literacy for CVI

Accessible Literacy: Controlling Background Clutter? Don’t Stop There!

So often when people think about making accessible books for children with CVI, they enthusiastically share ideas about removing the background clutter and complexity. They set off to create an accessible book. The trouble is that they stop at removing clutter and complexity but still leave the book inaccessible to the child.

Any materials created for children with CVI simply must consider all accessibility needs.

Literacy materials created should match all the assessment results both for ocular needs and for CVI needs. They need to incorporate the child’s compensatory skills as a support for visual skills. Materials that appear in books need to be meaningful and experienced by the child. If the child has no experience with the concept represented in the book, they will not understand or relate to the items or with the story. They will not remember the aspects presented in the book. The book should be based in the child’s natural routines of day to day life for the optimal building of visual recognition. Perhaps most importantly, they must appear in the correct accessible Form.

Form Accessibility

Any literacy material must consider the accessibility of the Form.  The form is the media understood by the child. The book creator must assess the form understood by the child in order to develop a book matched to the child’s perceivable media form. Is the child at the level of looking at and recognizing only 3D real items? It the child able to perceive and understand real photographs? Can the child understand if the item is multi-colored or does that make them think they are seeing several separate items of different colors?

If the child is only perceiving 3D items, 2D is inaccessible. No flat book by itself can provide access to literacy. It must be supported in several ways:

  • Make the book yourself. Use items already within the child’s visual world that occur in the child’s natural routines. These are the most likely to be recognized.
  • For students with fragile visual attention and fragile visual recognition, provide a storybox of real items to be explored using all the senses.  The child can look at the item, look at the item in all perspectives, feel the item and make sound with the item.
  • Photographs that appear in the Powerpoint book should use photographs of the exact experienced and recognized storybox items since it it likely that the child will still be coding items by color.

Compensatory Skills

Auditory: Separately delivered verbal information before and after the child looks.

Create some auditory interest by using the Powerpoint audio feature in the literacy creation. Capitalize on the auditory skills to give support to what is presented visually. (Example: Dog barking when the dog appears gives support for the visual image of the dog.)


Support visual understanding using tactile exploration of shape and function. Base the literacy material on real experienced items tactilely explored for understanding.

Impact of Light

Making Powerpoint books allows you to provides backlighting that can be beneficial for our students with CVI. It can reduce visual fatigue. The level of lighting can be adjusted if the child is sensitive to light. That backlighting helps to improve visual attention and helps to bring attention the the details of objects. It can also improve visual recognition.

Impact of Motion

Making Powerpoint books can allow you to create embedded motion, if desired, using the ”Animation” feature. Slower, predictable motion can help draw and sustain visual attention.

Response Interval

Unlike a book that needs to be held, the screen-based book is stable and remains available for as long as the child needs. It allows the literacy material to appear for any length of time that the student needs to visually locate, sustain gaze and understand what is on the screen. This allows you or the child to have the ability to control the speed of the activity.

Visual field

Any learning materials including literacy materials must consider placement in the child’s best visual fields. These are often raised positions that bring materials out of problematic lower visual fields using slantboards or raised screens. The stable nature of slantboards and raised screens provides consistent positioning and stable presentations.

More about Crowding/Clutter/Spacing and Object Arrangement

There is more clutter/crowding and spacing needs than just removing the background. The ability to reduce all clutter also considers spacing items for discrimination and using solid, saturated, one colored items for ease of visual recognition. To capitalize on predictability, objects on the page should be in a consistent arrangement such as a linear arrangement or an arrangement in a grid so the child can scan each page space on every single page to take in the whole scene.

Access to People

Consideration of the access to faces is an important consideration for literacy accessibility. With fragile visual attention to real faces, there is very, very fragile facial recognition of real people encountered in life. If children can not visually attend and can not recognize real people around them, flat photographs of real people are completely inaccessible and meaningless. If photographs of people must be used, code each person by the color of their clothing so children can discriminate the image effectively using that support of color.  

Sensory integration Using Vision

Due to difficulties with simultaneously presented visual and auditory information, create a book or a present a book considering a separation of the visual from the auditory components of the literacy material. Verbally read the story first then present the visual images. Provide verbal labeling of the objects on the screen. Provide labeling of actions on the screen.

Impact of Color

Consider color in accessible literacy. Solid one-colored items presented with be more easily seen as one complete item. The one color holds the image together for the best visual recognition. Using images in the book using vastly different colors will allow for fast identification and discrimination. Color can be applied to distinct areas to draw visual attention.

Provide black non-complex backgrounds for contrast and to reduce complexity.

Visual Curiosity

The use of Powerpoint books provide literacy access in near space where it is most perceived.

Because the child often lacks the incidental information, experiences that the child has in real life should be the basis of literacy. If the subject of the book is a cat, that child needs extended learning about cats. Where to cats live? What and how do they eat? What do their babies look like? How do they move? All this is information that most children learn by just watching. Our children with CVI need that learning access considered and delivered.

There are accessibility needs beyond removing the background! Consider all the assessment results when you create accessible books!

