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Reducing Complexity
Deirdre Galvin-McLaughlin
5/14/2018 10:41 PM
By Deirdre McLaughlin CF-SLP and Kayley McDonald OTD candidate
Have you ever looked at an Eye-Spy book and found yourself overwhelmed by the visual array and colorful objects when searching for the object? What about visually searching for Waldo in a Where’s Waldo book? Those are both examples of visual complexity, which is essentially what a child with CVI faces in environments that are full of colors, pictures, people, noises, and smells, all of which are competing for their attention. Because vision is not the dominant sense, children with CVI tend to rely on their other senses that are stronger and easier to use (hearing, touch, etc.).
There are three main components to complexity - auditory, visual, and positional.
Be aware of keeping the noise/talking down in the room, ensuring that the child is placed in a comfortable and accessible position, and there is not a lot of clutter in the room that is competing for their visual attention.
A useful strategy to adapt the complexity or visual clutter in the environment is by using a dark booth. By positioning the child so the are facing the inside of the dark booth with their body inside (shoulder just inside the booth to eliminate complexity in their peripheral visual fields), it allows for focused visual attention working on AAC and other activities on the iPad to promote visual attention. As children’s vision begins to progress, gradually complexity in the environment can be added in to progress their functional use vision in typical environments without requiring as much support. Be aware that a child with CVI may revert back to lower functioning visual behaviors (ex: looking at lights or staring out bright windows), when they become visually overwhelmed, tired, or are being overloaded by other sensory systems (tactile, auditory, smell, visual).
Another useful AAC adaptation strategy is to use low tech options such as symbols in a fiand be aware of having a field of one or two objects to ensure the child is not experiencing too much visual complexity and can visually attend to the one or two objects. It is important to note that traditional presentations of holding up symbols (objects, symbols) in left and right visual fields is likely not supportive for most children with CVI and it may be better to create a communication system where symbols are presented one at a time and accessed via partner assisted auditory visual scanning. An example of a one symbol communication book at a time is included for reference in Director of Boston Children’s Hospital Augmentative Communication Program John Costello CCC-SLP (refer to page 13 of the pdf). This is another amazing resource for clinicians and is available at the following website: http://www.childrenshospital.org/clinicalservices/Site2016/Documents/cviNorwayhandout.pdf
Modifying Environment: Dark booth - see PDF attached for DIY instructions made by student from Horizon High School.
Visual Behavior,Speech-Language Pathologist,Parent/Family Member,Occupational Therapist,Other,Intervention Strategies
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Statement A
My child doesn't seem to have real control over his body yet.
The only way I know that he wants something is because he fusses or whines when he's unhappy or uncomfortable, and he smiles, makes noises or calms down when he's happy and comfortable. Does this statement describe your child?
Statement B
My child has control over her own behaviors, but she doesn't use them to try to communicate to me.
She doesn't come to me to let me know what she wants, but it's easy for me to figure out, because she tries to do things for herself. She knows what she wants, and her behavior shows me what she wants. If she runs out of something to eat, she will just try to get more, rather than trying to get me to give her more.
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Statement C
My child clearly tries to communicate his needs to me through gestures, sounds or language.
He knows how to get me to do something for him. He uses some of the kinds of behaviors below to communicate:
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- Sounds such as squealing to show you he wants something or fussing when he doesn't want something
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Each question you will see is related to a certain message that your child might be able to express using a variety of behaviors. Read the question and decide whether your child is able to express the message described using any of the listed behaviors. If the answer is YES, then you must also decide whether your child has mastered the use of each behavior or whether it is still at an emerging stage. Check either the mastered or emerging box next to any behaviors your child uses to express the message. Use the following definitions to decide whether a behavior is mastered or emerging
Mastered
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Emerging
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Only does this when prompted or encouraged to do so. Only does this in one or two contexts or with one person.
Tips on Communication Devices
Each question you will see is related to a certain message that your child might be able to express using a variety of behaviors. Read the question and decide whether your child is able to express the message described using any of the listed behaviors. If the answer is YES, then you must also decide whether your child has mastered the use of each behavior or whether it is still at an emerging stage. Check either the mastered or emerging box next to any behaviors your child uses to express the message. Use the following definitions to decide whether a behavior is mastered or emerging