Cognitive vision impairment

Toward the end of the first year, problems in cognitive vision start to become noticeable. If an infant does not recognise family members by their faces but does recognise them by their voices, the infant may have a specific loss of the cell groups responsible for facial recognition or there is a specific lesion in memory. Some infants have no recognition of facial expressions and therefore cannot understand communication with other young children. These two deficits in cognitive visual functions are the socially most important ones and therefore they should be assessed during each ophthalmologic examination.

Of the more than thirty different higher visual activities that could become damaged, the common ones are capability to track a moving object and to perceive motion, to see an object that does not move, or to have different problems of parietal visual functions, eye-hand coordination, orientation in egocentric and allocentric space and eye movements. A clumsy toddler should always be assessed carefully as early as possible. Training of cognitive vision tests can be a part of early intervention therapies so that test situations are familiar and thus possible earlier than without training. During training it becomes obvious which tasks are more difficult than usually at similar age and these functions can be specifically trained. Since training of cognitive functions usually needs to continue until school age or even later, the earlier it is included in the therapies, the better possibilities training has to have an effect on the development of brain functions.

The tests described in the LEA Test System are only a part of cognitive vision tests but can be used earlier than most other tests. Numerous tests that include copying or drawing, finding details in pictures, understanding contents of drawings and photographs etc. need to be analysed for their visibility before they are used in the assessment of visually impaired children. The younger the child with severe vision impairment the more restricted his experiences of the world may be.

Picture perception is an especially difficult area to many visually impaired children. Therefore drawing to the infant and child with high contrast ink and filter pens should be a part of daily play situations. The pictures can be pictures of common objects to clarify the relationship between objects and pictures but also pictures from fairy tales to develop imagination.

Assessment of visual functions for communication is not routinely done before the infant is brought to day care. Since visually impaired children may have problems in seeing visual communication because of poor contrast sensitivity and visual acuity or patchy loss of central visual field or because of cognitive problems in recognition of facial features and/or expressions. Both the quality of the image available to the brain and the use of this information in communication should be evaluated. The personnel in day care needs to get information about the difficulties the child may have in a group of toddlers, problems with noise when auditory channel is the dominant distance sense and special arrangements needed in lighting, in showing pictures and objects to a group of children and how to inform other children and their families about vision impairment.

The clearer the description of vision for communication, the easier it usually is to integrate a toddler in a group of toddlers. However, there are even now day care centres that refuse to adapt their function to meet the needs of impaired children so also the attitudes of the personnel should be discussed in detail. Otherwise a visually impaired toddler may be experienced as a child with 'autistic behaviours' and intellectual disability when his responses differ from those of his sighted peers.