Powerpoint Books: Matching to Assessed Visual Needs

Literacy is so important for every child. I love making Powerpoint books for my students with CVI. You can make these for the class as a whole based on a thematic unit or make individual books tailored to each child’s visual needs and preferences.
Using Powerpoint books allows me to use strategies matched to the child’s assessed visual needs for visual attention and visual recognition
Color: I use the bright, solid colored targets for attention and recognition.
Motion: I can insert slight movement as needed using an inserted film clip. I also like to insert films to build cognitive understanding. If the child will look at a plastic toy fish, I do not want they to believe that “fish” are hard plastic, non-moving things. I want to build understanding of how they move, where they live and to have the child understand that fish come in different colors and shapes. I can insert a film clip of fish in a fish tank. I can talk about how fish are alive, breathe, have different colors, swim in water and how they move. Children with typical vision have this information without direct teaching. I want my students to have the same access.
Processing time: The images on the pages can stay present for as long as a child needs.
Visual Fields: The device using the Powerpoint can be placed in the best visual field. This is often at eye level.
Complexity: Powerpoint books allow me to choose a non-complex target and non-complex backgrounds for each slide page. If I take my own photographs or grab images from Google, I can Edit and erase all complexity before I insert the picture. If I take film, I can make sure that film is non-complex.
Light: Because the Powerpoint is created on a computer or backlighted device, the child’s need for light is satisfied. If there is light sensitivity, I can turn the light down lower.
Distance Viewing: The device playing the Powerpoint can be placed at the child’s assessed best visual distance. It can bring items for learning into the near space.
Visual Recognition: Children will look at familiar items better than non-familiar ones. Using pictures of familiar items and creating books about familiar topics, events or predictable sequences are much more likely to draw a child’s visual attention and interest. Remember that all children like predictable books!
Visual Motor: Visual attention is important for literacy but the ultimate goal is always independence to control the book and choice of books. With the ability to turn to the next page or to indicate a desire for a different book is often visual motor task. To encourage visual motor, there must be an access method that is matched to the child’s assessed visual skills to find and reach.

Here is a Youtube explanation of how to make the Powerpoint book

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.

Great Video: Perkins School for the Blind Teachable Moments


Marguerite Bilm created a CVI friendly literacy material around the Itsy Bitsy Spider song.

To create a book such as this for a child with CVI, Marguerite or the TVI working in the classroom would need to assess the student for their unique visual behaviors and skills.  The book would need to match those assessed visual skills.

To use a material such as this, the child would need to

  • Have some visual location abilities
  • Have some sustained gaze
  • Tolerate two items in an array of complexity
  • Be able to visually locate red and white items
  • Have the material presented visually prior to the auditory presentation
  • Have the material presented visually before the tactile page was touched
  • Have the book presented propped up in the best visual field. This propping up would also reduce glare from overhead that reflects off the page. (I have good luck rubbing laminated pages with a fine sandpaper. It takes the glare completely away!)
  • Have the book presented for as long as the child needs to look and to understand what they are looking at.
  • Have the book to be presented at the optimal distance
  • Have the book to be used routinely to build familiarity
  • Have the book be presented against this nice black background

Marguerite used light to draw visual attention. This tells me light is still important for her child, She also moved the light which tells me movement can still help draw this child’s visual attention.

There are some great characteristic considerations for this student!

Visual Attributes: A Strategy for Visual Recognition for Children with CVI

The teaching of verbal visual attributes features begins at birth.  It should be part of a child’s educational programming suggested to parents and teams. We would be careful to limit the auditory distraction of verbal visual attributes features to before a child looks at materials and would support again after a child looked at the material due to the issue of complexity.

Incidental Use of Verbal Visual Attributes Features

Narration of the verbal visual attributes features regarded by the child becomes a philosophy of instruction throughout the day.  This would provide verbal visual attributes features around items that a child can see at near and distance. If the child is looking at materials, these materials are important and often the most familiar to the child. “That’s your Elmo.  He is red with white round eyes.”

Planned Use of Verbal Visual Attributes Features:

I love to use attribute trays to discuss visual attributes. If the child likes balls, I would create a visual attribute tray of different balls.  This allows discussion of the colored balls and attribute language.

  • The first kind of tray would contain all the same colored, favorite balls.  The number presented would depend on how many items in an array a child can tolerate as determined due to clutter “That’s your favorite red ball.  Its round. It is small and fits into your hand. Its lightweight.  Oh, you dropped it, and it rolled”. There is another one.  It is red too.  You dropped it and it rolled”.
  • The next kind of tray would include several favorite balls and one added item that was very dissimilar in shape, size and color.  Discussion would include: “That is a spoon. It is silver with a long handle.  It is not red. It is not round. It does not roll when you dropped it.  It is not a ball.
  • The next kind of tray would include multiple kinds of balls of various sizes, weights, textures and colors. Discussion could focus on the similarities and differences of the balls.


Reducing Complexity in Board Book

Reading to all young children is important for bonding, academic success, language skills, literacy, logical thinking, auditory skills, experience expansion and concentration. Many times children who are visually impaired or who have multiple disabilities rarely share in those early special reading experiences.

This book was created by the speech therapist in our preschool. She grasped the concepts about CVI, understood the elements of the CVI assessment results and applied them to one of her student’s materials.

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This student loved to listen to the animal sounds games. The speech therapist found a board book to read. The two images were just too much for the child to look at when presented together.

She attached Velcro to the back of each page and attached a black flap on each side. She was then able to lift one flap at a time as she read that page. The flaps were removable as the child was more familiar and able to tolerate more complexity.

This book is a favorite! It matched a preferred auditory event with an adapted literacy material.

Preschool Valentines Book for Children with CVI


Here is the wonderful literacy material created at Concord Area Special Education Collaborative (CASE) by Tess, Speech and Langauge Therapist and Sue, Preschool classroom teacher for the February theme of Hearts.  It presents a clear, red heart as a single image on the page then uses the same salient feature with a variety of textures for each page.

The bumpy heart using bubble wrap


The lacey heary using lacey paper


The googly heart using googy eyes


The rough heart using sandpaper


The bead heart using party beads


The pom-pom heart using pom poms of various sizes.


Each page is presented with predictable text and funny voice for each type of heart.

Heart lacy text

Staff that understand CVI well create fantastic materials based on their firm understanding of the characteristics of CVI and their child’s needs determined after assessment. They then created individual books adapted for each child to share with family.

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.