30 Assessment in Children with Severe Cognitive and Motor Disabilities

The challenge

Some blind and low vision children also have severe cognitive impairments. These children may not be able to complete typical standardized testing as most standardized tests designed for school-age children are not appropriate for children functioning at an early developmental level.

Some blind and low vision children also have motor impairments, which limit their ability to use their hands to point, write, pick up, or manipulate objects. To properly assess these children, you must carefully plan and adapt your assessment.

Standardized and non-standardized assessment

To learn more about adapting your assessment for children with severe cognitive and motor disabilities, please see the e-book – Beyond the WISC (Engle, 2019). The e-book suggests that you try to do an age-appropriate standardized assessment measure whenever possible, with appropriate adaptations (Plan A). Choosing a measure that spans a wide age range, such as the Stanford-Binet-5, can be helpful. However, it is important to carefully match the test expectations with the child’s capabilities. For example, the Stanford-Binet-5 does not adequately separate visual from verbal tests, which can make it problematic for use in the blind and low vision population. For those students who cannot complete any of the standardized measures or for those who score at the “floor” of the standardized measures, it can be helpful to use a measure of early development, such as the Bayley-4 (Plan B). For those who cannot complete a developmental measure or where the measure is not capturing their capabilities, examiners may want to use an alternative, creative approach to assessment (Plan C). Plan C would include careful observation, detailed interviewing, criterion-referenced tests (e.g., developmental measures), and individualized structured activities.

Important areas to assess

When completing these assessments, consider what supports exist to stimulate the student’s motivation, curiosity, and engagement. The following questions adapted from the California School for the Blind’s “Frequently Asked Questions” might help guide your assessments (n.d.).

• What promotes the student’s engagement and interest?
  • What gains and maintains the student’s attention?
  • What materials, activities, or people help to engage the student?
  • What is the student’s stamina like? What is an appropriate expectation for the student’s sustained engagement?
• What are the student’s sensory preferences?
  • How does the student explore new objects?
  • How does the student react to assistance or prompts (verbal, physical, or both simultaneously)?
  • How does the student respond to familiar and unfamiliar environments?
  • How does the student engage in play?
• How are basic wants and needs communicated?
  • How does the student respond to interaction and communication attempts?
  • What supports are needed for the student to indicate a choice?
  • How does the student express feelings?
• How does the student participate in daily routines?
  • Does the student help in any small way such as holding an arm out while being dressed or opening mouth in anticipation of oral feeds?
  • Does the student anticipate any daily routines?
• What types of environmental factors support the student’s learning?
  • What is the student’s preferred position to promote engagement?
  • How is information best presented to promote learning?
  • Are staff trained to fade prompting as the student progresses?

Developmental assessment tools to consider

INSITE Developmental Checklist, Third Edition

As mentioned in the Tests Designed for Blind and Low Vision Students chapter, the INSITE Development Checklist is a criterion-referenced evaluation tool that evaluates various areas of development in children with sensory impairments and additional disabilities from birth to age six (Dennison & Wakins, 2024). The checklist includes a column with notes for considerations for children with complex needs, including motor and sensory impairments. The INSITE Developmental Checklist can be used with students functioning at an earlier developmental level than their chronological age.

Early Tactile Learning Profile

Early Tactile Learning Profile is a free observational checklist of tactile skills for individuals who are chronologically or developmentally functioning between birth and five years (Adkins et al., 2022). This assessment tool can help evaluation teams to recognize and support the tactile skills needed for learning and literacy. Literacy is defined more broadly than braille reading and writing, including “non-traditional” literacy with real objects, textures, and tactile symbols.

Child-guided Strategies: The van Dijk Approach to Assessment for Understanding Children and Youth with Sensory Impairments and Multiple Disabilities

While Child-guided Strategies: The Van Dijk Approach to Assessment for Understanding Children and Youth with Sensory Impairments and Multiple Disabilities (Nelson et al., 2009) is out of print, the American Printing House for the Blind (APH, 2022) has posted the evaluation forms for free. This approach encourages the examiner to look at the processes through which the child learns rather than evaluate discrete skills. The foundation of the assessment relies on the assessor establishing a relationship with the child. The child’s interests and abilities determine what materials are used to promote the child’s engagement. The report focuses on identifying strengths and next steps in development. Child-guided strategies are “conversational.” Establishing an interactive routine is important. To do this, the assessor may imitate what the child is doing then add new information. Communicative signals are elicited by stopping the routine and waiting for a signal from the child indicating a desire for continuation. Excellent video examples (van Dijk, 2014) of this approach are available. The article “A Framework for Understanding Young Children with Severe Multiple Disabilities: The Van Dijk Approach to Assessment” provides further information, including a table of the questions about biobehavioral state, orienting response, learning channels, approach-withdrawal, memory, interactions, communication, and problem-solving that are the focus of the assessment (Nelson et al., 2002).

