Central Coherence

Is your child:

• Missing the forest through the trees?
• Not getting the point?
• Failing to see the big picture?
• Skipping problems and sentences when reading or doing math?
• Noticing tiny details while forgetting important information?
• Working more slowly because of distraction by tiny details?
• Noticing the slightest object being moved around in the house?
• Not making sense when retelling a story?
• Telling stories using detail after detail but without a main idea?

Children with these challenges are said to “miss the forest through the trees.” That is, they are so focused on a single tree that they miss the ‘big idea’ or the ‘central idea’ which is the forest. When looking at a picture or telling a story, does your child tell all the details but miss the main point? Does he tell stories with no main character and no plot?

This peculiar pattern may emerge as your child describes an event or something that he saw earlier that day. He or she may get stuck in telling you all kinds of information but never get to the point. Visually, they might approach solving a jigsaw puzzle by studying the patterns and individual shapes, without even noticing the picture they are attempting to construct.

Another related topic with which difficulties with central coherence may show up is with reading comprehension. They may be able to read beautifully, and then when asked about the story, they cannot tell you anything about it. When children with these issues are asked to re-tell a story, the stories tend to lack a logical sequence and are not structured around the main idea.

What may be happening is that your child is overly focused on details and is missing the big picture, in multiple facets of life.

In psychology, when a child focuses so exclusively on details as to miss the big picture, we call this, ‘challenges with central coherence.’

Central coherence is seeing how many component parts fit together to make a coherent whole.

Central coherence difficulties could be related to attention, visual processing, or rigidity.

Shifting attention: Regarding attention, your child may have difficulty shifting attention, that is, the ability to shift focus back and forth between stimuli.

Sustained attention: It could also be challenges with sustained attention, that is, the ability to maintain attention to a task in the absence of immediate reinforcement. Your child may not see the big picture because he is struggling to focus on it and to maintain his attention to it. Instead, the child may be easily distracted by irrelevant details.

Visual processing It could also be visual processing, that is, challenges seeing objects and pictures accurately. Within the area of visual processing is the skill of visual planning. This term means visually planning moves and visualizing what something will look like when a move has been made.

Rigidity: Finally, challenges with central coherence could be related to rigidity. Rigidity refers to considerable perfectionism, attention to detail and resistance to change. Individuals with Autism Spectrum Disorders, Anxiety Disorders, OCD and trauma history may have a significant need for control and rigidity.

If you are concerned that your child may have trouble with central coherence, consider any challenges with: answering questions, reading comprehension, or story-telling.

Answering questions. An easy ‘quick check’ for one form of central coherence is to have a child sit with his or her back to you and describe a picture that you cannot see.

Children with poor central coherence may not be able to answer questions about the picture they see.

Ask your child questions like:

• ‘Are there any people in the picture?’
• ‘Are there any animals or shapes in the picture?’
• ‘How many objects are in the picture?’ Describe what you are picturing based on what your child says
• Then, most importantly, ask the child, ‘What is the main idea of this picture?”

In the picture at the beginning of this article, the child should be able to say, “there are two girls running on a path toward a forest.” Children without central coherence problems should be able to do this task fairly quickly and accurately.

If problems are noted, this concern probably requires further evaluation by a psychologist.

Reading comprehension. Another way to know if your child struggles with central coherence is through his or her reading comprehension. Children with poor central coherence tend to really struggle with getting the sequence of events and main idea in stories.

Story-telling. Finally, it may be that your child can read okay but cannot re-tell a story. If your child tells stories that are filled with details and do not make sense, central coherence could be an issue. In any of these three instances, challenges with central coherence are likely worthy of further assessment.

