How-to
How to rethink four social and environmental norms to fully include individuals with CVI
Learn why look and listen, sit still, group work, and over-designed spaces do not respect the accessibility needs of individuals with CVI, and ideas for inclusive practices.
Social norms and CVI
Many individuals with CVI automatically adapt to their unique vision (their normal). When it comes to accessibility for and acceptance of a person with CVI, we must understand how their adaptive behaviors and compensatory strategies communicate their needs and brilliance.
When we think about behavioral expectations in school, community and family gatherings, or even just while out and about town, so much relies on visual access. We rely heavily on visual cues of body language and facial expressions when performing social norms.
With CVI, the visual world can be confusing, “warped and distorted,” and the root of immense social anxiety, especially living in a world with social norms inaccessible to individuals with CVI and so many others in the disabled community.
Zeroing in on school—the general social and behavioral expectations in schools are not disability-inclusive nor respect the neurodiversity of children with CVI. Individuals with CVI are on the blindness spectrum and tend to display key visual behaviors. It’s important to understand these visual behaviors before judging, labeling, or making false assumptions about a person with CVI.
Let’s dive into four social and environmental norms in a school setting, how they affect learners with CVI, and some ideas for CVI supports and strategies:
1. Look and listen
Eye contact and looking at someone while they talk are among the most common expectations to ensure the person is paying attention. Often educators use “look” statements to the whole class—”1,2,3 eyes on me,” “look at me when I’m speaking,” “eyes up, writing utensils down”—that reinforce how to pay attention.
CVI visual behaviors to consider: access to people, sensory integration, visual attention and recognition, visual field abilities, response interval, impact of light, impact of motion, and visual clutter.
For many individuals with CVI, to listen well means that they can’t look at a face or orient their body towards the person who is speaking. Many people with CVI have face blindness, difficulty looking at faces and facial recognition, and interpretation of facial expressions. The very act of attempting to make sense of a face means other sensory information is challenging to process. So if you ask a person with CVI to look at you, they most likely will not be able to process what you are saying. Now add in a visually cluttered and noisy classroom, and processing any sensory inputs can become extremely difficult and fatiguing. This applies to when a student with CVI is giving a presentation—looking out to a room full of people is a complex, inaccessible visual demand. Respect what access looks like for the person with CVI before labeling or punishing them for not looking and listening.
Prosopagnosia is not only the inability to recognize faces, it can also involve experiencing faces as twisted and contorted… trying to look at people made it impossible for me to pay attention to what they were saying. If I really wanted to hear them, I had to tune out visually.
Nai, “On Social Anxiety and Cultural Norms”
Inclusive CVI supports
- Learn how the person with CVI shows they are listening and attending.
- Respect the need to listen only and turn off visual attention.
- Allow the person with CVI to look and orient wherever needed during presentations to the class or a group.
- If the student is in a new environment, a cluttered/busy environment, and/or fatigued, expect that they will be more tactile, kinesthetic, or use their auditory skills. Allow space for the student to do what they need to do for access.
- If they have central auditory processing disorder (APD) or are deaf or hard of hearing, know the supports and adaptations needed for processing what you are communicating.
- Know their reliable responses to ensure they understand the information you are sharing—verbal, gestures, AAC device, body language, or symbols, for example.
- Be aware of the environment. If you need to convey information, but it’s too noisy, cluttered, and busy, move to a quieter and less cluttered space. Perhaps step out into the hallway or a quieter corner of the room.
- Use a simple alert to show the person with CVI that you want to speak with them. For example, “Hi Mason, it’s Ms. Edwards, I would like to talk to you about ____.” This can also help with recognition and avoid startling the student with CVI who may not know that someone is suddenly near them.
2. Sit still / sit up and listen
Stillness is often used as a sign of attention and compliance in a classroom setting. Getting up without permission or any type of movement during a class lesson or during a conversation with peers can be misinterpreted as rude, hyperactive, or a behavior issue. But mounting research shows that movement activates the brain and enhances learning.
CVI visual behaviors to consider: impact of motion, sensory integration, visual attention and recognition, visual field abilities, visual clutter, form accessibility, impact of light, access to people.
Some individuals with CVI can use their vision better when they are moving. Many CVI families report that their child needs movement to help recover from visual fatigue. Suppose an environment is too crowded or cluttered. In that case, the person with CVI may need to remove themselves before they become too tired or physically feel the adverse effects of anxiety and stress from the inaccessible environment. Some might go to the perimeter of a classroom or need a break in a quiet space.
