Q&A Arising from the Webinar
Identify and Support Pupils with Mild to Moderate Vision and Hearing Problems
We had 1347 registrations for the webinar, and a lot of questions posted. We’ve tried to answer them all and have listed them below. In some cases we grouped questions that appeared to ask the same things. Just select your question(s) of interest and click to open and see the response.
(Professor Thomson):The general recommendation is that children should have their eyes tested by an optometrist every two years (or more frequently if recommended by the optometrist). Eye examinations are free of charge to children under the age of 16.
In terms of Vision Screening, guidelines recommend that children have one vision test on school entry. Many eye care professionals believe that this is wholly inadequate and have been pushing for further screenings at the ages of about 7 and 11.
(Dr Hendricks): I am sorry if I have given the wrong impression. I think it is all our “responsibility” to support our next generation. Ultimately health is parental responsibility. However, when children come to school or to a health service provider, we share some of this responsibility. As you say working together, is the best way to help them, education, health and family.
Being able to screen or check for a child’s senses in school seems an excellent use of resources at minimal cost.
(Professor Thomson): Yes – eye examinations are readily available in the UK and are free of charge. However, there is a surprising lack of awareness of the importance of good vision among some parents and eye care is given a low priority. Vision screening is there as a safety net.
(Professor Thomson): Vision problems can give rise to a wide range of symptoms and signs depending on the type and severity. Symptoms may include reports of difficulty seeing the board/TV, difficulty seeing words when reading, double vision, headaches etc. Signs might include a child screwing up their eyes or covering one eye. More generally, eye problems should be considered in any case where a child is lagging in terms of social/educational development or has behavioural problems.
(Dr Sebastian Hendricks): You will have heard several signs for hearing and vision problems during the presentation, however these are not the only ones and the best advice is possibly to be curious and think about hearing and vision. So on yourself the why question and could it be something different.
In my experience this is a very good generic skill that most Early Years Practitioner have already as without it you’re likely to miss something.
(Professor Thomson): SchoolScreener for Schools provides a simple and cost-effective tool to help schools implement Vision and/or Hearing Screening.
(Dr Hendricks): Many different tools can be used for vision or hearing screening. As those children who do then pass the screening would need to be referred elsewhere the establishment of such screening should be discussed with the local services as resources will need to be available to assess those referred. SchoolScreener for Schools is designed for and can even be modified to be used in different environments even a set up for screening adults exists.
If you want to screen children in secondary school then this would apply to all children.
If you have children or young people in whom you consider hearing/vision to be a problem as they show behaviour that might indicate that they can’t hear/see well, such as drifting off in lessons, being unable to focus on tasks in the classroom, misunderstanding tasks given, those who struggle to pronounce clearly, have difficulties learning new words unless they see them written down, who need a lot of time copying things from the screen or struggle reading, then you might want to consider preferring these for formal assessment or at least do a formal check-up / surveillance rather than screening.
(Professor Thomson): It is possible to do some form of vision assessment with most children with PMLD. This is best performed by an optometrist or orthoptist with specialist training.
(Dr Sebastian Hendricks): Hearing screening starts from early years with the implementation of the universal newborn hearing screening.
There are no formal national agreed further hearing screens despite the significant number of hearing losses arising after the newborn period.
A screening is only applicable if you want to find those with problems in a large number of people.
As soon as there are any concerns it would no longer be applicable to screen the child but to a formal assessment or at least surveillance which will use a different strategy and possibly different criteria to state if there is a problem.
If there are concerns regarding balance, speech and language, behaviour, engagement, then these children should rather have a specific check-up.
For the under 4 year olds this would most likely be a referral to the local paediatric audiology team. Depending on the referral guidelines this could either be a referral directly from yourself or General Practitioner [GP].
(Dr Sebastian Hendricks): My suggestion would be to approach your local orthopists and paediatric audiology service and ask if you could observe them in their assessment to get a better understanding of what they do and what questions they mark ask in the history.
(Professor Thomson): There is no requirement for local authorities to implement vision screening in secondary schools. Should a school wish to implement such a scheme, tools like the SchoolScreener provide a cost-effective solution. Otherwise, parents should be encouraged to take their child for regular eye examinations by an optometrist. SchoolScreener provides a simple and cost-effective tool to help schools implement Vision Screening.
Yes- as part of a process of elimination. If a child is struggling to see, they may become disengaged with classroom activities, and this can lead to behavioural issues.
(Dr Hendricks): Many different tools can be used for vision or hearing screening. As those children who do then pass the screening would need to be referred elsewhere the establishment of such screening should be discussed with the local services as resources will need to be available to assess those referred. The “SchoolScreener” is designed for and can even be modified to be used in different environments even a set up for screening adults exists.
If you want to screen children in secondary school then this would apply to all children.
If you have children or young people in whom you consider hearing/vision to be a problem as they show behaviour that might indicate that they can’t hear/see well, such as drifting off in lessons, being unable to focus on tasks in the classroom, misunderstanding tasks given, those who struggle to pronounce clearly, have difficulties learning new words unless they see them written down, who need a lot of time copying things from the screen or struggle reading, then you might want to consider preferring these for formal assessment or at least do a formal check-up / surveillance rather than screening.
