As a clinical psychologist, I have worked with scores of children and adults who have had to adjust to blindness or vision loss. My personal and professional experience has made me an expert in the field. The adjustment process takes not only days, months, but years, and probably a lifetime. Blindness or severe visual impairment can be either 1) congenital or 2) advantageous. Congenital blindness is blindness at birth and advantageous blindness is acquired after birth. You might ask, “which is worse? Being blind at birth or being blind later in life?” There’s no objective way of knowing the “correct answer.” It probably depends on a myriad of factors, such as, the person, their family, their educational resources, and their financial situation, but I can say unequivocally, that in all cases the adjustment process is not for the swift, but for those who can persevere. There is no easy way through it.
ADJUSTMENT TO BLINDESS IS A MARATHON
I often am asked, “Andre, Dr. Watson, you seem so well adjusted to blindness, how long did it take?” I often respond, “I’m still adjusting.” In life, we all are growing and changing to meet life’s different demands. The 2-year-old boy learns to be potty trained; the 13-year-old girl learns about puberty, the 20-year-old student learns about independence in college, and the 35-year-old parent practices positive parenting. We grow and adjust in infinite ways over years. For the blind person, she is adjusting not just as a person, but as a blind person in a world that is designed for sighted people. The blind or visually impaired person has to learn about life and then learn about how to cope as a blind person living in a sighted world.
WIND SPRINTS WHEN ADJUSTING TO BLINDNESS
Even though adjustment is a marathon, adjustment requires leaps, bounds, and even wind sprints. For many school-age children, it is a goal to achieve mastery over academics. They are competitive with themselves or each other. Their parents push them for excellence, or they strive for feelings of superiority in a world where they are so small. I remember so vividly practicing my times tables, so that I could answer quickly when my teacher asked. Other times, I remember studying and repeating how to spell words in preparation for a spelling test. When I received good grades, I beamed with pride.
For blind kids, academics are complicated. Students not only have to learn the material, but they have to literally blow it up, feel it, and hear it. For some kids, the font has to be increased on a page or monitor, it has to be braille on paper, or it has to be heard through speech output. Using adaptive technology also takes time to learn and master. If a child does not have the resources, internally or externally, they are doomed. It’s no wonder that statistics indicate that visually impaired people are less educated and poorer than their sighted counterparts.
For the blind child, excelling academically does wonders for their self-esteem as well as for their sense of belonging. Not only are their academics impacted, but their feelings of being “normal” depend on their success, and when blindness slows you down, a child cannot help, but to wonder, “if I could see, I would be better, more normal, or just like my sighted friends.”
For some children, low self-esteem comes along with blindness if the child does not feel successful or “just like everyone else.” In cases where the child is mainstreamed, there are opportunities to be exposed for socialization, but it can backfire easily as the child may feel more isolated, alienated, or different. “Why can’t I get the work as fast as other kids?” or “why does my teacher need to read the test to me?” or “why do the other students point out my accommodations as reasons for my success?”
In one case I worked on, a 10-year-old boy we’ll call Carl had lost his eyesight to medical malpractice. He was from a family where achievement was important. Not only academic achievement, but also athletic achievement. Developmentally, he was right in the middle of the stage where children need to learn their foundational skills in reading, writing, and arithmetic. Before going blind, he was on-par with his peers. One noticeable difference that his mother pointed out was that his spelling had become poor after he lost his eyesight. It is believed that we learn how to spell by visually reading, but after becoming blind, he started listening to books and academic materials. Moreover, he was learning braille and his braille skills had not quite caught up with his intellectual capabilities. For example, In learning braille, one has to start off with smaller and easier words. If these words are on a first-grade level, but the student is in the fifth grade, there will be an educational gap.
