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Brandon Observation Transcript

Sara:
Now we'll look at video clips of Brandon in his classroom environment participating in regular routines. We tried not to interfere so that this would be a good example of a normal day, even though, unavoidably, our presence was sometimes distracting to Brandon. We recorded our interpretations about visual behaviors on the part of the data collection sheet called "Observation Information."

In the first clip Brandon is playing the keyboard and looking at the overhead lights. There is a small amount of environmental noise and some noise that he is making with the keyboard. Let's watch the clip.

[video clip 1]

Sara:
We marked this in the row called "Complexity" because Brandon does not look at what he is doing/touching at this time, and in the row called "Light" since he is gazing at a light.

Lynne:
In the second clip, Brandon's teacher is engaging him in a familiar, enjoyable routine with a yellow whoopee cushion. The cushion is placed in the periphery on Brandon's left side, which is the side Brandon reportedly uses for viewing, and he seems to look at it, though he is very surprised when the cushion makes a noise. There is also the tactile input that it gives him. All this interrupts his viewing and he immediately looks away. He may have needed more time to look so that he could process the whoopee cushion visually. He did seem to look at it again briefly right before he added keyboard noises to the game. Yellow doesn't appear to be the best visual anchor for him in this instance.

[video clip 2]

>>Brandon: Mmmmmmmm... [startles at sound of whoopee cushion]

>>Teacher: Oh my goodness, I'm sorry, I totally...[begins to squeeze whoopee cushion rhythmically]

>>Brandon: [begins to vocalize in response to whoopee noises, then plays keyboard rhythmically.]

[laughter]

Lynne:
This clip gave us a lot of information, which we marked in the rows called "Color," "Visual Latency," and "Complexity."

In clip 3, Brandon is doing something very motorically difficult, which is walking in the hallway with his walker. This is a familiar routine surrounding a favored item, a blue button that Brandon likes to push. He is motivated to do the hard work of walking for it. Brandon's teacher is playing a silly game with him by giving him the auditory input, but as an experiment we asked her to nix the game for a bit to see if Brandon was able to look more. We see that he uses his vision more frequently when verbal play is not competing. During the play he looks up one time in 12 seconds, but during the silence he looks up three times in 16 seconds. During the silence, he also says, "Hi" to the teacher who is walking backwards in front of him, who is about 3 feet away.

[video clip 3]

>> Teacher: Left, left, left right left. Uh-oh, we're gonna scrape up against the wall unless we change course.

>>Brandon: Hi.

Lynne:
We marked the information from clip 3 in the rows "Complexity" and "Distance."

Sara:
In clip 4, we see Brandon at the button with his right side near it so that he can reach it, since he uses his right hand much more than his left. His teacher uses hand-under-hand guidance to support his hand use. She also provides him with physical support so that he can focus on moving his body and not worry about falling. Brandon has to turn his head to locate the familiar blue button using his left eye, which he does several times before he can act on the button. All this requires a great deal of motor planning and serves as competing tactile input. Again we see Brandon's looking behavior increase when the teacher pauses in her verbal play. The visual background is very plain: The wall is plain and off-white and the button stands out from the background.

[video clip 4]

>>Brandon: Button?

>>Teacher: Yes that's where we are: we're at the button and all you gotta do is reach out. You're totally gonna find it. I got you. I got you. You are not going to fall. You're gonna reach. Hey. There you go. Let's get you started a little. Ohhhh: it's exciting!

Sara:
We marked the information from this clip in "Color," "Visual Latency," "Field Preferences," and "Visual Novelty."

In clip 5, Brandon is able to fixate on the blue button for some time, even while the teacher is talking and even when he is reaching out to touch and push the button. When the button activates the door it makes a sound and gives the tactile input of the wind blowing in from outside, and Brandon looks away.

[video clip 5]

>>Teacher: Oh, want you to use that hand. Nice job, go ahead and push that button. Push push push. Give it a push. Nice! Oh, feel that cold air!

Sara:
We marked this information in "Field Preferences," "Complexity," "Visual Novelty," and "Visually Guided Reach."

 

Brandon Parent Interview transcript

Transcript

Lynne:
We asked Brandon's team of educators and his foster family to give us information regarding Brandon's visual behaviors. At that time, Brandon's foster family did not know him nearly as well, so they were unsure of how to answer some of the questions. They did not have a great deal of familiarity with CVI and its characteristics. We will skip over questions that do not contain any data for our data collection sheet unless they bring up interesting questions regarding visual behaviors. We recorded our remarks on the part of the data collection sheet marked "Interview Information." You can look at the parent interview guide on page 41 Appendix 4.A in Roman's book to help you interpret what the questions are getting at.

Sara:
Question 1 asks what to do to get Brandon interested in something. His family says to put the item in his hand to hold, which places no demands on vision, but his classroom staff says that among other things, they shake it, or put it on a light box and move it. So on the interview data collection sheet, we made a note of that in the "need for movement" and in the "light" rows.

Question 2 asks about knowing how Brandon sees something. Answers include head orientation toward the object and a slow reach, usually with a light box or with art. Since we don't know the visual qualities of the art, we can only mark this one in the row for "light" in that he orients his head towards the light box.

Question 3 asks about Brandon having a favorite side or head position. His family said his right side is his favorite side. We observed that too, in that he uses the right side of his body and his right hand more frequently. We may suspect that Brandon would prefer his right eye as well, but we know that he has retinal detachment in the right eye. His classroom staff were more tuned-in to vision-related behaviors, and they noticed that he uses his left side for viewing, and they also said his head was "slumped". This might mean that he has an upper field preference. At any rate, he definitely has a left field preference, which we marked in the row labeled "Field preferences".

Question 4 asked about searching for objects visually vs. tactually, and it was noted that he prefers finding things by touching and does not "usually" find them by looking alone. That would lead us to wonder what the environment is like on those rare occasions when he is able to find things visually.

Sara:
Question 6 asks about fields: where do you hold things when presenting visually. The answer also alludes to distance viewing. School staff reported "center, to left side within 1 foot range" which we recorded in the row called "Field Preferences" as "center left" and in the row called "Distance Viewing" as "within 1 foot".

Question 8 asks about what doctors have said about Brandon's vision. The family's answer is telling: totally blind, "but I don't think so." That means that they do see visual behaviors at home.

Lynne:
Question 9 asks about when Brandon likes to look at things. School staff said he will look at things that are on the light board and will look when he hears sounds, which seems to mean he alerts to sounds by turning his head. We recorded this response in the row called "Light".

Question 10 asks about what colors Brandon prefers to look at. Instructional staff said "maybe red". We recorded the response in the row called "Color."

Sara:
Question 12 asks about Brandon's response to ceiling fans and lights. His family noticed that he looks up towards these things. We recorded this information in the row called "Need for Movement" and in the row called "Light".

Question 13 asks about what Brandon does when he's looking at something, or how he positions his head. The school staff answered that he puts his face on things, which we recorded in the row called "Distance."

Lynne:
Question 14 asks whether Brandon notices things that move faster than he notices things that don't move. His family said he notices things that move. We recorded that answer in the row called "Need for Movement".

