Let’s get real about worksheets and CVI. No matter how you slice it, worksheets are the key tool that schools use to teach content and assess student knowledge and skills. Not all worksheets are created equal, but all worksheets have one thing in common for many individuals with CVI—they are inaccessible.
It’s nearly impossible to avoid worksheets in our educational system, so it’s important to figure out how to make the goal of a worksheet into an accessible learning task.
Worksheets are inaccessible for many students with CVI mainly due to visual clutter, black and white highly symbolic line drawings, font type and size, the need for visual-motor skills, and the general fact that worksheets are a two-dimensional (2D) form. CVI is part of the blindness spectrum—a worksheet should never be the first and only option provided to learn a concept and show learning.
Real three-dimensional (3D) objects are more accessible for many individuals with CVI to recognize and interpret. Real objects and experiential learning offer multiple sensory cues that support access and learning.
Matt Tietjen, TVI and creator of the 2D Image Assessment for students with CVI, cites work from neuroscientist Dr. Martha Farrah when describing the difficulty of processing 2D: As we move from objects, to photographs, to illustrations, to black and white line drawings fewer multisensory cues are available to support recognition.
Let’s look at an example: a car. What are the cues available to support recognition and concept development for each form?
You’ll notice that the farther we get away from the real object, the fewer cues available to support recognition and access. This is a problem when the majority of worksheets include highly symbolic black and white drawings. We also need to consider angles and the perspective of the image. An individual with CVI may learn to recognize a picture of a car from the side view. But when presented with a picture of the back or front of the car or a bird’s eye view, the car is unrecognizable.
Visual clutter is one of the biggest barriers to access for individuals with CVI. And the problem with many worksheets? They are crowded with too much text, drawings, and figures on the page. Too much visual information at once means nothing can be fully seen for individuals with CVI. Often looking at one thing at a time is how many individuals with CVI process the visual world. With too much visual clutter, vision may become blurry, the visual field may reduce, and the brain becomes overwhelmed, leading to profound fatigue.
Individuals with CVI require an approach to learning that incorporates multiple sensory modalities (tactile, auditory, kinesthetic, visual) matched to their unique needs. This includes using real objects and real-world experiences to support concept development. To be clear: a multisensory approach does not necessarily mean using all the senses together at once (remember, sensory integration while using vision is difficult for many with CVI). Instead, it is a thoughtful consideration of how to make learning accessible through different sensory modalities.
The goal is full access to education and the environment, every moment of every day.
If worksheets (without adaptations or a multisensory instructional approach) are solely being used to teach a concept, apply a skill, and show new learning and mastery of a skill, then the individual with CVI does not have access to an appropriate and accessible education—to Free Appropriate Public Education (FAPE).
Worksheets don’t help build foundations of learning. I have two kids with CVI, and worksheets are a HUGE waste of time. Without a foundational understanding of basic concepts, the house of knowledge soon collapses. Real-life experiential learning is key. I have always said my kids need to ‘live it to learn it.’CVI Parent
Perspective from a CVI Parent
“Worksheets are not accessible at all for my son. We consider the purpose/lesson presented by the worksheet when adapting. 3D is always best when possible. Present one problem or concept at a time in 3D, slides, Boom Cards, or Tiny Tap. We usually try a variety of modalities. We might start with 3D and then move on to using slides and boom cards for more practice. We do a good deal of concept development and salient features [visual attributes] for literacy to avoid empty language. No worksheet can do that.”
Learning activities must always match the individual’s learning needs as measured through comprehensive assessment and ongoing data collection. The ideas below are meant to inspire inquiry into what might work best for your child with CVI.
Perspective from a CVI Parent
“When my son was little, I would take abstract concepts like “more” and “less” and give them real-life meaning. So instead of a bar graph showing “more,” I would fill up 2 or 3 glasses with different amounts of apple juice. Or have a bar cookie/candy and have shorter and longer pieces. I used food a lot for math problems as it was motivating – counting out cheerios or M&M’s. The correct answer got eaten!”
Perspective from a CVI Parent
“Once my son got the diagnosis of CVI at age 13, we adapted math worksheets by cutting them into strips, but what worked best was redoing them and putting only one or two problems on a page with lots of space in between. I also got rid of any extraneous numbers or words or lines.”
Perspective of an adult with CVI
“Tina, an adult with CVI, shared how instrumental color is when solving math equations. Her vision often becomes blurry, especially with a lot of visual clutter and too much to visually process. If Tina’s working with only black print, she can’t follow the math problem. When each number and symbol has its own color, she can follow the equations. For example, the number 4 is always green, and the multiplication sign is always pink. So when she’s not able to see the symbol, she can use color to support recognition.” -From Visualizing Math: Considerations for Students with CVI
Perspective from a CVI Parent
“We are dealing with multiple disabilities, not just CVI. My son is nonverbal and does not have use of his hands. Using food for any activity is out of the question because he is 100% tube fed and has quite a few food triggers for seizures. Touching the inside of a pumpkin for an OT activity at school set off a huge seizure. So in our case, everything must, must, must be digital or 3D (with restrictions on what he can touch). If digital, it has to be accessible with a single switch with one touch, such as using a switch to activate an action or turn page. Preferably, the activity needs to be set up as a choice selection through Boom cards, for example, only if the teacher creates the cards to match his individualized needs for visual access.”
