The problem with labels

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At the start of each school year, teachers all over the country are receiving class lists with a growing number of children being labelled as having an impairment/disability that greatly impacts on their ability to learn. Labels such as Attention Deficit Hyperactivity Disorder (ADHA), Autism Spectrum Disorder (ASD), Dyslexia, Dyspraxia and Auditory Processing Disorder are becoming so common place, that teachers themselves are expected to not only recognise children with these labels, but to also provide appropriate support for them within the classroom setting. Given the complexities of these conditions, this seems like a tall order, especially when many experts do not always agree on the exact nature and impact of some of these conditions. It therefore, seems crazy and unnecessary to consider throwing yet another label into the mix for these children, who are already at risk of losing their own identity to a handful of labels adults have given them. But what if this new label could actually explain many of the difficulties a child is experiencing and may actually result in the removal of some of the other labels? This is potentially the case for children affected by aspects of Cerebral Visual Impairment (CVI).


CVI is an umbrella term for a number of visual issues related to the brain that affect the way a person sees the world around them. Although CVI has recently been recognised as the most common cause of visual impairment in children in the developed world, the vast continuum of visual difficulties associated with this umbrella term means that many of our children are not being correctly diagnosed. At one end of the CVI continuum, there are children who are functionally blind and don’t appear to be able to “see” the world around them. Fortunately, these children are more likely to receive an overall diagnosis of CVI, as their visual issues are more obvious. However, at the other end of the continuum, are children who may appear to have normal or near normal visual acuity when assessed by an optometrist (meaning that they are able to read to a level on the eye chart that is considered within normal range i.e. 6/6 – 6/12). Despite having normal or near normal visual acuity however, many children are greatly affected by what is commonly referred to as visual perceptual difficulties.


To complicate this impairment even further, our ability to accurately visually process the world around us is achieved unconsciously. Meaning that it is difficult for anyone, including the child themselves or the adults surrounding the child, to recognise that the issues they are having in class is actually related to their vision. Fortunately, however, there are a number of behaviours that children display that are associated with visual perceptual difficulties. These include:

-       avoidance of crowded and cluttered environments, or the increase of negative behaviors when in such places, such as tantrums and crying,

-       are easily distracted,

-       finding it hard to sit still for long periods of time,

-       social withdrawal due to difficulty finding friends in groups of people,

-       avoidance of schoolwork due to:

o   difficulty copying information,

o   difficulty simultaneously processing incoming visual and auditory information,

o   impaired ability to find numbers on a printed page

o   problems locating items, both on their work station and within the wider classroom environment,

o   difficulties with specific school subjects, such as maths and reading,

-       reluctance to move around both familiar and unfamiliar environments due to past embarrassing experiences of walking into objects and people and appearing clumsy,

-       an unwillingness to participate in sporting activities due to issues with depth perception and eye-hand coordination.

Do any of these sound familiar? Where does one label stop and another one start?

The good news is that researchers working in the field of identifying and understanding visual perceptual difficulties in children are starting to understand specific indicators that can help identify children with these types of visual difficulties. These include:

-       darting eye movements when searching for a specific item when it is surrounded by clutter,

-       focusing on only one item at a time instead of taking in the whole visual scene,

-       difficulties with visually guided movement (often inaccurate when reaching for an object),

-       fatigues easily and appears to get frustrated / anxious easily.

Another important aspect of visual perceptual difficulties, is that these issues are made worse when the environment around a person with these difficulties is cluttered. To understand this better, take a look at these videos and explanations of research conducted by The Laboratory for Visual Neuroplasticity, Harvard Medical School. Both the virtual reality Toy Box test and Crowded VR film show how difficult it can be for someone with visual perceptual difficulties to locate a specific item when the area around that item is cluttered. 


But how does this all relate back to those labels that many of our children have been given? When children are diagnosed with certain impairments such as: ADHD, ASD, Dyslexia, Dyspraxia and Auditory Processing Disorder, tools and teaching strategies are implemented in the classroom to help ensure the child has the same opportunities to learn as his or her peers. But if the child has been incorrectly diagnosed with one of those conditions, as a result of the similarities between visual perceptual difficulties and these impairments, or they have visual perceptual difficulties in addition to another impairment, the interventions being used may not be as effective as they could be.


But how do we help children with visual perceptual difficulties, I hear you ask. Given the complexities of the condition, the answer is surprisingly very simple! The first step is to




To help provide an optimal learning environment for not only children with visual perceptual difficulties, but for all children, the first step any teacher needs to take, is to look closely at their classroom environment and get a feel for how cluttered it actually is.


To learn more about this common yet often undiagnosed or misdiagnosed condition, tune in for part two of this blog series on visual perceptual difficulties.


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Nicola McDowell works as a senior tutor in the Institute of Education at Massey University, New Zealand. She is the Coordinator of the Blind and Low Vision endorsement of the joint Massey/Canterbury Specialist Teaching Programme. Nicola is currently undertaking doctoral research in education, focusing on developing an effective framework for supporting children with cerebral visual impairment. Nicola’s research interests include: supporting learners with disabilities (particularly visual impairments) to have equal access and equal opportunities for success within their educational environment. Also, issues related to empowerment of those with disabilities and their whānau / caregivers.

Nicola McDowell