Question 16 asks again about color preference. School staff again tentatively said "red" which we recorded in the row called "Color".

Sara:
Question 18 asks about Brandon's head position while reaching. His family said "straight". We recorded this information in "Field Preferences" and in "Visually Guided Reach."

Question 19 asks about what Brandon does in response to new things. School staff said he reaches out to touch them. We recorded that response in the row called "Visual Novelty" and in the row called "Visually Guided Reach."

Question 20 asks about positioning Brandon (or items) so that he can see them best. School staff said left side positioning and light as helpers, so we recorded their response in the row called "Field Preferences" and in the row called "Light."

Brandon Parent Interview Transcript

  • Documents
  • Videos
    • Introduction to Case Studies

      In this video, you are invited to participate in the assessment of each student.  You will need to use a data collect sheet (one is included on this website for your convenience) as well as blank copies of the assessment from Christine Roman-Lantzy’s Cortical Visual Impairment: An Approach to Assessment and Intervention.  You will use these documents for information as well as to write down your notes as you follow along in the assessment of each student.

    • Brandon (Phase 1)

      In this video, you are introduced to Brandon.

      • Brandon Interview 

        Lynne and Sara analyze the information from the completed parent interview and transfer it to Brandon’s data collection sheet.

      • Brandon Observation

        Lynne and Sara analyze the videos of Brandon’s everyday routines, as well as some environments we slightly modified to give more information about his vision.  We observed him in his living quarters, in his classroom, and walking in a quiet hallway.  We noticed that Brandon is extremely distracted by (and loves) social interaction. As the video is reviewed, data gleaned from it is recorded on the data collection sheet.

      • Brandon Direct Assessment

        Lynne and Sara analyze video from three different direct assessment sessions.  During each assessment session, the environment required a great deal of modification in order to elicit visual responses.  Information gathered from the direct assessment is recorded on Brandon’s data collection sheet.

      • Brandon Finding the CVI Range

        Lynne and Sara transfer the information on the data collection sheet to the CVI Range.  The Rating 1 Scoring guide was used to help synthesize the data and help complete Rating 1.  Rating 2 was was completed as well to find the CVI Range.

      • Brandon Filling Out the CVI Resolution Chart

        The CVI Resolution Chart can be a quick reference guide to use when developing the IEP to accommodate and support a student's current visual functioning.  Using Rating 2 for reference, the CVI Resolution Chart was filled out following the directions given on the bottom of the chart.

      • Brandon Present Level of Visual Functioning and Adaptations

        The Ratings in the CVI Range have uses that may be important to teachers of the visually impaired or others who are considering CVI assessment results and how they affect educational programming. Rating I can be used to determine present levels of visual functioning and Rating II can be used to determine modifications or adaptations for the Individual Education Plan. These two sets of information are important when writing a functional vision evaluation and learning media assessment, and can make up the bulk of the CVI narrative, if done separately.  In this video, Lynne and Sara show how that information can be used for planning Brandon’s IEP.

    • Cassie (Phase 2)

      In this video, you are introduced to Cassie.

      • Cassie  Interview

        Lynne and Sara analyze the information from the completed parent interview and transfer it to Cassie’s data collection sheet.

      • Cassie Observation

        Lynne and Sara analyze the videos of Cassie’s everyday routines, as well as some free play.  We observed Cassie indoors in her classroom, walking outside, and in the cafeteria.  Cassie enjoyed physically manipulating objects in her environment to make things happen.  She was also able to communicate several types of requests to adults using verbal approximations and gained attention using touch or her voice.  As the video is reviewed, data gleaned from it is recorded on the data collection sheet.

      • Cassie Direct Assessment

        Lynne and Sara analyze video taken during one direct assessment session. Cassie was taken from the active classroom to a setting with less competing environmental and visual complexity than the classroom.  Information gathered from the direct assessment is recorded on Cassie’s data collection sheet.

      • Cassie Finding the CVI Range

        Lynne and Sara transfer the information on the data collection sheet to the CVI Range.  The Rating I Scoring guide was used to help synthesize the data and help complete Rating I.  Rating II was was completed as well to find the CVI Range.

      • Cassie Filling Out the CVI Resolution Chart

        The CVI Resolution Chart can be a quick reference guide to use when developing the IEP to accommodate and support a student's current visual functioning.  Using Rating II for reference, the CVI Resolution Chart was filled out following the directions given on the bottom of the chart.

      • Cassie Present Level of Visual Functioning and Adaptations

        The Ratings in the CVI Range have uses that may be important to teachers of the visually impaired or others who are considering CVI assessment results and how they affect educational programming. Rating I can be used to determine present levels of visual functioning and Rating II can be used to determine modifications or adaptations for the Individual Education Plan. These two sets of information are important when writing a functional vision evaluation and learning media assessment, and can make up the bulk of the CVI narrative, if done separately.  In this video, Lynne and Sara show how that information can be used for planning Cassie’s IEP.

    • Ian (Phase 3)

      In this video, you are introduced to Ian.

      • Ian Interview

        Lynne and Sara analyze the information from the completed parent interview and transfer it to Ian’s data collection sheet.

      • Ian Observation

        Lynne and Sara analyze the videos of Ian’s trip to a local grocery store.  We observed him walking outside, in the van, and in the store.  Ian maneuvers through various sections of the store and then makes a purchase. As the video is reviewed, data gleaned from it is recorded on the data collection sheet.

      • Ian Direct Assessment

        Lynne and Sara analyze video from several different environments over the course of two testing sessions. Ian was taken from the active classroom to a setting with less competing environmental and visual complexity than the classroom.  Information gathered from the direct assessment is recorded on Ian’s data collection sheet.

      • Ian Finding the CVI Range

        Lynne and Sara transfer the information on the data collection sheet to the CVI Range.  The Rating I Scoring guide was used to help synthesize the data and help complete Rating I.  Rating II was was completed as well to find the CVI Range.

      • Ian Filling Out the CVI Resolution Chart

        The CVI Resolution Chart can be a quick reference guide to use when developing the IEP to accommodate and support a student's current visual functioning.  Using Rating II for reference, the CVI Resolution Chart was filled out following the directions given on the bottom of the chart.

      • Ian Present Level of Visual Functioning and Adaptations

        The Ratings in the CVI Range have uses that may be important to teachers of the visually impaired or others who are considering CVI assessment results and how they affect educational programming. Rating I can be used to determine present levels of visual functioning and Rating II can be used to determine modifications or adaptations for the Individual Education Plan. These two sets of information are important when writing a functional vision evaluation and learning media assessment, and can make up the bulk of the CVI narrative, if done separately.  In this video, Lynne and Sara show how that information can be used for planning Ian’s IEP.



Sara:
The Ratings in the CVI Range have uses that may be important to teachers of the visually impaired or others who are considering CVI assessment results and how they affect educational programming. Rating I can be used to determine present levels of visual functioning and Rating II can be used to determine modifications or adaptations for the Individual Education Plan. These two sets of information are important when writing a functional vision evaluation and learning media assessment, and can make up the bulk of the CVI narrative, if done separately.

