This page is short, with many links at the end.
When teaching a child with CVI, whether formally at school, or at home, there are some checks that need to do be done every time.
A recent study looking at CVI in mainstream school children found that at least one child in every class was likely to be affected, and of those identified in the research, 80% had some classroom difficulties. Research in our special education schools has identified CVI in 25% to over 50% of the children.
Please take a moment to look at the checklist in the image above.
For all of the children affected, it is likely that part of the reason for their learning difficulties is due to one or more of the points on that checklist. The checklist does not include every possible cause of difficulties, but we feel it covers the main areas that are frequently missed.
A child in every class is likely to be struggling with learning because something, or many things from that checklist, may have been missed.
Below are brief explanations of each point on the checklist in relation to the child with CVI.
Please also read the last paragraph on environment. For children with CVI, the environment they are learning in can be as important to accessibility as the quality of teaching and teaching materials.
1. Can I see it clearly.
All children should have had up to date eye / sight tests, and if needing treatment, such as patches, spectacles and contact lenses, these need to be comfortable and worn.
A child may have visual issues that can't be corrected by spectacles, meaning they can't see clearly for two reasons. One is because they can't see small detail, called reduced visual acuity. The other is where they can only see striking tones and shades of colours, but can't see the more subtle shades. This is called reduced contrast sensitivity.
Both of these impairments can and should be checked and measured.
To gain an understanding of what these measurements mean, you can take photographs of whatever you are wanting the child to look at, to see what it looks like to them using the free programme called sight-sim, which has been used to edit the images below.
Think about where the child sits in the class. What do you look like to them?
Not sure? Sit where the child sits, and get someone to stand where you would normally stand or sit, and take a photo, and compare the original picture and the modified picture using sight-sim. It's free.
The child will not always know if they can't see clearly - their vision is their normal, so to the child, they are seeing clearly - the fuzzy right-hand image (above) is their 'clear' vision. The person teaching needs to make decisions to make things clearer, by
...to the level so that what you want the child to look at can be seen clearly for them.
* Sometimes making things bigger for a child with CVI can make them more difficult to see. Many children need an approach where elements of what they are looking at are build up, one bit at a time, like building a jigsaw, in a quiet clutter free environment.
2. Can I see everything?
Many children with CVI can see only one or two things at a time, so when looking at what might seem to be a simple picture, with some friendly frogs in a pond, they may see only one element of that picture.
3. Do I see it consistently?
Children with CVI have repeatedly shared their experiences of having competing senses, so something that they may have been able to see clearly in certain situations, they stop being able to see in others, for a number of different reasons, including:
4. Can I hear you clearly?
Another common issue reported is difficulties with sound processing, meaning that even though the child may have typical hearing systems, they may find listening to you whilst trying to visually focus at the same time to be difficult, so they can't hear everything you say when they are looking at you.
5. Can I listen to you and look at you at the same time?
Looking at a person's face takes up a huge amount of brain processing, and may mean the child can't listen to you and look at you at the same time. Some children may be able to listen and learn more efficiently if they are not looking at the teacher and not being looked at.
If looking at your face is difficult for the child, and means they can't hear or see as well, because they find that it makes learning difficult, then this needs to be discussed. But also remember how much you communicate through your facial expressions, so when teaching, express yourself as you would if you were talking to someone on the telephone - where they can't see you, but can hear you. We have heard from children with CVI that they learn best from teachers who use their words effectively like this.
6. Do I appear to see less well when you talk?
This ties in with the above points as to how many things the child can attend to at once.
Many children with CVI are 'one thing at a time' children.
Children needing a 'one thing at a time' approach is because of difficulties processing many things at the same time, sometimes called parallel processing difficulties. Quite literally, many children with CVI don't have the same number of active pathways in their brain needed to parallel process even what may seem like simple things, like making sense of what they are seeing whilst you are talking.
What is 'one thing at a time' teaching? Exactly what it says...
Pick one, only one, at a time, and build, at the child's pace...one thing at a time.
7. Do all your words make sense to me?
CVI affects the development of language, in some very severely. Words are not always understood correctly, for many reasons including:
Children fill in the gaps where they have not understood, and sometimes they get this wrong. So when teaching, if learning is based on an understanding of words that have not been learnt correctly, then that next level of learning is going to be confusing and learnt incorrectly too.
Words are a major foundation of teaching, and if that foundation is unstable, then everything that is built on top of it will have fault lines. CHECK!
8. Can I shift my attention from you to my work and then to the board easily?
Remember - one thing at a time.
Imagine a child in your classroom, and someone has turned off the light, and so to see anything they have a little torch (flashlight), which they can shine on their work, but only allowing them to see a word or two at a time, then they have to move it, to you the teacher, but they have to find you, and if they shine it on your face it can be too much for them and overwhelm and disorientate them. Then they need to find the board (black board / white board / smart board). Once they have found the board they may or may not find the piece of work that is relevant, with this little beam of light, and anytime they are meant to be listening, the beam appears to go out, so when they try to look again, they need to start all over again trying to find everything, just using their little beam. That is how vision for some children has been described, and it can be why classroom learning is exhausting, stressful and difficult.
Why do so many expect a child who processes one thing at a time to be able to easily switch their attention from their work in front of them to the teacher and what the teacher is saying and their expressions and body language and other children in the class and the board? The answer is because for others not affected by CVI, this is easy, and they assume everyone can do what they can do.
