9. Intervention strategies to support children with BAVI

1. Basic and specific management of BAVI

Appropriate management of BAVI begins with particularly identifying the child’s visual and auditory processing deficits. Furthermore, it is essential to have a comprehensive understanding of each child’s individual needs to provide effective support. The goals of any basic management plan may cover everything that makes life easier for the child with BAVI and should include supporting the child to attain his/her optimum level of vision and hearing functioning, fostering the child`s autonomy or sense of agency, reducing the child`s emotional or psychosocial challenges and inclusion of multisensory learning, despite the child`s limits in simultaneous multisensory input. Besides, it must include a greater emphasis on relationship building and on highly individualized interventions that address the development of communication strategies with ample opportunities for social interaction.

Children with BAVI can display varied visual and auditory functional deficits and may require specific interventions to support their learning. Thus, it is important to provide actionable strategies to parents and teachers to reduce the impact of the child’s visual and auditory processing difficulties in daily life. Regarding the specific management of BAVI, the intervention will always require it to be tailored to the unique needs of each child. Since BAVI may share similar characteristics with both CVI and APD, the specific management strategies of BAVI could consider some intervention strategies implemented for children with CVI or APD. This is for the purpose of minimizing the adverse effects of visual and auditory processing deficits on the child`s day-to-day functioning.

The management of CVI in children necessitates a multifaceted approach that addresses early identification to assess visual impairment and aim for the minimization of visual impairment to enhance wellbeing. CVI interventions may involve both bottom-up and top-down approaches to improve the visual-spatial ability of children with CVI. Table 8 provides some suggestions for bottom-up and top-down management strategies for CVI.

Management strategies of CVI	Examples
Optimizing residual vision	maximizing remaining sight through environmental adaptations and optical devices
Implementing early visual stimulation	using high-contrast, slow-moving, brightly coloured, or illuminated objects to capture attention
Improving basic visual skills	targeted visual training; providing visual activities that enhance visual scanning, eye-hand coordination, visual discrimination or visual spatial relations
Applying task adaptations	waiting patiently for the child to process what they see; providing sufficient time for visual processing; using coloured, three-dimensional (3D) images/forms rather than two-dimensional (2D) representations
Providing structured routines	employing consistent, repetitive activities to help in the identification and recognition of visual targets
Accommodating environmental modifications	reducing visual complexity, using consistent lighting to decrease sensory overload; reducing visual clutter and visual fatigue; implementing orientation and mobility training
Enhancing complex visual skills	improving visual tracking skills by supporting the child to focus and follow a fast-moving object
Focusing on building compensatory skills (top-down strategies)	teaching the child to talk to themselves through what they are looking at (verbal mediation); encouraging the child to use the environment to predict what an object is. If they see a blurry shape on the kitchen counter next to the sink, top-down logic tells them it is likely a soap bottle or a cup, not a toy car (contextual clues)

Table 8. Some bottom-up and top-down management strategies of CVI with examples

Along the same lines, managing APD in children compromises a multifaceted approach to treating difficulties with listening and their interconnected links to a range of audiological factors (e.g. hearing acuity and auditory processing) and non-audiological factors (e.g. attention, working memory, and language abilities). APD interventions may involve both bottom-up and top-down approaches to improve the listening ability of children with APD (Almarjawi, et al., 2026). Table 9 provides some suggestions for bottom-up and top-down management strategies for APD.

Management strategies of APD	Examples
Optimizing residual hearing	maximizing remaining hearing through environmental adaptations and hearing devices
Applying task adaptations	waiting patiently for the child to process what they hear; providing sufficient time for auditory processing; reducing the rate of speech; providing short phrases and clear key words; simplify speech
Providing structured routines	placing the child closer to the speaker; preferential seating in the classroom
Accommodating environmental modifications	utilization of personal FM systems or noise-canceling headphones for acoustic amplification; reducing background noise or auditory information; reducing auditory clutter and auditory fatigue; reverberation management to increase the signal‑to‑noise ratio (e.g., sound-absorbing panels/materials)
Enhancing auditory skills	targeted auditory training by providing structured exercises to refine active listening skills; distinguishing and recognizing subtle differences between environmental or speech sounds/auditory discrimination training; playing sound-matching games/active listening exercises; drawing attention to the source and direction of a sound/sound localization training
Improving auditory processing skills in combination with music	targeted and strategic musical training for boosting auditory processing abilities over time; playing musical pattern games to develop timing and rhythm perception; providing dance or dance movement therapy
Improving phonological awareness (metalinguistic strategies)	focusing on the overall meaning or main idea of a message rather than trying to process every single individual phoneme or sound; helping the child to be aware of environmental sound cues or voices and to respond to them accurately; rhyming or identifying words with similar ending sounds; manipulating individual sounds by clapping syllables or words in a sentence; training the child to use surrounding context, body language, and situational cues to "fill in the blanks" for missed words
Focus on using higher-order cognitive skills (metacognitive strategies)	teaching the child to monitor their own attention and recognize when they have stopped understanding; using visualization, mind mapping, or repeating information back in chunks to strengthen working memory

