26 Important Areas to Assess

Standardized testing

Performance validity

Performance validity is important to measure in all psycho-educational assessments via objective measures. It is considered standard of care (e.g., National Academy of Neuropsychology position paper [Bush et al., 2005] and American Academy of Clinical Neuropsychology position paper [Sweet et al., 2021]). Unfortunately, most free-standing performance validity measures rely on vision. The Memory Validity Profile (MVP) provides separate norms for a purely auditory measure of performance validity (Sherman & Brooks, 2015). The MVP would be a brief, limited sample of performance validity. The Word Memory Test (WMT) has an oral version (Green, 2003). It is available to subscribers of the standard WMT at an additional cost. Only part of the oral WMT is accessible to blind and low vision students as there is a written multiple-choice section. Moreover, the oral version of the WMT has not been validated for use in children. The Pediatric Performance Validity Test Suite (PdPVTS) has five standalone brief measures of performance validity, one of which (Story Memory for ages 7-18) is administered auditorily (McCaffrey et al., 2020).

While using standalone performance validity measures is typical for neuropsychologists, school psychologists often rely on informal methods to measure response bias (Lovett et al., 2023). If unfamiliar with performance validity assessment, school psychologists should review “Response Validity in Psychoeducational Assessment: A Primer for School Psychologists” (Lovett et al., 2020).

Verbal reasoning

Verbal reasoning should be assessed in depth if perceptual reasoning cannot be validly assessed. You might consider adding “supplemental” verbal IQ tests. For example, on the WISC-V, you might include the Information and Comprehension subtests. Comprehension can assess verbal skills beyond “rote” learning to assess social judgment. However, there is evidence that scores on this subtest may be related to the level of visual impairment, presumably due to differences in concept development (Groenveld & Jan, 1992). The WISC-V has a Verbal (Expanded Crystallized) Index (VECI), which is comprised of the Similarities, Vocabulary, Information, and Comprehension subtests (Raiford et al., 2015). Normative data is only available based on the USA standardization sample (see the WISC-V Technical Report #1 Expanded Index Scores for score conversion tables, Raiford et al., 2015).

Another option is to use a cross-battery method of assessment. Per Decker and colleagues (2018),

The XBA approach often results in a more psychometrically stable and complete picture of cognitive abilities than that which can be obtained by a single battery. This approach may aid examiners of children with VI/B in selecting test instruments, as subtests from different batteries can be administered according to both their contributions to the CHC broad abilities and their level of appropriateness for these children. (p. 670)

For instance, an examiner might select the following subtests to evaluate verbal reasoning: DAS-II Verbal Similarities, RIAS-2 Guess What, RIAS-2 Verbal Reasoning, and CELF-5 Semantic Relationships.

Investigate the depth of meaning behind word use if the youth’s responses suggest the possibility of “hollow” language. Questions such as “How did you know that?” or “How would you use this information?” can clarify understanding.

Auditory memory

Rote auditory memory (short- and long-term) and working memory are essential to assess. Blind students often start their educational path through rote memory. Research consistently shows as a group, blind and low vision students tend to show strong auditory short-term memory, whereas working memory might not be as strong (reviewed in Greenaway et al., 2017). Assess working memory, not just rote short-term memory or recitation.

Consider the potential impact of concept development on the youth’s performance. For example, the WRAML3 Verbal Working Memory task requires students to know the relative size difference between various objects (Adams & Sheslow, 2021).

Options that provide composite scores by combining the performance from two or more subtests include the WISC-V and WJ-IV. The WISC-V provides an Auditory Working Memory Index, which is comprised of Digit Span and Letter Number Sequencing subtests (Wechsler, 2014). The WJ IV has the option of the Short-Term Working Memory and the Short-Term Working Memory Extended Clusters (Schrank et al., 2014). The Verbal Attention and Numbers Reversed Tests are in both clusters while the Object-Number Sequencing Test is added to create the extended cluster.

