Understanding the CVI visual behaviors

CVI is a brained-based visual impairment caused by injury to the brain’s visual pathways and visual processing centers. It’s usually diagnosed when abnormal visual responses can’t be attributed to eye problems alone.

Individuals with CVI tend to display key visual behaviors, and might display some or all of these behaviors. At Perkins, we synthesize current research and build on the work of leading theorists to ensure all individuals with CVI are fully understood. This is why we follow the science and center voices of individuals with CVI. The CVI visual behaviors are an ongoing need, they can change and improve for some, but the need never goes away.

Your child might display some or all of these tendencies. Knowing these CVI behaviors — and how to respond! — can go a long way toward supporting your child.

Watch an overview of the CVI visual behaviors and how they overlap at any given time and situation, putting up barriers to access.

Here’s a list of visual behaviors of CVI that are commonly evaluated and recognized by major theorists. No area is separated from the other—the CVI visual behaviors are highly connected—and all can impact the individual with CVI at any time. At Perkins, we also evaluate how individuals use their compensatory skills within each visual behavior. As you explore the visual behaviors below, each has a link to learn more.

Visual Attention: This is an assessment of your child’s ability to look and sustain gaze for recognition. For example, your child might focus on only one small area while unable to process or understand other items. We consider her ability to maintain gaze in cluttered and un-adapted environments, as well as her ability to maintain gaze while ill or tired.
Visual Recognition: This is an assessment of your child’s abilities to visually recognize known items or known classes of items. Your child might immediately recognize her favorite toy or cup but might not recognize a similar, unfamiliar toy or cup.
Impact of Clutter/Crowding/Spacing: This is an assessment of the number of objects your child can tolerate in a display. Sometimes spacing items out improves kids’ visual attention and visual recognition. Your child might have trouble with visual clutter — when too many things are in an environment, they might blend together. Or she might be able to identify items in a predictable line presentation but not when items are scattered on a table, because it’s too visually complex.
Visual Field Abilities: This is an assessment of visual field awareness and abilities to recognize materials in all fields. Your child might not respond to items in a particular visual field or she might pay more attention to one side, with a visual deficit in another. Visual fields assessed include their left and right peripheral fields, upper visual field, and lower visual field.
Impact of Color: This is an assessment of how your child reacts to different colors and black and white, how she uses color for visual attention and object recognition, and how she uses it as an overall strategy function. Many kids with CVI are reported to notice one color more than others. We try to see how color helps her understand the world.
Form Accessibility: This is an assessment of the “accessible form.” Think about a common figure, like Donald Duck: Even though it’s a cartoon, we know it’s a duck. A child with CVI might have trouble making that recognition. Your child might see three-dimensional items but have trouble with photos, for example. Or she might see color but struggle with black and white or line drawings.
Visual Guidance of the Upper Limbs: This is an assessment of reaching while maintaining visual attention, reaching accuracy, and looking while exploring an object. Your child might hold something in her hands but can’t look at it simultaneously, or she might gaze off into the distance while playing with an object. Or she might over- or underestimate her reach or reach tentatively.
Visual Guidance of the Lower Limbs: This is an assessment of her ability to step accurately or to place her foot accurately, such as into a shoe or stepping up onto a curb or stool.
Access to People: Your child might have difficulty looking at faces and difficulty with facial recognition. Some kids have trouble interpreting facial expressions. For example, you might smile, and she won’t smile back or look into your eyes. Many parents describe their child looking “through” them or past them.
Impact of Light: This is an assessment of the distraction of light, need for light, light sensitivity, attraction to light, and need for backlighting. Your child might be so impacted by light that it’s just a visual target; other kids benefit from lighted objects for improved visual attention or recognition.
Response Interval: This is an assessment of her degree of delay in visual attention and delay in visual recognition. Your child might take a long time to look at an object and a long time to understand what she’s seeing.
Impact of Motion: This is an assessment of her need for motion to gain visual attention; the distraction of environmental motion; the inability to follow fast-moving items; impaired perception of motion (difficulties understanding the speed, distance or direction of motion of objects); and a phenomenon called blindsight (the ability to avoid objects while moving, without awareness of the obstacle). Your child might need an object to move to know it’s there. Or she might have trouble assessing distance and speed, such as a ball or car coming toward them.
Sensory Integration and Impact on Vision: This is an assessment of the impact of competing sensory input on her vision use. Your child might not be able to listen or feel vibration while busy looking.
Visual Curiosity: Think about going to the grocery store. A child is constantly learning about shapes and objects as she watches mom or dad load up the conveyor belt from her perch in the carriage. A child with CVI might not absorb those incidental life lessons due to their visual impairment. As such, this is an assessment of the accessibility of “incidental learning” for distance materials and events with and without compensatory supports and for all visual fields.
Appearance of the Eyes: This is an assessment of alignment and eye preference. We assess whether both of your child’s eyes are working together. Are their eyes pointed straight when looking at something or does one eye turn in while the other turns out? Does your child favor or use one eye over the other? Does she alternate? This information is often validated by clinical optometry or ophthalmology examinations.
Movement of the Eyes: This is an assessment of ocular (eye-related) motor skills. We look at the way both of your child’s eyes move in different directions: horizontally, vertically, and diagonally. We analyze the child’s shifting of their gaze from one place to another, and how she responds to a moving target.

People with CVI use compensatory skills, or the strategies, techniques, and adapted materials individuals with visual impairments need to access educational curriculum and to navigate the world. Compensatory skills use strengths to overcome areas of challenge, and are often developed naturally. Individuals with CVI use their sensory channels and cognitive processes to figure out the world around them. Their experiences directly impact how these skills are shaped and used. Some CVI compensatory skills include context, auditory cues, verbal cues, tactile cues/exploration, and color coding. Some with CVI use their vision, some use their compensatory skills, and many use both.

It’s so helpful to understand these visual behaviors of CVI because they can affect your child socially, too. Your child might not recognize people, which makes it seem like he’s ignoring them — when, of course, he’s not. He might appear to lack empathy, but it’s just because he can’t recognize and respond to facial expressions. He might seem uptight or sad, because it’s so tough to relax when trying to process visual information. Or he might not automatically defend himself when a ball is thrown toward him.

Parents often know the difficulties their child has, so collaborative assessments help give the CVI context to what parents already deeply understand about their child.

That’s why an accurate diagnosis and CVI support team is so essential. Often, CVI can look like other issues, ranging from autism to ADHD. An accurate CVI diagnosis gets to the heart of the behavior and helps your child acclimate to everyday life.

Earn professional credits (PDP, ACVREP, CTLE, CE) for learning about the CVI visual behaviors. Visit the self-paced tutorial.

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.

Fazzi, E., et al. (2007). Spectrum of Visual Disorders in Children With Cerebral Visual Impairment. Journal of Child Neurology, 22(3), 294–301. https://doi.org/10.1177/08830738070220030801

Philip, S.S. and Dutton, G.N. (2014), Cerebral visual impairment in children: a review. Clin Exp Optom, 97: 196-208. https://doi.org/10.1111/cxo.12155

Roman-Lantzy, C. (2018). Cortical Visual Impairment: An Approach to Assessment and Intervention. 2nd ed., New York, NY: AFB Press.

Zihl, J., & Dutton, G. N. (2015). Cerebral Visual Impairment in Children: Visuoperceptive and visuocognitieve disorders. Wien: Springer.

Children with CVI tend to display key visual behaviors. Understanding how to address the following tendencies can go a long way in supporting your child.

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