UNIVERSITI TEKNOLOGI MARA
VISION SCREENING BATTERY FOR CHILDREN WITH LEARNING DISABILITIES IN SPECIAL EDUCATION CLASSES IN THE GOVERNMENT
PRIMARY SCHOOLS
NURUL FARHANA ABU BAKAR
Thesis submitted in fulfilment of the requirements for the degree o f
Master of Health Science
Faculty of Health Sciences
July 2013
A U T H O R ’S D EC L A R A TIO N
I declare that the w ork in this thesis w as carried out in accordance with the regulations o f U niversity Teknologi M ARA. It is original and is the result o f m y ow n work, unless otherw ise indicated or acknow ledged as referenced work. This thesis has not been subm itted to any other academ ic institution or non-academ ic institution for any other degree o f qualification.
I, hereby, acknow ledge that I have been supplied w ith the A cadem ic Rules and R egulations for Post G raduate, U niversiti Teknologi M ARA, regulating conduct o f my study and research.
N am e o f Student Student ID No.
Program m e Faculty T hesis Title
N urul Farhana Abu B akar 2009250834
O ptom etry H ealth Sciences
V ision Screening Battery for C hildren w ith Learning D isabilities in Special Education Classes in the G overnm ent Prim ary Schools.
Signature o f Student
Date July 2013
ii
A B ST R A C T
A validated vision screening battery is essential to efficiently identify those with vision problem s for prevention and early intervention. The use o f single-test design o f Snellen notation distance acuity testing in our national vision screening program m ight not be appropriate for children with learning disabilities in prim ary schools due to com m unication difficulties and intellectual discrepancies. The m ain purpose o f this study w as to determ ine a suitable vision screening battery for children with learning disabilities in special education classes in governm ent prim ary schools in M alaysia. To achieve that, four aspects w ere investigated w hich include gathering inform ation on com m on vision disorders am ong children with learning disabilities in governm ent prim ary schools, identifying appropriate personnel as potential vision screener, evaluation o f suitable vision screening tests as well as testing the sensitivity and specificity o f the proposed vision screening approach. R efractive error, strabism us, convergence insufficiency and accom m odative response anom aly w ere found as com m on vision disorders in children w ith learning disabilities in governm ent prim ary schools. Review on the issue on personnel suggested that nurses and assistant m edical officers could be the choice as vision screener. The Cam bridge C row ding Cards, the L ang II Stereotest and the m odified version o f CO V D -Q O L questionnaire w ere am ong the suitable choices o f vision tests for children with learning disabilities. T he use o f the tw o-level vision screening approach is recom m ended for children w ith learning disabilities in schools due to its high testability, high validity to detect im portant vision disorders, sim plicity and cost effectiveness.
ACKNOW LEDGEMENTS
I w ould like to extend m y deepest appreciation to m y supervisor A ssociate Professor Dr. C hen Ai H ong and m y co-supervisors; Professor Dr. A bdul Rahim Md. N o or and Dr. G oh Pik Pin for their guidance, com m ents and suggestions in the preparation o f this thesis.
M ost sincere appreciation to M inistry o f H ealth, M inistry o f Education D epartm ent o f O ptom etry, U iTM and all staff for their help and contribution during this project.
I w ould like to thank Research M anagem ent Institute, UiTM for the Excellence Fund grant and all sta ff for their assistance during this project.
CHAPTER ONE VISION SCREENING
The im plem entation o f an effective vision screening procedure has the potential o f im proving the quality o f health. Screening is a type o f preventive health care and w as defined by the US C om m ission on C hronic Illness in 1951 as “The presum ptive identification o f unrecognised disease or defect by the application o f tests, exam inations or other procedures which can be applied rapidly. The screening tests should be able to sort out apparently well person who probably have the disease from those w ho probably do not” (Allaby, 2002). There are three types o f screening, selective screening (conducted to high-risk group for disease); m ass screening (conducted to large num bers o f people w ithout reference to risk o f disease); and opportunistic screening (occurs in general practice) (Farm er & Law renson, 2004).The W orld H ealth O rganization (W HO) in 1968 suggested 10 criteria to be considered prior to designing a screening program and the criteria are used until now as a guideline by various health disciplines (W ilson & Junger, 1968). In 1998, the criteria for appraising the viability, effectiveness and appropriateness o f a screening program m e recom m ended by the UK N ational Screening C om m ittee provide a m ore organized and com prehensive guideline. The criteria are divided into four im portant com ponents that com prising the condition, test, treatm ent and program (A llaby, 2002).
B ehind the definition o f screening lies an approach for planning, delivering and evaluating instruction that requires the clinicians or healthcare practitioners to focus their respective attention on applying appropriate test or assessm ent to discrim inate those with diseases from those without. A screening test is different from a diagnostic test as it does not quantify the degree o f the problem or offer inform ation on the diagnosis. Conversely, a diagnostic test should be able to indicate the level or severity o f the condition as w ell as to support the m aking o f a clinical diagnosis to help the clinicians in choosing an appropriate m anagem ent plan for the condition. For this reason, it is im portant to determ ine an appropriate screening test w hich m eets the criteria suggested by the UK N ational Screening Com m ittee (1998): (a) the test should be sim ple, safe, precise and validated; (b) the distribution o f the test values in the target population is w ell-know n and the cut-o ff level criteria is w ell defined; (c) the
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