Listening comprehension

Auditory or oral comprehension (listening comprehension) is an essential skill for primarily auditory learners. When choosing a test, consider the visual demands of the task. For example, the WIAT-4 Oral Discourse Comprehension is a completely oral measure of auditory comprehension (NCS Pearson, 2020), whereas NEPSY-II Comprehension of Instructions has significant visual demands (Korkman et al., 2007).

Tactile skills

Tactile skills can be evaluated with the Tactual Performance Test (TPT). The TPT is a part of the Halstead-Reitan Neuropsychological Test Battery (Reitan & Wolfson, 1985) and was adapted for use with blind adults (Bigler & Tucker, 1981). The TPT requires a person to put blocks of different shapes into the corresponding holes in a board. Respondents need to use tactile form discrimination, kinesthesis, upper extremity coordination and movement, manual dexterity, and spatial relationship understanding. It is designed to be administered blindfolded and thus can easily be used with blind students. The TPT differentiates between adults who are blind with no known neurological involvement from those with blindness associated with neurological involvement (Bigler & Tucker, 1981).

The Tactual Formboard Test (TFBT) is a more recent adaptation of the TPT and is a part of the Neuropsychological Assessment of Adults with Visual Impairment (NAAVI), which is for individuals ages 16 and older (Gallagher & Burnham, 2017). Based on normative data collected from adults in Michigan, the TFBT differentiates between blind adults with a neurological disorder history or very low birth weight and those without such histories. Performance on the various trials of the TFBT provides information on tactile discrimination, spatial relations, spatial learning and memory, sustained attention, and planning skills. 

The NAAVI (Gallagher & Burnham, 2017) also includes the Digit Symbol, Block Design, Object Assembly, and Pattern Board subtests from the Haptic Intelligence Scale for Adult Blind (Shurrager & Shurrager, 1964). The Digit Symbol subtest measures tactile discrimination, spatial learning and memory, processing speed, and spatial orientation. The Block Design subtest assesses tactile discrimination, spatial understanding, spatial construction, and pattern analysis. The Object Assembly subtest examines tactile-spatial understanding, spatial construction, problem-solving, and manual dexterity. The Pattern Board measures tactile discrimination and spatial memory.

The Tactual Span is a new measure of tactile working memory. It involves touching the examinee’s fingers. The authors provide normative data for their group of young adults (Heled et al., 2020) and evidence for the validity of use in blind and low vision individuals (Heled & Oshri, 2021).

The Tactile Working Memory Scale (TWMS) is a rating scale designed to measure tactile working memory in congenitally deafblind individuals. The TWMS may also be used with “people with other disabilities who have difficulties using their vision and hearing effectively and who require bodily-tactile information for communication and cognitive development, such as children with complex communication support needs or children with brain related visual and hearing loss” (Nicholas et al., 2019, p. 59).

Additionally, Teachers of the Visually Impaired (TVIs) and Orientation and Mobility (O&M) Specialists may include tactile and spatial measures in their assessments. TVIs and O&M Specialists typically use criterion-referenced or informal tools, such as the Early Tactile Learning Profile (Adkins et al., 2021). Observing and interviewing the TVI and O&M Specialist can provide helpful insights about tactile and spatial skills. Given limited access to specialized evaluation tools, psychologists often rely on interviews, observations, and informal assessment methods to assess tactile skills.

Processing Speed

If the referral questions include concerns about processing speed, verbal (oral) fluency measures can be analogous to visual motor processing speed. For example, the WIAT-4 Oral Word Fluency subtest, NEPSY-II Word Generation subtest, or DKEFS Verbal Fluency Test can be used. Another option is to use auditory continuous performance tests that include response time scores, such as the auditory T.O.V.A.

Areas to assess via rating scales or questionnaires

Sleep

Blind and low vision individuals are at increased risk of sleep disturbances and disruption of circadian rhythms (e.g., day/night rhythm) (Ingram et al., 2022). The questions from the BEARS Screening Tool for Assessment of Sleep in Children may be helpful to add to interviews with parents, caregivers, and youth (Owens & Dalzell, 2005).

