profile2
Hearing Loss Assessment
profile1
Vision Impairment Assessment

Vision Impairment Assessment Algorithm
Developed by Dr. Susan Wiley

You will respond to less than 5 questions/statements.

Start Here

To begin, respond to one of the three options below that best matches your reason for starting this assessment

Known Vision Impairment?
(Based on history)

Yes

Child with Risk Factor for Vision Impairment? (See list below)

Yes No

Parental Concerns of Vision?
(Based on interview or ASQ)

Yes No

Risk factors:

  • Low birth weight (<3 pounds)
  • Cerebral palsy
  • Head Trauma
  • Hearing Loss*
  • Hydrocephalus/Shunt
  • Meningitis/Encephalitis
  • Retinopathy of Prematurity
  • Seizures
  • Syndrome associated with vision concerns
    • *Children with confirmed hearing loss (of any degree) and confirmed vision impairment (of any severity) should be referred to the Ohio Center for Deafblind Education.
    You answered “Yes.”
    Has child completed an ophthalmological exam?
    Yes No
    You answered “No, child has not completed an ophthalmological exam.”

    Next Steps:

    • With consent, contact primary care provider to initiate referral to ophthalmology
    • Get consent to receive report
    • Pending review of report:
      Does report indicated that the child has a Medically Identified Vision Impairment?
    Yes No
    You answered “Yes, child has completed an ophthalmological exam.”

    Next Steps:

    • Get consent to receive report
    Does report indicated that the child has a Medically Identified Vision Impairment?
    Yes No
    You answered “No, the child does not have a Medically Identified Vision Impairment.”
    Normal Vision

    Next Steps:

    • Monitor for vision concerns or changes
    Essential steps for children with confirmed vision impairment
    Visually related concerns in any child requiring ophthalmological referral  – OR – Start Assessment Over
    You answered “Yes, child has a Medically Identified Vision Impairment.”

    Next Steps:

    • Obtain Functional Vision Assessment
    • Ensure Vision Services on IFSP
    • Monitor for vision concerns, changes
    Essential steps for children with confirmed vision impairment
    Visually related concerns in any child requiring ophthalmological referral  – OR – Start Assessment Over

    Visually related concerns in any child requiring ophthalmological referral**

    Child has concerning vision behaviors:

    Any time:

    • Does not look at faces, give eye contact
    • Rubs eyes
    • Squints/closes eyes/cries, turns away from bright lights
    • Tilts/turns head to look

    If not occurring by 3 months of age:

    • Does not notice objects above or below the head
    • Notices objects only on one side
    • Does not notice objects above or below head

    If not occurring by 5-6 months of age:

    • Doesn’t visually follow moving objects
    • Doesn’t reach for objects
    • Over or under-reaches for objects
    • Seems unaware of self in mirror
    • Seems unaware of distant objects

    Older ages:

    • Covers or closes one eye when looking
    • Does not look at pictures in books
    • Holds books or objects close to eyes
    • Stops and steps/crawls over changes in floor texture or color
    • Trips over/bumps into things in path

    Child has notable eye concerns:

    • Far-away look in eyes
    • Cloudy or milky appearance of eyes
    • Droopy eye lid(s) (ptosis)
    • Jerky or wiggling eyes (nystagmus)
    • Random eye movements
    • Squinting, excessive blinking
    • Unequal pupil size
    • Watery, red, irritated eyes or eyelids
    Essential steps for children with confirmed vision impairment  – OR – Start Assessment Over

    Essential steps for children with confirmed vision impairment

    Obtain Functional Vision Assessment
    Add Vision Services and accommodations to IFSP
    Communicate to all team members, vision accommodations needed
    Monitor for changes in vision
    Determine newborn hearing screening results
    Refer to Ohio Center for Deafblind Education if identified with hearing loss of any degree (unilateral or bilateral)
    Monitor for hearing loss
    Ensure Part B programming includes needs related to vision on IEP/transition plan
    Visually related concerns in any child requiring ophthalmological referral  – OR – Start Assessment Over

    Hearing Loss Assessment Algorithm
    Developed by Dr. Susan Wiley

    You will respond to less than 5 questions/statements.

