Week 3: July 13-19

Webinars and Events Hive Summer Cohort 2025
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Instructions: After viewing the modules for the course Supporting the Assessment Process for Children with CVI, participants are expected to respond to one of the questions posted in a manner that reflects an appropriate level of analysis and engagement in the discussion; applying the knowledge and insights from the readings to practical applications; drawing conclusions based on the content, raising new questions, presenting a counter argument, etc. Each response should include the question number, be stated in complete sentences, and apply the knowledge from the readings and sessions to practical applications.

In addition, each participant is expected to comment on at least two participants’ responses. The responses should be reflective and thoughtful, not simple short answers like “I agree” or “Me too.” A thoughtful response integrates readings, may provide examples, add new information, or present a counter argument.

Assessing 2D image recognition for students with CVI

  1. In what ways do results of the 2D image assessment intersect with data collected for the Functional Vision and Learning Media Assessments?

  2. Analyze how individualization of the 2D image assessment might lead to more accurate conclusions about a student’s needs. What variables (e.g., cultural relevance, personal familiarity, sensory preferences) should be considered?

  3. Considering the role of fatigue, context, and environmental variables, how reliable are single-time assessments like the 2D image assessment in capturing a student’s true visual abilities? What alternative or complementary methods might yield richer information?

Commentary: Profiling Children with Cerebral Visual Impairment (CVI)…

  1. What are the implications of relying on current assessment tools that may not be sensitive to the full spectrum of CVI behaviors?

  2. How effective are current multi-method assessment strategies in capturing the full scope of CVI’s impact on learning and behavior? What would you add or change in these approaches to make improvements?

A Guide for Assessing Cerebral Visual Impairment

  1. Reflect on a student with CVI who showed signs of dorsal or ventral stream dysfunction. How did this impact their participation in classroom or daily activities? What specific challenges did the student experience? How did you adjust instruction or materials to support them?

  2. What are the strengths and limitations of using task-based observation as a primary method for CVI assessment, particularly in comparison to more objective assessments?

  3. Considering the lack of a singular, validated CVI assessment system, how well does this guide balance flexibility with consistency in approach?

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  1. How effective are current multi-method assessment strategies in capturing the full scope of CVI’s impact on learning and behavior? What would you add or change in these approaches to make improvements?

I have been a TVI for 20 plus years. There have been many different approaches to assessment for students with CVI in the time I have been teaching. Assessment has to be so individualized because each student is unique with regards to developmental abilities, academic functioning etc. etc. In my experience, I have used multiple methods to assess students who have CVI. I use an FV/LMA but then incorporate categories that will better reflect the needs of the student I am assessing as appropriate. A multimethod approach for assessment also gives a bigger picture of the child as a whole and how they function in given environments. My methods have evolved as thinking has evolved and is so often the case in our business, there does not seem to be any one tool that just hits every category or is perfect because student’s needs and presentations are so varied. I know I need to learn and understand more about better assessment for students who have CVI – this is one of the reasons I am taking this class. I think the biggest change I would make to any assessment is to keep things as simple and understandable as possible. We get very lost in formal language as we write reports and lose the point of making our document clear and concise. I struggle with this as a professional as well when I am given information.

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Analyze how individualization of the 2D image assessment might lead to more accurate conclusions about a student’s needs. What variables (e.g., cultural relevance, personal familiarity, sensory preferences) should be considered?