Table 9. Some bottom-up and top-down management strategies of APD with examples

Children with BAVI may need a combination of these CVI and APD strategies. It is important to emphasize that the CVI and APD strategies need to be intertwined rather than considered separately. For example, reducing visual complexity may be an appropriate CVI strategy, but that alone may not be sufficient if the child is still trying to function in a complex auditory environment. We may also need to reduce background noise or auditory information, simplify speech, provide additional processing time, avoid asking the child to look and listen simultaneously, and consider whether information should be presented multisensorial or through one sensory channel at a time. The visual and auditory processing strategies need to interact or work together, and the implementation approach will differ from child to child. In other words, their relevance will always depend on the individual characteristics, developmental profile, sensory functioning, needs and responses of the child.

However, we should be more cautious about some of the CVI and APD interventions that are mentioned in tables 8 & 9, particularly the top-down strategies. Some of the CVI and APD interventions may be useful, but they are not established BAVI interventions. The evidence base for BAVI interventions is still developing.

Furthermore, it is essential to consider that some of these intervention strategies implemented for a child with CVI or APD may be difficult to apply or are less effective for certain children with BAVI, for instance, for a toddler with global developmental delay or for a child with DB-BAVI. A child with DB-BAVI may display a different developmental path with restricted access to sensory input and limited processing skills for visual and auditory information, thus impacting how they learn, communicate, and interact with the world. While some adaptations or accommodations can be made on the above-mentioned management strategies of CVI or APD, compensation for a brain based auditory and visual impairment (BAVI) is much more complex and will require specialized, individualized and multidisciplinary approaches.

For individuals with BAVI, compensatory strategies based on the sense of touch, such as providing individualized tactile-based strategies could be helpful. Teaching compensatory tactile strategies have been suggested in the integrated rehabilitation approach of military war veterans with deficits associated with both auditory and visual processing (Saunders & Echt, 2012). Besides, tactile-based rehabilitation instructions could assist individuals with dual sensory loss to enhance their awareness of touch and to refine their touch cues/tactile skills to effectively supplement or replace vision and hearing (Martinello, 2025).

However, in children with BAVI more emphasis must be given to tactile sensory and tactile perception interventions, such as using targeted touch, pressure, and textured activities to help the brain process and respond to skin or bodily sensations. Touch is not necessarily an automatically accessible compensatory sense. Tactile information needs to be meaningful and interpretable for the individual child rather than simply added as another sensory input.

Providing individualized tactile-based strategies may enable a child with BAVI to develop adequate learning strategies and further influence the child`s life-long learning and communication development. The utilization of touch within early childhood instruction and throughout learning experiences will often be beneficial to support access to learning (Luckner et al., 2016). In this regard, tactile-based learning strategies that focus on tactile sensory perception and tactile cognition may influence the learner`s motivation and attention as well as in the selection and processing of information (Nicholas, et al., 2025).

2. Case-specific management of BAVI

Case illustration 1: Thomas

Before considering suggestions to strengthen outcomes for parents and teachers, it is helpful to describe the complex BAVI challenges of Thomas. Parents and teachers should understand the impact of BAVI on Thomas`s daily life. Fundamentally, the child with BAVI is a child who happens to have a distinct clinical disorder that diminishes the ability to process both visual and auditory information. The evaluation using the P-BAVI has identified Thomas`s difficulties due to BAVI. Table 6 provides the P-BAVI scoring profile for Thomas.

Basic strategies of BAVI should include supporting Thomas to attain his optimum level of visual and hearing functioning, encouraging his participation, reducing his emotional challenges, and improving his ability to effectively communicate. Specific strategies of BAVI should include actionable strategies to reduce the impact of Thomas’s visual and auditory processing difficulties in his daily life. Difficulties specific to Thomas have been identified through the P-BAVI evaluation. Specific strategies may include:

-Build learning through familiarity and predictability. Familiar songs, objects, routines and people should be used as entry points for introducing new activities and concepts. Consistent routines and predictable environments are likely to reduce processing demands and thus increase his engagement, understanding, and participation.

