Cerebral Vision Impairments can affect as many as one in thirty children, yet it can be hard to identify in a classroom, writes Dr Jonathan Waddington
So, you have a student in your class who’s bumping into other students in the playground, often seems distracted in the classroom, and has a meltdown whenever there’s a whole school assembly. These behaviours might seem like red flags for a range of learning difficulties related to conditions such as developmental coordination disorder, attention-deficit/hyperactivity disorder, or autism. On the other hand, these could be red flags for a sensory processing disorder such as cerebral vision impairment.
What is cerebral vision impairment?
Cerebral vision impairments, or CVIs for short, have become a hot topic as recent studies have indicated their prevalence has been significantly underappreciated in the UK. As many as one child in a primary school classroom of thirty students may have learning difficulties associated with CVI. Part of the issue with identifying these students and giving them appropriate support is that experts still aren’t fully agreed on a definition of CVI and how it should be diagnosed. Another part of the issue is that many of the behaviours associated with CVI overlap with the behaviours we commonly observe in other developmental conditions. This lack of clarity can lead to sensory needs being missed or misattributed to other learning difficulties.
The current working definition of CVI, at least in the UK, is a verifiable vision dysfunction that cannot be attributed to disorders of the anterior visual pathways or any potentially co-occuring ocular impairment. What that means in laymans terms, is that the brain is not able to consistently process sensory information from the eyes, or interpret that information in a meaningful way. There are a potentially wide range of visual dysfunctions covered by this definition, ranging from reduced clarity of vision to difficulty with processing the salient features of a face in order to recognise a friend in the playground. One particularly common dysfunction within this wide range is difficulty dealing with complexity, whether that’s the visual complexity of an object, a complex array of objects (i.e. cluttered spaces), or the complexity of competing sensory information. This has significant implications for some of the most complex multisensory environments in the modern world, like the classroom or the supermarket.
What it’s like living with CVI
Try to imagine walking through a supermarket. You might picture the sights first, aisles of multi-coloured food packaging designed to catch your eye, and other shoppers hurriedly rushing by. You might also imagine the sounds of the tannoy system, the constant beeping from the self-service checkout counters, and the other shoppers discussing their meal plans for the week. The scents of food from the deli counter and the bakery, the weight of the heavy shopping basket or veering trolley, and internal senses such as hunger all add to the sensory information that the brain has to sort through and interpret. This type of complex multisensory environment can be completely overwhelming for someone with CVI, leading to sensory overload and feelings of discomfort that can range from mild to intense. In some cases, the competing sensory information can appear to overwhelm the visual information entirely leaving the child unable to recognise or respond to the visual scene around them.
How we can adapt classrooms for sensory needs
Arguably, the average UK primary school classroom can become just as overwhelming. Brightly coloured student projects hanging up on the walls and ceilings create visual clutter, and other students’ busily chatting away or moving about add to the sensory complexity of the environment. Creating an accessible environment for students to learn in should be a priority. If we don’t take the time to ensure students can access their learning environment, they simply won’t be able to learn. Simple adaptations that can help create an accessible environment include keeping the ceiling and one wall free of hanging visual clutter, and painting the walls a saturated plain colour such as black for contrast. You can even create individualised learning environments within the classroom, using either cubicle partition walls or a tent that can reduce sound and block visual distractions. Teaching materials and toys can be designated to specific areas of the classroom and returned there when not in use. Open shelve units can be covered with a plain coloured cloth. Seating position, blinds, and non-reflective surfaces can be used to minimise distractions and discomfort from the light through windows.
How children with CVI can improve their functional vision
There are additional benefits from adapting the classroom to the sensory needs of children with CVI beyond the obvious access to learning. Studies have indicated that more than four out of five children with CVI do improve their functional vision as they develop. While the child’s vision impairment may not fully resolve, they can learn strategies that allow them to make the best use of their vision. That can range from learning structured scanning strategies to search a supermarket shelf for the item they need, or learning to recognise friends and family by matching salient features that they are able to perceive such as hair colour. It’s still not clear whether interventions can be used to improve functional vision for children with CVI but it seems unlikely that children will make improvements if their visual environment isn’t accessible. In theory, if we create a visually accessible learning environment, students will have the opportunity to practice using their vision to understand the world around them. If the learning environment remains inaccessible, that opportunity for incidental learning is lost. The benefits of making the classroom more visually accessible are likely to extend to students who don’t have CVI as well. Students with (and without) conditions such as attention-deficit/hyperactivity disorder will benefit from less sensory distractions in the environment. So, even if you’re not sure whether a child in your classroom is having difficulties due to a CVI or another developmental condition, there’s no reason not to adapt the classroom for the sensory needs of someone with CVI.
About the author
Dr Jonathan Waddington is a VI Advisor at InFocus and a Psychology Lecturer at the University of St Mark and St John. Jonathan has a research background in neuroscience and completed his PhD thesis investigating how eye movements optimise visual perception. He is currently researching whether gamified eye movement training can improve visual perception for children with CVI.