Attention and Neglect

Of vital importance is this notion of attention and its opposite, what might be called ‘neglect’. Attention is a key aspect to a child’s learning and to his proper functioning in the visual world. The ability to give full attention is essential in all areas of daily life, whether it be social relationships, academic learning or even play and exploration. Teachers can tell if a child is receiving information by the child’s body language. The movements of the eyes especially give away so much about a child’s focus of attention. Wandering eyes suggest a wandering attention; still eyes looking forward on a target indicate a focused attention. A child with CVI does not generally have typical eye movements and from this fact alone it can be inferred that their attentional system is not functioning properly.

Attention and neglect are tied up with the brain's ability to integrate sensory information and handle several sensory inputs at once. A typical child with CVI does not have the ability to handle multiple streams of information simultaneously. They will typically attend to one thing/input and neglect the others. Put another way they do not dual process: they are unable to handle sensory inputs from more than one sense at a time. It is not in point of fact easy for humans to dual-process. There comes a point for all of us when there is a ‘sensory overload’ if the environment is too noisy and there are multitudes of people milling around and numerous activities taking place at one and the same time. Developmentally it is only around four and a half years of age that a child starts to be able to ‘dual-process’. As a child develops their ability to handle more than one source of information at once gradually increases. I suspect that the attentional system learns to switch focus between different inputs so quickly that it is almost like a simultaneous processing, rather like learning to drive a car. When a person first takes driving lessons each action or sequence is carefully enacted as a separate motion. But after a period of time the sequences are integrated and performed almost as one complete action. The same thing applies to playing an instrument such as the piano or the guitar. Your body has the ability to learn sequences of actions and embed them in the memory so that such actions and sequences become ‘automatic’. When experiencing two or three individual sensory inputs at once the same principle should also apply. Receiving sensory information must be essentially sorted in a sequential manner but by learning, the sequences become embedded through familiarity and repetition and knitted or integrated together. Thus listening to and looking at an adult can be performed at once and the information integrated by the parietal lobes and other parts of the brain concerned.

What is the implication of this for parents, teachers and therapists? It means that a child with CVI will experience severe difficulties when presented with a complex pattern or scene, either in a book, or in a room. They will find it difficult to distinguish toys on their tray if presented together and at once. Choosing will be difficult as it demands the skill of being able to see and distinguish between several objects. Focusing on a task will be demanding in an environment which is busy with numerous sounds and images. A television on in the background or interruptions such as a door opening or sudden noises will place heavier demands on the attention of a child with CVI.

Those working with the CVI child will therefore need to think carefully about the environment, about the number of and nature of toys the child is given. Modifications to the child’s immediate environment will not be wasted and will help the child to keep his attention on the task at hand.

Please feel free to post your comments and agree or disagree with me or share your experiences. This will benefit others.