At the outset, the goal was to identify items that could be able to adequately sample behavioural manifestations of the domains of brain based visual processing dysfunction (BVD), and brain based auditory processing dysfunction (BAD) in a comparative manner. The individual checklist items are behavioural indicators of visual and auditory processing difficulties, and not direct measures of underlying neurological deficits.
The main objective was to design an observational checklist to identify behavioural characteristics that can describe visual lower-order and higher-order & auditory lower-order and higher-order functional deficits. The project set out to explore the daily visual and auditory processing difficulties of children “at risk for BAVI” and identify the functional deficits that best captured the impact of BAVI on auditory and visual processing in the child`s day-to-day functioning. Particularly, as pediatric BAVI is a newly defined issue and its phenomenology is complex, the evaluation framework model strives to be well grounded in clinical observations and in the experiences of parents and teachers of the child.
The items of the P-BAVI were formulated based on the BAVI conceptual framework (figure 3), by applying established clinical practices and expert consensus. Initial development involved reviewing current peer-reviewed empirical studies and reviews/guidelines from the different scientific disciplines on auditory and visual processing and its disorders (i.e., neuroscience, educational science, neurology, neuropsychology), as well as existing CVI and APD checklists to identify key indicators.
To start with, several clinical cases of children exhibiting behavioural characteristics of BAVI (“suspected BAVI”) were discussed and analyzed by the three authors (JN, CS, AS). This process allowed us to identify and specify items that described the behavioural characteristics that underlie visual lower-order & higher-order functional deficits and auditory lower-order & higher-order functional deficits in a comparative manner. Furthermore, this judgement ensured that all items were assigned to the relevant domain and functional deficits.
Initially 56 items were identified based on the conceptual framework of understanding BAVI as a malfunction between the seeing-hearing mechanisms and the neural processes involved in visual and auditory processing. Six out of the 56 items were deleted because they could not be clarified without significantly altering the underlying meaning. Furthermore, a systematic evaluation process that aided allocating the item content balance between the domains of BVD and BAD was implemented. The item content balance was achieved by ensuring that both domains were adequately represented in terms of number of items, item quality and conceptual relevance.
Out of the 50 items, 21 items were able to identify behavioural characteristics that underpin visual lower-order and higher-order difficulties, whilst another 21 were able to identify behavioural characteristics that underpin auditory lower-order and higher-order difficulties. Besides, 4 items that identified characteristics of visual preferences and 4 items that identified characteristics of auditory preferences were included. As a core objective, each of the 50 items were able to align with a specific visual lower-order and higher-order functional deficit or auditory lower-order and higher-order functional deficit.
As a first trail, the 50 items P-BAVI checklist was used as a starting point for a small-scale preliminary study in clinical practice (n=4). This study resulted in giving several illustrative examples for each item in the checklist for the purpose of adding clarity.
Furthermore, some items of the P-BAVI checklist with examples were reviewed by professionals in deafblindness (n=21) at a workshop organized by the Royal Kentalis in October 2025 and at a workshop for special education teachers (n=10) at the school for deafblind children, Kentalis Rafael in March 2026, both in the Netherlands. To ensure consensus the professionals were asked to rate each item on two response choices (yes or no), after watching a short video sequence of a child exhibiting BAVI behaviours/characteristics. The results showed that most of the professionals were able to identify the behavioural manifestations of BVD and BAD on the selected P-BAVI items. However, the findings revealed a mixed profile, with some visual and auditory domain items demonstrating similar patterns of difficulty, while other items could not be fully compared. For instance, similar BVD and BAD domain items were scored in a comparative manner that allocated item content balance (i.e., rated as yes and demonstrating similar patterns of difficulty on the BVD and BAD domain items), whilst some items were not (i.e., rated as yes or no and not demonstrating similar patterns of difficulty on BVD an BAD domain items). This mixed profile may suggest that the P-BAVI was able to capture different levels of BVD and BAD issues or the difficulties of assessing BVD and BAD items between the two domains.
A similar consensus process was done at the Consortium Centre Jules-Léger (CCJL) in January 2026. CCJL is a specialized francophone educational institution in Ontario, Canada and supports students aged 4 to 21 who are deafblind, deaf or hard of hearing, blind, or have low vision. Four deafblind resource consultants reviewed the 50 items of the P-BAVI checklist with actual students from their caseloads. These students were individuals who have been identified with CVI and ADP or with characteristics associated with CVI and ADP, across different ages and developmental profiles.
Overall, there was consensus among the consultants that they could answer yes or no to most of the items. They also began noticing possible clusters and similarities between some of the BVD and BAD characteristics. At the same time, some items, particularly within the BAD domain, were more difficult to answer definitively depending on the student's age and developmental level and required more analysis. Besides, using the checklist helped the consultants to pinpoint similarities and interactions between vision and hearing.
The finalized form of the P-BAVI contains 50 items and two domains. The P-BAVI items are typically clustered in accordance with the two domains of BVD and BAD; 25 BVD items that include visual lower-order & higher-order functional deficits) and 25 BAD items that are auditory (low-order & higher-order functional deficits) in coherent and comparative manner.