What is CVI?


Reading using Recognition

Reading by Recognition, Using Look - Ideas to Try

We know, from many accounts, that children with cerebral visual impairment (CVI) often find learning to read a challenge.

Before proceeding, it is important to rule out two very commonly overlooked, and easy to resolve issues around reading difficulty in all children.

1. Are Spectacles Needed?

The first thing that everyone needs to think about is whether glasses are needed.

Two things need to be considered.

  • Are the child's eyes out of focus? (Refractive error)
  • Can the child bring near things into focus? (Visual accommodation)

2. Is the print size big enough?

Next, check that the words simply aren't too small. In much of children's literature, there is a significant reduction in font size in printed books aimed at children around the age of seven or eight years. It takes considerably longer for the eyes to naturally adjust to this new much smaller size of text, and for this reason many children lose previous enthusiasm in reading around this age. Hand held reading devices like Kindles can be used to increase the font size.

CVI is one of the many causes of reading difficulty. When it is present it can make reading difficult in different ways. Another cause of reading difficulty is dyslexia. Dyslexia is not a type of CVI, however this approach to reading may be useful for some with dyslexia.

At the end of this section we have shared many reasons parents have reported why they think their children with CVI are having difficulty reading, and some of the ways they have tried to deal with this.

Most children are taught to read phonetically. This means that they learn the alphabet, and then look at the words in terms of the different individual letters they know, and bring them all together to form the word, and demonstrate that they know it by speaking it correctly. That's a lot of different skills.

The Chinese language is not taught phonetically. Each symbol is unique, and children are taught to recognise the symbol that represents each word. This method works because our brains learn through a simple repeated process of experience, memory and recognition.

  • They see the symbol (experience)
  • They remember the symbol (memory)
  • They recognise the symbol when they see it again (recognition)

As this process is repeated, their library of known words in their temporal lobes grows, and they become more confident recognising the words, and become more confident readers. It is interesting to note that for Chinese, dyslexia is rarely, if ever seen.

Additional learning challenges affect children worldwide, but in China, dyslexia for Chinese characters is rare because they are read visually and not sounded out.Additional learning challenges affect children worldwide, but in China, dyslexia for Chinese characters is rare because they are read visually and not sounded out.

Can the child recognise?

Ask the child with CVI if they can recognise the meaning of any of these symbols:

They might not get all of them, but if they get some, they have demonstrated a capacity to correctly recognise quite detailed symbols. Words are detailed symbols, and can be learnt using recognition alone, as can these symbols.

Think about the words you are now reading. While you were probably taught to read phonetically, you are now actually reading using whole word, and whole phrase recognition. You look at the word and immediately recognise it, there are now few words you have to spell out (phonetically) because you don't recognise them. So, what we are encouraging you to try, is to help teach the child with CVI and reading difficulties, to read the way you do, but skipping the phonetic step, as many find this very difficult.

The best way is to give it a try. Using Look agree the settings for the font, size, colour and background colour.

Now copy & paste the following passage and put it into the pre-defined text section:

Hi, my name is Keira, I am a horse.
I have a secret.
Can you keep a secret?

Let the child click the right arrow to move each word along. They may already know some words and not others. If they do not know a word, tell them. When the child is ready they can move to the next word.

When they have completed the passage, if they wish, let them start again. Help with words they have not remembered, and of course encourage, and congratulate every new word learnt. The child may well memorise the passage which will help, but with the repeated process of experience, memory and recollection, the words are likely to become known and recognisable. Once a word is known, it should stay known.

But then what happens when a new word comes along that looks like another word already recognised, like horse and house?

Here, you have to look at the word as a picture, not individual letters, and think of something within the picture to help the child correctly tell them apart. It is only the two middle letters that are different - the r in horse and u in house, so...

The r might look a bit like the shape of a horse's head (the u definitely doesn't look like the shape of a horse's head!). The u might look like something you could sit in, and you would have seats in a house.

The child won't always need these cues, over time they will get better at recognising.

This way you are making each word both perceivable and meaningful for the child, which with motivation and fun is a powerful combination for learning.

And when another word comes along that they find confusing, apply the same principal. So for the word happy, a similar length to both horse and house, but without the seat or horses head, then think of something else. Happy has pp, which might look like two lollypops, which make some people happy! The key is to help the child by bringing in a cue that is already known to them (like a horse, seat and lollypop).

