After careful assessment, the results provide us with numerous strategies for improving visual skills. This does not mean we get struck and only provide one kind of stimulus. For example, in a recent assessment of the attention to color, parents, caregivers and therapist mentioned the child’s preference for red and yellow. In my direct assessment using large pieces of shiny fabric, I confirm this is true in both lateral fields. With latency, the child does look at both these colors with 2 minutes. I then presented green to the right and left lateral fields and waited 5 minutes for the child to look on each side. There was no looking to this green shiny fabric.
I set the child up in an active learning activity area with the green fabric draped up on his right, slightly touching his right hand to create familiarity with this color. The child makes accidental movements that cause the fabric to move. The shiny fabric is also reflecting light that increases the appearance of movement. Within a few days, this child is moving this fabric purposefully building increased color skills, understanding how his body is connected to the outside world, and building right field skills.
Color is such an important support for children with CVI to visually attend and to recognize. Just because there is greater or faster attention to some colors, this does not mean other colors are not accessible. If fact, if you make all objects the same color for a child, you are interrupting their reliance on color to figure out and distinguish one item from another.
Children with CVI can struggle with reduced or no eye contact. I always struggle with behavior-based teams as I try to explain that eye contact is impossible for some children due to CVI. Eye contact can sometimes feel like the only focus for a child’s education in these behavior-based programs. These children with CVI are visually impaired and CAN’T look at the complexity of the noisy, moving, ever changing face.
We would never demand “looking” from a blind child yet it appears again and again on IEPs for children with CVI, a poor and impossible goal. There are so many other things to work towards! Eye contact is a skill we want to develop but it comes after visual skills are solid for less complex targets.
I see eye contact develop when the child is accessing materials in the world visually. Then I begin to see “face contact” where a child looks towards people’s faces but not necessarily in the eyes. I do encourage children to face the speakers and remind them to point “nose to nose”. If they begin to orient towards the speaker’s voice using their auditory skills this is seen as more typical for socialization.
Eye contact does develop with support and understanding of the impact of complexity. Eye contact skills are first seen in familiar, quiet environments but as soon as the speaker begins to deliver a message, the eye contact disengages. The child clearly can’t listen and look to the complex face at the same time as eye contact skills build. Children might also need to look away from faces when delivering a message themselves. Children might then develop the ability to look at familiar faces but not at unfamiliar ones or have eye contact abilities when the speaker is calm with a softer voice.
Lack of eye contact in children with CVI is not a social breakdown such as that seen in children with autism. It is a complexity issue for the child with CVI. The eye contact visual skills must be developed not demanded.
I’m off to see a new child this weekend and want to bring materials for assessment. Top on the list is the parent interview. Parents have all the answers if you ask the right questions! Here’s a general list of items for a kit. I will need to adapt this to the child I meet:
- Child’s favorite toy (ask ahead)
- Materials similar to the favorite toy in salient feature
- Visually simple toy that can be activated to create noise.
- One yard of fabric of favorite color and other colors
- One yard of shiny fabrics of each color
- Plain black backgrounds: invisaboard, All-in-One boards, black placements or black fabric
- Slightly complex backgrounds
- Very complex backgrounds
- Childs favorite small finger foods (Cheerios, M&Ms, veggie sticks, cookies, fruit)
- Child’s favorite cup or spoon
- Plastic slinkys of different colors
- Set of pom poms of 6 different colors
- Set of balls of 6 different colors (can roll to see distance sustained attention)
- Black and white toys
- Bubbles for blowing
- Measuring tape
- Large mirror
- Suspended moving toy: windsock, spinner, pin wheel
- Small Lightbox, Lightbox app on the IPAD
- Clear or colored translucent items for the Lightbox
- Sets of red or yellow objects to be sorted into containers of red or yellow.
- CVI Complexity Cards (laminated so you can use food on top)
- Lights with colored caps or colored fingerpuppets.