CVI picture understanding

How Does This Make Sense?

The child has limited visual attention. He does not look at many items and the looking is very, very brief. The child enters school and icons, that very symbolically represent materials, are chosen to be used for his communication system.  How does this make sense?

  • The child is not looking at 3 dimensional things in their environment therefore can’t build visual recognition of real 3D items. The can’t see the backpack and jacket in real life and recognize them. On the device, these icons appear. They are 2 dimensional and represent these things. How is the child expected to connect the 2D symbol to an 3D item they can’t look at and can’t recognize??


  • This child is very visually impaired yet pictures are used??
  • The child, if they can locate items, can only tolerate looking at a 3 dimensional item one at a time, yet they are presented with a HUGE amount of symbols on a communication system.


  • The child can only look at items that move yet symbols are presented as stable items??
  • The child is constantly told to “look” using central vision, yet it is their peripheral vision which is the most functional.
  • The child is presented with 2 dimensional pictures the represent part of an object (which they can’t recognize in 3 dimensions!). I had to struggle with this one below.


Teachers of students with visual impairments who understand CVI and how to assess CVI must work hard to help teams understand this disconnect. Without the vital information gained from the CVI assessment of functional vision, the communication device materials and other 2D learning materials are inaccessible. Would we ever do this to a child with an ocular impairment?? I don’t think so!

Building Literacy Around What Children Care About

We all pick up books based on our preferences for topics.  Why should our children with CVI be any different? Parents have a wealth of information about what their children’s passions. These are the favorite and visually familiar things we should build our literacy materials around for our children.

My student is fascinated by cell phones. I grabbed a Google image of a cell phone (actual size) and chose a fairly complex book. I applied Velcro to the back of the cell phone image and to multiple places on each page.

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The book became The Ten Ladybugs and the Cell Phone.

Because my student really likes this item and had a firm visual memory for this item, his success was almost immediate. Once he could locate the cell phone picture, he could hand it to me and play with a cell phone for a minute.

With this success, I can go several places with this skill.  I can increase the complexity of the background and/or decrease the size so the cell phone becomes more symbolic (not the exact real cell phone size).

This makes learning interesting for my student and I can work toward my goals. We are both engaged and happy to work together! We move to increase and expand my student’s literacy interests based on their preferences not mine!

Literacy: Searching for a Visual Attribute

My 3 year old student who is non-verbal had no interest in any literacy materials when she arrived in preschool due to ocular and cortical/cerebral visual impairments.  Her preschool provided rich experience based literacy using adapted books matched to her ocular visual needs and matched to her CVI assessment. Each book had an accompanying storybox with 3D materials to support each non-complex picture.

I wanted to check visual recognition of one 2D image.  I choose the book Zoom! Zoom! Zoom! I’m Off to the Moon by Dan Yaccarino. It had a series of images of round pictures.  As a consistent visual feature, I used a shiny, gold, round sticker. I presented this sticker on a white non-complex background. I knew my student loves the Itsy, Bitsy song. With hand under hand support, each time the sticker was presented we would touch the sticker together and I sang part of her favorite song.


With her success with pointing to this one sticker, I applied the sticker in different places on each page of the Zoom! book.





After a week, she was looking at the pages and finding the shiny sticker each time. She would lean closer to reduce the complexity, isolate her index finger, point and look at me and smile. True recognition! With the increasing interest, she really studies all the classroom adapted books and even chooses books during her free time on the mat.

2D Considerations




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When I lecture about CVI and the use of 2D images for communication, I often show these line drawings that are so often chosen as symbols for kids.  The images are partial and highly symbolic.  The only way I understand what the drawing means is because I have  intact visual memory and cognitive abilities to make the fantastic leap in understanding what this picture is referencing.  (Even with that visual memory and cognitive abilities, it takes me a while to figure out what this picture represents!)

People choose these types of 2D images for kids who are not even looking or not looking long enough to access the image at all.

Children must have any 2D symbol use built on solid understanding of the real 3D before the symbol is at all useful.  We must be very careful using symbols that children can not access.  It is easy to confuse lack of understanding of pictures with cognitive or language issues when they are real lack of access to the image in the first place.

Looking does not mean understanding.  Holding pictures in front of kids does not mean they are looking long enough to interpret it.

Evaluate Pictures for Clarity and Perspective

bad contrast hat

When the child with CVI is ready for images, we need to make sure the picture is clear and represents as close to a real perspective as possible.  The above picture of a construction hat is clear but the background provides no contrast and is distracting.  The glare from the overhead light is a problem and the perspective is confusing.  Our brains with perfect vision can understand this is a hat.  Children with CVI do not have the benefit of the visual memory that supports this understanding.

good cvi picture hat

This picture is so much clearer with much better information for the child with CVI.  Supported by seeing this exact same hat in a story box, the child with CVI can build a visual memory and build 2D understanding of this image.

No high tech equipment was needed for this picture.  I covered a tissue box placed up on its end with my black sweater.  I placed a black background behind it.  I used my iPhone to take the photograph.

The shift from 3D real items to 2D images needs to be carefully support by pairing with the exact same real object and presenting clear photographs.