Social-emotional development

As mentioned in the Language and Social Development and Mental Health and Emotional Development chapters, mental well-being and social-emotional development are important to evaluate. Blind and low vision students commonly have challenges with mastering social competency skills since most sighted people gain social skills through observation, experiences, and imitation. The degree to which students can gather and use sensory information related to social interactions effectively impacts how successful they may be in accurately reading the social environment, initiating interactions, and responding to others (Sacks & Page, 2017). The Social Skills Assessment Tool for Children with Visual Impairments (SSAT-VI: R) is a social skills checklist explicitly created for this population (Sacks & Wolffe, 2006).

Other rating scales that psychologists frequently use (e.g., BASC-3, BYI-2, or Piers-Harris 3) can be used when evaluating blind and low vision students. Refer to the Rating Scales chapter for considerations when using rating scales developed for the general population.

Adaptive functioning

Adaptive functioning is overall more impaired in groups of blind and low vision individuals (reviewed in Greenaway et al., 2017). On the ABAS-II, Greenaway et al. (2017) found that a group of high-functioning blind and low vision students (Verbal IQ > 80) had intact attention, memory, and working memory skills, whereas aspects of adaptive functioning (Home Living and Functional Academics) were low compared to the normative sample.

While norm-referenced adaptive functioning rating scales provide information about how students function relative to others their age, criterion-referenced checklists can inform whether students are progressing in skills at a pace similar to what is expected of other blind and low vision students. The Independent Living Skills (ILS) Checklist was designed to gather information on the progression of blind and low vision students’ skills (Michigan Department of Education Low Incidence Outreach [MDE-LIO], 2018). Their grade-level guides may also be helpful in considering what adaptive behaviors the student can currently perform (MDE-LIO, n.d.). Please see the chapter on the diagnosis of intellectual developmental disorder for more information on assessing adaptive functioning.

Transition and vocational skills

Transition and vocational considerations also should be evaluated for students who are 14 or older. What’s in Your Assessment Toolbox (Herlich & Zimmerman, 2024) lists career education criterion-referenced tools and checklists, including ones created for blind and low vision youth. Several options are available freely online. Project Aspiro (n.d.) has Career Education Competencies Checklist and Transition Competencies Checklists (student, teacher, and parent forms) that Dr. Karen Wolffe created; however, an updated checklist can be found in “Career Education” chapter of Volume II of the Foundations of Education, Third Edition (Wolffe, 2017). Total Life Learning: Preparing for Transition was developed for students from three to 22 with blindness, low vision, deafblindness, or multiple disabilities and includes a curriculum assessment tool (Bridgeo et al., 2014).

Heled, E., & Oshri, O. (2021). Validation of the Tactual Span in individuals with congenital and acquired blindness. British Journal of Visual Impairment, 41(2), 328-342. https://doi.org/10.1177/02646196211044983

Herlich, S., & Zimmerman, S. (2024). What’s in your assessment toolbox? California School for the Blind. https://docs.google.com/document/d/1QiKonP7gV_s_QfOcCSXTimo88vKdOFRW/pub

Ingram, D. G., Cruz, J. M., Stahl, E. D., Carr, N. M., Lind, L. J., & Keirns, C. C. (2022). Sleep challenges and interventions in children With visual impairment. Journal of Pediatric Ophthalmology & Strabismus, 59(2), 77–86. https://doi.org/10.3928/01913913-20210623-01

Korkman , M. , Kirk , U. , & Kemp , S. (2007). NEPSY-Second Edition. NCS Pearson.

Kúld, P. B., Kef, S., & Sterkenburg, P. S. (2021). Bibliometric mapping of psychological well-being among children with a visual impairment. British Journal of Visual Impairment, 39(2), 131–146. https://doi.org/10.1177/0264619620915245

Lovett, B. J., Schaberg, T., Nazmiyal, A., & Spenceley, L. M. (2023). How do school psychologists address issues of effort, motivation, and honesty during evaluations? Journal of Psychoeducational Assessment, 41(6), 603-618. https://doi.org/10.1177/07342829231175938

Lovett, B. J., Spenceley, L. M., & Lewandowski, L. J. (2020). Response validity in psychoeducational assessment: a primer for school psychologists. Contemporary School Psychology, 26, 279–289. https://doi.org/10.1007/s40688-020-00334-5

McCaffrey, R. J., Lynch, J. K., Leark, R. A., & Reynolds, C. R. (2020). Pediatric Performance Validity Test Suite. MHS Assessments.

