Reading Competence of Visually Impaired Pupils in Sweden

K. Fellenius

Abstract: This article reports on a study of the reading competence of 25 visually impaired pupils in Sweden, who were followed from 1988 to 1991. Neither visual acuity, reading media, optical aids, nor reading distance were clearly related to reading competence. Rather, good readers were pupils who scored higher on verbal cognitive tests and had a greater interest in reading as a leisure activity.

In Sweden, most pupils with visual impairments and no other disabilities attend school with fully sighted students in the regular public school system, and those with multiple disabilities are educated primarily in special schools. Thus, the majority of visually impaired pupils who do not have additional disabilities are educated, by teachers who lack training in meeting the special needs of visually impaired pupils, in normal classrooms of about 25 pupils each.

In-service training for classroom teachers is provided by the Tomteboda School Resource Centre (formerly the special school for the blind). Consultant teachers from the National Swedish Agency for Special Education act as liaisons among the pupils, their families, and the official habilitation effort and arrange further training for classroom teachers locally. However, since they concentrate on providing services for a large group of visually impaired pupils on a regional basis, they have little time to follow the reading development of individual pupils. Rather, their main task is to give advice and support to visually impaired pupils and classroom teachers, not to teach these pupils.

To obtain some information on the reading skills of people with visual impairments, Mats Myrberg, of the Stockholm Institute of Education, initiated the project, Reading Skills, Reading Training and Technology for the Visually Handicapped, in 1988. In the first phase of the project, the situations of three groups of visually impaired persons-pupils, professionally active adults, and older people-were documented on the basis of records from low vision clinics (LVCS) (Myrberg & Bäckman, 1993). The pupil group consisted of 246 children and adolescents, aged 5-19, who were enrolled in either a compulsory, comprehensive school or an upper secondary school (gymnasium). Significant differences in reading performance were found for the three groups, with the pupils demonstrating the highest performance.

Another investigation, conducted at the same time, mapped the pupils' reading ability on the basis of journals kept by the consultant teachers. However, these two sources of information proved inadequate for determining all the aspects of the pupils' reading ability. The records of the LVCs yielded information on the medical and optical prerequisites for reading, whereas the consultant teachers' journals contained mainly administrative information (Fellenius & Myrberg, 1993).

To obtain a clearer picture of factors that are important for developing and maintaining a functional reading capability from both the medical-optical and educational perspectives, the second phase of the project was begun in 1991. In this phase, two main issues were explored: 1) the pupils' development, in terms of medical factors and optical rehabilitation from 1988 to 1991, and 2) the pupils' reading needs and the demands on their visual and reading abilities, both at school and at home, in 1991.

Definitions

READING ABILITY

Different definitions of reading ability are presented in the literature, depending on which perspective an author adopts: ethnic, individual, social, cultural-historical, or communicativetheoretical (de Castell, Luke, & MacLennan, 1986). Reading can be described simply as a process with two important components: the decoding of symbols and understanding (Hojen & Lundberg, 1992). Thus, it is a process that involves both technical abilities and interpretation of the meaning of the text. When both these characteristics interact in such a way that the reader understands the meaning and message of the text, then the reader has reading ability, which he or she can use in different situations (Dalby, Elbro, Jansen, Krogh, & Christensen, 1983). Many people who have competence in one of these components but not the other do not have reading ability, which may be blocked by a number of factors, such as functional impairment.

Koenig (1992) suggested that there are two levels of literacy for visually impaired people: basic and functional. Basic literacy, the reading and writing ability developed in school, is the basis for ongoing leaming and the development of reading skills; it can be measured by reading tests and is considered to be equivalent to the average reading ability of sighted eighth-grade pupils in American schools. Functional literacy is the use of reading and writing skills in everyday practical situations in school, at home, at work, and in the community at large.