Lynne:
The plus statements in Rating I of the CVI Range can be used to determine present levels of visual functioning: we also used the more specific description provided in the CVI Range Scoring Guide under the plus column. For Cassie, these are the plus statements:

"Less attracted to lights: can be redirected." Cassie "may stare at lights, but is able to shift attention from lights when appropriate visual targets are presented in controlled environments."

"Blinks in response to touch and/or visual threat, but the responses may be latent and/or inconsistent." Cassie "blinks to touch at (the) bridge of the nose and..to the quick movement of a target toward the face, but the responses may be delayed..."

Sara:
"Shows strong visual field preferences." Cassie "glances toward or has eye to object contact with targets when presented in specific positions of [her]...central viewing fields."

She "may notice moving objects at 2 to 3 feet." Cassie "glances toward or has eye-to-object contact with objects that move in space or are made of shiny or reflective materials and are at distances up to three feet."

"Visual attention now extends beyond near space, up to 4 to 6 feet." Cassie can "visually locate or fixate on certain objects" (that have movement qualities) "at distances as far as 6 feet away." And Cassie's "ability to detect objects or movement at 4 to 6 feet may depend on the degree of environmental complexity."

Lynne:
"May regard familiar faces when voice does not compete." Cassie definitely "glances at or looks directly into faces of familiar people, but only when the familiar person is not speaking."

"Selection of toys or objects is less restricted; requires one to two sessions of "warm up"

The numbers on Rating II, or the highlighted areas of the CVI Resolution Chart, can be used as a helpful guide for describing appropriate modifications for your student.

Number one. Cassie did not have a color preference, but did seem drawn to stripes. Items that are striped may draw her visual interest, and stripes should be considered when choosing toys or objects for Cassie. Multicolored stripes may be a little complex for Cassie. Stick to two to three colors maximum for now.

Sara:
Number two. Move an item or move something near an item to activate Cassie's visual attention, particularly against complex backgrounds. When giving Cassie an object prompt within routines, tap or wiggle the item if she does not initially respond. This can be useful within 2-3 feet, which is the usual working distance in interactive routines, and may also be helpful in situations where she is up to or slightly beyond 10 feet away, such as while traveling indoors.

Number three. Provide frequent breaks when asking Cassie to engage in a lot of visual behavior. Cassie's visual behaviors decrease after about ten to fifteen minutes in non-complex environments after she is asked to do visual tasks continuously. Cassie may not be able to use her vision yet in unfamiliar, environmentally complex situations or when she is upset or feeling poorly. Whenever Cassie's nystagmus is engaged, this will also increase potential for visual fatigue.

Lynne:
Number four. Continue to present objects within Cassie's best visual field, which is her lower central field. Items that she may encounter in her peripheral fields, such as landmarks for frequented locations, can be highlighted with material that is reflective or shiny to best be seen. Even though Cassie's best visual field is her lower central field, she tends to walk with her head up and back. It may be helpful to add shiny or reflective materials to items that are close to or on the ground if she seems to trip over them frequently. Cassie should be encouraged to use a cane and/or a human guide when traveling outdoors.

Sara:
Number five. Cassie is able to use her vision in familiar environments, such as the cafeteria, with quite a lot of noise. New environments with a lot of competing information like noise, lots of stuff to look at, or with tactile input, may make looking difficult. When visiting new places, consider how to decrease some of the complexity to encourage more looking, such as going to the location when it is less busy and noisy. When Cassie is looking into a person's face, that person should resist the urge to begin talking to her to try to increase the amount of time she is able to look at faces. Cassie may not yet be able to see pictures, but she did show some interest in them. If staff were to pair simple, high contrast, pictures of single colored objects that currently represent activities, she may begin to look at them. The shiny qualities of laminated pictures may detract from the content of the picture. It would not be advisable for Cassie to depend on pictures for communication at this point.

Lynne:
Number six. Light does not seem to distract Cassie from tasks at hand. It may be used, however, to draw visual attention, such as using a window as a location landmark or lighting up an area in the classroom or at home to help Cassie find it. It also may help to shine a light on an object to help bring Cassie's visual attention to it. Cassie has some sensitivity to light, so bright lights should be avoided. Wearing a sun visor or sunglasses should be encouraged when traveling outdoors.

Sara:
Number seven. Cassie is able to see objects that have movement properties beyond 10 feet. This is another good reason to accommodate visual landmarks by affixing materials to them that have reflective properties. When directing Cassie to something that is far away or a person who is beyond 10 feet, that person may move his or herself or an object to help Cassie visually locate the target.

Number eight. Cassie was able to detect all novel items, but did not examine them. Familiar items within routines that have appropriate color and complexity requirements should continue to be used: this will encourage sustained visual attention. On occasion, a new item can be added to a routine or an old item can be replaced with something that looks different but serves the same function.

Lynne:
Number nine. Continue to encourage Cassie to interact with her environment using functional routines. Cassie may need space between objects, such as when making a choice, in order to find the item and correctly communicate what she wants. Items should be arranged horizontally, since Cassie seemed to occasionally overreach or underreach, and they should be presented within her best field. It may be that only two to three items will fit if there is space between them. Presenting choices on a plain background that contrasts well with the choice symbols may also assist in her ability to correctly reach toward the item she wants. These considerations should also be applied to functional routines in which Cassie is acting upon objects. If there are many items in a functional routine, items should be well spaced and it may help to highlight objects that are more toward the edges of Cassie's best visual field with shiny or reflective material.

Lynne:
The CVI Resolution Chart can be a quick reference guide to use when developing the IEP to accommodate and support a student's current visual functioning. Following the directions at the bottom of the page, we will draw an "X" through boxes that represent resolved visual behaviors, use a highlighter to outline boxes describing current visual functioning, and draw a circle in boxes that describe visual skills that may never resolve due to coexisting ocular conditions. The highlighted boxes correspond with the scores given on Rating II.

Sara:
For Cassie's CVI Resolution Chart, in the first row, color, we put an "X" in the first box, "Objects viewed are generally a single color," because Cassie looks at things that have more than one color. We put an "X" in the second box, "Has 'favorite' color," because she did not seem to show a color preference. In the third box, "Objects may have two to three favored colors," we also put an X, since Cassie showed no color preference, and would look at a small variety of items that had two or three colors. The next box, "More colors, familiar patterns regarded," was what we highlighted, since Cassie seemed to be interested in many colors and especially in the familiar stripe pattern.

Lynne:
In the second row, need for movement, we marked the first and second boxes with "Xs," because Cassie was able to look at things that didn't move, though we found movement definitely helped her to visually attend, particularly when there were high levels of complexity. We highlighted the third box, "Movement continues to be an important factor to initiate visual attention."

Sara:
The third row, visual latency, presented a question of ocular vs. CVI characteristics. We definitely saw Cassie looking at most things immediately. She was able to locate these targets, and demonstrated that by reaching for them after she had seen them. If the target had high levels of complexity and was new to her, however, she did not study it. So we marked "X" in the first two boxes, because we did not see latency in most situations. We did see it after we had asked her to look at a lot of new things in a non-routine testing session. She became tired and her looking behaviors decreased. By the end of the testing session, it seemed to take her quite a while to decide to study a visually simple item that produced movement, and when she did look, it was not for long. So we highlighted the third box in that row, "Latency present only when student is tired, stressed, or overstimulated." We circled the next two boxes because, according to her eye report, Cassie has intermittent nystagmus. Nystagmus can also cause decreased looking if the student is tired, stressed, or overstimulated.

