I think we can all agree that being home-bound due to a global crisis like the Coronavirus pandemic is not ideal (to say the least). But, sometimes less-than-ideal circumstances can potentially have a silver lining for some.

In our case, my oldest child no longer needs to be at school by 8am(!), which means I can take my sweet time leading the kids through our morning routine of dressing, combing hair, and brushing teeth. My oldest two children need minimal assistance, so I have found myself better able to focus on these everyday life skills with Rosalie, my daughter that has Cortical Visual Impairment. Prior to our state’s school closures and stay-at-home orders, there was zero morning time to spend choosing outfits and Rosalie wore whatever I laid out the night before.

When I began introducing clothing options, Rosalie (2.5 years old) already knew the names of most colors – but that doesn’t mean you need to wait for this knowledge in order to begin! In fact, clothing could be a fun way to help teach colors (I do this frequently for Rosalie by describing the colors of shirts everyone in our family is wearing each day).

How did I begin?

Any time I present a new object or life skill I first think about the goal because the goal determines how I present the information.

For example, learning about clothing can be presented as a tactile, visual, or auditory activity (and, of course, the next logical step of “dressing” involves motor skills). As a 2-year-old, Rosalie is often learning ALL of these things for the first time whenever she is presented with new information (unlike an older child, who may already have the firsthand knowledge and vocabulary to understand how something looks or feels when given only auditory instruction, for example). All of the senses are important modes of learning, so what do I present first to my child with CVI???

Because I’m working hard to improve Rosalie’s functional vision (and vision motivates and drives her motor skill development), the priority is almost always for me to present visual information first. In order to maximize the use of vision, I provide ample opportunity to explore visually before adding additional information. Practically speaking, this means I present visually before speaking or having her touch. Once she is visually engaged, then I begin using descriptive language (auditory learning) and, while continuing to narrate, explain what something feels like and ask if Rosalie wants to touch it (tactile learning).

In short, I present Rosalie her clothing options as a visual, auditory, and tactile activity (in that order), doing my best to account for any visual latency and/or complexity (two of the 10 characteristics of CVI).

Exact strategies will look different for everyone, so I’ve decided to share not only photos of what it looks like for us right now, but ALSO some general ideas of what I might do for my child in other CVI Phases.

Please note that these are not the only or best strategies for all individuals with CVI; in this space I’m sharing things I have done or would do for MY daughter.

Let’s begin at the start.

In Phase I CVI, the main goal is to get the individual looking. It doesn’t matter WHAT the objects are, so much as whether or not they captivate the child’s visual attention (think light wands, shiny beads, reflective pinwheels, string lights, Mylar balloons, etc.). But as the child starts bridging the gap from Phase I-Phase II, it makes sense to intentionally start using the 10 characteristics of CVI to inform decisions about everyday objects.

In Phase II CVI, the goal is to begin integrating vision with function. In other words, it’s time to start adapting and/or strategically presenting everyday objects (like clothing) in late Phase I to early Phase II.

Someone in late Phase I or early Phase II CVI will likely need many of the common educational strategies associated with early phases of CVI (and complexity will still have a significant impact, requiring multiple adaptive considerations). These strategies may include:

• blocking out visual complexity/distractions with a solid-colored background
• adjusting lighting (natural and artificial) so the individual isn’t distracted by environmental light sources
• using a flashlight to spotlight the article of clothing (drawing visual attention to it)
• utilizing shiny and/or light-up toys or objects to initially grab visual attention (and bring it to the clothing you want to be seen)
• strategically choosing BRIGHT clothing in a preferred color
• presenting in the preferred visual field(s)
• giving plenty of time for visual latency (aka: WAIT for them to look)
• if needed, utilize movement to draw visual attention (i.e. gently shaking the clothing to get them to look)
• reduce or eliminate any auditory (i.e. talking, music) or physical complexity (i.e. if motor delays are present, work on vision in the least physically demanding position)

As functional vision improves, certain supports will gradually become less needed – to the point where an individual may visually attend to the article of clothing without the help of as many of the strategies listed above. However, it will be important to continue addressing the 10 characteristics of CVI that are ongoing concerns for an individual.

Everyone’s timeline and visual skills will be different, but I suspect (I’m not a CVI professional) this ability to look at one piece of bright clothing (without adjusting lighting, the background, etc.) would emerge for most during Phase II CVI.

As the ability to process additional complexity continues to develop, it would be appropriate to start showing pieces of clothing side by side (rather than one at a time).

This is how I present clothing options to my child right now:

• I select 2-3 pairs of pants to present visually
  • after she looks at each, I describe them and ask which she wants
  • she verbally tells me and/or reaches and grabs her choice (I encourage her to grab it, since this is refining her visually-guided reach)
• I select 2-3 shirts to present visually
  • after she looks at each, I describe them and ask which she wants
  • she verbally tells me and/or reaches and grabs her choice
• I present a small basket of hair bows
  • she looks in the basket, reaches for the color she wants, and grabs it
  • if she misses the color she is aiming for OR changes her mind, she drops the one she isn’t interested in and I wait for her to grab another
  • we repeat this process until she definitively tells me which she wants to wear (she has the verbal skills to communicate this, but previously I would know by which one she held onto/didn’t let go of)
• I hand her the bows she has dropped, one at a time, and ask her to put the bow back in the basket (for an added challenge I could: ask her to visually search for the dropped bows, pick them up, and place them in the basket…but “put-ins” are currently a work in progress for Rosalie, so I place it in her hand – which allows her to focus solely on the act of accurately putting it in the basket)

You may notice that some of the strategies I’m using are (generally speaking) appropriate for someone in late Phase II CVI, while others may be better-suited to someone in Phase III CVI. This is because I have been watching my daughter bridge the gap between Phase II-Phase III CVI and am operating from a standpoint of knowing how much visual complexity she can handle with (novel) vision and motor skill activities.

In Phase III CVI, the goal is to continue refining functional vision. While some of the 10 characteristics may appear to have resolved, someone in Phase III will need ongoing adaptations in order to gain visual access to a variety of materials and environments. But, as they refine their functional vision they will keep learning to better operate (visually) with added complexity, even in novel situations.

The ability to visually process, recognize, and interpret everyday objects placed altogether in a crowded basket, bin, or drawer (like how I offer Rosalie her basket of hair bows) presents a high level of visual complexity that – without significant visual adaptations – can be incredibly challenging even for individuals well into Phase III CVI.

Keep in mind, requesting the child to reach and grab the object they want in addition to all that visual complexity makes it even more challenging and complex – so I would not recommend this strategy unless someone has clearly exhibited they can visually function with this kind of “Phase III skill.”

Note: if the presentation is too visually complex you may see task avoidance, inability to pick out a specific object, changing the topic, or visual fatigue (looking away, light gazing, rubbing eyes, a tantrum, etc.).

It’s important to remember that an individual’s CVI Phase, CVI Range Score, and how they function within the 10 characteristics of CVI should inform and guide decisions about all CVI strategies and adaptations. This will allow someone to maximize their visual functioning and progress more quickly than if they are presented with activities that are too easy or too challenging.

What are some strategies you’ve used to promote clothing choices and dressing skills for the kids with CVI in your life? Leave them in the comments for other readers to find below!