1996-2007, Optometrists Network
The Vision Screening of Academically & Behaviorally At-Risk Pupils
A Peer-Review Journal Article by:
Journal of Behavioral Optometry
Vast numbers of American school students are academically "at risk." Hundreds of publications in diverse academic fields have been written about students with unsatisfactory academic achievement. According to Donmoyer and Kos 1 700,000 students drop out of high school each year. Dropout rates for minority youth are twice that of white students. The vast majority of academically at-risk youth are from low socio-economic backgrounds and often display characteristics such as poor school attendance and anti-social behavior. Many at-risk students come from dysfunctional families characterized by substance abuse, psychotic disorder, and family violence.2Several types of school programs (supplemental, whole-school restructuring, therapy, intervention team approaches, and community/home/school partnership programs) have addressed the needs of at-risk students. Supplemental programs include pull out programs such as Chapter One reading programs and all-day kindergartens. Non-graded schools and site-based management are examples of whole-school restructuring programs. Therapy programs include effective education programs that attempt to apply humanistic psychology to educational practices. Intervention teams comprised of teachers, administrators, guidance counselors, and school psychologists have focused on potential dropouts. Lastly, community/home/school partnerships enhance the self-esteem and cultural identity of at-risk students.1 Despite the implementation of these programs, the Education Commission of the States estimates that 30% of our nation's youth fail to acquire a sufficient education to obtain adequate employment.3
None of these educational programs can be effective if students lack adequate vision. Although the school nurse tests most youngsters using a Snellen screening, few schools utilize a comprehensive vision screening program. Important visual skills such as tracking that are necessary for learning may not be measured. Undetected visual problems may lead to academic difficulties.
In spite of the importance of vision to the learning process, limited studies have screened special populations. Suchoff and Mozlin 4 noted significant visual problems among a population of inner city adolescents. Johnson and Zaba 5-6 found significant visual difficulties among illiterate adults and among at-risk college students. There is a need, however, to screen additional special populations, particularly inner city elementary, middle, and high school students who have been assigned to special alternative school settings for behavioral reasons.This study has three purposes. The first purpose was to screen students who had been designated as academically at-risk, aged 8 to 18, in order to rule out vision difficulties as contributing to academic difficulties. The second purpose was to examine the prevalence visual difficulties among students with both academic and behavioral problems. Students who attended three alternative public school programs designed for students who were both academically and behaviorally at risk were compared with their counterparts who were only academically at risk, in order to determine whether behavioral status related to vision. A third purpose was to determine whether there was a significant relationship between passing the "Literacy Passport Exam"8 (a statewide exam that must be passed before being admitted to a regular high school program) and success on the NYSOA subtests.
Methods / Subjects
Thirty-three of 81 at-risk students who were selected for visual screening attended alternative school settings due to their behavioral problems, while 48 of the 81 attended traditional schools. One of the alternative school settings was on the elementary level, one on the middle school level, and one at the secondary level. Students who attended the alternative elementary or middle school had been assigned to these schools because of behavioral and/or social problems. Students chose to attend the secondary vocational school or have been assigned there because of behavior problems. The 81 students ranged in age from 8 to 18 with a median age of 14; 41 were males and 40 were females; 62 were African-American, while 19 were Caucasian. One of five individuals in this city is on public assistance with 60% of the city's students qualifying for free or reduced lunch. The median family income is less than $27,000 and seven in 10 students come from minority families. Approximately a million-and-one-half people live in this metropolitan area.
One of the researchers, assisted by local volunteers screened the students, using the New York State Optometric Association Vision Screening Battery (NYSOA).7 The NYSOA (1983) includes the following nine tests:
The Fusion subtest was not included in the data analysis. A student data sheet containing various demographic data and test scores was completed on each student. In addition, each student completed a student appraisal form that contained attitudinal questions concerning the student's school and reading, and questions concerning whether he or she had seen an eye doctor or had ever worn glasses. Lastly, teachers completed a teacher appraisal form and a checklist of visual problems (see Appendices 1 and 2). The teacher appraisal form asked teachers to agree or disagree with a series of statements concerning student achievement in relation to peer ability, individual ability, referrals to the school nurse, etc. A modified checklist of possible visual problems was utilized for teacher observations.
