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Vision, Hearing, Spinal, and The Risk for Type 2 Diabetes screening

* These tests are only available in selected areas where specialists administer them. Please call Dawn Heil to discuss this at 847-854-0348. If you have a form from a school or a child facility, please complete it, attach payment, and return it to your administrator.*

In 1983, the Special Senses and Communication Disorders Act, Texas Health and Safety Code, Chapter 36 was passed by a Texas Legislative Session. They mandated hearing and vision screening for all public and private students who are four by September 1st of the school year and all Kdg, 1st, 3rd, 5th, and 7th grade students and for new students in any of the other grades (also included 9th grade but it was dropped in 2004 when it was changed to the Vision and Hearing Screening Program). These screeners who administer the screening tests much be certified by the state and service more than 400 schools in the Metroplex.  They specialize in all ages of children but if adequate screening cannot be achieved, a refund will be given and the student must be screened elsewhere.

Vision screening includes distance acuity screening using the SNELLEN vision charts (Letter or Tumbling E) or the alternate HOTV chart.  Each eye is screened individually by covering them. Specific regulations and guidelines are set by the Texas Health Department.  Usually children in second grade and older, identify letters in a row and those who are younger, indicate with their hands the direction of a letter E.  If these are too difficult, they can look at a chart with the letters HOTV and point to each one on a card in front of them (they do not need to know the letters since they match the shapes).  A cover/uncover screening test is also done to identify any possible muscle weaknesses which is very important in young children.  If these are identified early, the prognosis is much better.  Children who are younger than five years old, can pass according to the Health Department regulations with a 20/20, 20/30, or even 20/40.  Generally children of this young age do not need and do not have experience in identifying small shapes in a distance.  Their attention span may also affect this ability.  When children are five and older, they must pass with a 20/20 or a 20/30.  It is critical a student have adequate vision acuity to learn effectively in the classroom.  A referral needs to be professionally examined by a vision specialist but does not always mean there is a vision problem.  A screening is not a diagnosis but requires further testing to determine why a passing score was not achieved.  Those who wear glasses, must either provide recent documentation (less than one year) or have the screening with the glasses on if worn for distance acuity to determine if the prescription is still adequate.  Wal-Mart Vision Center and the Lion’s Club can be contacted for help with glasses if needed.  Parents and teachers can help children move their hands to show the way of the letter E or to match the letters HOTV from a chart on the wall to a chart in front of them. 

Hearing screening involves a Pure-Tone Sweep screening test done at 25 dB HL (indicates the loudness) at the 1000, 2000, and 4000 Hz frequencies (high/low tones) in each ear.  If any of the frequencies are missed, a referral to a hearing specialist (private students can contact the local public school district or their pediatrician for further testing).  Each student responds to “beeps” heard through headsets of a calibrated audiometer to determine a pass or referral.  It is highly recommended a referral should be taken to a family physician to make sure there are no physical causes for the failure due to wax build-up or fluid in the ears, sinus or ear infections, or something else which could be causing a hearing concern before another test is administered.  Parents and teachers can practice with their children by quietly saying “beep” and having them raise their hands or by placing some headsets on the ears and turning soft music on and off so they can respond. 

In 1986, spinal screening was added to the public and private school requirements for grades 6th and 9th (Program Rules, V.C.S., Art. 37-141-37.152—refer to the Bureau of Maternal and Child Health, Texas Department of Health).  Certified by the health department, screeners look for signs of possible abnormal spinal curvature or back roundness (Scoliosis or Kyphosis) which is referred to a physician.  Students are evaluated individually by a “forward-bend test”. Some signs noted can show uneven shoulders, hips, or shoulder blades as well as a sway/rounded back or a curved spine.  Girls should wear two-piece bathing suits or a sports bra with shorts and boys will need to take off their shirts with shorts or pants which can be at their hips.  Screeners are very respectful of their privacy and someone from the school will be present at all times.  Parents and teachers can prepare their children by discussing what will be expected during the screening session.

The Risk for Type 2 Diabetes screening was mandated in 2005-07 in Texas for public and private students in grades 1st, 3rd, 5th, and 7th .   Exposed skin is observed by trained screeners usually when they perform the vision/hearing screening tests which can indicate possible high levels of insulin produced by the pancreas.  If the acanthosis nigricans marker is seen, two resting blood pressure measurements and a body-mass index (weight/height) will be done.  This can be an early indicator of type 2 diabetes.  Once identified, the risk can be decreased by proper nutrition and exercise so the early markers can begin to fade.  It is essential the family physician and the school work together to solve this problem. Parents and teachers should discuss this with their students so they are prepared for additional blood pressure and body-mass screenings if needed. 

For all of these mandatory screening tests, a referral does not provide a diagnosis but rather a strong recommendation to have further testing.  It is valuable to get professionals involved early so later problems may be prevented.  School and childcare facilities must complete reports in these areas as determined by the laws and include individual reports in the students’ files.  They are also required to follow the referrals and report findings.  These are critical in the education of each student.




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