(Professor Thomson): There is some evidence that the prevalence of myopia (short sightedness) relates to time spent outdoors. The exact reasons for this are not clear at this stage.
(Professor Thomson): Duane’s syndrome is a rare eye. condition where one or sometimes both eyes do not move to the left or right fully and the eyelids may open and. close as the eyes try to turn. Children with this condition really need to be managed by an orthoptist or ophthalmologist although treatment options are usually limited.
(Dr Hendricks): All of the terms above are sometimes used by health professionals to talk more or less about the same problem, except for infections that lead to infectious discharge coming out of the air.
often when children or even adults get a cold the nasal lining swells up and blocks the tube between the middle ear and the back of the nose stopping fluid to drain from the middle ear into the back of the nose and stopping from air getting into the middle ear from the back of the nose.
If this fluid in the middle ear builds up it makes it harder for the eardrum to push/vibrate against it and so sounds become quieter. If this fluid stays in there for longer periods of times it becomes thicker something more like glue.
Then it sometimes happens that the tube opens up again partially or completely but then again not opening again so the hearing changes from between normal to having a hearing loss back to normal and again having a hearing loss. So with this constant hearing loss or fluctuating hearing levels the brain can find it very difficult to tune itself into the ability to distinguish between the speech one wants to listen to and the speech that is more disturbing and stops one from understanding well.
We know that is can have a long term effect ability to listen to one particular sound or voice amongst others which can continue throughout the education and even beyond even if these children then have completely normal hearing when they go for an assessment. This difficulty of processing auditory information in the same way as other people can have a significant impact on understanding teachers and other pupils in schools. Lowering background noise levels in relation to the sound that they should be able to hear is one of the key ways to support this young people.
this also includes improving of classroom and school acoustics.
(Dr Hendricks): There is nothing in addition that I can think off. However, sometimes children have ongoing fluctuating hearing levels because of OME/glue ear over many years without anyone realising. This can mean the child struggled to hear and therefore understand well, missing out on learning. Particularly if this child has been ‘accused’ of not concentrating or not listing/paying attention they won’t raise the issue, they might also be too shy to say something, particularly if they find learning more challenging anyway. Some children will politely answer that everything is okay if asked, just not to open another can of worms for them.
These children can have significant gaps in their learning that they were able to hide for some time.
Curiosity is key to try engage and with them. “I have noted that you seem …. I wonder if hearing and understanding what I and others say can sometimes be difficult.” pauuuuuuse. “I wonder if there is anything I can do to help?”
Even young children, sometimes have great ideas how people can help them; they won’t volunteer that information unless asked.
About 20% of children age 5-10 have conductive hearing loss due to OME in the winter at anyone time. It is less in the summer months. From the age of 11 years the frequency is less as the anatomy has changed and everything grows allowing better drainage of the middle ear.
If you have fluid in the middle ear the natural way to drain would be through the eustachian tube into the back of the nose.
A grommet is a little plastic tube that is inserted into the eardrum creating a way for fluid to drain from the middle ear into the outer ear canal even when the eustachian tube is blocked. This means the fluid does no longer build up, the ear drum can move more freely and hearing sounds no longer need to be louder (more powerful) to move the eardrum, so in short the hearing is better.
(Professor Thomson): Opsoclonus-myoclonus syndrome (OMS), also known as dancing eye syndrome (DES), is a rare neurological condition which develops over days or weeks in early childhood. This condition needs to be investigated and managed by a medical team. The impact on a child’s educational development will depend on the nature and severity of the condition and ideally teachers should liaise with the medical team to determine what accommodations and adaptations may be required.
(Dr Hendricks): Dancing Eye Syndrome | OMAS | Repeated Eye Movement – https://dancingeyes.org.uk/
(Professor Thomson): Bilateral Congenital Glaucoma needs to be investigated and managed by a medical team. The impact on a child’s educational development will depend on the nature and severity of the condition and ideally teachers should liaise with the medical team to determine what accommodations and adaptations may be required.
(Professor Thomson): Astigmatism occurs when the front of the eye (the cornea) is slightly “rugby ball shaped”. It is very common and can generally be corrected by glasses.
(Professor Thomson): There is some evidence that the prevalence of vision difficulties among young offenders is significantly higher than in the general population, so some form of vision assessment is likely to bear fruit. The gold standard approach would be for each person to have a full eye examination by an optometrist. However, some form of vision screening would be a good first step.
SEE ALSO this case study from Cookham Wood YOI.
Vision and Hearing Screening Really Does Make a Difference: HMP YOI Cookham Wood Case Study
(Dr Hendricks): Yes, there are many areas where a hearing and vision screening can be very helpful. We know that children who offend often have additional health needs and so a screening right at the start would be helpful to identify problems that when rectified might help them to find a way back to a healthy and crime free life. So, my suggestion would be to screen hearing and vision right at the start once they are identified as offenders, perform a general health including mental health check by qualified professional and check for other adverse factors. Ideally it would be done, before people start offending, so offer it as a screening in places where young people go.
