Developing a schedule to identify social communication difficulties and autism spectrum disorder in young children with visual impairment

Abstract

Available observational tools used in the identification of social communication difficulties and diagnosis of autism spectrum disorder (ASD) rely partly on visual behaviours and therefore may not be valid in children with visual impairment. A pilot observational instrument, the Visual Impairment and Social Communication Schedule (VISS), was developed to aid in identifying social communication difficulties and ASD in young children with visual impairment affected by congenital disorders of the peripheral visual system (disorders of the globe, retina, and anterior optic nerve). The VISS was administered to 23 consecutive children (age range 1y 9mo–6y 11mo, mean 4y 1mo [SD 1.6]; 12 males, 11 females) with visual impairment (nine with severe and 14 with profound visual impairment). Item analysis was carried out by fit of the items to the Rasch model. Validity of the VISS was explored by comparison with the Childhood Autism Rating Scale (CARS) score, and the clinical ASD diagnosis (n=9). Correlation between the VISS and CARS total scores was highly significant (Spearman’s rho=−0.89; p=0.01). Below threshold rating on the VISS (score of 35) showed good agreement with the clinical ASD diagnosis (sensitivity 89%, specificity 100%). This preliminary study shows the VISS to be a promising schedule to aid the identification of ASD in young children with visual impairment.

Childhood vision impairment, hearing loss and co-occurring autism spectrum disorder

“…Current diagnostic instruments used to detect ASD by assessing eye contact, joint attention, and gesture have not been validated in children with VI. 38 Also, several items in the evaluation of children for ASD rely on vision, social interaction, and intelligence testing, which likely cannot be applied to children with VI. 39 Lack of feedback on social behavior and play experiences, limited interaction with others, and potential co-occurrence with other DDs, complicate assessment of ASD among children with VI.…”

Social communicative variation in 1–3‐year‐olds with severe visual impairment

“…Although an observational schedule has been recently validated (Absoud et al . ) there is, to the authors' knowledge, no standard interview tool available with which to detect early social communicative difficulties in preschool children with VI. The need to establish which infants and preschoolers are most at risk and which developmental aspects are most vulnerable is of diagnostic and preventative import.…”

“…; Dale & Sonksen ; Sonksen & Dale ) and of clinical autism (Absoud et al . ). The social communicative domain may be especially vulnerable because of the intensity of vision‐dependent behaviours such as eye contact, facial expression, gaze monitoring, imitation and gesture.…”

Language and communication development in preschool children with visual impairment: A systematic review

“…The remaining four articles received a higher rating of IIb as they were identified as well-designed quasi-experimental studies. Two studies (Absoud, Parr, Salt & Dale, 2011 ; Hoevenaars-van den Boom, Antonissen, Knoors & Vervloed, 2009 ) developed assessment tools. Peltzer-Karpf ( 2012 ) made use of neuroimaging to compare study group results, and Rattray and Zeedyk ( 2005 ) conducted a longitudinal study with a static four-group comparative design.…”