Lynne:
In the fourth row, visual field preferences, we marked an "X" in the first box, "Distinct field dependency," because we did see Cassie respond to highly stimulating things in her peripheral fields. We highlighted the second box, "shows visual field preferences," because Cassie needed non-shiny or static things placed in a specific spot to see them. Even a very favored item could not be detected slightly out of her best field, which was her lower central field.

In the fifth row, we found that Cassie could definitely use her vision when there were low to medium levels of background noise, though sometimes this would increase the difficulties in other areas, such as looking at touching at the same time. We marked an "X" in the first two boxes, and highlighted the third box, "Student tolerates low levels of familiar background noise. Regards familiar faces when voice does not compete." This last statement in particular really seemed to describe Cassie's behavior.

Sara:
The sixth row, light-gazing and nonpurposeful gaze, we thought about for quite a while. When Cassie is busy doing something, she does not seem to be distracted by light, though she does respond to it by squinting for short periods of time. She may take a brief time out to look at a light in a totally new and out-of-routine situation like when we pulled her out of her classroom to do some direct assessment, but in general, when she is working on something, she does not get distracted and stop looking at other things because of light. When she does take a break she easily redirects herself back to the activity at hand. So we put an "X" in each of the first two boxes and highlighted the third box, "Light is no longer a distractor."

Lynne:
In the seventh row, "Difficulty with distance viewing," we marked "Xs" in the first three boxes because we definitely noticed Cassie seeing objects beyond 6 feet if they had movement qualities. We highlighted the box, "Visual attention extends to 10 feet with targets that produce movement."

The eighth row, "Atypical visual reflexes" we mulled over for a while. The first two boxes we obvious Xs, so we marked those that way. We really noticed that Cassie always blinked when an open hand came toward her face. So that would not be an intermittent response. That caused us to put an "X" in the third box as well. We then highlighted the next box, "Visual threat response consistently present (both reflexes near 90 percent resolved)."

Sara:
The ninth row was interesting. We presented Cassie with a number of new objects. She did not study many of them, particularly the ones that were challenging due to complexity of the target, but she was able to detect and respond to them. Sometimes, she just knew something was there, and reached in the general vicinity to find it tactually. Sometimes she reached directly toward a novel item if there was a plain background. So the novelty of the item did not seem to present a problem as far as detecting it visually. We put an "X" in each of the first four boxes and highlighted the last box, "Selection of objects not restricted."

Lynne:
In the last row, absence of visually guided reach, we put an "X" in the first two boxes because Cassie was able to look and touch at the same time particularly when items presented were familiar or had movement qualities against a non-complex background. We highlighted the third box, "Visually guided reach used with familiar objects or 'favorite' color." The "familiar objects" part seemed very important, though "favorite color" was not really an issue.

Sara:
Now we'll look at the forms in the back of Christine Roman's book, 2 pages after 185, or maybe page 187, called "Essential Forms." The part we'll fill out first is called "The CVI Range: The Across-CVI Characteristics Assessment Method", or "Rating I". We'll compare the notes we have taken from all of our information sources to the "CVI Range Scoring Guide" which is on page 97, or appendix 5.A. On the CVI Range Scoring Guide in the column marked "Characteristic," you will be directed toward the section of your data collection form where you might find supporting information.

We found all the scores in the first section, "CVI Range 1 to 2: Student functions with minimal visual response," to be marked in the "R" column. The characteristics at this level we found to be resolved.

Lynne:
In the second section, "CVI Range 3 to 4: Student functions with more consistent visual response," we still have some characteristics that were resolved, but not all. The first statement, "Visually fixates when the environment is controlled," we marked as Resolved, because the statement from the "CVI Range Scoring Guide" which seemed to best describe Cassie's visual functioning we found under the "R" column: "Establishes eye-to-object contact with familiar or novel objects or human faces, even in the presence of visual or other sensory stimuli." We found support for this in the complexity section of the observation data collection sheet.

Sara:
For the second statement, "Less attracted to lights; can be redirected," we found the stipulation to be true under the plus column, so we marked her with a plus: She "may stare at lights, but is able to shift attention from lights when appropriate visual targets are presented in controlled environments." This information was found in the "light" row of the observation and direct assessment data collection sheets

For the third statement, "Latency slightly decreases after periods of consistent viewing," we noticed that Cassie did not exhibit delays in looking at familiar items, but did sometimes with novel items, if she was tired. We found that out from the latency section on the direct assessment sheet. We marked that as resolved in the column described as, "A delay in directing vision toward a familiar object is rarely, if ever, present."

Lynne:
The fourth statement, "May look at novel objects if they share characteristics of familiar objects," we marked as resolved because Cassie regularly was "able to glance toward or have eye-to-object contact with objects never previously seen that may or may not resemble 'favorite' objects." We found that information from the observation and the direct assessment in the area of novelty.

The fifth statement, "Blinks in response to touch and/or visual threat, but the responses may be latent and/or inconsistent" seemed like a pretty good description of what Cassie did during the direct assessment, in that her response was just a little slow. We found the plus description to be consistent with that: "Blinks to touch at bridge of the nose and possibly to the quick movement of a target toward the face, but responses may be delayed or slightly inconsistent."

Sara:
The sixth statement, "Has a 'favorite' color" definitely seemed resolved. We marked it in the "R" column, which is described as, "Visual attention to objects is not dependent on a particular color." This was supported by information from all three data collection sheets in the area of color.

The seventh statement, "Shows strong visual field preferences," we found to be true as described in the plus column, "Glances toward or has eye-to-object contact with targets when presented in specific positions of peripheral and/or central viewing fields." We found support for that in the corresponding row on all data sheets.

Lynne:
The eighth statement, "May notice moving objects at 2 to 3 feet" we marked in the plus column because we saw that Cassie "Glances toward or has eye-to-object contact with objects that move in space or are made of shiny or reflective materials and are at distances up to 3 feet." We did not see that she could see things that did not have these qualities beyond three feet. We found support for this in the movement, distance, and complexity sections from all data sheets.

The ninth statement, "Look and touch completed as separate events," we marked in the plus-minus column because we saw that Cassie "Occasionally uses visually guided reach." We found support for this in the "visually guided reach" section of all data sheets.

Sara:
In the next section, "CVI Range 5-6: Student uses vision for functional tasks," we continued to find some that were resolved. For the first statement, "Objects viewed may have two to three colors," we found the resolved description to be the most true from all the data collection sheets in the areas of color and/or complexity, because Cassie "Pays visual attention to multi-color or multi-pattern objects, with or without preferred color."

For the second statement, "Light is no longer a distractor," we found the plus-minus description, "Occasional gazing at primary sources of light," to be the most true, with support from information in the row called "light" on all data collection sheets.

