Visuoperceptual profiles of children using the Flemish cerebral visual impairment questionnaire

Abstract

Aim To investigate the underlying factor structure of the 46‐item Flemish cerebral visual impairment (CVI) questionnaire, differentiate the factor scores of children with and without CVI, and examine the impact of comorbidities on factor scores. Method The records of 630 children (386 males, 244 females; median age 77mo; interquartile range 63–98mo) who visited the CVI clinic and the Centre for Developmental Disabilities at the University Hospitals of Leuven from 2001 to 2018 were reviewed systematically. Inclusion criteria included an up‐to‐date questionnaire, a definitive diagnosis, and clinical assessment. Results Three hundred and forty‐five children (179 with CVI [108 males, 71 females; median age 74mo; interquartile range 61–93mo] and 166 without CVI [110 males, 56 females; median age 88mo; interquartile range 70–107mo]) were included. An exploratory factor analysis resulted in a 5‐factor (object and face processing impairments; visual (dis)interest; clutter and distance viewing impairments; moving in space impairments; and anxiety‐related behaviours) biologically and clinically plausible model, which retained 35 items and explained 56% of the total variance. Mann–Whitney U tests indicated that factors 1 to 4 were significantly higher in children with CVI compared to children without CVI (p‐values ranged from p<0.001 to p<0.05; effect sizes ranged from 0.11 to 0.33); factor 5 showed no differences. Autism, developmental coordination disorder, epilepsy, and cerebral palsy impacted factor scores. Interpretation A 5‐factor structure of the Flemish CVI questionnaire differentiates children with and without CVI. Comorbidities should be accounted for when researching CVI. What this paper adds Cerebral visual impairment (CVI) is characterized by impaired object and face processing and impaired visual interest. CVI is also characterized by impaired clutter and distance viewing, and impaired moving in space. All children (with or without CVI) demonstrated anxiety‐related behaviours. Autism affected object/face processing, whereas developmental coordination disorder, epilepsy, and cerebral palsy affected visual interest.

What assessments are currently used to investigate and diagnose cerebral visual impairment (CVI) in children? A systematic review

“…Neuroimaging was reported in 29 (63.0%) articles. The most commonly reported imaging technique was MRI ( n = 22) 20,21,28–34,41,44,45,47,48,50,51,56–58,64–66 . Ten articles reported use of CT scans 20,21,29–31,35,46,51,58,65 and five reported use of ultrasound 29,31,45,48,51 .…”

“…In her book, she uses a 25‐item questionnaire which parents complete during a face‐to‐face interview with the clinician 72 . Two articles included in the present review reported use of the Flemish CVI questionnaire developed by Ortibus and colleagues 50,66 . This questionnaire was designed as a screening tool to seek evidence of behaviours associated with CVI and contains 46 items 50 .…”

“…Children with CVI often present with oculomotor deficits 1,20 including nystagmus, 20,21 strabismus 20,84 and abnormal saccadic and smooth pursuit eye movements 1,21 . Thirty‐two articles (69.6%) reported carrying out an ocular movement assessment 7,11,20,21,29–38,40–46,55,57–60,65,68 and 26 (56.5%) an ocular posture/alignment assessment 11,20,21,29–38,40–45,48–50,55,58,59,66 . Of those who specified details of the ocular movement assessment, six included saccadic eye movement assessment, 21,34,36,42,49,66 four smooth pursuits, 21,42,57,65 nine assessed the optokinetic nystagmus response (OKN), 21,32,41,45,46,49,51,57,65 eight assessed the child’s ability to fix and follow, 21,29,32,34,44,49,50,57 and two assessed convergence 38,42 .…”

“…Of those who specified details of the ocular movement assessment, six included saccadic eye movement assessment, 21,34,36,42,49,66 four smooth pursuits, 21,42,57,65 nine assessed the optokinetic nystagmus response (OKN), 21,32,41,45,46,49,51,57,65 eight assessed the child’s ability to fix and follow, 21,29,32,34,44,49,50,57 and two assessed convergence 38,42 . Twenty‐three articles commented on whether the child presented with nystagmus eye movements 7,11,20,21,29–36,38,40,42,44,50,55,58,59,66,68 …”

“…Three articles which extracted results of IQ assessment from medical notes did not list which tests were used to ascertain intelligence. The most common intelligence test employed by included articles was the Wechsler Intelligence Scale ( n = 8) 21,28,34,35,38,47,50,66 . Two articles classified intelligence according to the Committee of Test Affairs in Netherlands (COTAN) criteria for IQ scores; however the authors did not state which tests were used to obtain the scores 52,55 .…”