of primary concern to the counselor, as is helping the teacher understand the child and his special needs prior to the first visit of the child to the school.

The counselor sees that parents also visit the school before the child is enrolled in order that they be assured that their child will be in welcoming and accepting hands. Where advisable, the counselor should be ready to remain with the child through the early adjustment period. Only after a favorable adjustment has been made should the counselor relax his direct involvement in the child's nursery school placement and shift to the role of consultant, available to the school whenever it feels the need for special information and interpretation of the child's activities and progress.

The process is one of mutual contribution because the alert counselor receives as much from his services to the school as the school does from him. A situation in which the school and the child are both comfortable in the presence of the counselor provides an admirable opportunity for the kind of observation of the child that reveals clues to his potential and to his ability to adapt to the requirements of a situation.

The opportunity to observe the child's reaction to the nursery school situation gives the counselor important clues to his potential and needs and provides invaluable material to be used by the professional specialists who may evaluate the child. His reaction to the nursery school situation shows aspects of his ability to adapt to the requirements of the world in which he lives.

The severely disturbed blind child may remain at a plateau for long periods of time; he may appear to regress or progress in the nursery school experience. Often periods of seeming regression follow periods of rapid progress. The counselor must be prepared to cope with these turns of events by recommending changes in the child's program if it seems advisable or by giving the parents and teachers the support needed to understand and tolerate that regressed behavior which seems a necessary phase in the over-all development of the child. As the child expresses his need for a richer and more demanding environment, he may be placed with a more ma

ture group of children. At the point where he can care for his basic bodily needs, follow directions to a reasonable extent, and communicate verbally well enough to be understood, he may be considered ready to be tried in a regular public or residential school educational program. Because his adjustment may still be precarious, the counselor should remain in contact with the child and his school until he has made a satisfactory adjustment there. Parent counseling continues throughout this period.

If the child is unable to take the next developmental steps at any level of the preschool program, appropriate opportunities for further development at his own pace must be found or created. Parental anxiety is understandably high in cases where normal progress is long delayed. Parents need the support of an understanding counselor in planning for present and long-range goals for themselves and for their severely disturbed child.

An astute counselor working with disturbed blind children is always aware of the fact that sooner or later these children will be appraised and/or evaluated, and that every shred of evidence of their growth and development should be made available to the psychologist when he makes his considered judgment relative to the real potentials of the children. When the time of appraisal comes, the counselor would no doubt be consulted and if he can bring to such a conference a cumulative record of the growth and development of the child with particular emphasis on those incidents which might be misinterpreted, he may well be the stabilizing influence in the appraisal process and thus, ultimately, upon the future of the child's life. Such record keeping would reflect details of behavior but, more important, it would reveal timing and time factors which might seem unimportant in the record of a normal child but which are saturated with significance when applied to a severely disturbed blind child.

III. Analysis of Factors Affecting
Development and

Influencing Appraisal of

Severely Disturbed Blind Children

At no time have there been as many blind children functioning with little or no useful vision as in our population today. It has been conservatively estimated that about one-tenth of the blind population consists of children and youth-most of whom were blinded by a peculiar ocular abnormality which frequently accompanied prematurity during the period 1939-1954.

Most of the children who became blind as infants during this period are presently of school age and enrolled in different types of educational services. However, there is coming to the attention of professional persons an increasing number of children who seem to be ineligible for these school services. If one is to help these children and their families, one must try to understand some of the factors which have affected the child's development.

It must be remembered that much of our present understanding of blind children, fragmentary though it is, has been gained only as a result of cumulative observation and experience, often on a trial and error basis, during the less than 20 years since the appearance of retrolental fibroplasia. In broad terms, one can say that most of the insights seem to have come about as efforts have been made to apply current concepts of personality development characteristic of this period to blind children and to separate the indirect from the direct results of the physical impairment. Unfortunately, few people have had opportunity to gain this understanding and the evidence is over

whelming that most blind children with serious developmental and emotional problems are reflecting the type of emotional and environmental deprivation which has arisen because of misunderstanding of the child's needs at the successive levels of his development. One cannot overestimate the difficulty of the parents' task of meeting the child's needs or overlook the fact it has been complicated by prevailing stereotypes and lack of knowledge.

It is all too easy to blame parents and to assume that their own personality difficulties are the root of the problem. There is no evidence that all these parents initially had personality problems but, it should not be too unexpected, if such problems were to appear. As one reviews any substantial number of case histories of young blind children, there is striking evidence of the difficulties which have beset parents as they have struggled to cope with the problems presented by the blind child and one is forced to the conclusion that the failures are in most cases those of society, not primarily those of parents themselves.

the

Uncertainty on the part of a parent sets the stage for problems in the child's feelings about himself. This is true for all children. For the blind child the uncertainty may have far-reaching effects on his growth and development. Failure to understand the child and to have reasonable expectations for his behavior are a major source of developmental problems.

DEVELOPMENTAL PROBLEMS

If the environment fails to provide a blind child with the basic essential opportunities for growth, he may develop serious problems. It appears that these problems cannot be attributed directly to blindness. Rather, misunderstanding the needs of the blind child can bring about the same wide of deviant behavior that may range be seen in any child guidance clinic. Such problems may often be extreme. And in the case of these children they are. Their intensity is often difficult to explain except in terms of the frustration that comes to the blind child when all of his experiences "go against the

grain" and he is not permitted to direct his energies toward mastering his environment. This added factor accentuates the atypical aspect of his behavior, which is essentially that of any child whose basic needs are not being met. Professional workers have been repeatedly impressed by the intensity of the blind child's response in fighting against restrictions, limitations and the wrong kind of adult handling. The response can be manifested in either withdrawal due to the child's wariness of human relationships or negativistic behavior. Equally impressive is the speed of the change which sometimes occurs after what appears to be a relatively slight change in the handling of the child. The intensity of the response needs careful consideration therefore, both in diagnosing the child's behavior and in assessing the prospects for treatment.

The aggressive acting-out behavior is really a positive factor, although it may be difficult for the harassed parent to recognize it as such. The child should be given appropriate opportunities, bounded by realistic limits to his activity, in order to encourage acceptable response. The blind child who responds to frustration only by withdrawing into himself is much more puzzling and harder to reach. His behavior, however, as annoying as it may be to the parent, can be more readily tolerated if the parent is helped to understand causal factors.

COMMUNICATION PROBLEMS

In most cases it seems possible to say with some positiveness that when speech development is delayed it is because of emotional and environmental factors and seldom because of organic factors. Often parents seem to have placed a high premium upon speech as evidence of the child's intellectual capacity and have become not only

confused and disturbed by the child's apparent lack of response to

them, but also frustrated by their inability to communicate with him on a satisfactory level. Yet, the early speech of these children has often followed the "normal" pattern. Significantly, the reappearance of speech after apparent failure to develop usually comes only

98-466 O- 63 (Vol. 4) - 9