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Bielefeld Observation Scales for

Blind Infants and Preschoolers


(BOS –Blind)

Focus : Achieving Quality in Education: Attitudes Policies


Topic : Early Childhood Intervention

Michael Brambring, Ph.D.


Professor of Clinical Psychology/Rehabilitation
Department of Psychology
University of Bielefeld
P.O. Box 100131
D-33501 Bielefeld
Germany

0049 521 106 4345


m.brambring@uni-bielefeld.de

The BOS-Blind scales were developed as part of the longitudinal study "Early Intervention and
Family Counseling for Blind Infants and Preschoolers." They are the outcome of systematic
observations of 10 congenitally blind children over 5 years.
All the children in this study had been born blind; eight were fully blind, and two possessed
minimal light perception. Home visits were used to try out interventions to promote the child's
development together with parents and to discuss any childrearing or emotional problems that
emerged (Brambring 1993, 1996). Twice a year, we also organized weekend meetings for all family
members to encourage contacts between families and an exchange of information (Brambring,
1997a, 1997b).
From the end of the first to the end of the third year of life, early intervention home visits
lasted 2-3 hours and were carried out every 2 weeks. After this age, they were carried out only
every 4 weeks because all the children were now being integrated in regular preschools. After each
early intervention visit, participant observations on the development of each child were entered in
the first version of the observation scales. Developmental data obtained in this way is highly
accurate, because of the short interval between each early intervention home visit.
We tested the first version in a 1-year in-practice cooperation project with 21 early
interventionists from Germany, Switzerland, and Italy who evaluated the scales in their regular
work with a total of 43 blind children. Their feedback led to a number of new observation items and
to major improvements to the design of the current version of the scales.
Participant observation during the early intervention home visits permits a highly
differentiated assessment of development. A total of 600 different developmental skills and 56
different qualitative aspects of development can be assessed from birth to the fifth or sixth year of
life. Age data from the longitudinal study are available for 371 of these developmental skills
(61.8%). Values are only missing for skills that had either been acquired already before the
beginning of the project or had still not been mastered when it came to a close. Age data are also
missing for new skills added to the scales later on the recommendation of the early interventionists
participating in the evaluation.
At the end of the project, the 10 children could be classified to one of three groups on the
basis of their developmental progress: Four were nonretarded; three, retarded; and three, severely
retarded. These age data on blind children represent a decisive advantage of BOS-Blind, because
they make it possible to compare development in the single blind child with the acquisition ages of
other blind children. Other assessment instruments for early intervention with blind children
(Bishop, Shafer, & Shier, 1984; Ferrell, 1985; Nielsen & Petersen, 1990; Trief, 1992) do not report
the age at which children who are blind acquire specific developmental skills, and the Oregon
Project (Brown, Anderson, & Boigon, 1991) presents tasks in a sequence based on age data for
sighted children. Hence, these instruments are limited in their ability to assess the development of
blind children correctly, and they may even lead to false conclusions regarding their specific
developmental path (Brambring, 2005).
Another major advantage of BOS-Blind is that it has been constructed as a real criterion-
referenced assessment tool. This means that for each single developmental skill, the sequence of
acquisition is listed from the simplest signs to the final full acquisition.
This principle of presenting the developmental sequence within each skill is demonstrated in
Table 1.

Table 1
Substeps Within Developmental Skills (Criterion Referenced Assessment)

Age data in months


Median (50%); Children's individual scores
Skill
Nonretarded Retarded Severely
n=4 n=3 retarded n = 3

9. Standing up

13 14 25
a. Pulls up to standing position 12/12/14/18.5 12/14/19.5 17/25/25.5

b. Lifts from kneeling to standing position

19 31 30
c. Stands up via crawling position
18/18/20.5/42.5 17.5/31/42 26/30/41

10. Standing up alone

26.5 35 39
a. Stands up from sitting by pushing down on one hand
24/25.5/27.5/M 22/35/>60 26/39/45
34 ? 43
b. Stands up without supporting self
25.5/30/39/42.5 35/>60/M 26/43/49.5