- Present information using one sensory modality at a time. Thomas appears to process information most effectively when sensory demands are less complex or simplified. Whenever possible, visual, auditory, and tactile information should be presented sequentially rather than simultaneously. Activities should avoid requiring him to look, listen, and manipulate objects at the same time, as simultaneous sensory input may reduce his ability to attend and participate.

- Allow Thomas to take ‘sensory breaks’, as looking and listening are demanding for him. Short breaks or pauses during an activity may stop him from getting too tired and help him focus better on the next task.

-Provide a quiet learning environment which is necessary for Thomas to learn and develop. Especially, auditory clutter is very disturbing for Thomas. Interaction and communication should occur in quieter environments whenever possible. Background music, televisions, multiple conversations, and other competing sounds should be minimized, particularly during learning activities. Reduced auditory complexity is likely to improve his attention and ability to process meaningful information.

- Allow Thomas sufficient time to process visual and auditory information. Thomas may need extended time to notice, process and respond to sensory information, particularly when materials are unfamiliar or during demanding or increasing environmental conditions. Thomas should be allowed sufficient wait time, and rapidly changing activities should be avoided.

- Simplify visual and sound environments simultaneously. Thomas sometimes seems not to respond to very bright light in a dark room. By presenting individual visual objects one at a time in a simple, non-visual clutter environment and in a quiet, non-auditory clutter surrounding may foster his visual attention.

- Monitor and respond to Thomas`s signs of sensory overload or feeling overwhelmed. When he is overstimulated and feels stressed or upset, it is important to reduce the amount of spoken information, long phrases and the rate of speech. Humming and holding him tight (deep pressure) may help him calm down. Besides, reducing environmental visual and auditory clutter could be effective.

- Provide music and rhythms for boosting communication and processing abilities. Singing is one of Thomas's strongest motivators and appears to facilitate attention, engagement, and participation. Preferred songs, rhythmic activities, and musical routines should be incorporated into his daily life and may benefit to support transitions, anticipation, and communication opportunities. ‘Songs of reference’ are already being used by his parents at home for communicating activities to him.

- Use the bodily-tactile modality for contact, communication, exploration and orientation. Tactile and oral-tactile experiences appear to be important avenues through which Thomas gathers information about his environment. Opportunities for safe exploration of real objects should be provided, and tactile experiences should be paired with language, routines, and meaningful activities to support understanding and concept development.

- Implement tactile signs and gestures which seem to be more appropriate compared to visual signs or only spoken language. Thomas is very open to a hand-under-hand approach, which is a way of interacting and communicating using touch. Attention should be given to his whole-body during interaction, since he also uses his feet to communicate his needs.

The P-BAVI was not only helpful to identify BAVI characteristics, but it also provided a stronger foundation for deciding what to change in Thomas's sensory environment and in his social interaction patterns so that he can function and learn more successfully. Table 10 gives an overview of how Thomas learns and responds to his environment.

OBSERVED STRENGTHS
Familiarity Recognizes familiar songs (‘songs of reference’) Recognizes familiar voices Recognizes familiar objects implicitly	Motivation Strong response to singing songs Greater involvement in tactile interaction Interest in tactile exploration	Functional Memory Quickly learns new songs with tactile gestures Anticipates in certain songs with tactile gestures Recognizes meaningful objects
OBSERVED CHALLENGES
Sensory complexity Difficulty with background noise Multiple simultaneous sounds can be overwhelming (he ‘freezes’)	Dual-task Processing Difficulty listening and tactile exploring at the same time Difficulty looking in almost all circumstances One sense often takes priority over others (usually auditory or tactile)	Variability Responses change depending on fatigue Responses change depending on the envionment Responses change depending on interest
KEY SUPPORTS FOR SUCCESS
To support listening abilities Quiet environment Familiar voices Use intonation and singing voice Clear key words	To support tactile development One sense at a time Hand under hand interaction Make visual and auditory experiences tactile as well	To support participation Predictable routines Processing time Sensory breaks Strategic use of music
KEY MESSAGE
When the environment and the approach for interaction are adapted to his sensory needs, Thomas demonstrates increased understanding, engagement and participation Tactile input + simplicity + motivation + calm = greater success

Table 10: An overview on Thomas`s observed strengths and challenge with key supports for success.

Case illustration 2: Xavyer

Before considering suggestions to strengthen outcomes for parents and teachers, it is helpful to describe the impact of the complex BAVI challenge on Xavyer`s daily life. Fundamentally, the child with BAVI is a child who happens to have a distinct clinical disorder that diminishes the ability to process both visual and auditory information. The evaluation using the P-BAVI has identified Xavyer`s difficulties due to BAVI. Table 7 provides the P-BAVI scoring profile for Xavyer.

