“CVI may often go unidentified, and it is therefore crucial to recognize the telltale signs in order to set in motion the processes leading to formal identification and characterization of the condition through collaborative and comprehensive assessment. Without proper identification and intervention, children with CVI may struggle in the school system and fail to reach their full potential.” Pawletko, T., Chokron, S. & Dutton, G. N. (2015). Considerations in the Behavioral Diagnosis of CVI. In A. H. Lueck & G. N. Dutton (Eds.), Vision and the Brain: Understanding Cerebral Visual Impairment in Children (p. 170). New York, NY: AFB Press.
Assessment is where teachers begin when introduced to a new student. Assessment for learners with CVI needs to cover many areas as we work to understand the child’s strengths and needs. A parent interview is crucial and should be a first step in the assessment process. Parents know their child best, and by having a conversation with parents and caregivers we gain much information that formal assessments won’t provide. Talk about how the child functions at home, what are his likes and dislikes, how do I know he is happy? scared? overstimulated? tired? frustrated?
Parents are also the link to the medical information we need. By communicating to parents how important it is that we have current ocular reports and chart notes from doctors, we start to form a partnership and establish a sense of trust and knowledge that we care about the education of their child. We start to build a Team.
Next come the functional vision assessments, learning media assessments, orientation and mobility assessments, and the other team members assessments (OT, PT, Speech, classroom teacher, etc.). Be aware that professionals from other disciplines may not understand CVI. An in-service to all the professionals working with the child is great way to introduce this diagnosis and what it means for learning. Assessing “arena style” where the vision teacher acts as the facilitator working with the child and other team members (including the parents) are in the room observing and asking questions (note passing is less intrusive and keeps the quiet environment intact). Team assessment prevents parents from having to answer the same questions over and over and it creates a common understanding of the child. You will also be modeling how to present materials appropriately to the child with CVI, by controlling the environment (eliminating visual clutter, keeping the room quiet, etc.). If all team members cannot be present, asking permission to videotape and share the team assessment would be helpful and will provide a permanent record of where the child began.
After the assessments the team will need to work together to develop goals, establish a communication plan and begin instruction using the vision teachers input on how to adapt the child’s environment so that he can access the learning materials.
Strategies to consider for children who need environmental accommodations:
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Try not to make changes in the child’s environment
- Store toys in small bins organized by color and type of toy
- Put clothes back in the same place each time
Keep environment simple
- Avoid patterned carpets and tile patterns
- Avoid visual clutter on walls, refrigerators, bulletin boards
- Use solid color dish, glass, silverware placed on a contrasting colored place mat
Prepare child for loud noisy places
- Take a practice trip beforehand to familiarize child with visual cues for orientation
- Take photographs and break down learning about the place into steps with added visual features
- Arrive early before crowds form
Be understanding when the child’s behavior is a reaction to frustration or fear and misunderstanding of the environment
Have an orientation and mobility assessment to determine if a cane or pre-cane device is appropriate for travel or for identifying the child as visually impaired when traveling
Avoid conversations when child is using their vision to travel safely
Faces are very complex. Do not expect a child to be able to look at you and hear what you are saying at the same time. Do not take lack of eye contact personally.
Adults and peers should verbalize feelings as the child may not recognize an angry look or a sad face.
Family, teachers, friends should verbally identify themselves when meeting the child
Teachers could brainstorm use of a color identifier on name tags to assist in identification
Friends on playground should call out and let the child know where they are
Mark teams with specific color shirts or bandanas to help student find team members
Give a verbal warning when balls are moving toward the child
Allow child to sit closer to the television or movie. Child may hold head in a way that works best for viewing moving objects. Child may enjoy “just listening” to the information instead.
Eye movements may not be made independently of head movements, and may not be typical or ‘smooth’
School work may need to be uncluttered
- Limit the number of problems on one page
- Increase space between lines and possibly between letters of words to avoid crowding and complexity
- Use color to highlight where the answer should be written
- Use a typoscope to block out other parts of the page as the child is working on a problem
- Use color to highlight or outline individual letters or words to give them meaning
- Outline key features of pictures to highlight the important parts
- Use a piece of black paper to act as a guide to keep the child’s place when reading and simplify the page
Help the child to develop a mental image library
- Point out and describe environmental sounds
- Verbally describe items and concepts
- Provide tactile input for the child to touch/hold