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

• Body space awareness: standing too close or failing to read social cues could be related to central coherence; self-awareness could also be related (recognizing self, body part identification, and figuring out where objects are in relation to you)
• Attention (Focusing): problems shifting or sustaining attention could be related to central coherence challenges
• Depth Perception: problems judging how far away something is could be related to central coherence issues
• Learning problems: challenges with reading or writing could be related to central coherence problems
• Spatial reasoning: difficulties with visual spatial processing may be related to central coherence issues

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this information does not serve as a diagnosis in any way. See the ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

• Autism Spectrum Disorder (ASD): children with ASD may be rigid because they perseverate (hyper-focus) and have challenges shifting activities. They may prefer to do things their own way as it is predictable and gives them what they want; they may not consider other’s perspectives or be willing to try their ideas. These children may focus on details and fail to integrate the whole picture.
• Attention Deficit Hyperactivity Disorder (ADHD), Combined or Hyperactive Impulsive Type: children with ADHD may be distracted. Children with ADHD show the following symptoms: challenges in sustaining attention, distractibility, hyperactivity, and impulsivity. Inattentive children may struggle with central coherence.
• Developmental Coordination Disorder: children who have challenges with fine motor, likely including poor handwriting, may have trouble with central coherence due to challenges with visual-motor coordination
• Specific Learning Disability in Reading / Dyslexia or Hyperlexia (Educationally Identified Disabilities – may be diagnosed clinically as well): children who have challenges with reading or reading comprehension may also struggle with related central coherence problems
• Specific Learning Disability in Writing / Dysgraphia (Educationally Identified Disabilities – may be diagnosed clinically as well): children who have challenges with writing due to visual or motor processing deficits and may struggle with central coherence problems

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

• CLEAR Child Psychology: to obtain a customized profile of concerns for your child or to chat live with a psychologist
• Physical Therapist: to assess and treat gross motor coordination; to help with large muscle groups and movement
• Occupational Therapist: to assess and treat fine motor skills and sensory integration needs
• Psychologist or Neuropsychologist: to consider symptoms in context, may be related to visual spatial problems, attention, or learning
• Optometrist or Ophthalmologist: to evaluate your child’s vision if concerns are present

These professionals may recommend or administer the following tests for this symptom:

• MVPT-4: test of certain aspects of visual perception
• Beery VMI sequence: test of visual-motor integration, visual perception and motor coordination
• WISC-V: test of intelligence. Using tasks of block design, coding, symbol search and cancellation, examiners can look specifically at visual tracking and visual-motor
• DAS-2: test of cognitive ability. Provides a spatial index score consisting of block design and a copying or recalling designs subtest. Concerns can be assessed using the spatial index.
• WIAT-III or WJ-IV: tests of academic achievement for related concerns in reading, writing, or math
• TOWL: test of written language. Provides standard, age and grade equivalent scores for writing only
• Writing samples: assessments of a child’s schoolwork may help uncover any visual-spatial skills impacting handwriting problems

[1] Kroncke, Willard, & Huckabee (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings. Springer, San Francisco.

• Springer
• Amazon

[2] Barton, Erin. Educating Young Children with Autism Spectrum Disorders.

Retrieved: http://www.nasponline.org/books-and-products/products/books/titles/educating-young-children-with-autism

[3] Fein, Deborah (2011).  “The Neuropsychology of Autism”

Amazon: https://www.amazon.com/Neuropsychology-Autism-Deborah-Fein/dp/0195378318/

[4] Koegel, Lynn Kern & LaZebnik, Claire (2010). Growing up on the spectrum: A guide to life, love and learning for teens and young adults with autism and Asperger’s.

Amazon: https://www.amazon.com/Growing-Up-Spectrum-Learning-Aspergers/dp/0143116665

[5] Giler, Janet Z. (2000). Socially ADDept: A manual for parents of children with ADHD and / or learning disabilities.

Amazon: https://www.amazon.com/Socially-ADDept-Children-Learning-Disabilities/dp/0966696921/

[6] Giler, Janet Z. (2011). Socially ADDept: Teaching social skills to children with ADHD, LD, and Asperger’s.

Amazon: https://www.amazon.com/Socially-ADDept-Teaching-Children-Aspergers/dp/047059683X/

Image Credit:
Description: Two sisters run through the forest holding hands. Summer sunny day…
Image ID: #384716971 (Shutterstock)
By: Tatyana Domnicheva
Child-visual-development
Previously Licensed on: May 13, 2017
Stylized by Katie Harwood exclusively for CLEAR Child Psychology

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