The relation between visual orienting functions, daily visual behaviour and visuoperceptual performance in children with (suspected) cerebral visual impairment

Background: Children with cerebral visual impairment (CVI) present heterogeneous visual orienting functions (VOF) and higher-order perception. Multiple assessment methods evaluate CVI, but the relations between them remain unclear. Aim: To investigate the relations between VOF and (1) daily life behaviour and (2) visuoperceptual tests in children with (suspected) CVI. Methods and procedures: VOF were tested with a validated eye tracking-based paradigm. Visual perception was assessed using the children's visual impairment test for 3- to 6-year olds (CVIT 3-6) and (retrospective) visuoperceptual dimension results. Caregivers completed the Flemish cerebral visual impairment questionnaire (FCVIQ) and an expert panel scored relations between VOF and the other methods. We compared experts’ survey responses with data-based results (linear mixed models and correlations). Outcomes and results: Fourty-four children (23 boys, 21 girls; median age = 7y11mo, SD = 2y7mo) participated. Twenty-one experts completed the survey. Slower VOF was significantly associated with (1) object and face processing impairments, (2) visual (dis)interest, (3) worse visual spatial perception (to local motion and form stimuli), and (4) worse CVIT 3-6 object and scene recognition (to cartoon stimuli). Conclusions and implications: Integration of VOF with existing visual assessments provides a better clinical picture of CVI and can prevent misdiagnosing children as inattentive, incapable, or unmotivated.