Lynne:
The third statement was, "Latency present only when the student is tired, stressed, or overstimulated." We found the plus-minus description to be the most true according to information from the rows on latency and complexity in the direct assessment data, in that Cassie exhibits an "Occasional delay in directing visual attention to a target."

The fourth statement, "Movement continues to be an important factor for visual attention," we found, in the plus-minus column, "A small element of movement may help establish or maintain visual attention," to be the most true for Cassie, which was supported by data from all collection sheets in the area of movement.

Sara:
The fifth statement, "Student tolerates low levels of background noise," seemed to best describe Cassie in the plus-minus column, "Occasionally is able to maintain visual attention in the presence of sound. One or two particular sounds are tolerated during viewing; many are not tolerated." This was supported by our notes from the observation and direct assessment information on complexity.

The sixth statement was "Blink response to touch is consistently present." We marked that one as resolved, which read, "Blink-to-touch response present; blink-to-visual-threat response (when target moves quickly toward face) inconsistently present." We found this in our notes on visual reflexes on the direct assessment information sheet.

Lynne:
The seventh statement, "Blink response to visual threat is intermittently present" we also marked in the resolved column, since Cassie's "blink to visual threat response" is "consistently present," even if it is sometimes slow. This information was in the visual reflexes row of the direct assessment information sheet.

In the eighth statement, "Visual attention now extends beyond near space, up to 4 to 6 feet," we marked a plus. Cassie "can visually locate or fixate on certain targets at distances as far as 6 feet away," and her "ability to detect objects or movement at 4 to 6 feet may depend on the degree of environmental complexity," as stated in that column. We found support for this in the area of distance in the observation and direct assessment information sheets.

Sara:
The ninth statement, "May regard familiar faces when voice does not compete" we found to be a plus. This is described as "Glances or looks directly into faces of familiar people, but only when the familiar person is not speaking." That description seems to be dead-on for Cassie, which we saw more than once during the observation.

In the next section, "CVI Range 7 to 8: Student demonstrates visual curiosity," we no longer found items that were resolved, but did still find a few plusses. The first was one of those: "Selection of toys or objects is less restricted; requires one or two sessions of 'warm up'." The plus statement in the CVI Range Scoring Guide was, "Looks at new objects that have attributes of familiar objects. Recognizes new object immediately after one or two presentations." We interpreted recognition as visual attention, since Cassie doesn't verbalize most of her thoughts. In our notes about the observations and direct assessment, we found supporting data in the areas of complexity and novelty.

Lynne:
The next statement was, "Competing auditory stimuli tolerated during periods of viewing; the student may now maintain visual attention on objects that produce music." We marked this as a plus-minus because the description, "Occasionally is able to maintain visual attention while other sensory input competes. Particular types of sensory inputs may continue to interfere with visual attention," was accurate for Cassie. We noticed Cassie using her vision in some familiar noisy environments, like the cafeteria and during her hygiene routine, during the observation. Other times during the observation, low-level noise, even if it was familiar, seemed to interfere. There were notes alluding to this in the observation information sheet in the area of complexity.

Sara:
The next item, "Blink response to visual threat consistently present," seemed to best describe Cassie with the plus statement from our direct assessment notes in the section on visual reflexes, which was, "Blinks simultaneous to the approach of an object or open hand moving quickly on midline toward the face." So we marked it as a plus.

For the statement, "Latency rarely present," we found the plus-minus to be a better description of Cassie's behavior, which was, "Seldom demonstrates a delay in detecting a target after it is presented." We mainly saw a quick visual response to all sorts of targets during the observation and direct assessment, even if the response was brief, except for when Cassie was tired. This data was gathered by considering visual behavior patterns across multiple observations; there was not a single clip that gave us this, it was more the summation of all the clips.

Lynne:
The statement, "Visual attention extends to 10 feet with targets that produce movement," we found to be a very good description of Cassie. We marked her in the plus column, which was, "Is able to visually locate and/or fixate on certain targets at distances as far as 10 feet away, especially with targets that produce movement. Attention at this distance may depend on the degree of complexity of the environment." We found that during the observation, in a familiar location -the classroom- Cassie could find things that move. She also moves a lot herself, which may be helping her find things. These notes were also on the observation information sheet in the area of distance.

Sara:
For "Movement not required for attention at near distance," we found Cassie to be best described by the plus-minus statement, "Occasionally is able to detect and attend to visual targets beyond two feet." This one was a hard call since Cassie moves herself so much, and when we did see her being still and detecting items that were beyond 2 feet, they often had movement qualities, but some familiar ones did not, such as her accordion. Cassie is also able to travel successfully indoors visually, and maneuver around items without tripping for the most part. We found support for our choice of the plus-minus statement in the direct assessment information in the areas of movement and distance.

Lynne:
For the statement, "Smiles at/regards familiar and new faces," we found the plus-minus again to be the best description, which was, "Occasionally glances toward and/or makes eye contact with familiar faces." We found this in the interview and observation data collection sheets in the area of complexity. Cassie did not look at her less familiar assessors at all during the direct assessment.

The statement, "May enjoy regarding self in mirror," was a tricky one. We weren't sure whether Cassie was looking at herself in the mirror, exactly, or if she just had a social script about mirrors, (such as, she has learned when you see this shiny flat thing you put your face on it and say your name). It seemed as if she was looking for a little bit, so we thought the plus-minus, "Inconsistently glances at own image in mirror," was the best description from the direct assessment information sheet in complexity.

Sara:
For the statement, "Most high-contrast colors and/or familiar patterns regarded," we thought the plus-minus column, "Is able to visually attend to some simple patterns, especially familiar ones or those that are highlighted with the preferred color," best described Cassie. Cassie doesn't seem to have a preferred color, but she seems to find items that are one or two colors, rather than three or more, easier to visually attend to, and she seems very interested in stripes. Stripes with many colors seem to be too complex to visually study at this point, though Cassie really tries. We found information on this in the color, complexity and novelty sections of the observation and direct assessment information sheets.

Lynne:
The next statement, "Simple books, picture cards, or symbols regarded," also seemed to be most applicable to Cassie in the plus-minus column, which is, "Visually attends to a small set of two dimensional materials; is not able to generalize the images to new contexts." Cassie did not seem to really attach much meaning to the 2-D items we saw her look at. She seems to be just beginning to look at non-complex 2-D items. We found information on this in the novelty and complexity sections of the observation.

Sara:
In the next section, "CVI Range 9 to 10: Student spontaneously uses vision for most functional activities," we marked the minus for all items except the following two, which were plus-minus. In the second row, "Only the most complex environments affect visual response," Cassie seemed best described by the plus/minus description, "Demonstrates visual curiosity in familiar environments that have low degrees of sensory complexity." We found support for this in the complexity and/or novelty sections of all areas of data collection.

Lynne:
In the eleventh row, "Look and reach completed as a single action," the choice that best described Cassie was again the plus-minus, "Uses visually guided reach only when the background complexity is reduced." Cassie used visually guided reach on a plain background when the complexity of the target was lower, or when the item had movement qualities. There was only one time when she was able to find a very familiar item on a complex background and reach directly toward it. We found data to support our choice in the visually guided reach section on the direct assessment information sheet.