Basic strategies of BAVI should include supporting Xavyer to attain his optimum level of visual and hearing functioning, encouraging his participation, reducing his emotional challenges, and improving his ability to effectively communicate. Specific strategies of BAVI should include actionable strategies to reduce the impact of Xavyer’s visual and auditory processing difficulties in his daily life. Specific strategies may include:

- Present information with one sensory modality at a time; Xavyer appears to process information most effectively when sensory demands are simplified. Whenever possible, visual, auditory, and tactile information should be presented sequentially rather than simultaneously. Activities should avoid requiring him to look, listen, and manipulate objects at the same time, as simultaneous sensory input may reduce his ability to attend and participate.

- Build learning through familiarity and predictability; Familiar songs, objects, routines, picture cues, and people should be used as entry points for introducing new activities and concepts. Consistent routines and predictable environments are likely to reduce processing demands and increase his engagement, understanding, and participation.

- Reduce auditory clutter and competing sounds; Instruction and communication should occur in quieter environments whenever possible. Background music, televisions, multiple conversations, and other competing sounds should be minimized, particularly during learning activities. Reduced auditory complexity is likely to improve his attention and ability to process meaningful information.

- Simplify visual environments; Visual information should be presented in a structured and uncluttered manner. Presenting one object or picture at a time, using plain backgrounds, and reducing the number of competing visual elements may increase his ability to visually attend, recognize, and respond to information.

- Use visually salient materials; Xavyer demonstrates increased visual attention to bright colours, illuminated objects, and movement. Educational materials should incorporate high contrast colours, movement, and visual features that are meaningful and motivating to him. Whenever possible, objects should be presented within his preferred right central visual field.

- Allow additional processing time; Xavyer may require extended time to notice, process, and respond to sensory information, particularly when materials are unfamiliar or when environmental demands are increased. Adults should allow sufficient waiting time and avoid rapidly changing activities or repeating instructions too quickly.

- Incorporate music and rhythm into programming; Music is one of Xavyer's strongest motivators and appears to facilitate attention, engagement, and participation. Preferred songs, rhythmic activities, and musical routines should be incorporated into daily programming and used to support transitions, anticipation, and communication opportunities.

- Monitor and respond to signs of sensory overload; Xavyer demonstrates signs of sensory overload in highly stimulating env1ironments, including disengagement, turning away, mouthing objects, and seeking to leave the environment. Staff should monitor for these behaviours and provide opportunities for regulation, reduced sensory input, and access to quieter spaces when needed.

- Maintain highly structured and predictable environments; Xavyer appears to function most successfully in familiar, organized, and predictable environments. Maintaining consistency in routines, material placement, and environmental organization is likely to support orientation, participation, and emotional regulation while reducing cognitive and sensory demands.

- Support tactile and oral-tactile exploration; Tactile and oral-tactile experiences appear to be important avenues through which Xavyer gathers information about his environment. Opportunities for safe exploration of real objects should be provided, and tactile experiences should be paired with language, routines, and meaningful activities to support understanding and concept development.

The P-BAVI was not only helpful to identify BAVI characteristics, but it also provided a stronger foundation for deciding what to change in Xavyer 's environment, programming and interactions so that he can function and learn more successfully. Table 11 gives an overview of how Xavyer learns and responds to his environment.

OBSERVED STRENGTHS
Familiarity Recognizes preferred objects Recognizes familiar songs Recognizes certain familiar voices Navigates familiar environments	Motivation Strong response to music Interest in lights and movement Greater engagement with preferred activities	Functional Memory Remembers familiar routines Recognizes meaningful symbols Anticipates certain sounds or activities
OBSERVED CHALLENGES
Sensory complexity Difficulty with visually cluttered environments Difficulty with background noise Multiple simultaneous sounds can be overwhelming	Dual-task Porcessing Difficulty looking and listening at the same time Difficulty listening while manipulating objects One sense often takes priority over others	Variability Responses change depending on fatigue Responses change depending on interest Responses change depending on the environment
KEY SUPPORTS FOR SUCCESS
To support visual abilities simple materials reduced visual distraction familiar objects optimal positioning	To support listening abilities quiet environment familiar voice short phrases clear key words	To support participation predictable routines processing time sensory breaks strategic use of music support tactile and oral-tactile exploration
KEY MESSAGE
When the environment is adapted to his sensory profile, the student demonstrates increased understanding, engagement, and participation. Familiarity + simplicity + motivation + calm = greater success

Table 11: An overview on Xavyer`s observed strengths and challenge with key supports for success.