The impact of cerebral visual impairment on scholastic competence tests in grade 1 children

Purpose: Cerebral vision impairment (CVI) refers to a disturbance in visual processing related to damage to the visual areas in the brain and/or visual pathways. It is commonly assumed that CVI underlies functional vision difficulties, affecting the way individuals use their visual skills and abilities to perform daily tasks. Recent research estimated that around 3% of mainstream educated elementary school children have CVI. Experimental research shows that CVI negatively impacts specific learning processes linked to mathematics and reading. This study aimed to clarify how CVI impacts children’s performance at school, in children’s natural educational environment.
Methods: As part of the Luxembourgish school monitoring program, the complete cohort of first graders (N = 5536) participated in three standardized pen and paper competence tests administered by the teacher in their classrooms. The stimuli were visually displayed for the areas of mathematics and early literacy. For listening comprehension, the stimuli were presented via an audio file. The complete cohort also completed questionnaires collecting motivational and background information (gender, home language). Parents further provided information on migration background, socio-economic status and parental education. Next, a representative sample of this cohort (n = 1129) individually participated in a visual competences’ screening led by a team of clinical experts. The screening included a neuro-visual assessment (Evaluation of Visuo-Attentional Abilities battery, including 9 subtests) as well as optometric and orthoptic assessments. Based on the experts’ clinical screening outcome, the sample was split into children with CVI (n = 38), children with optometric and orthoptic diagnoses (n = 201) and children without CVI (n = 890).
Results: The analyses focused on the comparison between typically developing and CVI children. The results from multiple regressions showed that CVI children obtained significantly lower scores than children without CVI for mathematics and early literacy but not for listening comprehension, when controlling for background characteristics (gender, socio-economic status, migration background, parental education, and home language). Listening comprehension was however a significant predictor for mathematics and early literacy for both groups when controlling for background measures. More concretely, the explained variance of these models was higher for CVI children suggesting that they highly depend on auditory compensation strategies to complete written achievement tests.
Conclusions: The prevalence rate for CVI was 3% within the representative sample confirming internationally reported rates. These results confirm the impact of CVI on learning processes in a school related environment and emphasize the need for the implementation of an early systematic identification of children at risk. The results on the use of compensatory auditory strategies stress that these children would benefit from an alternative presentation of their school material, allowing to build on these students’ strengths and provide them with a fairer assessment.