Does your child have trouble walking on uneven surfaces or focusing her eyes? Does she not respond to your face or sometimes call someone else “Mom” or “Dad”? Does your child seem not to look at toys or things in the room? What’s going on? You’re confused and worried — and you might even have been told that your child could have Cortical Visual Impairment/Cerebral Visual Impairment (CVI).
We’re parents ourselves, and we’re familiar with many of these common behaviors and how they show up in young kids. Many of the things that seem unusual — clumsiness, calling someone by the wrong name, trouble walking, or trouble looking at things — are actually manifestations of CVI.
No two kids are exactly the same. We’re constantly learning more about the manifestations of CVI, and more research is needed to understand how it manifests itself in various kids because every child is different.
Manifestations of CVI in children
However, in addition to the common CVI visual behaviors, you might notice these behaviors:
1. Trouble with direct eye contact and social gaze.
This is often the behavior that parents spot first. Some kids even withdraw from unfamiliar faces, so you might worry about her social development, even though the cause is CVI.
Why it happens: If your child doesn’t seem to recognize you, it’s not because she doesn’t love you! The technical term for not being able to recognize people by their faces is prosopagnosia, and it’s very common for kids with CVI.
CVI impacts some kids’ ability to attend and look at faces because they have trouble with visual attention. People who don’t understand CVI might think that this is a feature of autism rather than an aspect of CVI. For other children, CVI impacts their ability to see details of faces; they can’t spot the features that make dad “Dad” and mom “Mom.” Your child might learn one visual feature of a person and confuse people based on that feature; for example, if you have blonde hair, she might approach another person with blonde hair mistaking her for you. Difficulties with facial regard and facial recognition lead to social difficulties and can lead to fearful interactions with others.
2. Clumsiness. Clumsiness happens for many reasons. Problems with neglect or visual attention in lower visual fields might make your child trip and fall. She might knock down items when reaching due to visual-motor problems, such as knowing where an item is in space and accurately reaching out for it.
Why it happens: Your child might seem “clumsy” due to difficulties seeing objects in a particular visual field or because she’s not able to process the entire scene. She could be unsure of where items belong, so reaching is difficult, and she might often knock objects down.
3. Trouble sorting or picking things out in a crowd. This is called simultanagnosia, and it happens because kids with CVI have trouble with visual crowding and clutter. They struggle to attend to many items at the same time.
Why it happens: Due to simultanagnosia, children with CVI have trouble attending to many objects at one time or recognizing items in a large group, especially if they’re too close together. Your child might struggle with looking at or recognizing multicolored items, because to her, a multi-colored object actually looks like multiple ones.
4. Inconsistency and fatigue. Your child might have wildly different responses to the exact same stimuli depending on mood, time of day, fatigue, or illness, or other factors.
Why it happens: Children with CVI work so hard to use their vision to process the world. Your child might seem tired, even if she’s well-rested and healthy. This leads to fatigue, especially later in the day or after being in a challenging, cluttered, and noisy environment. Your child might struggle if a familiar item appears in a new place because she relies so heavily on visual prediction to recognize her world. Illnesses can also diminish the energy needed to do the hard work of using vision.
What you can do
You can help your child feel more at home in her environment with simple adaptations, including:
- Labeled drawers using color, which will support her ability to recognize where to find things;
- Solid bedsheets and comforters, which provide a non-complex background for clothes and toys and reduce the overall visual complexity of her bedroom;
- Adjustable shades, which allows light to be controlled in her environment;
- Tap lighting for cabinets, which provide light support for visual attention and recognition of objects;
- Simple utensils and personal care items in separate, consistent colors, so finding and identifying them is easier.
To learn more about easy at-home adaptations (and shopping tips!), watch this video from Perkins eLearning Considerations for Reducing Complexity within the Home.