Individualizing the 2D image assessment can provide much more accurate information on what a student is able to perceive. Though this can include the materials that are available, it can also include using images that are taken from online and using observations of students in the actual classroom setting.
One of my first students I assessed with these included a combination of materials. In her classroom setting she often had morning seat work while the teacher took care of all the beginning of the day pieces. This often involved worksheets related to letters and numbers students were working on. They sheets were quite cluttered, having 5-6 separate sections all with information pertaining to the lessons of the week. On one worksheet there was a turkey with 5 feathers. Each feather had a line drawing of an item that either began with the letter N or didn’t. Students were to color the feather for the N words. The teacher had reviewed the images with the student first but there was a lot of information for her to retain and toward the end of the feathers, she lost track of what the images were. There was a picture of a nest that she didn’t color. I took this paper with her into a separate room and asked her about this piece. I then asked her what the “nest” picture was and she told me it was a tire. I then said, “What if I told you it was a nest?” Her response, “Then it needs color!” Had we not been assessing for CVI it would have been thought that she didn’t know the concept.
I also have a student who is more nonverbal as he was unable to speak for many years due to a trach but has been working on speaking since it was removed. He cannot verbalize many words and though tries hard he’s not intelligible. We have not yet done the 2D image assessment but when we do, I will use a combination of strategies, including the use of up to 3 images where he is asked to point to a specific one.
I also find exposure and experience are critical to students with CVI. The curriculum uses a lot of images and for our students these may not be accessible and/or they may not fully understand them, which will impact their ability to answer specific questions accurately. An informal assessment of a student’s reading skills required that she read a full passage about a treehouse. This story had images as well that had not been introduced to her. She was able to read very well with this grade level probe and could answer questions with 95% accuracy. The questions she missed pertained to the treehouse itself and she had no experience with this concept so was unable to understand some details.
It’s also important to consider the location these tools are used with a student. In the middle of a classroom it may be very difficult for a student to access the information and provide accurate answers. The flip side of that is it is important to work within the classroom environment as if it does present with visual challenges, this is just as important to document and address.
There are also students who are not academic who require proper access to materials as well. It should not be assumed these students cannot access such information but is also very important to assess as many are often provided with picture symbols for communication. I had one student who can only access objects and picture ID was not an option for her. She had an outside agency evaluate her for communication devices and recommended an iPad with specific 2D options. They didn’t know of her CVI and its impacts and thus the evaluation was not valid.
As Dutton says, “If you met one person with CVI, you met one person with CVI”. This thinking holds true in how we assess each student as well.

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  1. What are the implications of using current assessment tools that may not be sensitive to the full range of CVI behaviors?

CVI is a complex and sometimes overlooked visual impairment - students with CVI may have what appears to be “normal” vision when it comes to the standard eye chart, but they can still struggle to process visual information due to issues like impaired visual attention, crowding, figure-ground, visual complexity, and visual recognition of objects, faces, places and more. If we conduct our assessments to look beyond the basic visual acuity/field loss measures, we can better assure that we don’t misdiagnose or underdiagnose or even contribute to a child being mislabeled. Children run the risk of missing out on support, if CVI is not identified, the child will not get the visual strategies and accommodations they need to access information and learning opportunities.

How effective are current multi-method assessment strategies (history, structured questionnaires, observation, and direct assessment) in capturing the full scope of CVI’s impact on learning and behavior? What would you add or change in these approaches to make improvements?

The current emphasis on using multiple assessment methods (history, interviews with parents and teachers, questionnaires, observation, direct assessment of the child) is an improvement over single-test-only approaches. It is important to understand that with CVI children can appear to have normal vision, especially when very young, when in reality, there are difficulties that become apparent with certain tasks. A multi-method approach can help tease out the CVI patterns that might be evident across different observers and testing situations. For example, a battery that includes parent interview, teacher observations, and structured tasks administered to the child can help identify a pattern of visual responses that might not be as clear in a clinical environment.

Some problems are that there are limited standardized, validated assessment tools. Most of the tools that have been published are either opinion checklists or adaptations from visual impairment tools from other populations. We need more validated CVI-specific assessment batteries.

Assessments should be ongoing, since the child may show certain CVI behaviors at one time, and then as they get older and demands increase in school, those behaviors may change or new ones may appear.Development of more CVI-specific standardized tools that are validated for children with CVI, not just adaptations of general visual impairment scales, would be helpful.

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I agree with the importance of individualizing the images used during 2D image assessments. As you mentioned in the post, when the testing is individualized and we are using images with meaning for the student, we are assessing much more than the ability to match an object to a 2D representation, we are asking the question, “What does this image mean to this student?” When we individualize the testing, we are then getting much more useful and meaningful information about where the students is in his or her understanding of their environment and where they need support. It made me think in evaluations I conduct, are there areas that can be individualized like Cultural relevance and familiarity of images and concepts for the student, their personal familiarity with and life experience with objects and/or scenes, and their sensory and perceptual needs (contrast, color, clutter, tactile, and other 3D options, etc).

