Towards population screening for Cerebral Visual Impairment: Validity of the Five Questions and the CVI Questionnaire

Abstract

IntroductionCerebral Visual Impairment (CVI) is the most common cause of visual impairment in children in the developed world and appears to be more prevalent in children with additional support needs (ASN). There is an urgent need for routine screening for CVI, particularly in children with ASN, however, current screening questionnaires for CVI have limited validation. The aim of this study was to evaluate two screening tools: the Five Questions and the CVI Questionnaire. Additionally, the distribution of CVI across neurodevelopmental disorders is unknown. This too was investigated.MethodsAn online survey was completed by 535 parents. The survey was advertised via social media, CVI websites and parent email systems of four schools. The survey comprised of the Five Questions, the CVI Questionnaire and additional questions regarding the child’s diagnoses. Whether or not a child had a diagnosis of CVI and/or additional neurodevelopmental disorders was based on parental report.ResultsBased on parent reports, both the screening tools accurately screened for CVI diagnoses in children. The Five Questions and the CVI Questionnaire have construct validity (as determined through factor analysis), high internal consistency (as determined by Cronbach’s alpha) and convergent validity (as determined by correlation analysis of the raw scores of each questionnaire). This study also highlights that among children with neurodevelopmental disorders, a large proportion have parent-reported CVI (23%-39%) and potential CVI (6.59–22.53%; as identified by the questionnaires).ConclusionThe current study demonstrates that the Five Questions and CVI Questionnaire have good convergent validity, internal consistency and a reliable factor structure and may therefore be suitable as screening tools. The study also highlights that reported or potential CVI is evident in a large proportion of children with neurodevelopmental disorders.

As‐indicated versus routine vision screening of preterm children: a 17‐year retrospective regional study

“…; Gorrie et al. ). We did not find other comparable studies on the outcome of routine visual screening in preterm children (Jonas et al.…”

“…CVI is very versatile and can show very subtle signs of visual interpretation problems (Dutton 2013;Macintyre-Beon et al 2013;Kaul et al 2016;Leung et al 2018), and not one test provides a present/not present diagnose. Recently, more reliable questionnaires have been developed (Ortibus et al 2011;Gorrie et al 2019). We did not find other comparable studies on the outcome of routine visual screening in preterm children (Jonas et al 2017).…”

A pilot study of the Austin Playing Card Assessment: A tool to detect and find the degree of visual perceptual difficulties related to clutter

“…However, no matter the cause of the visual perceptual difficulties, the issues still manifest in the same way, with the parents all reporting difficulties in the areas covered by the history-taking inventory. Moreover, as already discussed, many children with visual perceptual difficulties are not being correctly diagnosed due to a common lack of awareness of CVI among healthcare providers, especially when the child has normal or near normal visual acuity (Chong & Dai, 2014; Fazzi et al, 2009; Gorrie et al, 2019; Maitreya et al, 2018; Martin et al, 2016). Therefore, these seven children may well have had CVI, or a combination of CVI and a developmental disorder that caused their visual perceptual difficulties, especially when there is clear evidence that many developmental disorders have overlapping visual difficulties (Chokron & Dutton, 2016; Dutton, 2015b; Pawletko et al, 2015).…”

“…A mixed-method research study was used to support the testing of an assessment tool to detect visual perceptual difficulties that the researcher had developed in response to working with a young child with cerebral palsy and multiple visual perceptual difficulties. 1 However, in New Zealand, as with many other countries around the world, children with visual perceptual difficulties are not often being diagnosed with CVI, especially if they have normal or near normal visual acuities (Chong & Dai, 2014; Fazzi et al, 2009; Gorrie et al, 2019; Martin et al, 2016). Therefore, to obtain participants for this research, children with developmental disorders were also considered, as many of these conditions have been shown to also have visual perceptual difficulties that overlap with CVI.…”

Improving outcomes for primary school children at risk of cerebral visual impairment (the CVI project): protocol of a feasibility study for a cluster-randomised controlled trial and health economic evaluation

“…Both teachers and parents will also be asked to complete a short vision-specific questionnaire which elicits behaviours suggestive of CVI. 21 Finally, the teachers will be asked to complete a questionnaire about their perception of their own teaching skills and abilities.…”