In his investigation of the reading develoment of sighted pupils in Swedish schools, Grundin (1975) found that Swedish children develop basic reading ability (decoding symbols and understanding meaning) generally by grade 6. He also noted that if pupils can fully comprehend what they read, they have functional reading skills. In this article, the term reading ability is used to denote a pupil's fluency, speed, and retention when reading a text.

READING SPEED

Hult (1980), a Swedish researcher, found that 90 words per minute (wpm) was the average reading speed of sighted adults when reading aloud a text of about the same difficulty as the one used in the LVC in this study. Mangold and Mangold (1989) noted that 60 wpm was an acceptable speed for visually impaired pupils in grades 1-3, but it would not be adequate by grades 4-5. Furthermore, a Danish study indicated that the average reading speeds of pupils with low vision were 75 wpm in grade 4 and 95 wpm in grade 7 (Kristiansen, 1989). A corresponding study of braille readers found that the average reading speed of these pupils was 75 wpm in grade 5, compared to 130 wpm for sighted pupils in the same grade (Kristiansen, 1986).

READING COMPETENCE

The concept of reading competence includes both reading ability and functional literacy. It is tnus a broad concept that covers different levels of reading ability, from the simplest everyday reading tasks to highly advanced strategic reading, and involves both the abilities and needs of the individual and the demands of the environment.

Several factors interact in any assessment of a pupil's reading competence. They are depicted in the interaction model shown in Figure 1, which promotes a holistic view of a visually impaired pupil in which the degree of impairment is situational, the concept of impairment is relative, and the environment is a complex physical and psychological context (Kylen, 1988). The aim of the study reported here was to illuminate the interaction among the various factors that may influence the reading competence of visually impaired pupils.

Method

SAMPLE

In the second phase of the project, a simple random sample of 30 pupils was selected from the pupil group studied in the first phase. At the time of data analysis in 1991, 25 of these pupils (12 girls and 13 boys) were still attending school full time and became the study group--10 were at the intermediate level (grades 4-6); 8 were at the upper level of public school (grades 7-12); and, of the remaining 7 pupils, 5 were at the upper secondary school (gymnasium), 1 was in an adult-education boarding school, and 1 was in a youth training program. Four of the 25 pupils had small additional impairments; 2 of them had cerebral palsy but attended regular comprehensive schools, and the other 2 had transferred from the comprehensive schools to a unit for pupils with mild mental retardation in 1988.

Figure 1. The reading competence of visually impaired pupils: An interaction model.
Individual capabilities/possibilities Environmental requirements/demands
Reading Competence
medical school
cognitive leisure
motivation day-to-day

Of the 25 pupils, 22 had congenital visual impairments and 3 had acquired visual impairments in early childhood. Their diagnoses varied greatly, but the largest group (13 pupils) had some form of retinal anomaly, and 1 had juvenile macular degeneration. With regard to levels of visual impairment, 4 had profound visual impairment (less than 20/400), 8 had extremely low vision (20/400-20/200), and 13 had low vision (greater than 20/200); 11 pupils had a measured visual acuity of over 40/200. Two of the 4 pupils with profound visual impairments were braille readers, and the remaining 2 could read printed text with the help of a closed-circuit television (CCTV) or strong magnifiers.

PROCEDURES

The 1988 and 1991 data on medical and optical devices obtained from the LVCs were compared to determine habilitation efforts and results. These data were then compared to the pupils' use of optical devices by observing an ordinary reading situation in the pupils' schools in 1991. Each pupil also underwent a systematic vision assessment at their regular LVC.

The pupils' reading ability was assessed on two occasions to obtain a more varied picture of their reading competence-at the regular LVC, with optimal ergonomic prerequisites and lighting at the time of the vision assessment, and in the regular school environment under ordinary conditions a few months later. The reading tasks were different on the two occasions to allow for comparisons between the clinical setting and real-life conditions; a narrative text was used at the LVC, and an expository text from the pupils' regular textbooks was used at school. At the LVC, a vocabulary test and a short-term-memory verbal test were also administered to determine the verbal cognitive ability of each pupil. In addition, during the investigator's visit to the schools, the pupils were interviewed individually about their reading habits and reading interests.

