it may be a language issue, or, as is often the case for child with CVI and CCN, it could be both. Therein lies the complexity for professionals – vision and language are intimately interconnect- ed. Vision and language are perhaps most significantly intercon- nected for children and youth with CCN who are provided with AAC supports that privilege vision such as pictographic symbols or sign language. In order to provide the best access to com- munication and language development for these children, it is necessary to untangle the complexity of vision and language. This untangling will require professionals to step outside of our silos and work together in order to tease this relationship apart. WHO ARE WE TALKING ABOUT? The population of children who may benefit AAC to sup- port communication and language development is commonly referred to as having CCN (Buekelman & Light, 2020; Light & McNaughton, 2011; Loncke, 2014). These children are “unable to communicate effectively using speech alone. They and their communication partners may benefit from using AAC methods, either temporarily or permanently. Hearing limitation is not the primary cause of complex communication need.” (Perry et al., 2004, p. 261) The “etiologies associated with CVI and CCN in children are often the same” (Blackstone & Roman, 2019, p. 65). While not all children with CCN also have CVI or vice versa, AAC profes- sionals have long recognized that many children with CCN have problems with their vision. As many as 48 to 75% of children and adults with developmental delays and cerebral palsy and 75 to 90% of children with severe and profound cognitive dis- abilities demonstrate significant visual problems (Blackstone & Roman-Lantzy, 2018). According to Dutton & Bauer (2019) “40% of the brain serves vision, it is therefore highly likely that children with cerebral palsy and other major developmental dysfunctions, may have additional hidden visual difficulties” (p. 66). These vision difficulties may remain hidden “because affect- ed children cannot describe them, or because the evident mo- tor impairments have taken precedence. The default condition for all such children needs to be that they may have CVI, until proved otherwise, rather than the other way around” (Dutton & Bauer, 2019). WHO ARE CHILDREN WITH CVI/VISION NEEDS? Any child who is not using their vision typically isn’t seeing typically - this can have major implications for their literacy and language development! In the February/March article of this series, Wagner, Hanser and Musselwhite defined CVI as a “neurological disorder which impacts the processing of visual information in the brain” (2020). To date, the articles of this series have used the term CVI in a broad sense, and have depended primarily on outcomes of the CVI Range Assessment to help the reader choose visually appro- priate emergent literacy strategies.
Image 1: A man walking a goat on a leash.
WHAT’S THE CHALLENGE? The following short story provides as an example of the kinds of challenges people with CCN and CVI may encounter with the complexity of vision and language. It also highlights the fact that professionals may also struggle with these issues. As indicated in previous articles, Tietjen (2019) suggests that the primary and most persistent educational impact of CVI of- ten revolves around visual complexity. To illustrate this Tietjen, in his What’s the Complexity Framework Course (2018) presents an image, similar to the one below, of a man walking a goat on a leash (Image 1). The authors used this example when mentoring a speech lan- guage pathologist (SLP) who was working to support a young boy with CCN and CVI. What occurred was a unique opportunity to see and hear firsthand how tightly vision and language are in- terwoven, and how one’s professional lens may impact one’s in- terpretation of the child’s challenge of vision, language or both. The TVI was explaining the issue of visual complexity and the impact that CVI may have on a child’s ability to correctly interpret visual information by sharing the goat on a leash image. The TVIs version of why a child with CVI might incorrectly say that the ani- mal on the leash was a “dog” was due to their vision – they couldn’t visually discern that the animal on the leash was a goat and there- fore would go to their more general assumption that an animal on a leash would be a dog and therefore label it as such. The SLP to whom this issue of visual complexity was being ex- plained replied, “Well if I had a child label that animal as a ‘dog’ I would have assumed it was because they didn’t have the word “goat” in their lexicon ( vocabulary ) – that is: they didn’t know what a ‘goat’ was and therefore called it a dog.” Of course, both of those interpretations of the child’s labeling of the goat as a dog could be correct. It may be a vision issue or
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