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I think your post is right on target, particularly about the idea that there is no “perfect” tool and no two students who present in quite the same way with CVI. I also totally agree that a multi-method assessment approach provides a much more complete picture of the student and his or her CVI. To not use a combination of tools, including the Functional Vision/Learning Media Assessment (FV/LMA) combined with some form of interview, observation, and additional category specific measures would miss far too much information to provide a truly comprehensive assessment. However, as you said, even with multiple measures, there are still significant limitations.
I think the key is what you shared that simplicity and clarity are essential. In the end, any assessment is only as valuable as its ability to inform real world decision making and support.

If I could add or change anything about our current multi-method approaches, I would include more collaborative, interdisciplinary assessment. So often the assessment is completed in parts with vision specialists completing their piece, OTs another, speech another, etc. However, bringing those perspectives together more intentionally (not just in meetings, but also in shared observation and goal setting) can help to see the whole child more clearly.

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The implications of relying on current assessment tools that may not be sensitive to the full spectrum of CVI characteristics include an inaccurate or incomplete picture of the whole child. This incomplete picture of the whole child can lead to the student’s CVI related needs not being addressed which can negatively impact the student’s communication, social emotional development, and academic success. Additionally, not when the whole child is not taken into account it is difficult to build on the child’s strengths, and develop a meaningful plan of action.

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I also believe that incorporating the 2D assessment process will be very valuable for my student’s who have multiple disabilities, and may use an AAC device. It is often difficult to know where a barrier to communication might lie - is it that the child does not have real life experience with the concepts/ideas? Are the icons inaccessible due to manifestations of CVI? I am excited to share this resource with my SLP team.

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I am not a TVI but an O&M specialist- and I can say that I can echo how important collaboration is and that it is through this process that the whole child often comes into focus for me. I am so grateful that the teams I work with often invite me to observation periods of assessment to collaborate. Especially since the area of CVI is new to me and the teams I work with; so it is great to muck through it together as “we” often each provide valuable insight.

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Assessments are challenging for our students with CVI. I too have been in the field for a long time and have seen this area of need evolve into what it currently is. That being said, the assessment piece is still complex and highly individualized. I see students who present in the academic setting with potential characteristics of CVI and who fall into the higher at risk categories yet when I assess with specific tools, there are no issues. This doesn’t mean the concerns initially observed don’t exist, but I’m not sure, at times, what to attribute them to.
I do a lot of observations of students. This too poses problems as the time involved can be enormous. Working for a district I have the flexibility to do what I need to do but I know many cannot put this amount of time in. However, with my caseload numbers, putting the time into such a process takes away from others. I do find, though, that it’s important to give the time needed.
I have not found one tool to be the tool either. I take from different resources and use what I have found works to obtain the information needed.
As you stated, the assessment process is unique to each student so we are constantly adjusting our practices to address this.

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I agree with what you said about problems with assessment tools for students with CVI. In regular education classrooms, so much is standardized and there are direct steps from point A to B. We do not have that in our business and it is frustrating when team members want definitive information and absolutes. We are mainly using tools to reinforce observations we are making - especially with students who have communication issues. I think job experience and keeping our knowledge base as up to date as possible is still the best way we can approach both assessment and service for these students.

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I agree with what you are saying with picture symbols - I have students with a direct CVI diagnosis who have multiple involvements and the team members who do communication assessment and provide communication services for those students use Core boards - often times they are small pictures and they put 5 or more pics on a background. The pics are symbolic and often they are well contrasted and simple - but with even 3-5 the board can become complicated for students with CVI. Team members will consult with me and then they put everything on a black background - but still with the same 5 tiny pictures! I talk about experience and exposure and moving gradually from object, to object picture, to then possibly a picture symbol. In some cases, no matter what I say the pics remain and in my experience with that child, that system does not work because the child may never interpret those pictures visually the way they do objects or maybe even real object pictures and we started at symbolic rather than working toward that. Those that serve that student’s communication needs are trying to build functional vocabulary and I get it, but the student has to be able to interpret those symbols to ever associate them with the communication that is the specified outcome. I think the statement you included at the end is spot on - you really have to approach each individual with CVI uniquely and tailor assessment and service to their unique needs.

