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


    1. hi,,,, any suggestions to help with social isolation , this is becoming more of an issue with my little one who has this diagnosis... relating to her peers is getting increasingly difficult i am informed by the school ,,, and adult company is all she seeks out...

    2. In-class support is a two edged sword. It can provide the help the child needs but it frequently isolates the child. Inclusion in mainstream needs to be managed properly. A child that is constantly being taken outside to have one to one work never has the chance to build peer friendships. A child also gets dependent on the adult and never learns to do things for him/herself. I suggest gradually moving away the support at appropriate times during the day when the child can manage it. Support needs to be a safety net to catch the child not a bubble to surround the child. Try to get your child into some extra curricular clubs where there is no adult support and the child can mix with peers on a social basis without academic pressures.

    3. In the mainstream class my little one with p.v.l. is realy struggling with noise... she cant concentrate and every noise not just in her classroom but she can hear the nursery class next door. distracts her ... any suggestions.... a work booth was tried with her... but didnt help because of the noise... she is now taken out to the staff room...are there any aids for this????

    4. Children need a carefully controlled work environment. As distractibility and short attention span are major causes of difficulty, teachers and parents need to look at providing a work area that is as distraction free as possible. At school this means careful positioning in class. A place to sit where there is little passing ‘people traffic’ and a limited field of vision helps children to stay on task. At the front near the teacher’s desk is not an ideal position. At home, children need to be away from the television, siblings, and ‘kitchen clatter’. A spot in their bedroom (not near a window or door) facing a blank wall can be a start to improve concentration. Noise level in the working environment is important. CVI Children have difficulty tuning out background noises. It is difficult at home or in school to provide the degree of quiet needed. This calls for some innovative solutions such as earplugs or headsets to reduce external noise. In the long term some acoustic treatment of the walls can be a partial solution. Wall surfaces that absorb sound rather than reflect sound would be preferable.

    5. my daughter with p.v.l. has been diagnosed with dyslexia.. lower field loss , along with loss of vision in one eye... the school and other agencies brought in to help have been having her attempt to learn single letters .. and one using keyboard with sound for single letters even though we have been told that phoniics isnt an option,,,, do you have any ideas on how she can achieve literacy , are there any teaching strategies that will help her ???

    6. Hello,

      I am a specialist in Autism and work in outreach alongside Maurice. I would recommend that your daughter works with concrete objects. This may be objects related to a story, including objects that engage the senses to develop her understanding of these concepts.

      In terms of phonics, I would use concrete objects again, cut out letters with items that relate to the same letter. This can be put in bags, Such as P bag F bag. She can then learn letters and the sound of letters through a range of mediums. This will help with concept reinforcement.
      I hope this helps.

    7. thank you lyndsey... much appreciated... after an assessment we had we where told that the whole word way was probably the way to go... do you have any strategies for this... ??? she does recognise the E for her name but after this couldnt distinguish ... also she can... on her bookmarked programmes find her cebeebies , nick junior... disney .. can suss out macdonalds from a moving car... it seems to be symbolism??? once she knows these .. can also order her you tube bookmarks depending on thier possition???

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