Cortical Vision Impairment (CVI)-informed assessment and treatment of challenging behavior in a child with SCN2A-related disorder.
Add a five-minute vision check to your FBA, then color-code and position your FCT cues so the child can truly see them—problem behavior fell to zero in one CVI case.
01Research in Context
What this study did
A BCBA and a teacher of the visually impaired teamed up with one preschooler. The child had autism, severe vision loss from cortical vision impairment (CVI), and a rare gene change (SCN2A).
First they ran a regular FBA. They saw the child hit, bite, and flop to escape hard tasks or to get snacks. Next they added a functional vision assessment. They learned bright colors, simple shapes, and left-side placement helped the child see cues.
Mom then used CVI-friendly prompts and a bright two-picture schedule. She taught the child to touch a card that said “break” or “eat.” They ignored problem behavior and gave the requested item only after the card touch.
What they found
Challenging behavior dropped from about 20 times an hour to near zero during 10-minute work sessions. The child used the new cards instead of hitting or biting.
Mom kept the plan going at home for three months. Gains held without extra coaching.
How this fits with other research
Stevenson et al. (2025) scoured 13 studies and found no agreed ASD test for kids with visual impairment. Thomas et al. show the fix: bolt a vision assessment onto your FBA before you treat.
O'Reilly et al. (2005) and Leon et al. (2023) already proved visual schedules cut problem behavior. Thomas adds the CVI lens—use high-contrast color, cut visual clutter, and place cues in the child’s best seeing field.
Orsmond et al. (2009) wiped out problem behavior by tweaking the environment alone. Thomas keeps that spirit but targets the visual world instead of the physical one.
Why it matters
If a child has both autism and any vision loss, vision issues can keep FCT from working. Run a quick vision assessment, then paint your prompts and schedule cards with the colors, size, and spot the child actually sees. You may save weeks of slow progress and cut injury risk for everyone in the session.
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Join Free →Hold a red “break” card in the child’s left visual field, require a touch before granting escape, and ignore flops—data showed near-zero behavior by session three.
02At a glance
03Original abstract
This report presents results of parent-implemented behavioral treatments for a child with cortical visual impairment (CVI), intellectual disability (ID), epilepsy, and autism spectrum disorder (ASD) associated with a pathogenic variant in the SCN2A gene (i.e., SCN2A-Related Disorder). Treatment evaluations were informed by combined results of functional behavior assessment (FBA) and functional vision assessment (FVA) which yielded CVI-related accommodations. The treatment of escape-maintained challenging behavior involved the evaluation of behavioral prompting strategies in accordance with CVI-related accommodations, extinction (EXT), and differential reinforcement modifications. The treatment for behavior problems maintained by access to food (tangible-edible) included functional communication training (FCT), EXT, and schedule thinning with schedule-correlated visual signals. Overall, integrating child-specific CVI-related accommodations was essential for developing effective behavioral interventions for this child. FVAs are accessible and practical for uptake by behavior analysts in vision-informed assessment and treatment of challenging behavior.
Journal of Neurodevelopmental Disorders, 2024 · doi:10.1186/s11689-024-09580-7