Comparable variables of reading ability from both situations were reading speed, reading fluency, and reading retention. Other comparable variables were choice of reading medium (audiocassette, braille, optical aid, or CCTV) and ways of reading (types of optical aids used, choice of letter size, and reading distance).

Reading at the LVC

The reading tests consisted of two texts of slightly different levels of difficulty (for use with pupils of different ages) that were taken from the literacy study of the International Association for the Evaluation of Educational Achievement (IEA) (Elley, 1992). The tests were available in various print sizes, on audiocassette, and in braille, so the pupils could choose the most comfortable way of reading. Pupils from the upper level of public school (grades 7-9) were asked to read both texts to uncover weak readers at this level.

Reading retention was measured according to the pupils' responses to multiple-choice questions after reading. Criteria for reading speed (both silent reading and reading aloud), based on the research cited earlier, were at least 90 wpm for pupils at the upper level of comprehensive school and older and 70 wpm for pupils at the intermediate level (grades 4-6). Both types of reading speed were calculated by dividing the number of words in the text by the time in minutes and seconds it took to read the text. Reading fluency was ascertained by recording breaks, repetitions, and errors during the first five sentences of oral reading; three or fewer mistakes were considered good reading fluency.

Reading ability in school

The investigator visited 23 of the 25 pupils at school and asked them to choose a text from their regular textbooks for silent reading and reading aloud and to decide how they would read the texts. Both types of reading speeds were calculated in the same way that they were at the LVC. A comparison of the results in both settings showed how each pupil performed when reading texts of different levels of difficulty and types (narrative at the LVC and expository in school).

While a pupil read aloud in school, his or her reading fluency was assessed qualitatively according to the following three-point scale: 1) reads fluently with few regressions or no regressions or breaks, 2) reads with some technical problems (some breaks, repetitions, or errors) but does not have great problems, and 3) reads with difficulty (numerous regressions, repetitions, and breaks). After the pupil had read silently, his or her reading retention was evaluated, according to how he or she retold what was read, on a three-point scale, from 1) correct, complete, and understandable to 2) understandable but not fully complete or correct to 31) limited retelling or only partially understandable.

Each pupil's reading performance in school was videotaped, so it could be analyzed further at a later date. In addition, during the interviews mentioned earlier, the investigator discussed the physical conditions under which the pupils read, in relation to special lighting arrangements and other adaptations.

Cognitive ability

Two tests of cognitive ability were used: a vocabulary test and a short-term-memory test. The 20-word vocabulary test, administered at the LVC, was taken from a vocabulary test for grade 6, reported in a Swedish study by Emanuelsson and Svensson (1986), and the short-term-memory test was taken from a Swedish study of aging, memory, and dementia bv Nilsson (1992). The mean performance on the vocabulary test was 11.5 correct answers out of 20; the results of this test correlated highly with the examination for visually impaired pupils reported in a previous Swedish study (Deligren, 1966). In the short-term-memory test, 12 short words were read aloud, and the pupil was asked to repeat them from memory; the average number of correct answers was 5-6.

Functional reading

During the interviews at school, the pupils were also asked about their functional reading during leisure time and about their reading habits and interests. In addition, they were asked how often they read different types of text in different subjects at school, on the basis of questions taken from the IEA literacy test (Elley, 1992). The pupils' responses to the latter questions were recorded on a four-point scalealmost every day, about once a week, about once a month, or almost never-and were used as a measure of the reading demands of school.

Results

VISUAL ACUITY AND OPTICAL AIDS

The LVCs provided additional medical information for 12 pupils in 1991. These data revealed that the pupils' visual acuity had remained relatively stable between 1988 and 1991. In three cases, there was a notable improvement over the 1988 visual acuity of 40/200, and in one case, marginal deteriorating acuity.