RECOMMENDATIONS FOR CARL
In order for Carl to keep up with his peers, he would benefit from various pieces of adaptive technology. If he has some vision, special magnifiers, expensive computer equipment, and mobility training will be important for him. These will all help him with learning materials and gaining independence which children, parents, and teachers value. He will also need more time to learn how to use these pieces of equipment. Unfortunately, just because someone is blind, they don’t get 25 hours in a day or 8 days a week, he may fall behind, or be forced to do some wind sprints in this marathon of adjustment. His teachers will need to be specially trained to understand how he now will process information through his ears and hands. They need to be able to push him and expect that he can excel with his peers with harder work. His family will need to be taught as well about what blind people and kids can do. Sometimes parents become overprotective or overcompensating, or just down right be in denial, which can create all sorts of psychological issues for the family and for Carl.
Most importantly, Carl and his family need psychological and emotional support. Even though Carl is running a Marathon, he will need some water and time to catch his breath. The journey is long with ups and downs, and most definitely mistakes and failures. For humans, making mistakes are tough, but for the blind person, it comes with the territory. Actually, for sighted people, making mistakes comes along too, but it is so much more difficult when “you’re the only one” looking the wrong way in a photo, or spilling your milk, or taking forever to find lesson 3 in your math book. Emotional support should be accepting, nonjudgmental, but also, ultimately encouraging. And what a tough balance that is to be accepting and encouraging. Yes, you make mistakes, and it is OK, but I know that when the time is right, you’ll look up, catch up, and maybe even pass the other runners on the track.
Psychological and emotional support can come in the way of professional help. As the adjustment process will be a lifetime, therapy and counseling should be available to Carl. Carl will need to grow through the stages of development as a blind person. As he grows, he will need to adjust. After he learns how to do work as a school-aged child, he will then need to learn as an adult. After he learns how to adapt socially as a child, he will need to learn as a man. His sense of manhood and adulthood will need to be supported. Hundreds of hours of psychotherapy should be available to him.
In cases where I have served as an expert witness on blindness, it has been clear to me that few people completely understand what is required to be successful.
The adjustment to blindness process is a marathon where a myriad of resources and supports are required. Adaptive equipment in the home and school are necessary, along with training to use the equipment. Psychologically, it is an uphill battle for children that are adjusting to blindness. They need extra time and attention. Their families need training and support as well. Teachers, coaches, and other professionals need the skills and knowledge to appropriately prepare a visually impaired or blind child in life. Lastly, psychological support is key. Individual and group therapy is important throughout the lifespan for a child growing with a visual impairment. Just one period of time might not be adequate as well. Just because a child or individual has gained mastery over a few tasks and skills, that does not mean that they will not need to continuously gain skills and confidence in a world that is designed for the sighted.
In cases where a child’s blindness is the fault of someone else, litigation is an option in seeking compensation for damages. An expert witness in the area of pediatric blindness and visual impairment can be an asset in helping parties understand the adjustment process and the road to recovery.
Dr. Andre Watson is an expert in child blindness. He has a BS in psychology and minors in Africana Studies and Spanish from the University of Pittsburgh, and his MA and doctorate degrees in clinical psychology from Widener University. Watson has over 20 years of experience treating the disabled. Dr. Watson is a licensed psychologist in the Philadelphia area where he has a private practice where he has treated children and adults. A portion of his practice is dedicated to helping blind children, conducting group therapy for blind adolescents, evaluating children with emotional and developmental disabilities, providing psychoeducation to parents of disabled children, and public speaking. He has over a decade of teaching psychology courses at the University of Phoenix’s Philadelphia ground campus. For four years, he has served as a psychologist adviser for Community Behavioral health which oversees behavioral health treatment to children and families with Medicaid in Philadelphia. He is a former Paralympian where he competed in Judo in 2008. He is also the founder of the Audiodart club of the Delaware Valley which is a recreational group for blind and visually impaired individuals. Dr. Watson is the author of Vision in The Dark: How Living in The Dark Taught Me to See The Light, and is the president of Your Vision for Life Psychological Services LLC. He can be reached at Dr.firstname.lastname@example.org or at 215-631-3230 for consultation or psychological services.