The child has only one thing to do learning to read using recognition, which is learning to recognise the whole word as a picture, not having to break it down into multiple single letters and put them back together again to learn the word. This method (phonetic) clearly is a successful teaching approach for many children, but those with CVI can find it particularly challenging and stressful. Part of the problem is that it simply might not make sense. When something doesn't make sense, and there is pressure to succeed:

  • The child may feel stupid
  • The child may feel as though they're disappointing people
  • The child may become frustrated
  • The child may avoid reading
  • The child may start making random guesses rather than try (because there is no point in trying as it makes no sense)
  • The child may not be happy, and one needs to be happy to learn well

Using recognition, which may make learning to read something the child can now understand, you may find them:

  • Excited and eager to please
  • Motivated
  • Surprised at themselves (all this time they might have thought they were stupid)

You be the judge, we are not suggesting this will be the answer for every child, but we definitely think it is worth a try. You can use our story (click here for the full story), or make up your own stories. Remember:

  • If the child does not know a word, tell them what it is
  • If the child is struggling to tell two words apart, look at them as images (rather than a group of letters) and find something meaningful to the child, to help them separate the two words (as we demonstrated with horse, house and happy).
  • Keep it fun and meaningful, use stories rather than lists of words.
  • Encourage wider use, maybe get family members to send emails, and cut and paste the text into Look and let the child read their own messages.
  • Be patient, if the child learns to recognise just one or two easy words, then they have shown you that they have the capacity to learn to read this way, with patience.

This approach is not limited to using look, there are readers on various appliances. Some children will find following a single word on the uncluttered of screen very helpful, others may not need this. Do take a few minutes to review our section about selecting fonts, as font size and spacing can make a considerable difference.

What, Why and How Does CVI Affect Reading?

Below we have listed a number of reading difficulties in children with CVI we've been told about, with the commonest reasons why, and successful strategies parents have created or adopted to help their child read.

  • 1. What: Blurred vision due to low acuity, and / or low contrast sensitivity (despite glasses)
  • Why: Less brain processing capacity for image detail or the 'camera shake' of nystagmus
  • How: Enlarging the words and giving them high contrast or using look or a tablet such as a Kindle set to large print and spacing between words.

Using a tablet such as a Kindle, set to large print has been very helpful for some children, both with CVI, and without CVI but where the books they want to read are printed in a font size that that is too small.Using a tablet such as a Kindle, set to large print has been very helpful for some children, both with CVI, and without CVI but where the books they want to read are printed in a font size that that is too small.

  • 2. What: Limited visual fields or lack of visual attention to one side or the other
  • Why: Left or right hemianopia or inattention interfering with the flow of reading
  • How: Methods to read one or a few words at a time, including using look, cutting a rectangular hole out of card (to block out the other text) to read through, or using a typoscope (see below).

Please note, for some the black surface of the typoscope has proven a visual distraction.  It should be clear by observing the child's known reading skills is it helps, or makes reading more difficult.Please note, for some the black surface of the typoscope has proven a visual distraction. It should be clear by observing the child's known reading skills is it helps, or makes reading more difficult.

Note: In our experience, some able children find they can read text vertically downwards if they have left hemianopia interfering with reading, and vertically upwards it they have right hemianopia. This works because, as they read, the line they have just read moves across into the area they do not see, so the area that does not see does not get in the way.

If the impairment of vision on one side is due to lack of attention, moving the text to be in front of the side of the body with intact attention can help significantly.

  • 3. What: Words running into each other, jumbling or fizzing on the page
  • Why: Difficulty processing a lot of visual information at once
  • How: Presenting one or a few words at a time to cut down the effects of clutter. This can be done with look, a tablet, a slot cut into plastic or cardboard or a typoscope.
  • 4. What: Difficulty reading and speaking at the same time (to read out loud)
  • Why: Difficulty doing two things at once, like reading and speaking
  • How: Speaking the word the child is looking at so they hear (rather than having to speak) what it sounds like
  • 5. What: The shapes of letters being difficult to learn
  • Why: Difficulty interpreting shapes of separate letters
  • How: Presenting whole words at a time, because there is more to recognise.
  • 6. What: The sounds that letters make being difficult to put together to make 'phonemes'
  • Why: Difficulty assembling the letters and turning them into sounds that can create words
  • How: Using look and say methods rather than sounding out methods of learning to read
  • 7. What: Difficulty understanding the meanings of the words
  • Why: Difficulty with language interpretation
  • How: Using clear singular salient words to match your child's experience, as it happens, and building up their vocabulary

Any of these reading issues, alone or in combination can affect a child with CVI.

As we hear from more parents we will add to this list, please check our Updates section for notification of any additions. Please let us know your experiences, and what has worked for you, email info@cviscotland.org

Click here to start using look.


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At CVI Scotland we are devoted to helping people understand cerebral visual impairments, and together working towards developing the understanding of this complex condition.