This paper explains research looking at the changes in the behaviour of children in a special needs school (in Northern Ireland) after unmet eyecare needs were met. For most children, this was a case of needing glasses, which is really important in special education.

Research has shown that just under half the children attending a specialist school for children with learning difficulties are likely to need eyecare, most needing glasses. So if you are involved in a special school, do a quick headcount and see if this many children in the school currently wear glasses, and by wearing glasses we mean:

• A correct up-to-date prescription, which can be difficult to get for some children who struggle with what might seem a scary optometrist's room with worrying confusing equipment, so...
• They might need help from an optometrist with special training who works with this group of children, and...
• If they need a prescription, this needs to be in correctly fitted glasses, including where needed...
• Specialist frames for children with a range of facial features, like low set ears or a flat / wide nose, which mean standard spectacle frames may not be a good fit, then...
• They have to wear them, and enjoy wearing them rather than constantly fighting them, which is a skill for both the child and those supporting them, and of course...
• Access to ongoing eye care and assessments, for the rest of their lives. And throw in...
• An extra pair of glasses, as glasses can get broken, oh, and ideally
• Make this service free... All of it.

Research has consistently shown that many in this group of children, especially children with autism, have either had no eye tests, or these have become out of date or were inconclusive.

Anyone who wears spectacles (or contact lenses) knows how disabling it is to not have their glasses on. You can't learn from what you can't see. So for children with special learning needs, to not have glasses when they need them, seems just, well, wrong. Of course they should have glasses but, there's a bit of a problem

• There are still relatively few optometrists trained in working with this group of children, many being non-verbal with significant communication problems, who struggle to sit still. But the good news is that there is a growing number of optometrists gaining specialist training, to support these children.
• Parents of these children have an awful lot on their plate, and everything from cutting nails and going to the hairdresser or the dentist can be a challenge and stressful for all.
• It is often not at all obvious when a child who has learning needs needs glasses, because a lot of the challenges, like being clumsy, may just be interpreted as being part of their learning disability. So a sight test may well be low down on the list of things to do.
• For children who've had a sight test and need glasses, wearing glasses can be very challenging, from getting the right frame to understanding how to encourage the child to enjoy their new clearer vision
• This means not expecting them to wear their glasses every waking moment, because they may feel very comfortable with their old fuzzy world.

So, it is difficult, yet this problem of unmet eyecare needs in special schools has importantly been the subject of increasing research. The charity SeeAbility have extensive resources with more information.

Improved vision is needed to help children with learning disabilities to best see and learn. To make this happen they ideally need:

• Access. More children who need glasses with correct prescriptions and frames, need to get them and wear them. This ideally needs specially trained optometrists to visit their schools.
• Dispensing. Dispensing (the actual part where the glasses are selected and fitted) needs to be a part of that in-school service.
• Support. Many children in this group do not like wearing glasses. Encouragement needs the school team and the family to be helped to work together, at the child's pace, to help them learn to accept, and eventually enjoy the new clear vision these things on their face give them.
• More! This paper adds evidence that shows this group of children need a lot more than the standard age appropriate eye tests that one would routinely undergo at the opticians.

This paper is part of an incredibly important project involving passionate specialists from vision and research groups, working collaboratively across the UK, to get much needed eye care to the children in this group.

What about CVI?

Of the two hundred children taking part in this research, one had been given a cerebral visual impairment diagnosis.

The researchers' comprehensive vision testing included assessing visual perception skills, using two tests. One was a questionnaire called the Visual Skills Inventory (VSI) and the other a set of cards with increasingly crowded images (called LEA Crowded). These two tests showed that nearly a quarter (23.5%) of the children had visual perception difficulties.

Visual Perception Difficulties

CVI causes visual perception difficulties, but so do other conditions. To confirm whether CVI is the cause of the child's visual perception difficulties requires a medical assessment and where appropriate, a diagnosis. That is why the term visual perception difficulties rather the CVI is used, because with these tests, that is all that has been confirmed.

Will some of the children with these visual perception difficulties have CVI as the cause? Almost certainly.

This is the first time (that we are aware of), where visual perception difficulties have been measured and the results published for this group of children, and this clearly shows that more understanding is needed to find the causes of the children's difficulties, so that support can be matched to known needs.

Why Is Vision Important in School?

There are various figures about how much learning is visual, or connected to vision. Some suggest 70 to 80%.

So vision is a massive part of learning.

For the children with visual perception difficulties, we know it can be hard to get a medical CVI assessment. So we suggest trying some of the strategies for CVI, like:

• Thinking about the physical environment and reducing visual clutter, movement and noise.
• Helping the child build visual memories by keeping things in consistent places to find and explore
• Ensuring the child is always physically comfortable and feeling calm and in control.

If these approaches work, then maybe learn and try some more.

With what we are learning about how common CVI may well be, in both children and adults, medically diagnosing everyone is not going to be a practical possibility, it is as simple as that. So we need to think in other ways.

Support for CVI is harmless, and improving access to information, may well help all children learn, so why not 'err on the side of caution' and assume visual perception difficulties may be CVI. Try the strategies, and if they work, take that as a positive outcome. The condition is then being successfully dealt with.

Back to this paper. For the children who had unmet eyecare needs and got the support they needed (mostly glasses), did their behaviour improve? The paper gives a fascinating and detailed explanation of the measured improvements obtained, like staying focused and on task.

In short, of course their behaviours improved.