Michigan Department of Education Low Incidence Outreach. (n.d.). Independent living skills. https://mdelio.org/blind-visually-impaired/expanded-core-curriculum/independent-living-skills

Michigan Department of Education Low Incidence Outreach. (2018). Independent Living Skills (ILS) Checklist. https://mdelio.org/sites/default/files/documents/BVI/ECC/ILS/Checklists/ILS_Checklist_2018.pdf

NCS Pearson. (2020). Wechsler Individual Achievement Test (4th ed.).

Nicholas, J. T., Johannessen, A. M., & van Nunen, T. (2019). Tactile Working Memory Scale – a professional manual. Nordic Welfare Centre. https://nordicwelfare.org/wp-content/uploads/2019/12/NWC-TWMS-Handbok-webb.pdf

Owens, J. A., & Dalzell, V. (2005). Use of the “BEARS” sleep screening tool in a pediatric residents’ continuity clinic: a pilot study. Sleep Medicine, 6(1), 63–69. https://doi.org/10.1016/j.sleep.2004.07.015

Project Aspiro. (n.d.). Using this website to help children or youth. http://projectaspiro.com/en/service-providers/using-this-site/Pages/Children-and-youth.aspx

Raiford, S. E., Drozdick, L., Zhang, O., & Zhou, X. (2015). WISC-V technical report #1 expanded index scores. Pearson Assessments. https://www.pearsonassessments.com/content/dam/school/global/clinical/us/assets/wisc-v/wisc-v-technical-report-1.pdf

Sacks, S. Z., & Page, B. (2017). Social skills. In M. Cay Holbrook, T. S. McCarthy, & C. Kamei-Hannan (Eds.), Foundations of education, volume II: Instructional strategies for teaching children and youths with visual impairments (3rd ed., pp. 752-802). AFB Press. https://www.aph.org/product/foundations-of-education-volume-ii-instructional-strategies-for-teaching-children-and-youths-with-visual-impairments/

Sacks, S. Z., & Wolffe, K. E. (Eds.). (2006). Teaching social skills to students with visual impairments: From theory to practice. AFB Press. https://www.aph.org/product/teaching-social-skills-to-students-with-visual-impairments-from-theory-to-practice/

Schrank, F. A., McGrew, K. S., & Mather, N. (2014). Woodcock-Johnson IV Tests of Cognitive Abilities. Riverside Publishing.

Sherman, E. M. S., & Brooks, B. L. (2015). Memory Validity Profile. Psychological Assessment Resources, Inc.

Sims, S. V., Dreyzehner, J. K., DeCarlo, D. K., & Lombardo, T. (2018). Mental health needs of blind and visually impaired youth and their families. Journal of the American Academy of Child and Adolescent Psychiatry, 57(10), S96–S96. https://doi.org/10.1016/j.jaac.2018.07.403

Sweet, J. J., Heilbronner, R. L., Morgan, J. E., Larrabee, G. J., Rohling, M. L., Boone, K. B., Kirkwood, M. W., Schroeder, R. W., Suhr, J. A., & Conference Participants. (2021). American Academy of Clinical Neuropsychology (AACN) 2021 consensus statement on validity assessment: Update of the 2009 AACN consensus conference statement on neuropsychological assessment of effort, response bias, and malingering. The Clinical Neuropsychologist, 35(6), 1053–1106. https://doi.org/10.1080/13854046.2021.1896036

Wechsler, D. (2014). Wechsler Intelligence Scale for Children (5th ed.). Pearson.

Wolffe, K. E. (2017). Career education. In M. C. Holbrook, C. Kamei-Hannan, & T. McCarthy (Eds.). Foundations of education, volume II: Instructional strategies for teaching children and youths with visual impairments (3rd ed., pp. 831-874). AFB Press. https://www.aph.org/product/foundations-of-education-volume-ii-instructional-strategies-for-teaching-children-and-youths-with-visual-impairments/