Changes in the power of optical aids were recorded for eight pupils during the three-year period. Two of these changes involved a transition from magnifiers to reading glasses in frames. For one pupil, the power of the reading glasses had been slightly reduced, and for five, it had been slightly increased.

With regard to the pupils' use of different reading media on the three occasions (at the LVC in 1988 and 1991 and at school in 1991), there was a slight decline in the number of pupils who used reading glasses in school and a tendency for the pupils to get along with ordinary spectacles and accommodations. In summary, 15 of the 23 pupils with low vision used some form of optical reading aid in the LVC test in 1991 (the remaining 2 pupils were totally blind), compared to 18 pupils in 1988. The power of these optical aids varied considerably. For example, 5 pupils with extremely low vision (visual acuity of 20/400 to 20/200) read with strong plus lenses (>=+10 plus D), and 3 pupils with visual acuities ranging from 20/400 to 20/100 used CCTVS.

CHANGES IN READING MEDIA

AND WAYS OF READING

Fourteen pupils of various degrees of visual impairment (from totally blind to mild low vision) did not change their reading media or ways of reading from 1988 to 1991. They included four pupils with extremely low vision who were already using power reading glasses, magnifiers, and/or CCTVs in 1988. However, 11 pupils did change their reading media or ways of reading during this period. Among them were some with progressive eye diseases or conditions (such as glaucoma and juvenile macular degeneration) and reading problems, but also some whose visual acuity had increased and could manage without optical aids or with slight power aids. This group tended not to use their optical aids at school. Furthermore, there was no interaction between age and changing reading media or ways of reading. Therefore, no general patterns in development in this area could be discerned during the three-year period.

VERBAL COGNITIVE TESTS

Fifteen of the 25 pupils scored higher than the average of 11.5 words on the vocabulary test (MD= 12). The results correlated positively with the pupils' ages (rxy =.37). Eight of the pupils were in grade 4 or 5, that is, grades that were lower than the grade (grade 6) for which the test was originally intended; however, the results of only four of these pupils were lower than average. The results of the text varied considerably because of the variation in the sample (R=2-19). The highest marks were obtained by two pupils from the highest levels of schooling and the lowest, by a pupil from a unit for pupils with mild mental retardation.

Most of the pupils had good short-term-memory function, but strong variations in the group were noted. For example, four pupils recalled fewer than 5 of the 12 words (5-6 words was an average result), and three of them also had low results on the vocabulary test. The median value on the memory test was 7 correct answers. The lowest mark (3 correct answers) was obtained by a pupil with an additional handicap and the highest (11 correct answers), by the pupil from the folk high school. The correlation between the answers on the two tests was positive (rxy =.44).

READING ABILITY

Reading speed

Three criteria were used in the LVCs to estimate reading speed in the first phase of the project in 1988: low speed, fewer than 30 wpm; medium speed, 30-70 wpm; and high speed, over 70 wpm. In 1988, 55 percent of the 246 pupils had a high reading speed, and 14 percent had a low speed, subjectively or objectively measured. In 1991, no pupil had a low reading speed in the LVC test, 18 pupils read at a high speed on the easier of the two tests (an average of 139 wpm during silent reading), and 5 had a medium reading speed. The pupils' average reading speeds for the textbooks in school were considerably below those on the LVC tests: 76 wpm for reading aloud and 103 wpm for silent reading. The variation in speed was large, both within and among the school levels, which may partly be explained by the fact that the texts read in school varied in content, as well as in the degree of difficulty.

Reading fluency and retention

Twenty of the 23 pupils were assessed as having good fluency when they read relatively easy text at the LVC, but only 8 of 22 were so assessed when they read the texts at school (3 pupils did not read aloud in school). All reading media and ways of reading (braille, CCTV, and reading glasses from +3D to +15D) were represented among the fluent readers. Thus, the results indicate that there were no clear interactions between ways of reading or reading media and fluency.