13. Walking

12 12.5 18.5
a. Makes walking movements when held by both hands 11.5/12/>12.5/15.5 11.5/12.5/14
15.5/18.5/25
15 17 25.5
b. Walks holding onto one hand
13/14.5/15/19.5 16/17/18.5 20.5/25.5/29.5
15 17.5 24.5
c. Walks along furniture
13/14.5/15.5/28 15.5/17,5/20 20.5/24.5/>61.5
16.5 21 26.5
d. Walks alone - at least 3 steps 15.5/15.5/17.5/33 16/21/25 23/26.5/41
18 21 36.5
e. Walks alone - at least 10 steps
15.5/18/18.5/33 16/21/29 24/36.5/41

Table 1 illustrates the criterion-oriented ranking of the developmental skills for "walking." The
ranking proceeds from "walking movements when held by both hands" through "holding onto one
hand," "along furniture," and "at least 3 steps," up to full acquisition with "walks alone –at least 10
steps." Table 1 also gives age data for the acquisition of each substep in the three groups of blind
children. The upper value in each cell is the group median and the lower values give the acquisition
age for each of the 10 children in the longitudinal study. Missing age data are for items added after
the evaluation phase. The entries "?," ">," or "M" each indicate that values could not be computed
for various reasons.
This intervention-oriented approach fulfills two essential needs in early intervention: First, it
permits an assessment of which developmental skills the child can master at present; and, second, it
indicates which substeps can be anticipated next in the promotion of the specific developmental
skill involved.
A third major advantage of BOS-Blind is that, when developing the scales, particular care was
taken to assess blind-specific aspects that are not covered by developmental assessments for sighted
children. These include the observation of grasping and searching behavior, orientation and
mobility, play behavior, and daily living skills, or the assessment of cognitive abilities with the use
of auditory or tactile materials. For example, cognitive abilities are assessed with tasks such as
"sorts spoons and keys correctly (3 spoons, 3 keys)" instead of sorting colors, or "repeats sound
pattern: high, high, deep, deep" instead of ranking different forms. Alongside these blind-specific
aspects, the scales naturally assess all the other major developmental domains in infancy and
preschool age.

The scales are not a developmental test, because the items are not presented in a standardized form
with standardized materials. In contrast, they serve as an observation tool in an ecological setting.
Therefore, the developmental skills listed in the BOS-Blind are ones that can be observed
spontaneously during a home visit or can be assessed in play as part of an early intervention.

The BOS-Blind is designed to be used in three different ways:


1. As a reference, to look up which developmental skills are relevant for children who are
blind and when they acquire them. For this purpose, all the user needs is the manual,
because it contains all developmental items and the age data from the blind children in our
longitudinal study separated into the three subgroups.
2. For practical intervention, using the workbook to enter observations on the child after each
early intervention home visit. Through the intervention-oriented ranking of the items, this
documentation provides not only information on the current state of development of the
child but also indications regarding which developmental steps need to be practiced next.
3. For scientific research— similar to our own longitudinal study— in order to obtain a highly
differentiated documentation of development in children who are blind.

The complete BOS-Blind scales are made up of a manual and a workbook containing a total of 11
individual test books for documenting the observations after an early intervention session and
getting ideas on what to promote at the next home visit.
The manual contains a general overview of the scales. It offers theoretical, methodological,
and practical suggestions on how to observe and promote development in children who are blind.
For each developmental domain, it starts by describing the importance of vision for the acquisition
of the specific skills and, thus, the problems facing blind children. It then considers what
alternatives are available to blind children, and how their development may be promoted. Finally, it
lists the developmental skills and the longitudinal age data for each developmental domain.
The workbook is used to document the observations during a home visit. Experiences from the
1-year in-practice cooperation with early interventionists have shown that, with some practice, such
documentation should not take longer than 15-20 min.

The 11 test books cover the following domains:

Book 1: First Notes After Each Early Intervention Home Visit


This book has been designed to jot down observations, assessments, and talks with
parents quickly and comprehensively immediately after an early intervention home
visit. These notes can then be transferred to the other individual test books after
returning to one's office.
Book 2: Case History and Course Documentation
The book has two parts: Whereas the first is for documenting reports on the child's
home situation and health up to the beginning of early intervention (the case history),
the second is for recording additional information over the early intervention period
such as new health problems or new treatments (the course documentation)
Book 3a: Developmental Assessment of Blind Infants up to 18 Months Chronological or
Developmental Age
Book 3a has been developed specially to gain a more differentiated assessment of
development in congenitally blind children during their first 18 months of life. Such
detailed assessment is particularly important when working with children who are both
blind and severely retarded, because their development often proceeds in very small
and slow steps.
Book 3b: Problem Behavior in Children Who Are Both Blind and Severely Retarded
Early intervention is particularly difficult with children who are both blind and
severely retarded, because they frequently exhibit such a variety of problem behaviors.
Book 3b is designed to perform a careful assessment and developmental course of
problem behavior in this population.
Books 4-11: Developmental Assessment after 12 Months
Each of the Books 4-11 covers one developmental domain from a developmental age
of 12 months to 5-6 years. The 6-month overlap between Book 3a and Book 4-11 is
intentional. Once a child has attained the level of an 18-month-old in one
developmental domain, you can assume a level of 12 months or above in the other
domains as well. Then, you can move on to Books 4-11.

The following list gives an overview of the domains of development and the aspects of
development assigned to them.

Book 4: Posture and Balance


Inhibition of Primitive Neonatal Reflexes and Postural Reactions
Sitting
Standing with Support
Kneeling
Standing Independently
Standing and Walking on Tiptoes
Maintaining Balance
Book 5: Self-Initiated Movements
Protective Reactions, Sitting Up, and Sitting Down
Getting Up to Crawling and Standing Position
Walking
Belly-Crawling and Crawling
Qualitative Aspect: Quality of Independent Walking
Locomotor Play
Climbing Up and Down Steps and Furniture
Other Types of Locomotion
Hopping and Jumping
Book 6: Orientation and Mobility
Reaching and Searching in Near Space
Searching in Far Space
Self-Protection and Safety
Qualitative Aspect: Quality of Self-Protective Behavior
Verbal Comprehension of Spatial Relations
Qualitative Aspect: Quality of Orientation and Mobility Behavior
Book 7: Manual Skills
Basic Manual Skills
Advanced Manual Skills
Book 8: Daily Living Skills
Eating and Drinking
Dressing and Undressing
Toilet Training and Personal Hygiene
Book 9: Cognitive Development
Comprehension of Object Properties and Functions
Discrimination and Classification
Memory
Understanding Time and Analogies
Qualitative Aspect: Assessment of Play Behavior
Book 10: Language Development
Preverbal Communication
First Words
Advanced Language Skills
Qualitative Aspect: Speech Language Abnormalities
Book 11: Socioemotional Development
Emotional Development
Social Interaction
Social Behavior
Qualitative Aspect: Behavior Problems

Experiences up to now in the German-speaking countries have shown that the scales permit a
differentiated and systematic observation of development in blind children. As a result, early
intervention can be tailored to fit the developmental level of each single child. Hopefully, the
English publication will help to improve early intervention for blind children and family counseling
in English-speaking countries as well.

References

Bishop, V. E., Shafer, S., & Shier, S. (1984). Individualized programming for blind and visually
impaired infants and young children. Phoenix, AZ: Eighth International Seminar on
Preschool Blind Children.
Brambring, M. (1993). "Lessons" with a child who is blind. Development and Early Intervention in
the first years of life. Okemos, MI: Blind Children's Fund.
Brambring, M. (1996). Early intervention with blind children: Main findings of the Bielefeld
longitudinal study. In M. Brambring, H. Rauh, & A. Beelmann (Eds.), Early childhood
intervention: Theory, evaluation, and practice (pp. 419-435). Berlin, New York: de
Gruyter.
Brambring, M. (1997a). Parent support groups in early intervention (Part One of Two). The British
Journal of Visual Impairment, 16, 33-37.
Brambring, M. (1997b). Parent support groups in early intervention (Part Two of Two). The British
Journal of Visual Impairment, 16, 73-80.
Brown, D., Anderson, S., & Boigon, S. (1991). OR project: the Oregon project for visually
impaired and blind preschool children. Medford, OR: Jackson Education Service District.
Ferrell, K. A. (1985). Suggestions for raising young blind and visually impaired children. New
York: American Foundation for the Blind.
Nielsen, L. (2000). Functional scheme: Levels 0-48 months. Copenhagen: Sikon.
Trief, E. (1992). Working with visually impaired young students. Springfield, IL: Charles C
Thomas.