(Dr Hendricks): You share the same frustration as those people working in those services. Paediatric Audiology has been particularly underfunded, and priority has always been very low. Most services don’t have strong voice and even at national level. The pressure for everyone is similar to schools where you have to deal with far too many children in each class. Would it not be nice to have a maximum class size of 15 pupils? Everyone would feel so much better. It is not deliberate by those people, it is the lack of resources.
(Dr Hendricks): None, unless the employer has set this up. Although for most this would not be a screening but surveillance because there is a risk that people loose their hearing / vision because of noise or other things in relation to their work or they need excellent hearing/vision to perform their job well e.g. pilots.
Would you need screening beyond 18 years age? Possibly not if the young people had good health care before. What might be helpful is a good system to check those people who report a change and problems.
The time to screen again would be at an older age where people don’t realise their hearing is getting worse and hearing aids would help them to be able to communicate better.
(Dr Hendricks): Speech can be delayed for reason related physical reasons. These include but are not limited to verbal apraxia, neurological problems related to nerve function and other conditions. If there is a lack of communication intention or ability, e.g. where the developmental level of the child is at a level before they would start to speak or the child does not feel the need to communicate verbally, then this can also be the reason why the child is not speaking even if they their ears can hear everything very accurately.
(Dr Hendricks): Dual or multisensory impairment have a much greater impact on the individual and their families than their single problems added together. The reason for this is that usually we compensate with vision for hearing loss and vice versa. Many rehabilitation suggestions make use of the other sense to help people. This can obviously not happen in dual sensory impairment.
Sense Charity ( https://www.sense.org.uk ) is the organisation for more information and resources. For education the multisensory impairment teachers of the local authority are another important source of help locally.
Some health care services off specialist clinics for dual/multisensory impairment. Great Ormond Street Hospital for Children is one of them.
(Professor Thomson):
There are a range of colour vision tests available. They are simple to administer and generally accurate. Children as young as 5 can be tested. Colour deficiencies are common (8% of boys, 0.5% of girls) and are usually hereditary and non-progressive. The primary reason for detecting colour deficiencies is so that adaptions can be made in the classroom and colour-deficient children can be steered away from careers where their colour vision deficiency may be a barrier.
(Dr Sebastian Hendricks): Children learn to balance over years. Balance is the complex play of vestibular, somatosensory and vision together in harmony in order to instruct the muscles in the body to relax or contract in just the right amount and readjust with a split of a second.
All of this interplay is learned over time, years and years. They more children are given a chance to explore their environment physically they better they get. So a small child’s balance tends to be not as good as one with the same experience who is older.
Sometimes loss of hearing and loss of vestibular function go alongside each other, but there are many conditions which are completely independent of each other.
(Dr Hendricks): I am sorry not to be able to answer this question as a whole webinar could be held about this topic alone.
Each child will have their own specific recommendation after diagnosis. A place to start reading more about it would be HOME | Apdsite (apdsupportuk.wixsite.com) https://apdsupportuk.wixsite.com/apd-support-uk
(Professor Thomson): Colour vision deficiencies used to be a barrier to entry in many professions. There is now increased awareness of the impact of colour deficiencies and wherever possible, tasks requiring excellent colour vision are adapted to make them accessible to those with some degree of colour deficiency. However, there are still some specific jobs/tasks which do require excellent colour vision and it as well for those with colour vision deficiencies to be steered away from such occupations at an early stage.
(Professor Thomson): Yes- sometimes simple adaptations in the classroom can ensure that those with colour vision deficiencies are not disadvantaged.
(Professor Thomson): The advent of more fashionable spectacle frames for children has meant that compliance is less of a problem than it used to be. It is also possible to fit children with contact lenses from quite a young age.
(Dr Sebastian Hendricks): This is a difficult question to answer. As the reasons for it are very individual. In younger children it is mainly the adaptation to something on their head that they don’t understand helps them but giving them uncomforteness as it is something new. This can often be overcome by kind gentle Persist of wearing for increasing time periods. You start with only a few seconds or minutes and then increase this over time of weeks. There are also children who simply struggle being able to accept wearing anything on their head or even being touched around it. For them it feels impossible to keep a hearing aid on. Fortunately there are not many.
In older children perception of others and themselves sometimes comes to play. This is a very difficult challenge, and some teenagers decide not to wear the aids despite them knowing that they are helpful, but other external factors matter more to them. They feel unable to wear them for external reasons and self-image. Many children these days grow up with a strong positive self-image of themselves with their hearing aids which is wonderful to see. Many adults struggle with this issue for themselves 😊.
(Dr Hendricks): As a lot depends on your local set-up. The SENCO and the Advisory Teacher for Hearing and Vision should be your first contact. They are employed by the local authority and know how the local system works and often have excellent information on hand.