Among the fluent readers were pupils with the lowest recorded acuity (5/300) and the highest (20/80). A similar spread was noted for reading distance: Four of the seven fluent print readers read at distances greater than 20 cm (about 10 inches), and two read at less than 10 cm (about 5 inches) (one of whom read at a distance of 2 cm, or about 1 inch). Also, many pupils at the intermediate level had difficulty with fluency, whereas those at the upper level of public school and at the upper secondary level had greater fluency.

Sixteen of the 22 pupils obtained good scores for reading retention on the LVC test. This result matches the result for the scores on the school test, in which 15 of 22 pupils were judged to have good retention even when their fluency and reading speed were considered to be low. It also verifies the findings of an earlier study (Tobin, 1985) on the reading comprehension of visually impaired pupils.

READING ABILITY AT THE LVC VS. SCHOOL

When the results of the tests of fluency, retention, and reading speeds at the LVC and in school were compared, it was found that in two-thirds of the cases, good readers (8 pupils) performed well and poor readers (7 pupils) performed poorly on the tests in both reading situations. Another 8 pupils (the uncertain readers) performed well on the LVC test but poorly on the school test. Only one pupil did better on the school tests than on the two LVC tests, but showed good reading ability on the easy text and so was treated as a good reader in the analysis, bringing the total number of good readers to 9. The remaining pupil, who read only at the LVC, was not included in the analysis.

As Table 1 shows, good readers were found in all the grades in the school system and had a wide range of visual acuities. The wide range of visual acuities, in turn, accounted for the broad spectrum of optical aids used for reading and for reading media other than braille.

The poor readers, with a few exceptions, tended to be in the upper grades; the youngest one, in grade 6, also had a motor impairment. Their visual acuities varied, all the reading media and reading aids were represented, and variations in reading distances were large.

Table 1: Visual and technical reading data on the three groups of readers (N=24).*
Types of readers Gender Grade Visual acuity Reading medium Ways of reading Reading distance
M F
Good readers (n=9) 3 6 Grade 4 to USL1** 5/300-20/80 Print no optical aids, refractive glasses, reading glasses, CCTV 1-> 20cm 0.40-> 8 inches
Poor readers (n=7) 4 3 Grade 6 to USL2** 20/400-20/40 Print, braille, magnifier, cassette No optical aids, CCTV, computer 3-> 20cm 1.2-> 8 inches
Uncertain readers (n=8) 4 4 Grade 4 to USL2** 20/200-20/40 Print, braille no optical aids, refractive glasses, reading glasses 10-> 20cm 4->8 inches

**One pupil read only at the LVC and so was not included in the analysis.

**USL = Upper secondary level (gymnasium) or comparable level.

Five of the eight uncertain readers were at the intermediate level in school and had high visual acuities; there was also one braille reader. In this group, there were some pupils with strong power lenses (8x) and some with weak ones (+3D). Although the differences between the good readers and the poor readers were insignificant with respect to visual acuity, reading media, and reading aids, the uncertain readers tended to have relatively better visual acuities than did the other two groups,

Table 2 provides an idea of the cognitive and motivational factors that may influence reading ability. Both the good readers and the uncertain readers tended to have better scores on both the short-term-memory test and the vocabulary test than did the poor readers, and the spread in their scores was narrow. However, whereas the good readers read works in connection with their leisure interests, the uncertain readers generally did not, preferring to watch television (TV) or listen to the radio. Therefore, it seems that good cognitive preconditions and an interest in reading are necessary for good reading ability.

The scores of the poor readers were lower than those of the other two groups and varied widely on both tests, and these pupils had little interest in reading. Since three of the pupils in this group had lower scores for reading ability than their scores on the cognitive ability tests would predict, they may be defined as having a reading handicap on the basis of their visual impairments. There were also pupils with additional handicaps in this group.