Sara:
There is one minus you may have a question about if you continue to compare the information from our data collection sheets to the statements in the CVI Range Scoring Guide. For the description, "Visual attention extends to beyond 20 feet," we realized that we didn't have any data. We went back and asked Cassie's teacher if she had seen Cassie looking at anything 20 feet away or more. The teacher said that Cassie doesn't do that during any of their classroom activities inside or outside, so we went ahead and marked that one as a minus from interview information. The rest of the minuses should be evident from notes on the data collection sheets.

Lynne:
On page 61 of "Cortical Visual Impairment" Roman wrote, "The individual statements that describe visual behaviors are matched to the child's visual responses and scored until a 'ceiling ef-fect' has been reached. A ceiling effect occurs when the pluses that indicate the student's current level of functioning end, and a cluster of minuses occur for four or more consecutive items. The minuses indicate that the student has not yet reached the level of functioning described in that range. The student's score of the assessment is determined by the number of the CVI Range in which the last plus item occurs prior to the shift to scores of plus-minus and minus. Since each group of statements is identified by a range of two scores, the lower number of the range is assigned if the plus statements end in the middle of the cluster, the higher number is used if the plus-scored statements are marked to the end of the cluster."

This would put Cassie in Range 7 to 8, in which she had 4 plusses and 6 plus-minuses. We would pick the lower number, since plus statements end in the middle of the cluster, not the end. So we wrote Cassie's Rating I score as a 7.

Sara:
The next section is called Rating II, the "Within-CVI Characteristics Method." The numbers stand for "not resolved" at 0, and in increments of .25, stand for various levels of resolution up to 1, which means "Resolved." These numbers correspond with numbers on the top row of the CVI Resolution Chart. The CVI Resolution Chart can be found at the end of the book within the forms in the same section as the CVI Range Ratings I and II. Rating II can be completed by matching the level of resolution described on the Resolution Chart of each characteristic that best depicts the child. Each characteristic is given a number, and after that, the numbers are added up to find a value for Rating II.

For number 1, color preference, we found that Cassie was able to detect items with multiple colors or crazy patterns, but she didn't really attend to or examine them unless they were just a couple colors, or had a "striped" pattern. We scored this characteristic as .75 (Range 7 to 8).

Lynne:
For number 2, need for movement, we found that the description, "movement continues to be an important factor to initiate visual attention," was right on the money for Cassie, so we scored this one as .5 (Range 5 to 6).

For number 3, Visual latency, we found that Cassie only seemed to take longer to look when she was tired, such as when we asked her to look at lots of new things out or her routine for a sustained amount of time. We scored that one as .5, (Range 5 to 6).

Sara:
For number 4, Visual Field Preferences, we found that Cassie only seemed to notice her non-moving, striped, but extremely familiar and favored accordion in her best visual field, which was lower and central. She noticed moving or supercharged shiny things in her peripheral fields. We marked this one as .25, (Range 3 to 4).

For number 5, Difficulties with visual complexity, we found that Cassie was able to tolerate low levels of familiar background noise and that she would occasionally look briefly at familiar faces, but only if those people were not talking, so we marked this as a .5, (Range 5 to 6).

Lynne:
For number 6, Light-gazing and nonpurposeful gaze, we thought that Cassie wasn't that distracted by lights because she always self-directed her visual attention away from lights to other targets. We marked her as .5, (Range 5 to 6).

For number 7, Difficulty with distance viewing, we found that Cassie was definitely able to see things beyond 10 feet if they were moving or if she was moving, so we scored that one with a .75 (Range 7 to 8).

Sara:
Number 8, Atypical visual reflexes, was best described in Range 7 to 8, "Visual threat responses consistently present (both reflexes near 90 percent resolved)," which would make that one a .75.

For number 9, Difficulty with visual novelty, we found that the statement in range 9 to 10 best described Cassie, "Selection of objects not restricted," in that she could detect almost any novel object. For her to study or examine objects visually, there were more requirements in the areas of color, complexity, and movement. So we would definitely want to think about those characteristics when choosing items for functional routines. We marked her as a 1.

For the last one, number 10, Absence of visually guided reach, we noticed that Cassie uses visually guided reach best with familiar objects, so we marked her as a .5, (Range 5 to 6).

Lynne:
So adding up all ten numbers, .75, .5, .5, .25, .5, .5, .75, .75, 1, and .5, we got a total of 6. Cassie's score for Rating II was recorded on the first page as a 6, making her CVI Range from 6 to 7, with a difference of 1. If you look at the very top of the CVI Resolution Chart for reference, it appears that Cassie's visual abilities fall into the high Phase II CVI Range, "Integrating Vision with Function."

Lynne:
For the direct assessment, we took Cassie out of her busy classroom to a quiet, visually non-complex room and presented her with many novel items to look at. We also brought her favorite toy, an accordion, along for comparison. Cassie was able to look at new items and play with us for a while, but the session definitely seemed to tire her out toward the end. We were able to get a lot of information from our interview and observations as well, so we only ended up asking her to participate in one direct assessment session.

Sara:
In clip 1, we see Cassie reaching for a pan, an item her teacher told us Cassie likes to play with in the classroom. In a complex array, Cassie located the general area of the item visually and aurally, then searched tactually to pick it up. It may have been that she was actually reaching for the accordion.

[video clip 1]

>>Teacher 1: Doo-doo-doo-doo-doo. Bang bang bang. Bang bang bang.

>>Teacher 2: Underreached, totally. Or overreached.

Sara:
We marked that on the sheet called "Direct Assessment Information" in "Complexity" and "Visually Guided Reach."

Clip 2 shows Cassie looking up toward the overhead light, taking a break from looking.

[video clip 2]

>>Cassie: Ah! Ahhh!

>>Teacher 1: Ahhh!

[Cassie clapping]

>>Teacher 2: Yay! Where's the bang bang? Where'd it go?

[Teacher 1 banging on pan, then Cassie laughing.]

Sara:
We marked that in "Light."

Lynne:
Clip 3 is a long one and contains a lot of information. We see Cassie interacting with a number of items in a complex array. It seemed like she needed to clear the area before she could find her favorite item, the accordion. Often she uses a combination of vision, to detect that something is there, and then searches tactually to find the exact location, particularly with multi-colored items. She is able to reach correctly toward a blue item that has movement qualities and toward a white and black item on a black background. She briefly examines a black and white item up close. All this time we are providing a cheering section, also known as teacher noise! This was fun, but may have interfered with Cassie's ability to look. Many things to watch here in clip 3.

[video clip 3]

>>Teacher 1: Bang bang.

>>Cassie: Bang bang bang.

>>Teacher 2: Oh, the ball. Ooh!

>>Cassie: Yay!

>>Teacher 1 and 2: Yay!

>>Teacher 1: You got it.

>>Teacher 2: [laughing] Yay! Oooh...

>>Teacher 1: Ookie.

>>Teacher 2: Plop.

>>Teacher 1: Oop! Oh. Up! Ohhhh!

>>Cassie: Ooohhhh!

>>Teacher 1: Ooohhh!

>>Cassie: Cassie's?