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  1. In what ways do results of the 2D image assessment intersect with data collected for the Functional Vision and Learning Media Assessments?

The 2D Image Assessment complements both the Functional Vision Assessment (FVA) and Learning Media Assessment (LMA) by helping determine how well a child with CVI interprets two-dimensional images. This is important because many FVA and LMA tasks use photos or symbols, which may not be visually accessible to the student.

If the 2D Image Assessment shows difficulty with 2D materials, it can explain why a student struggles with picture recognition and help teams choose more appropriate media, like real objects or tactile symbols. It also supports better IEP planning by guiding visual supports and accommodations that match the child’s actual visual needs.

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Thank you for sharing such a well-rounded and insightful perspective. I completely agree that relying solely on standard vision tests can lead to major gaps in identifying and supporting children with CVI. Your point about the risk of mislabeling or missing a diagnosis is so important—especially since many children with CVI do appear to have “normal” vision on basic screenings, yet still struggle profoundly with visual processing in everyday settings.

I also appreciate your discussion of multi-method assessment strategies. Gathering data from multiple sources—especially parents and educators who see the child in different environments—really does help build a more accurate picture of how CVI affects learning and behavior. I agree that we need tools specifically validated for the CVI population, rather than just adapting tools designed for other types of visual impairments.

Your suggestion for ongoing assessment is critical. CVI is not static, and as visual and cognitive demands grow, new challenges can emerge. More CVI-specific, standardized tools—and ongoing professional development to use them well—would go a long way toward improving identification, support, and outcomes for these students. Thanks again for such a meaningful contribution!

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You make such an important point—when assessment tools don’t capture the full spectrum of CVI behaviors, we risk missing key information that affects every part of a child’s development. I completely agree that an incomplete understanding can limit not only the support a student receives but also their opportunities to build confidence and thrive socially, emotionally, and academically.

I also really appreciate how you emphasized the importance of seeing and supporting the whole child. Without a full picture, it becomes so much harder to recognize and build on their strengths. Your words are a great reminder of why we need more comprehensive, CVI-specific tools and ongoing collaboration across teams to truly meet each child’s needs. Thank you for sharing!

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  1. In what ways do results of the 2D image assessment intersect with data collected for the Functional Vision and Learning Media Assessments?

The results of the 2D image assessment provide data to include for the Functional Vision and Learning Media Assessments. The data would add and factor in with other data points taken to determine visual functioning and the most appropriate learning media.

  1. Analyze how individualization of the 2D image assessment might lead to more accurate conclusions about a student’s needs. What variables (e.g., cultural relevance, personal familiarity, sensory preferences) should be considered?

The individualization of the 2D image assessment might lead to more accurate conclusions about a student’s needs because every student with CVI is different. If you’ve met one student with CVI, you’ve met one student with CVI. It is important to consider cultural relevance because some images could be of objects not familiar to students from diverse backgrounds. If the 2D image is of an object unfamiliar to the student due to where they come from, asking them what they see may not yield a useful response. It is also important to consider sensory preferences because some students may be used to accessing materials with their hearing or by touch. Also, some students may have some sensory sensitivities to things such as light, air, or the kind of chair they sit in.

  1. Considering the role of fatigue, context, and environmental variables, how reliable are single-time assessments like the 2D image assessment in capturing a student’s true visual abilities? What alternative or complementary methods might yield richer information?

While the 2D image assessment is a reliable assessment, it should be used as part of the vision/learning media assessment process and not the whole assessment. Testing students with 2D images can be done as part of their daily routine could help to reduce fatigue and help students to put images in a context of daily life. Complementary strategies include teaching visual thinking skills, and using a multisensory approach. These methods would help to yield a better overall individualized analysis of a student.

  1. What are the implications of relying on current assessment tools that may not be sensitive to the full spectrum of CVI behaviors?

The implications of relying on current assessment tools that may not be sensitive to the full spectrum of CVI behaviors are that assessment could be inconclusive, incomplete, and/or inaccurate.

  1. How effective are current multi-method assessment strategies in capturing the full scope of CVI’s impact on learning and behavior? What would you add or change in these approaches to make improvements?