All of the adaptations discussed above are often applied at the same time when adapting worksheets for a student with CVI. We have to always consider how all of the CVI visual behaviors come into play when thinking about access to learning.
In Matt Tietjen’s presentation about CVI and the Math Mind, he shared this example of adapting a math worksheet with 16 equations to solve. Using an All-in-one board with a black felt background, one equation is presented using a red plus sign, a green equal sign, and a blue box to post the solution to the equation. Numbers on are white cards in large black font. Notice the reduction of visual clutter, increased spacing, intentional use of color, accessible font and size, learning presented in an accessible visual field with manipulatives to support visual motor and tactile cues.
In Matt Tietjen’s presentation about CVI and the Math Mind, he shared this example of using a 3D model for a geometry multiple-choice problem about a triangular prism. Each answer choice is now a 3D shape using blue paper to match the color on the worksheet. The learner with CVI can use tactical cues and real object manipulation to show what they know.
In Matt Tietjen’s presentation about CVI and the Math Mind, he shared this example of using color to group related elements in these instructions for a geometry problem to reduce visual search, show visual relationships, and convey salient information.
Often handwriting worksheets, like this one for the letter “k,” use black and white drawings and concepts learned through incidental learning to teach handwriting skills, all of which are not accessible for many with CVI. Adaptations include using real objects for real-world connections to items that begin with the letter K, a Wheatley board (pictured above) with long and short velcro lines and pink dots for tactile exploration and manipulation to teach visual recognition, spatial configuration concepts, elements of the shape, short, long, angle, and diagonal. Also, Molly, a CVI parent, intentionally uses color and colored dots on the writing lines to support the visual motor skills of writing.
Worksheets in elementary school, even in middle and high school, require visual-motor skills like cutting, sorting, and pasting. Visual-motor skills are complex for many individuals with CVI. Remember, always ask: what’s the goal of the worksheet learning? For the one above, it’s to sort lowercase and uppercase letters. Molly, a CVI parent, created this adaptation that includes high contrast and large font letter cards (white letters on a black background are preferred for this student with CVI). Notice the intentional use of color for placement—green for uppercase and blue for lowercase.
In Trust the Process: A Case Study in Literacy and CVI, Amanda Whelan, TVI and Assistive Technology Consultant, and Joy Wilson, TVI and O&M Specialist, explained how they adapt worksheets for their student with CVI using various iOS apps. Notice the adaptations for the cluttered worksheet (which also requires cutting and pasting of letters): removed visual clutter, added colored realistic images, color-coded the boxes to place the letters, highlighted “CVC” in student’s favorite color (pink), and showing a small chunk of the task at a time. This adapted learning task was then completed on an iPad (backlighting to support visual attention and recognition) in the Stick Around app, where the student dragged the correct letters to spell out the CVC word in each picture.
Molly, a CVI parent, shared adaptations for this cluttered worksheet filled with line drawings that focuses on the sight word “be.” The parent scanned the original worksheet, saved it as a pdf under OneDrive, opened the file under OneDrive on iPad, used the marker tool in white to remove all the visual clutter, and used the highlighting tool for the writing line. With the iPad position at eye level, her son used the zoom tool to make the task larger and the stylus pen to complete each task one at a time.
On the left, Logan uses his AAC device’s keyboard with the Tiny Tap app to type in the word’s missing letter “o”. On the right, Logan uses his touch screen monitor to select the yellow Pentagon. Notice minimal visual clutter and intentional use of bright bold colors against a plain background.
On the left, Krish uses his iPad and a stylus pen to write the number 6 next to an image of a clock that shows 6:00. Notice reduced visual clutter, only one task presented at a time, enlarged images and details, and the use of his favorite color, pink, to write his answer. On the right, Krish uses his keyboard on the iPad to type sight words on writing lines. Notice the intentional use of the color pink to highlight the bottom of the writing line and the color red for the word model and the text he types.
Kira, a CVI parent, shared how she adapted a worksheet that used black and white images to show words that start with a certain letter of the alphabet. On the left is the original worksheet where she wrote down what her son thought was each line drawing: V for van was “car,” W for wind was “cloud,” X for fox was “squirrel,” Y for yellow was “crayon,” and Z for zebra was unrecognizable. Kira replaced the line drawing with real colored photographs or real realistic colored illustrations. These images needed to be directly taught and learned through repetition before being connected to the learning activity. Each of these letters with its corresponding image was presented one at a time.
Read about how one parent uses low-tech CVI accommodations for a visually complex task—studying maps.
The need for adapted materials to access learning is a great opportunity to teach students with CVI self-advocacy skills when presented with an inaccessible worksheet. For example, talk the student through the problem and solutions. “This worksheet is cluttered with things too close together. People with CVI like you have trouble when things are too close together without spacing. To control the clutter, you can use your black cover or ask for the worksheet to be adapted on your iPad so you can zoom in, add color, and type your responses.”
Learn more about what access looks like for individuals with CVI