the text. Reading simpler texts on the same subject prior to

reading grade level material would also activate prior knowledge.

MC’s Teacher’s Observations He appears more confident and less fearful . He is better able to express his thoughts and feelings. Due to the strategies that were recommended, CM is

better able to express his thoughts in writing even handling open ended topics.

CM is more assertive, beginning to advocate for his needs with selected staff members.

He was the first member of the class to memorize the song for the Awards Ceremony.

Positive Signs The implementation of the clinical model has led to

increasing collaboration across disciplines at the earliest stage of assessment.

The participating clinicians found the initiative empowering, each commenting that it confirmed their core belief that “there had to be a better way” of assessing and understanding their students

Positive Signs When presented with their individual list of strengths

and challenges, virtually every student commented that they had not previously realized that they had any strengths.

They seemed empowered by the opportunity to reframe their experience in terms of strengths and weaknesses, which everyone has, rather than defining themselves solely through their disability

Positive Signs Teachers have commented that having the ability to

refer students to the list of their specific strengths has been particularly valuable when they encounter inevitable setbacks.

Clinicians and teachers have found that the identification of specific breakdowns (e.g., weak phonemic awareness) rather than broad labels (e.g., reading disability) has enabled them to select specific interventions.

Positive Signs

There has been a broad recognition that even students who share a disability have individual needs and abilities. As one student eloquently stated, “That’s what I’ve been trying to say for years. It isn’t just that I’m blind, I have a reading problem!!!!”

Challenges At first, it was difficult for clinicians to move beyond

traditional “testing” paradigms to gain comfort with more dynamic, qualitative approaches to assessment.

Conversations across disciplines can be challenging. For example, the assessment model required psychologists and learning specialists to review each other’s findings and collaborate in synthesis, formulation, and diagnosis.

Challenges

Even as clinicians grew to prefer the new assessment paradigm, without broader process change across the Institute, there were limitations in their ability to apply their new knowledge.

Lessons Learned It was critical to move slowly, communicate

frequently, provide staff opportunities to express their concerns and objections.

Skepticism and resistance is inevitable. It is unlikely that everyone will ever be enthusiastic

about this or any change. Having clear, unequivocal support from the Executive

Director, Governing Board, principals, and key thought leaders has been critical.

Final Thoughts from the Core Team

“Overall the team found this process to be enlightening, allowing us to discover strengths when assessing, rather than just seeing weaknesses”

“We can now view students through a different lens and have a new perspective.”

“In identifying affinities, teachers can now incorporate a student’s affinities into their teaching.”

Final Thoughts from the Core Team

“The demystification process, which allows children to understand their strengths and challenges, has made a tremendous impact in the lives of our students and how they view themselves.”

Final Thoughts from the Core Team

“Our teachers proudly supported the children, by displaying the student’s personalized “My Kind of Mind” sheet.”

“The teachers have appreciated the learning plan they’ve been provided with, as they now have a road map of how to address their student’s learning needs.”

Final Thought from the NYISE Team

“We feel that we are still in the early stages of synthesizing and implementing the neurodevelopmental process. We are excited about the next phase of this professional development process.”

Conclusions

Reframing the learning needs of visually impaired children in terms of individual profiles of specific strengths and weaknesses has been empowering to the students and staff at NYISE.

Despite the fact that the program is in its infancy, we are optimistic about its long-term potential not just for the students and staff at NYISE, but for the broader community of visually impaired learners.