6 Tips for Supporting Children with CVI on AAC

For children who use augmentative and alternative communication (AAC), visual access is communication access.

This matters especially for children with cortical or cerebral visual impairment (CVI), whose visual processing differences affect how they notice, interpret, recognize, and use visual information. Functional vision often looks very different from what acuity alone would predict, and preferences for color, visual field, contrast, size, and representation vary from child to child and can shift with the environment or task.

The goal isn’t to make an AAC system “high contrast” or to cut symbols. It’s to make the system visually accessible to that child while preserving access to language.

Check out 6 tips for supporting children with CVI using AAC in this article by Ashlyn Hudson, MOT, M. Ed, Director of Education Strategy and Access for Knowledge Is Now.

✨1. Start with the child’s CVI profile, then observe

A CVI range or functional vision profile offers important clues about visual field preferences, attention, complexity, color, movement, and latency. It’s a starting point, not a layout prescription.

Watch the child across activities and environments:

- Where do they tend to look, and which colors or features draw attention?
- How long do they need to locate and process information?
- Do they respond differently to objects, photographs, or graphic symbols?
- Does clutter, symbol size, spacing, positioning, or lighting change performance?

Example: A student’s profile notes a left visual field preference. At snack, he finds his “more” symbol quickly when the device sits just left of midline on his tray but misses it repeatedly when the same device is centered on the table during circle time. Same system, same symbol. Positioning changed access.

✨2. Reduce visual clutter, not language

A screen filled with small symbols can make locating a target difficult. Fewer, larger symbols with more spacing may offer an easier entry point. But reducing visual complexity should not mean reducing vocabulary.

Example: A team moves a child from an 84-location grid to an 8-location page. The display looks cleaner, but “stop,” “more,” and “different” now sit two pages deep, and the child stops initiating. A better first move: keep the 84-location grid, temporarily mask the buttons not yet in use so white space increases without changing button locations, and turn the message bar off temporarily to see whether it was competing for attention.

Ask: Can symbols be spaced farther apart? Are unnecessary visual elements adding clutter?

Think: less visual competition, not less communication.

✨3. Make contrast and color work for this child

There is no single CVI-friendly color scheme. Some children locate symbols faster on dark backgrounds; others do better on light ones, depending on the symbols themselves. For light-tech AAC, matte lamination reduces the glare glossy sheets create under fluorescent classroom lighting.

Many children show a color preference. Once you identify one, you can build it in, for instance, adding a yellow border around words on a black background so the buttons stand out. Remember, preferences are highly individual. The yellow outline that helps one child locate “go” may pull another child’s attention away from the symbol itself.

✨4. Choose meaningful representations

For some children, real objects or photographs are more meaningful and more visually accessible than abstract graphic symbols.

Consider the child’s experience with the objects and how they respond. If a child encounters oranges as peeled segments in a bowl at snack, a photo of orange slices may be more meaningful than a picture of a whole orange. The same is true for a child’s own belongings: a photo of her red cup on a plain black background is usually easier to process than a stock image of a cup on a cluttered counter.

Also weigh whether a symbol and written word are both necessary. If you’re reducing competition, one representation may serve better than two.

✨5. Design for where and how the child looks

CVI can affect visual attention and visual field use. A child may consistently look toward one area, find information easier in a particular position, or need extra time to locate and process a symbol.

Example: A child reliably locates symbols in the lower left quadrant but rarely scans to the upper right. Moving core words “more,” “stop,” “go,” “help” into her lower left, and leaving less time-sensitive vocabulary in the upper right, supports her access without shrinking her system.

Latency matters too. If a child needs 12 seconds to locate a symbol and we re-prompt at five, we’ve interrupted the search. Count silently before repeating.

The most accessible location is the one that works for this child.

✨6. Adjust the system over time

An AAC system for a child with CVI is never finished. Visual functioning changes, and so do vocabulary needs, motor skills, positioning, environments, and preferred representations.

A 2025 longitudinal study of students with CVI and severe speech and motor impairments who used AAC found improvements in functional vision and communicative competence over time, with modes and access methods varying widely across students.

Rather than asking, “What is the best AAC layout for a child with CVI?” ask: “What visual characteristics help this child access this system, and how do we know?”

Visual Access is Language Access

Vision isn’t a separate consideration from communication. A child may have a robust AAC system and still be shut out of language if they can’t efficiently locate, process, or distinguish the symbols. And a system simplified so far that the vocabulary disappears isn’t a solution either.

Finding that balance takes collaboration among SLPs, OTs, teachers, vision professionals, AAC specialists, families and most importantly, the child.

A Simple Starting Point

1. Learn the child’s CVI profile and functional vision.
2. Observe across activities and environments.
3. Identify visual preferences and barriers.
4. Change one variable at a time.
5. Watch how the child responds.
6. Adjust based on what you learn.

CVI-informed AAC should be individualized, flexible, and responsive not a one-size-fits-all template. As research grows, our job is to keep asking not only, “Does this child have access to AAC?” but also, “Can this child visually access the language we’ve given them?”

Learn More – All Things AAC

On-Demand AAC Course Offerings: Assessment, Intervention, Access & More!

References

Boster, J. B., Pitt, K., Brown, K., Potts, J., & Overholt, A. (2025). Design characteristics of augmentative and alternative communication interfaces for children with cortical visual impairment: Results from two focus groups with vision professionals. American Journal of Speech-Language Pathology, 34(2), 692–705. https://doi.org/10.1044/2024_AJSLP-24-00318. (ASHA Publications)

Blackstone, S. W., Luo, F., Barker, R. M., Roman-Lantzy, C., Romski, M. A., Sevcik, R. A., & Casella, V. (2025). Children with cortical/cerebral visual impairment and speech and motor impairments who use augmentative and alternative communication: A retrospective, longitudinal examination of school records. American Journal of Speech-Language Pathology, 34(5), 2795–2812. https://doi.org/10.1044/2025_AJSLP-24-00544. (ASHA Publications)

Boster, J. B., McCarthy, J. W., Brown, K., Spitzley, A. M., & Blackstone, S. W. (2021). Creating a path for systematic investigation of children with cortical visual impairment who use augmentative and alternative communication. American Journal of Speech-Language Pathology, 30(4), 1880–1893. https://doi.org/10.1044/2021_AJSLP-20-00203. (PubMed)

Pitt, K., Boster, J. B., Underwood, K., & Thiessen, A. (2026). Enhancing photographic AAC displays for children with cortical visual impairment: Foundations for accessible design and implementation. Disability and Rehabilitation: Assistive Technology. https://doi.org/10.1080/17483107.2026.2662436. (PubMed)