People with CVI adapt naturally to their unique vision, so they may move around to make sure they can access something in their best visual field. Or they might move closer to see the material better (for some, moving closer means getting rid of the background clutter around that item). Movement like rocking, fidgeting, or tactually exploring an object or surface can be calming and anchoring. If a new object or inaccessible worksheet is presented, the person with CVI may put their head down, move away to avoid it by turning their head or walking away. Individuals with CVI have incredible compensatory strategies to survive in a world that is not visually accessible and can be downright scary.
Time on task can only happen in short 5-8 minute bursts, after that he needs a movement break.
CVI Parent in 6 big ideas to help to reduce visual fatigue in children with CVI
Inclusive CVI supports
- Allow a person with CVI to move as they need to. They are doing what they need to do for access and self-care. Trust that they are the experts of their brains and emotional and physical needs.
- Provide a quiet break corner in the classroom with blank walls and away from distracting light and movement.
- Ensure the student has optimal supportive seating to support learning and attention.
- Use presentation accommodations (slant boards, all-in-one board, iPad stand, etc.) to ensure all learning materials are in the strongest visual field.
- Provide frequent proactive breaks that support the needs of the learner with CVI. This can include movement, listening to music in a quiet corner, tactile exploration of a preferred object or fidget, or a snack. These proactive breaks are unique to the student’s needs and should be documented in the IEP.
- Always provide a multisensory approach to learning rooted in assessment results, so all materials and instruction are fully accessible.
- Ensure the learning environment has an adapted space with reduced clutter, noise, and motion.
I did a lot of writing on myself to learn how to write because feeling it on my body, and then feeling my hands moving is what helped me learn to write.
Nai’s CVI Perspective
3. Group work and peer collaboration
Engaging in groups and collaborative work is part of the learning experience at every grade level and every facet of life. Listening to others, taking turns, meeting and greeting, curiosity, and cooperation are some of the required skills for being an active member of a group.
CVI visual behaviors to consider that impact the development of social skills: access to people, visual curiosity impact of motion, sensory integration, visual attention and recognition, visual field abilities, visual clutter and crowding, form accessibility, impact of light, visual guidance of upper and lower limbs, response interval.
Social learning primarily relies on visual information, such as attention to visual inputs (familiar and unfamiliar); recognition of people, places, and things; interpretation of facial expressions and body language; objects and targets in an environment; the visual curiosity of new things or something in the distance; imitation; and pop culture references and trends from television and movies. For an individual with CVI, social learning experiences are not fully accessible, and they require “intentionally designed opportunities intended to bridge the barriers to social inclusion that are heightened by the effects of CVI.” (Roman-Lantzy, 2019)
The act of finding and joining a group of peers can be problematic in the classroom and even more so in unstructured and unpredictable gatherings (recess, lunch, in the hallway between class, before and after school). Joining an existing group can be one of those most difficult skills to teach a child with a visual impairment. The student might not perceive a group if it is at a distance, so they are not even aware of the option of joining an existing group.
Individuals with CVI may miss visual cues that support collaborative learning, such as attention to a new item, transitioning between discussion topics, taking turns, or orienting to the project or play schema. Group work is often based on something that is visually shared, which can be difficult for a student with CVI to access, especially when surrounded by the noise and motion of peers. Then there’s body language that communicates interest (leaning forward), relaxed posture (chilling with friends), leaning on desks (informal conversation). Without full access to people and the environment, group work and social gatherings can trigger anxiety.
I missed social cues, I misinterpreted people’s reactions and I couldn’t always recognise the person that was talking to me… I often found it difficult to process what people were saying, especially if I was in a visually cluttered environment, or if there were too many people involved in the conversation.
Nicola McDowell, “CVI and mental health”
Inclusive CVI supports
- Implement direct instruction in social interaction as part of the Expanded Core Curriculum (ECC).
- Use specific and descriptive language to establish context and facilitate a group learning experience. Allow individuals with CVI to preview the environment (group centers in a classroom, assembly hall, the playground). Talk about the environment and landmarks to support orientation.
- If there are regular group gatherings, assigned seats can be helpful for a child with CVI. For example, use color or tactile markers on the carpet to assign spots for circle time or morning meeting. This will provide predictability and routine for the entire class and help the child with CVI memorize where they sit and who sits next to them, reducing anxiety, frustration, and fatigue.