Some of the current multi-method assessment strategies are more effective in capturing the full scope of CVI’s impact on learning and behavior. Perkins has a very inclusive assessment coming about that encompasses 16 behaviors, at least 3 interviews, observations, and checklists. The only change I would make is to not have to put identifying information in their online platform; but you can use a pseudonym.

A Guide for Assessing Cerebral Visual Impairment

  1. Reflect on a student with CVI who showed signs of dorsal or ventral stream dysfunction. How did this impact their participation in classroom or daily activities? What specific challenges did the student experience? How did you adjust instruction or materials to support them?

The student with CVI had some impact on their participation in classroom and daily activities. In terms of dorsal stream deficits, the student needed auditory reminders for where chairs were set up in a classroom. If any changes were made to classroom furniture placement, a verbal warning was necessary. The student needed specific directions on how to navigate in an outdoor space. Sometimes, the student would think all green objects were the same objects, so some instruction in visual thinking strategies was necessary. Many 2D materials had to be made larger and less complex. For instruction, we used as many 3D objects as possible as opposed to 2D images.

In terms of ventral stream deficits, the student would learn to identify one green object and then call other green objects of similar size by the same label. The students’ responses were much more accurate given a high contrast background with low complexity. Distinguishing facial expressions was challenging, so we would teach and encourage distinguishing tone of voice. We also followed the practice of identifying ourselves upon greeting and also telling her which students were in the room and where they were. One staff member didn’t seem to understand this practice as the student ‘could see’. I tried to explain that, yes she can see, but does have low vision and faces and placement of people may not be as apparent to her. This student navigated familiar environments very well. With less familiar environments, she relied on a cane and the use of O and M techniques.

  1. What are the strengths and limitations of using task-based observation as a primary method for CVI assessment, particularly in comparison to more objective assessments?

The strengths of using a task-based assessment are that observation of daily life behavior vs. a 1:1 work time, getting a good overall picture of the students visual functioning, and observation is flexible and good to use as a comparison to an objective assessment. For task-based assessments, detailed observation notes are critical in the data collection process. A more structured 1:1 session still has the value of more concrete data, more flexibility allowing for visual breaks (taking data on how many and how often they appear to be needed), and numerical data.

  1. Considering the lack of a singular, validated CVI assessment system, how well does this guide balance flexibility with consistency in approach?

This guide provides a good framework for data collection during an observation session. Using a guide can help to focus an observation session to specific areas for reference along with providing a form for note taking and analysis. The results should give the observer notes from which to form a formal analysis and review.

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It seems you use many different forms of assessment with your students, which is admirable. Each student with CVI is so unique and different. Multiple assessment allow for increased data collection. The more we know about our students, the more we can give them accessibility to instruction.

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I completely agree. It is important to use multiple means of assessment. It is okay to start with symbols or real-life pictures and then move to objects. Pictures and objects should be of no more than 1-2 colors and of varying sizes as they are presented to students. This assessment is such an important part of the FVA and LMA.

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I really agree with your view on collaboration. I have worked closely with other specialities from the onset of my career, starting out as an early interventionist. I always felt like I needed to know all the answers for our team in the realm of visual abilities for each student when I became the TBVI, but the discussion on curiosity made sense to me and put me more at ease; permitting me to continally use ongoing evaluation as a remarkable and valuable assest to apprpropriate programming

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Question #4: What are the implications of relying on current assessment tools that may not be sensitive to the full spectrum of CVI behaviors?

According to Lueck, Shokron, and Dutton (2023), relying on current assessment tools that may not be sensitive to the full spectrum of CVI behaviors means that (1) “many children with CVI of all ages…remain undiagnosed, underdiagnosed, or even misdiagnosed” (p. 2) which may cause long term consequences in multiple domains of function like “preacademic, academic, or those related to mobility, or social skills, or overall mental health” (p. 2).

While this knowledge can be terrifying as a parent, educator or even the child themselves (depending on understanding of the situation), that the current assessment strategies do not often capture the full scope of the CVI looks like and how it affects student lives. However, the article recommends targeted screening for at-risk children and early rehabilitation interventions which could significantly and positively impact students. It brings hope that each student, regardless of how CVI manifests, can get supports individualized to their own specific needs in preference, culture, interests, cognitive abilities, and activity levels.
SMG

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