Table 1 depicts the number and percentages of subjects that failed NYSOA subtests. Eighty-five percent of the subjects failed one or more of the visual tests, with more subjects failing the Tracking subtest (37%) than any other subtest. As can be seen from Table 1, a significant number of subjects failed Visual Acuity-Far, Visual Acuity-Near, Stereopsis, and Visual Motor Integration.
Table 2 portrays the failure rate on the NYSOA subtest of 33 academically and behaviorally at-risk students who attended alternative schools compared with students who were academically but not behaviorally at risk and attended traditional schools. Fifty-two percent of the alternative students failed the Tracking subtests, while only 27% of the traditional students failed Tracking. In addition, more alternative students than traditional students failed Visual Acuity-Far, Visual Acuity-Near, Hyperopia, Stereopsis, Color Vision and Visual Motor Integration. Furthermore, 97% of the alternative students failed at least one subtest.
A chi-square analysis determined the statistical significance of failure rates of students who attended alternative schools vs. traditional schools on the NYSOA sub-tests. This analysis indicated the greater failure rate of the alternative students was at the .01 level of significance for the Stereopsis subtest and at the .05 level for the Tracking, Hyperopia, and Color Vision subtests. The greater number of alternative students failing one or more subtests was at the .05 level of significance. Furthermore, a chi-square statistical analysis determined that the failure rates on the Reading portion of the "Literacy Passport Exam" for students who attended alternative schools were significantly higher (.05) than for their counterparts who attended traditional schools.On the other hand, no significant relationship was found between failing one or more of the NYSOA subtests and the Writing (essay) and Math sections of the "Literacy Passport Exam" nor failing the NYSOA subtests and current language and math grades. In addition, no significant relationship was found between failing one or more of the NYSOA subtests and dropping out of school nor being absent from school.
The most significant finding of this research was the 85% failure rate on one or more tests among these at-risk students. Moreover, they experienced significant failures on Tracking (37%), Visual Acuity-Far (35%), Stereopsis (28%), Visual Acuity-Near (31%), and on Visual Motor Integration (29%) subtests. Tracking, Visual Acuity-Near, and Visual Motor Integration are very important tests because they detect visual problems at the reading distance of 13 to 16 inches, a distance at which most school learning experiences occur.
Tracking is particularly important in learning to read. Since reading incorporates language acquisitions, the visual verbal process, and tracking, if one lacks the ability to efficiently move one's eyes across a page of print, this is likely to interfere with one's reading development. Thus, passing the reading scale of the "Literacy Passport Exam" is likely to be difficult. Therefore, the significant relationship between failing the reading scale of the "Literacy Passport Exam" and tracking as well as measures of near point vision such as Visual Acuity-Near (31%), Visual Motor Integration (29%), and Stereopsis (28%), lends credence to Johnson and Zaba's (footnotes 5 and 6) earlier studies. These found a significant relationship between failure on various NYSOA subtests and academic failure among illiterate adults and college freshmen.
Many at-risk students may not be aware that they have a visual problem. Instead, they may simply believe that they have a reading or learning problem. This self-perceived learning problem along with undetected visual problems is likely to frustrate many of these students. In spite of working hard at their studies, these children may be unable to keep up with their classmates. Unless students with these undetected visual problems are properly diagnosed and treated, they may become behavioral problems. Provisions for alternative schools may need to be made. Thus, the 97% failure rate of the academically and behaviorally at-risk population in the present study is understandable.
In an at-risk population a general or modified academic and behavioral appraisal of the student's performance is usually not sufficient. Even though teacher observations of student behavior are very important, these observations alone will not always detect visual difficulties. Therefore, with at-risk populations, it is essential that classroom teachers work closely with visual care professionals, community volunteers, and organizations in order that each pupil receive a comprehensive vision screening and appropriate follow-up care.
The authors are most appreciative of the contributions of Dr. Katherine Devine and Phi Delta Kappa for funding this research.
The URL of this page is: