Thursday 3 February 2011


Sometimes a child appears to be regressing in primary school compared to her time in the nursery or reception class. She did better in nursery. What has changed? In the UK each school setting is quite different from the next. Nursery, reception, year one… year six… secondary… sixth form. Every setting has a very different atmosphere and ‘feel’ and the demands of each are quite different. To a child that has suffered brain damage they may not cope so well as the challenges of the curriculum increase in complexity. That is when parents often begin to search their heart and ask whether a setting is really ‘working’ for the child. I have seen children with various conditions very happy and settled in mainstream nurseries and even in the reception class but as soon as they go up the school the frustrations increase especially as the child sees their classmates doing better than they are and they cannot cope with the same complexity of work. So self esteem plummets and the child is unhappy. Sometimes the child manifests behavioural problems which only arise from the child’s frustrations.  Take a case of a child with a combination of difficulties like this – optic nerve damage, periventricular leucomalacia, visual acuity of 6/18 in the left eye and 3/36 in the weak right eye.  In addition there is an inability to recognise people by their faces (prosopagnosia).  Faces and locations are stored in the same part of the brain and it is easier to recognise people when they are in a familiar location. Outside of that location it becomes harder for all of us. Face blindness can be optic nerve hypoplasia. It can be very poor visual acuity but 6/18 is only just over the borderline of visual impairment and should be enough to recognise people. So it is more likely rooted in the left side of the temporal lobe of the cerebral cortex.  That is the place where faces (and their locations) are stored. The diagnosis of this child’s difficulties are summed up in CVI.

Face blindness is not often associated with CVI but where it is some specific strategies should be in place. The child has probably developed some perfectly good strategies of her own to recognise people. But for face blind child it would help to do the following:

Significant people should be clearly identifiable by certain coloured clothes (colours or patterns), easily distinguishable perfumes, sound of voice and tone of voice and also they should frequently and deliberately name the child so that she hears the voice and learns who it is.
This form of positive discrimination is important to a child with these issues.

The excellent Scottish VI website states that CVI is known to cause problems with: -  
  • Reduced clarity of vision
  • Difficulty seeing things when there is a lot to see
  • Getting around
  • Recognising objects
  • Focusing for near objects
  • Fast eye movements
  • Visual field loss

    Wednesday 2 February 2011


    A child with CVI in particular needs a predictable environment and routine. Try to keep your child's environment  as stable as possible. You may have found that it affects them adversely when you move them to somewhere new. If you move a young person out of their familiar place it can be very disconcerting and anxiety levels sometimes run high. I have seen this very thing happen. A young man I work with suffered considerable disruption to his routine, when he was moved into a new class. Virtually immediately he became aggressive and moody. The solution decided by the team around the child was to place him in a small classroom with less challenging peers and adults that he had known for years. He immediately settled back into his comfort zone. Changes to the environment can have a major impact on children with CVI. A child who is  happy at home can become a different person when taken outside into a busy shopping area. It is an unfamiliar location and you cannot control it. The effects on the child are quite significant and  not easy to predict.

    Consider the environment your child spends most of their time in. What is it like? Is it busy, colourful and stimulating? Or is it a place where you have taken on board the advice of the teacher for visual impairment and made some adjustments? What kinds of adjustments are we thinking of? Remember if our goal is to maximise the child’s attention then anything that detracts from that needs to go. What I usually say to parents and teachers is that everything in the environment needs to be thought through. The walls of the home are often covered with pictures and sometimes with patterned wallpaper. Ideally walls should be plain (possibly with blocks of colour to help the child orientate themselves). It should be matt paint so there is no reflection. And so on... Never underestimate the influence of a child's environment and especially a CVI child.