READING COMPETENCE

Reading demands of school

Subjects such as Swedish, mathematics, science, foreign languages, social and civic studies, and work with dictionaries in comprehensive schools and comparable subjects in upper secondary schools were considered to peace heavy reading demands on pupils. The measure for high reading demand was determined to be three or more of these subjects in a pupil's schedule per day.

Of the 22 pupils who were assessed on both the reading tests in school and reading demands (results of both variables were not available for 3 pupils), 11 had high reading demands (7 of whom were good readers), and 11 had low reading demands (9 of whom were poor readers). No pupil reported high reading demands for homework.

Table 2: Scores on cognitive tests and reading interests of the three types of readers (N=24).*
Scores on cognitive tests
Types of readers Short-term memory test Vocabulary test Reading interests
Good readers (n=9) 5-10 MD=7.5 8-18 MD=12.5 Half usually borrow books from the library; 8 read in connection with a leisure interest. Day-to-day reading habits: 3 read books, 1 reads a daily newspaper, and 3 read both books and a daily newspaper
Poor readers (n=7) 5-11 MD=6 2-19 MD=9 1 usually borrows books from the library; 3 read in connection with a leisure interest. Day-to-day reading habits: 1 reads books and 1 reads a daily newspaper.
Uncertain readers (n=8) 3-9 MD=7.5 6-19 MD=12.5 1 usually borrows books from the library; the same pupil reads in connection with a leisure interest. Day-to-day reading habits: 1 reads books, 1 reads a daily newspaper, and 1 reads both books and a daily newspaper.

*One pupil read only at the LVC and hence was not included in the analyses.

**The average number of correct answers on the 12-word short-term-memory test was 5-6 and on the 20-word vocabulary test, 11.5.

Furthermore, the interviews revealed that distant reading on the chalkboard, on overhead projectors, and on wall maps caused problems for the majority of the 22 pupils, irrespective of their reading ability. Only 6 pupils said they could manage without help, and the remaining 16 said they received help from their classmates or from their teachers, who read aloud from the chalkboard. Furthermore, only 8 of the 16 pupils who reported difficulties with distant reading used such distance aids as binoculars and CCTVS.

FUNCTIONAL READING

During the interviews, 22 of the 25 pupils (2 pupils, 1 who was a poor reader and 1 who was an uncertain reader, were braille readers, for whom the questions were irrelevant, and, as was mentioned before, 1 pupil was not included in the analysis) were asked how well they coped with the reading demands in other settings, such as reading queue signs at the post office, other signs in the community, and subtitles on TV movies and looking up phone numbers in telephone directories. With regard to the 9 good readers, 6 could read queue signs in the post office and other signs in the community, 8 could look up phone numbers, and all 9 could read subtitles on TV movies. For this group, there was a clear interaction between acuity and distance reading. Thus, 3 pupils had difficulty reading various signs at a distance, but all 9 could read subtitles on TV movies, regardless of their acuities, if they sat close enough, and all had reading speeds higher than the 110 wpm required for the task (Dalby et al., 1983).

With regard to the poor readers, 4 of the 6 pupils could read the various signs at a distance and 3 could look up phone numbers, but none could read the subtitles on TV movies, either because of their low visual acuities or their low reading speeds. In relation to the 7 uncertain readers, 5 could read queue signs at the post office, 6 could read other signs in the community and subtitles on TV movies, and 4 could look up phone numbers. However, it should be noted that for some of the younger pupils, tasks, such as using a telephone directory, had not yet become a real issue and thus they may not be regularly confronted with heavy day-to-day reading demands because of their age.

Discussion

One important purpose of the study-to determine the reading development and the consequences of visual impairment at different ages and in different environments-was fulfilled through the longitudinal investigation of medical-visual and optical factors, together with observations and interviews. In addition, since the random sample included all categories of visually impaired readers, it can be regarded as highly representative of visually impaired pupils in Sweden. The strength of the study was the more varied picture of the reading ability of each pupil in different reading situations; however, large individual variations among the pupils with regard to visual acuity, age, diagnosis, and general development made internal comparisons difficult.