Sensing and Learning

Similarly, the Sensory Learning Kit (SLK) – Guidebook and Assessment Forms has been discontinued and replaced by Sensing and Learning (Smith & Chambers, 2023). The SLK was designed for learners with significant challenges who have motor, sensory, communication, and cognitive impairments. Sensing and Learning is a guidebook that expanded on the SLK concepts and integrated feedback from teachers of the visually impaired. While the SLK included various items, APH sells the Sensing and Learning as a standalone book but links optional items for the activities described in the book.

The sensorimotor learning model is designed to help learners move through hierarchical states/stages. This model recognizes that some children spend periods of time in what Smith calls “extended states” where they are sleepy or agitated. The goal would be to help them achieve and maintain focus on objects to promote learning. A series of objects are available that help stimulate the child’s various senses to see what they respond to. The next goal would be to help the child explore objects through their available senses. This would then move to understanding the function of objects and then learning to label objects. The goal is developing “Coherence” – the feeling that you understand what is going on in your environment. For more information, see a video with Millie Smith: “Strategies for Assessing and Teaching Students with Visual and Multiple Disabilities” (Smith, 2016).

Functional Scheme

Functional Scheme (Nielsen, 2003) is an assessment appropriate for individuals are chronologically or developmentally functioning between 0 and 48 months. This assessment tool was developed to evaluate many developmental areas in children and adults with multiple disabilities. The 20 areas measured include gross movement, fine movement, mouth movement, visual perception, auditory perception, haptic-tactile perception, smell and taste, spatial perception, object perception, verbal language, nonverbal language, language comprehension, social perception, emotional perception, play and activities, toileting skills, undressing and dressing skills, personal hygiene, and eating skills. The skills in each area are in three- to six-month increments from birth to age four. Learn more about Functional Scheme in a video with Patty Obrzut (2016).

Additional evaluation tools that may be appropriate for students with multiple disabilities are listed in the section on assessing students with deafblindness.

References

Adkins, A., Baltisberger, S., Kitchen, S., & Sewell, D. (2022). Early Tactile Learning Profile. Texas School for the Blind and Visually Impaired. https://www.tsbvi.edu/wp-content/uploads/assets/documents/statewide-resources/early-tactile-learning-profile-combined-fillable.pdf

American Printing House for the Blind. (2022, February 3). Child-guided strategies: The van Dijk approach to assessment. https://www.aph.org/product/child-guided-strategies-the-van-dijk-approach-to-assessment/

California School for the Blind. (n.d.). Frequently asked questions (FAQs) – Consultation. https://www.csb-cde.ca.gov/outreach/assessmentcenter/faqs.aspx#multidisciplinaryassess 

Engle, J. (2019). Beyond the WISC: Psychological assessment of cognitive functioning in special populations. Pressbooks. https://pressbooks.bccampus.ca/jengle/

Nelson, C., van Dijk, J., McDonnell, A. P., & Thompson, K. (2002). A framework for understanding young children with severe multiple disabilities: The van Dijk approach to assessment. Research and Practice for Persons with Severe Disabilities, 27(2), 97-111. https://doi.org/10.2511/rpsd.27.2.97

Nielson, L. (2003). Functional schemes. Lilliworks Active Learning Foundation. https://www.lilliworks.org/products/p/functional-scheme

Obrzut, P. (2016, December 1). Functional scheme [Video]. Texas School for the Blind and Visually Impaired. https://library.tsbvi.edu/Player/13415

Smith, M. (2016, November 15). Strategies for assessing and teaching students with visual and multiple disabilities. Perkins. https://www.perkins.org/resource/strategies-assessing-and-teaching-students-visual-and-multiple-disabilities/

van Dijk, J. (2014, July 8). Child-guided assessment. Perkins. https://www.perkins.org/resource/child-guided-assessment/#transcript