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

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