This is called self-referencing. We all do it, we come pre-programmed to self-reference. This is not a criticism, but, we need to be able to journey into the child's world, to 'tune-in', and to get a glimpse of how they experience things, and make adjustments that enable them to learn.
9. Are there distractions?
We all know what it is like to be distracted when we are trying to concentrate. Loud roadworks outside a window, or strong smells coming from a kitchen, or phones constantly beeping and buzzing. It can be very irritating and can make concentrating more difficult because these all compete for our attention. With CVI, because for many there are fewer active pathways to enable splitting of attention, the issue of distraction is far greater. Something you may find slightly irritating or difficult to ignore, for the child with CVI may mean they have lost their ability to look or to listen. Learn to tune-in to the child's world and pick-up when distractions are causing difficulties, including:
Aspects of the environment can interfere with learning and these are explained at the end of this page.
10. Have you given me enough time?
The child with CVI may need things to be repeated more than other children, often because it has been difficult for them to learn owing to the issues described above. If there is not enough time in the class schedule, find time to check that they have understood, and make suitable arrangements if more time with more teaching is needed. We know this can be difficult, but each child has the right to learn. We hope this list will help in making the arguments needed to ensure learning is accessible for the child you support, including where needed, the provision of extra teaching / support time.
11. Have I understood the basics of what you are teaching?
We all understand in levels, no matter what we are learning. Learning maths, even to an advanced level, starts with learning numbers and counting. You would not try to teach algebra to a child who can't count to ten. If some words have not been already learnt, a child may not correctly understand what you are teaching, because what was taught before has not been learnt correctly. We need strong foundations to build learning upon, and if unstable, everything that is added can also have a degree of instability.
12. Have I lost confidence and need reassuring?
Not understanding can lead to many challenging emotions in children, including feeling:
If this is an area where they regularly struggle, they may dread learning in class.
This adds even more difficulties, and learning becomes harder still. Going through our list lets one find out where the difficulties may be. If you find out, reassure the child. It's not their fault. Make a plan and agree how you can best communicate. If a child is feeling very worried, they may not feel comfortable discussing this in front of the class, so agree how they can show you or tell you they are not coping in a way that the child is happy with.
Happy children learn best.
The learning environment can add to difficulties, or make learning easier. This is slightly different from distraction because we are considering the part of the brain where what they can see and hear, is mapped. Think of the example of the child who needs a torch (flashlight) to see and can only shine it on one thing at a time. Think of that beam as being the child's vision in the cluttered classroom, where the field of attention can become so narrow that they sometimes can't see anything at all. Noise clutter and movement can make looking, listening and trying to understand and learn, even more difficult. In a clear quiet environment, the beam of their torch widens out so they can see more. By making positive changes to the environment, you can improve the child's vision by diminishing their visual impairment
Newsletter 30 has more details and links to the research around how many children in schools may have CVI.
Lesson 12a gives an example of using this Teaching Checklist around learning numbers.
Eyecare - All children need regular sight and eye health checks, usually at a local optician, sometimes in a clinic. This page looking at some research simply explains why it is so important.
Visual Acuity, Lesson 3b Visual Acuity &Lesson 5b Reduced Visual Acuity
Contrast Sensitivity, Lesson 3c Colour & Lesson 5c Reduced Contrast Sensitivity
Sight-Sim is a free programme to download onto your computer where you can add any photo or image and see what it looks like with different measurements of reduced visual acuity and reduced contrast sensitivity.
Making things bigger causing difficulties for children with reduced visual acuity. This problem is explained on this page: The Reduced Visual Acuity and Simultanagnosia Problem.
Jigsaw Learning. Approach of building up what you want a child to learn bit by bit, or piece by piece, like a jigsaw, called the 3Z approach (Zoom In, Zip Up, Zoom Out).
Simultanagnosia Spectrum, explaining vision where only one thing at a time can be seen, see also the 'Beach Video' below and Lesson 7c Simultanagnostic Vision.
Lesson 9d The Sound Map Explains the difficulties many children with CVI have with sound processing, including finding looking and listening at the same time challenging.
Not Looking to Listen. Short page explaining a child who needed people to turn around to be able to hear them.
Yellowstone's Blog (3) Accessible Teaching - the best teachers for this child with CVI are the ones who explain what they are teaching in a way that does not rely upon what can also be seen.
Gordon Dutton's Blog (6) Radio Parenting - When talking to a child with CVI, imagine you are presenting a radio show or talking on the telephone, where they can't see what you are looking at or see your facial expressions, so you need to use your words alone to explain.
One Thing At A Time
Parallel Processing, this page has a link to some amazing videos where you can actually see the fewer pathways in the brain meaning reduced parallel processing, creating the need for 'one thing at a time; learning.
Gordon Dutton's Blog (18) Parallel Processing
Newsletter 26, CVI, Language and Learning, explaining the role of language in learning and why CVI can create difficulties.
Self-Referencing Level 4 Lessons - we all do it, we are pre-programmed to do, but we need to be able to step outside of our world and understand the child's world. PLEASE read.
Lesson 2d Meaningful Learning - Learning is built in layers, and the best learning has strong foundations, just like a wall.
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