    Start Here

    Known Hearing Loss?
    (Based on audiology report)

    Yes No

    Does the child exhibit Risk Factors for Hearing Loss (from JCIH)? (See list below)

    Risk factors:

    • Speech/Language Delay
    • Parental concern about hearing
    • Family History of Hearing Loss
    • Prematurity/NICU > 5 days
    • Congenital Infection (such as CMV)
    • Bacterial meningitis
    • Craniofacial abnormalities
    • Syndromes associated with hearing loss
    • Ototoxic medications (gentamycin, lasix, chemotherapy)
    • Head Trauma
    Yes No
    You answered “No known hearing loss.”
    Has child had recent audiology evaluation?
    (within last 4-6 months)
    Yes No
    You answered “Yes, there is a known hearing loss.”
    Is the Regional Infant Hearing Program involved (on IFSP)?
    Yes No
    You answered “No, child has not had a recent audiology evaluation.”

    Next Steps:

    • Refer child for audiology evaluation
    • Get consent to receive results
    • Pending review of results:
      What are the results?
    Normal Results Permanent Hearing Loss of any type or degree confirmed
    You answered “Yes, child has had a recent audiology evaluation.”
    What were the results?
    Normal Results Permanent Hearing Loss of any type or degree confirmed
    You answered “No, the child does not have any Risk Factors.”

    Next Steps:

    • Monitor Hearing and Speech/Language Development
    • Re-test if concerns noted
    Essential steps for children with confirmed hearing loss
    Hearing and Language related concerns in any child requiring audiology referral  – OR – Start Assessment Over
    You answered “Yes, child has Risk Factors.”

    Next Steps:

    • Monitor Hearing and Speech/Language Development
    • Re-test at 24 months
    • Re-test sooner if concerns noted
    Essential steps for children with confirmed hearing loss
    Hearing and Language related concerns in any child requiring audiology referral  – OR – Start Assessment Over
    You answered “No, the Regional Infant Hearing Program is not involved.”

    Next Steps:

    • Make referral to Regional Infant Hearing Program, ensure services are added to IFSP
    Has child completed an ophthalmological exam?
    Yes No
    You answered “Yes, the Regional Infant Hearing Program is involved.”
    Has child completed an ophthalmological exam?
    Yes No
    You answered “No, child has not completed an ophthalmological exam.”

    Next Steps:

    • Initiate referral for eye exam
    Essential steps for children with confirmed hearing loss
    Hearing and Language related concerns in any child requiring audiology referral  – OR – Start Assessment Over
    You answered “Yes, child has completed an ophthalmological exam.”

    Next Steps:

    • Get consent to receive report
    Does report indicated that the child has a Medically Identified Vision Impairment?
    You answered “No, the child does not have a Medically Identified Vision Impairment.”
    Normal Vision

    Next Steps:

    • Monitor for vision concerns or changes
    Essential steps for children with confirmed hearing loss
    Hearing and Language related concerns in any child requiring audiology referral  – OR – Start Assessment Over
    You answered “Yes, child has a Medically Identified Vision Impairment.”

    Next Steps:

    • Go to Vision Impairment Algorithm
    • Involve Ohio Deaf-Blind Education Center
    • Obtain Functional Vision Assessment
    • Ensure Vision Services on IFSP
    • Monitor for vision concerns or changes
    Essential steps for children with confirmed hearing loss
    Hearing and Language related concerns in any child requiring audiology referral  – OR – Start Assessment Over

    Hearing and Language related concerns in any child requiring audiology referral**

    Child has concerning listening/speaking:

    • Does not look attend to voices, sounds (all children with autism spectrum disorder should have a definitive hearing evaluation)
    • Asks “what” or “huh” a lot
    • Asking for people to repeat what they have said
    • Talking too softly or too loudly
    • Favoring one ear/turning one ear to a speaker or the TV
    • Difficulty localizing sounds (i.e. calling the child from another room and the child not knowing where to look)
    • Having to face the person talking to understand what is being said
    • Speech delay
    • Language delay
    • Articulation problems which are not improving

    Child has notable physical concerns:

    • Child has a known vision impairment
    • Frequent ear infections
    • Child has a cleft lip/palate
    • Shape of ear is abnormal
    • White patches of skin or white patches of hair
    • Kidney problems
    • Heart problems
    Essential steps for children with confirmed hearing loss  – OR – Start Assessment Over

    Essential steps for children with confirmed hearing loss

    Obtain Audiology report and recommendations
    Add Hearing (Regional Infant Hearing Program) Services and accommodations to IFSP
    Communicate to all team members, hearing accommodations needed
    Monitor for changes in hearing
    Evaluate and monitor for vision loss
    Refer to Ohio Center for Deafblind Education if identified with vision loss
    Ensure Part B programming includes needs related to hearing on IEP/transition plan
    Hearing and Language related concerns in any child requiring audiology referral  – OR – Start Assessment Over
    Return Return