- Create designated spaces for group work and provide clear instructions (for all grade levels), “Okay Josiah, Kayla, and Autumn go to the green group table next to the bookshelf.” With previewing and memory, the student with CVI can safely navigate and orient to this predictable place in the room.
- When transitioning to group work in the classroom, use clear and concise directions rather than only visual cues (e.g. pointing, arm movements, facial expressions, list of groups on the board). Also, make sure to use descriptors to support access to people. For example, “Carmen, join Zoe, who’s wearing a bright pink shirt today. She’s sitting on the carpet next to the board”; rather than, “Carmen, go sit with Zoe.”
- Learn about how the child with CVI recognizes people and uses these compensatory strategies as strengths to build on.
- For unstructured and unpredictable gatherings (recess, lunchtime, hallway transitions to the next class), build some predictability, like a buddy or friend to join, sitting at the same table in the lunchroom, and previewing schoolyard and salient landmarks to use during recess time.
4. Overly decorated classrooms
In schools, there is this notion that a good learning environment means every inch of the walls and ceilings are covered in decorations, posters, and student work. Somehow we got to a shared understanding that a sparse classroom does not reflect well on the educator. This is simply not true. In the past decade, we’ve seen more research that shows cluttered and overly decorated classrooms “disrupt attention and learning” for most students in the class.
CVI visual behaviors to consider: visual clutter and crowding, visual curiosity, impact of motion, sensory integration, visual attention and recognition, impact of light.
Clutter is CVI’s public enemy number 1!
CVI Scotland
Visual clutter has a big impact on access for many individuals with CVI, disrupting the ability to use vision at all. An overly decorated classroom can mean that the student with CVI cannot use their unique visual and compensatory skills for learning. The visual clutter has already created an overload of visual demand on the CVI brain and now add in the noise and distracting movement and light sources, and the individual with CVI can become fatigued, anxious, stressed, confused, and completely overwhelmed. Locating people or items is near impossible. Even a patterned carpet can make the floor seem like it’s moving. Some individuals with CVI have a drastically reduced visual field in the presence of clutter and cannot control where they are looking. The more visual information a person with CVI needs to process, the more warped and distorted the visual world can appear.
In her blog post, “The war on cluttered classrooms,” Nicola McDowell wrote: “As a teenager, I didn’t have much control over many of the environments that I spent time in, including my classrooms at school. This meant that the majority of my day was spent in an environment that was visually cluttered with pictures, artwork and posters plastered all over the walls, covering the windows and at times, hanging from the ceiling. This clutter, combined with the overload of other sensory information, such as the constant noise, movement and smells of a classroom full of students, meant that I spent the whole school day feeling anxious and on edge.”
Inclusive CVI supports
- Leave some walls blank, allowing for more seating and learning options for a student with CVI.
- Remove unnecessary furniture, equipment, and boxes
- Organize open shelving using single-colored opaque bins.
- Educators should minimize background clutter in the space that they usually stand to speak to the class.
- Use a dark single-colored sheet or table cloth to cover the background or bookshelf, which can help during read-aloud time or morning meetings.
- Create a quiet break time zone for the class. Every student can benefit from a calm space to reset.
- Create predictable places for resources and learning materials so students know where to find and put back things.
- Use single-colored plain carpets.
- Incorporate intentional use of color to support attention to landmarks and details in the classroom.
As always, behavior is communication. The more understanding of CVI, the more we can understand why people with CVI do what they do and fully see their capability. It’s time we reflect on why we uphold certain norms even when it causes anxiety and barriers for people with CVI and many in the disabled community. For all who work with and care for individuals with CVI, what are some ways to implement inclusive norms and expectations? How can we weave these into the fabric of our schools and communities? Let’s get to work!
Explore more!
- The science behind visual fatigue and CVI
- CVI phrases – what NOT to say to someone with CVI – and what is better to say instead from by Dagbjört Andrésdóttir, adult with CVI
- How do you greet a child with CVI? and It’s not you, CVI, it’s me from Start Seeing CVI
- Considerations for CVI & Social Inclusion by Dr. Roman-Lantzy
References:
Dutton, G. & Lueck, A. (2015). Vision and the Brain: Understanding Cerebral Visual Impairment in Children. New York, New York: American Foundation for the Blind Press.
Mindick, N. (2011). Understanding Facial Recognition Difficulties in Children. London: Jessica Kingsley Publishers.
Roman-Lantzy, C. (2019) Cortical Visual Impairment: Advanced Principles. Louisville, KY: APH Press.
