Table 3.

Parent history: current visual skills

Detection (knows something is there even if not what it is—depends on acuity) Do you think she/he sees normally? Why/why not? Does she/he look at your face? Up to what distance? Does she/he follow as you walk away/as a toy is moved? What size object/at what distance can she/he detect visually? Does she/he try to peer closely at things?

Considerations Elicit a description of the child's response to each potential visual task. For example, fixation or orientation/reaching/naming Could response be dependent on any other clues including sound?

Children with additional difficulties Does she/he ever stare at lights? Does she/he often turn head or eyes in one particular direction? Are there any movement difficulties that could explain this?* Does she/he show any difficulty with steady looking or seem to need more time than other children to look at something? Can she/he look steadily at an object so that you know for sure what s/he is looking at? If your child's eyes show frequent movements,† how often are you sure that these movements are part of ‘active looking’? Can she/he look at and reach for something at the same time? Does she/he make eye contact that makes you feel looked at?

Recognition (ability to know what target is through visual information alone, may depend on detection of visual detail and on cognitive skills) Does she/he recognise your face (without voice)? Does she/he return a silent smile? Does she/he recognise objects through vision alone? Or needs additional cues? What objects does she/he recognise? How far away? Does she/he look at pictures? Can she/he recognise simple unfamiliar pictures, or pick out any detail from a ‘busy’ picture? Does she/he watch TV? Seated at what distance? Remains visually oriented even when sound is muted?

*Does the child have a persistent asymmetric tonic neck reflex? Is there evidence that a particular head position is associated with minimisation of nystagmus? Can we be confident that the eye or head turning is definitely vision related or could they be spontaneous movements that are not in response to any stimulus?

†Ensure parents do not mean nystagmus, which is a wobbly movement or fast to and fro flickering.