Although the pupils' visual acuity remained relatively stable during the three-year period, 45 percent of the pupils changed their reading media or optical aids. These changes could be an indication of positive or negative habilitation tendencies; that is, moving from a nonportable to a portable medium can have positive implications for one pupil but not necessarily for another if the reading demands are limited.

Furthermore, the aim of finding the most technically effective aid can collide with a pupil's acceptance of it and can result in the pupil not using the aid, as was evident in the fact that some of the pupils did not use their optical aids in school. To help pupils overcome their resistance to using these aids, professionals must be sensitive to the pupils' physical and psychological maturity and connect training to relevant targets in daily reading situations, so the pupils get the necessary experience in using the aids.

Another result of the study was the identification of three groups of readers-good readers, poor readers, and uncertain readers. The findings revealed that neither visual acuity, reading medium, nor way of reading seem to have a decisive effect on reading ability. Rather, a common factor among the good readers was that they read during their leisure time, and this reading was often in areas of interest to them (whereas the poor readers and the uncertain readers did not read outside school). Thus, one implication of this finding is that good readers appear to use their reading ability because it fills a function for them and they are motivated to read. Therefore, poor and uncertain readers need to be helped to improve their motivation, as well as their technical ability. One way to do so is to expose them to models of effective visually impaired readers-those who have developed their own reading strategies on the basis of their reading media and technical aids.

Another implication of this finding, as has been noted by several researchers (see, for example, Stanovich, 1986), is that frequent reading is a decisive factor in good reading ability, since the more one reads, the better one's vocabulary and hence the greater one's satisfaction when reading. Thus, poor readers who rarely read may be caught in a vicious circle: their failure to read results in the absence of vocabulary development and little satisfaction while reading, which results in little, if any, improvement in reading ability. A severe visual impairment makes it more difficult to maintain natural contact with the written language outside study situations, and, in some cases, the reading media that are preferred or used can exacerbate the problem. Since research has shown that even weak readers make progress if they are stimulated to read in reading training programs, this problem may be ameliorated, in part, by enrolling all levels of visually impaired readers in these programs.

To develop individual reading-training models, it is necessary for teachers to be familiar with their pupils and to maintain consistent contact with them and with their families. Such contact is especially important for younger pupils because whatever increase in the amount of reading they do will have to be outside the school environment. In addition, for uncertain visually impaired readers, many of whom could be helped to become good readers, the intermediate level of comprehensive schools seems to be a critical period for reading development. At this time, many of these pupils' sighted classmates make extensive strides in their reading development, and noticeable differences between sighted and visually impaired pupils are seen. To avoid a situation in which visually impaired pupils avoid confronting more advanced reading situations when they are with their sighted classmates and to stimulate visually impaired pupils to read better, intensive efforts are necessary.

In this regard, the importance of a holistic perspective, which takes into consideration all the settings in which visually impaired pupils function, is clear. However, success can be attained only if professionals with various areas of expertise-medical, technical, and pedagogical-cooperate and if pupils become more actively involved in trying to influence their own reading development. With close cooperation among pupils, LVCS, consultant teachers, school personnel, and pupils' families, visual impairment need not lead to reading disabilities.

References

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The research reported here was conducted at the Department of Educational Research, Stockholm Institute of Education, and financed by grants from the Swedish Council for Social Research, the Swedish Ministry of Health and Social Affairs, and the National Agency for Education.

Kerstin Fellenius, M.A., special teacher, doctoral student, and senior lecturer, Department of Special Education, Stockholm Institute of Education, P.O. Box 47 308, S-100 74 Stockholm, Sweden; E-mail: kerstin.fellenius@hls.se.