>>Teacher 1: That's Cassie's!

Sara:
We recorded this information in the rows for "Color," because Cassie examined the black cow with white spots. She did not look at other novel multi-colored items except the blue koosh ball, which was moving. We recorded that in "Need for Movement," because the moving koosh definitely drew visual attention. We also marked "Complexity," because she did not seem to be able to locate her favored item until clearing the table. She seemed to visually know items were there but then had to tactually locate them, which could have been due to the complexity of the array. We also marked this information in "Visual Novelty" because she was able to briefly look at some of the testing items, which were unfamiliar, and was able to visually detect that other novel items were on the table, even if unable to determine the exact location, and in "Visually Guided Reach," because Cassie reached directly for a novel moving item and for her favorite, familiar accordion without looking away. She was able to visually locate other items but then could not reach directly for them, except one, which was a slightly shiny white item on the black background. That clip sure did give us a lot of information, Lynne!

Lynne:
In clip 4, I present a shiny reflective mylar thing in Cassie's left, right, and upper peripheral fields. Cassie seems to detect the item in the periphery and then turns her head to view it in her best field. Sometimes the item is up to 2 to 3 feet away. Cassie detects it every time.

[video clip 4]

>>Cassie: Turn off? On. Hi. Bye.

>>Teacher: Bye.

>>Cassie: Off? Are off?

>>Teacher: They're off.

Lynne:
We marked this in "Need for Movement," and in "Field Preferences," since she was able to detect the highly see-able item when it wasn't in the best field. We also marked this in "distance viewing."

In clip 5, from about four feet away, Cassie locates and reaches directly for her favored item on an extremely visually cluttered background with low environmental complexity. It is not apparent whether she is keeping her eyes open while reaching and finding the accordian.

[video clip 5]

>>Cassie: Hi.

>>Teacher: Ha ha ha. I see.

Lynne:
We marked this in "Complexity" and in "Distance viewing."

Sara:
In clip 6, Lynne is holding Cassie's accordion just to the left of Cassie's best visual field. Cassie does not seem to know it is there at all until she turns her head. You can see her hands expressing delight the moment she sees it.

[video clip 6]

>>Teacher: Ready? Set!

>>Cassie: Sit down?

>>Teacher: Sit down? [Cassie laughs.] Then it just appeared over there all of a sudden. Ready? Set!

>>Cassie: Go!

>>Teacher: Go!

Sara:
We marked this in "Field Preferences."

In clip 7, Cassie is enjoying one of her favored interactions with an adult, which is to have someone play the accordion while she watches their arm. We throw a kink into it by putting multi-colored stripes on the arm in the form of a long glove, to see if that will make Cassie want to look more or less. We see a mix of behaviors. It seems like Cassie tries to look at the striped arm for about 10 seconds (she stops when she hears a funny sound), then later she tries blocking out the novel striped arm, or at least part of it, by putting her hands over it.

[video clip 7]

>>Teacher 1: Ready? Set! Go!

[Teacher 2 sneezed. Cassie laughs.]

>>Cassie: Hands up. Hands up.

>>Teacher 1: Sara's turn. Is she looking at it?

>>Teacher 2: Kind of blocking it with her hands.

Sara:
We marked that one in "Color," since she sort of looks, in "Need for Movement" because the movement seems to draw her visual attention, in "Complexity" because she is able to look while the accordion is playing when the target is complex, but then has enough, and tries to block out some of the colors. And we marked "Novelty" because she does seem to look at the new item, even if indirectly.

Lynne:
Clip 8 is interesting: Sara presents Cassie with a mirror to look at. Cassie seems to try to look at it but it's hard for her. It may be the reflective quality or the movement inside the mirror that she is drawn to, but she squints and looks away. She asks for the lights to be turned off, and after the lights are off, she looks at the mirror much in the same way she looked at other 2-dimensional items, except her face is right against it. She only looks for a little bit. She seems to know the social script of how we interact with mirrors, in that she labels herself in it. It is hard to tell if she can actually identify that it is her own face in the mirror or if she is even looking at her face at all.

[video clip 8]

>>Teacher 1: What's that?

>>Cassie: Off?

>>Teacher 1: Who is that?

>>Cassie: Turn it off?

>>Teacher 1: Cassie! Who's that?

>>Cassie: Turn off!

>>Teacher 1: Lights off?

>>Teacher 2: It's hard for her to see. She looks at it and she's immediately squinting.

>>Teacher 1: Ok. Off.

>>Teacher 2: No, I mean that mirror.

>>Teacher 1: Oh, the mirror's too bright?

>>Teacher 2: I don't think it's too bright. I think it's hard for her to look at. Can you angle it so it's reflecting her movement so she can see it? That might attract her attention.

>>Cassie: Cassie!

>>Teacher 1: There's Cassie! Hi! There you are. Hi!

Lynne:
We marked our observations in "Need for movement," since the reflective mirror does draw visual attention; in "Complexity," because she needed to reduce complexity by dimming the lights before she could identify and participate in the mirror social script, and because of how close she got to the mirror- perhaps to block out some of the complex background. We also marked this one in "Light," because the mirror acted as a light source at times and drew her visual attention and caused her to squint.

Sara:
Cassie is getting pretty tired of our shenanigans by the time we're to clip 9. But she's a good sport. I present her with a black fan and she glances toward it briefly and then actually seems to look for a little longer after about 10 seconds. Then after another similar time period she takes it and looks closer. Even though it's a single-colored item with movement properties, Cassie still has a hard time looking after all the work she's been doing. Let's watch.

[video clip 9]

>>Teacher 1: Are you over it? What about this?

>>Cassie: One.

>>Teacher 2: Oh, she thinks your arm is moving it.

>>Cassie: Two. Off.

>>Teacher 1: Off? On.

>>Cassie: Cassie! Off, off, on?

>>Teacher 1: The lights off? You do it? Can you reach 'em? I'll show you.

Sara:
We marked that one in the row for "Visual Latency" because of the amount of time it took her to look at the fan and because of the fact that she's definitely showing signs that she is tired.

Lynne The last clip, clip 10, involves Sara rapidly bringing her open hand toward Cassie's face to test her blink to threat reflex. Cassie blinks the first 2 times and her response is a tiny bit slow.

[video clip 10]

>>Teacher: Looks pretty good. It's a little slow, but pretty good.

Lynne:
We marked this data in "Atypical Visual Reflexes"

Sara:
Now we'll look at clips from video we took when we were observing Cassie in a familiar environment: her classroom. Most of the clips are during Cassie's regular routines. We did have a little time to try some things with her in her classroom, which is when you'll see her playing with me and Lynne. We recorded our thoughts on the sheet called "Observation Information"

In clip 1 we see Cassie playing with a keyboard and not looking at her actions at all. It isn't apparent whether the keyboard was making any noise. We can definitely hear another electronic toy that doesn't seem to be controlled by what Cassie is doing. Let's watch clip 1.

[video clip 1]

>>Cassie: Stand up.

Sara:
So we marked that one on our Observation data sheet under "complexity" since the sensory environment, tactual and maybe auditory, seemed to compete and win out over Cassie's use of vision.

Lynne :In clip 2 we see Cassie checking her calendar with her teacher. Her teacher has paired an object with a picture for the activity that they are "finishing," which I believe they refer to as "Listen." The picture is a single color photo of a pinkish-red colored square on a black background, probably a cd case, and it is very non-complex. It is also laminated and shiny, which may play a factor in Cassie's looking, if she is drawn to things that are shiny. Cassie brings the photo close to her face and tilts her head slightly back while looking. Let's watch clip 2.

[video clip 2]

[stomping sounds]

>>Teacher: CD?

>>Cassie: Is...finished.

>>Teacher: Finished?

Lynne:
We marked that clip in the row called "Field preferences" since she seemed to bring the picture into the field identified by the interview, and in "Complexity," because she held it so close to her face, as she might have been blocking some of the background in order to see the two-dimensional image.

Sara:
Clip 3 shows Cassie during her hygiene routine. Cassie is sitting in front of a sunny window, where she does this routine. She seems to be drawn toward the light, but then has a squinting response. The light seems attractive but also unpleasant. Cassie is holding the toothpaste tube and shakes it in front of her own face. We noticed that the toothpaste tube had a striped pattern on it with a dark pink, a white, and an aqua stripe. A familiar song, "Quack quack" is playing. That song is a regular part of the hygiene routine: they actually refer to hygiene as "Quack quack." Let's watch the clip.

[video clip 3]

[music playing]

Sara:
We marked that one in "Color" because Cassie seemed to be drawn to the striped pattern. We also marked that in "Need for movement," since she shakes the tube while looking, and in "Light" because of her attraction to the bright light.

Lynne:
Clip 4 shows Cassie in the same area being attracted visually to the shadow of the blinds on the wall, which creates a striped pattern. She shows this interest by reaching for the shadow. Again she looks toward the light and then squints in response to it.

[video clip 4]

>>Teacher: Hi.

>>Cassie: Off? Off?

>>Teacher: [whispering] Off. We'll turn that off today. It's so bright. Ooooh, we are going to brush brush brush.

Lynne:
We marked that information in "Color" because again, she is interested in the stripes and in "Light" because again, she has the same response as in Clip 3.

In clip 5 Cassie picks up an item from a complex array. It is hard to tell if she is doing this visually or tactually. The item she chooses is a single color. She picks it up and moves it around while looking at it.

[video clip 5]

>>Teacher: Brush brush brush?

Lynne:
We marked this information in "Color" and "Complexity."

Sara:
In clip 6, Cassie picks up another single color item from the same array. This time the item has a texture on it that creates a striped pattern. Cassie studies this for a bit.

[video clip 6]

Sara:
We marked our ideas again in "Color" and "Complexity."

In clip 7, Cassie is exploring a light purple comb. She looks at it, then begins exploring it tactually, but as she does this, she seems to stop looking at it. Then she looks again briefly after she is done feeling the comb. The comb pattern also creates stripes. Cassie then seems alternately attracted to and repelled by the light reflecting from the metal "finished" basket.

[video clip 7]

>>Teacher: It was supposed to be on repeat.

>>Cassie: [laughs] Finished. Finished. Finished? And...

>>Teacher: It's finished.

Sara:
We marked that one in "Color" because it was an additional, single color item with stripes; in "Complexity" because the sensory environment competed with looking; and in "Light".

Lynne:
Clip 8 shows the sensory environment perhaps affecting Cassie's visually guided reach. She reaches towards a familiar item, her brush, on a non-complex background, the yellow sequence box. She looks away just before she makes contact with the brush. The music is also playing loudly.

[video clip 8]

>>Teacher: Good job! Brush your hair?

Lynne:
We marked these observations in "Complexity" and in "Visually Guided Reach."

Clip 9 happens at the end of the routine and the hygiene music is turned off. This is the first time Cassie looks at her teacher's face during this routine. Cassie looks away as soon as the teacher vocalizes.

[video clip 9]

>>Teacher: Quack quack off?

>>Cassie: Finished?

>>Teacher: Finished! Good job!

We marked that in "Complexity."

Sara:
In clip 10, we see Cassie looking very closely at Lynne's arm, which is moving while Lynne plays the accordion. The accordion is Cassie's favorite toy at school. Let's watch clip 10.

[video clip 10]

Sara:
We tried looking closely like Cassie did and found that the arm makes a big stripe, and thought that might be what Cassie was interested in. We marked this in "Color," and "Need for movement."

In clip 11, Cassie has left the area in which we were playing, then returns to ask for help getting on the swing. She find's my moving hand from about 15 feet, then pulls me over to request help.

[video clip 11]

Sara:
We marked that in "Need for Movement" and in "Distance Viewing."

Lynne:
Clip 12 shows Cassie's response to a striped pattern that I drew for her. The stripes are black and they are on white paper. Cassie's holds the item extremely close to her face. She opens her eyes wide and turns them up. She only examines the 2-d stripes briefly.

[video clip 12]

>>Cassie: One.

>>Teacher: Two. Three.

>>Cassie: Finished.

>>Teacher: Ok, thank you.

Lynne:
We marked this information in "Color" since there was some interest in the stripes; in "Field Preferences" because of where she places the item and holds her eyes; and in "Complexity" because she holds the item so close seemingly to block out the background. Also, once the talking starts, she lowers her eyelids and stops looking.

The next three clips are from a different observation of Cassie in the cafeteria, which is generally a very complex place. Cassie is able to use her vision surprisingly well in this environment.

Sara:
Clip 13 is very interesting. It shows Cassie on her way to the cafeteria. Cassie is able to navigate her route to the cafeteria, which is flat up until this point, but things break down on the stairs. Let's watch clip 13.

[video clip 13]

Teacher: Ooh! Two steps at a time! A daredevil!

Sara:
As you can see, Cassie basically closes her eyes and descends the stairs tactually. You can tell by the way she acts at the bottom of the stairs, reaching with her feet to see if there are more. She is getting information from her competing tactual sense in order to do this, so we marked this one in "Complexity." It also seems that stairs would be visually complex because they change as you move in relation to them. Even though you would think the stairs might look like a striped pattern, Cassie does not look at them. We also interpreted this as "Visually Guided Reach" because in this setting, Cassie is not able to look at and reach successfully with her feet to descend the stairs.

Lynne:
In clip 14, Cassie's teacher is asking her to pick up her milk. This is a noisy and visually complex environment, but Cassie is still able to find the milk carton, which is a complex, familiar, and favorite target. Also, her teacher draws Cassie's visual attention by moving the milk up to an easier to reach position and by moving her hand and tapping the milk, giving that movement to alert Cassie's visual system.

[video clip 14]

>>Teacher: There's the milk! Milk.

Lynne:
We marked the information in this clip in "Movement," "Complexity," and "Visually Guided Reach," noting that Cassie looked away just before she touched the milk carton.

Sara:
In clip 15, Cassie is able to look at her teacher's face in the noisy cafeteria just briefly. Then when her teacher makes a sound, it seems to be too much for Cassie, and she looks away.

[video clip 15]

[Teacher leans in and makes silly sound]

Sara:
We marked this observation in "Complexity."