Developmental outcome, including setback, in young children with severe visual impairment

Abstract

This study retrospectively investigated the developmental perspective of 69 children (40 males, 29 females) with 'potentially simple' congenital disorders of the peripheral visual system: development was examined in the context of degree of visual impairment. Developmental and visual assessments were carried out at 10 to 16 months (Time 1) and 27 to 54 months of age (Time 2). Participants were grouped according to (1) visual status: profound visual impairment (PVI), severe visual impairment (SVI); (2) developmental status on the Reynell-Zinkin scales. A majority of the sample showed normal development on all subscales (62% Time 1, 57% Time 2). Those with PVI were more developmentally vulnerable than SVI with a greater incidence of (1) uneven developmental profile at Time 1 (48% PVI, 16% SVI); (2) global learning difficulties at Time 2 (37% PVI, 0% SVI); (3) delay on individual subscales at Time 2 (p<0.02 PVI versus SVI); (4) deceleration (verbal comprehension 74% PVI, 24% SVI, sensorimotor understanding 70% PVI, 27% SVI); and (5) severe developmental setback (33% PVI, 7% SVI). Risk factors of visual level, age, and sex for poor developmental outcome in infants with visual impairment were established.

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

“…The fit of the individual items to the Rasch measurement model is shown in Table I. Twenty-five of 29 items showed acceptable fit statistics (with the exception of items 5,6,12,13). A further indication of the appropriateness of the VISS items was the point measure correlations which indicated that all items, except for the misfitting ones, correlate well with the overall scale.…”

“…The Rasch mathematical model is increasingly being used when assessing clinical measurement and quality of life tools. 14,16 Analysis showed acceptable fit of the scale and of the items to the Rasch model, except for four of the items (responds selectively to voices [5]; holds arms up to be lifted [6]; enjoys social play [12]; responds to being called by name [13]). Items 6 and 13 were underfitting (too unpredictable according to the Rasch model) and items 5 and 12 were overfitting (too predictable).…”

“…Only children with congenital disorders of the peripheral visual system (disorders of the globe, retina, and anterior optic nerve), where there is no known damage of the central nervous system, were included in order to minimize confounding factors. 6 Visual disorder diagnosis had previously been confirmed by paediatric ophthalmologists and ⁄ or neurologists. Participants were grouped according to their current visual level ⁄ degree of visual impairment at the time of assessment: profoundly visually impaired -able to detect a spinning 12.5cm lightreflecting ball at 30cm or less; severely visually impaired -able to detect a 12.5cm spinning woollen ball at 30cm or better.…”

“…The VISS was designed to identify the range of social and communicative behaviours seen in visually impaired children during the developmental preschool age period; 1,3,5,6,8,11 items were also influenced by International Classification of Diseases (ICD-10) ASD diagnostic criteria. 10,12 None of the VISS items were vision dependent.…”

“…[1][2][3][4][5][6][7] Although the mechanisms underlying the development of social communicative difficulties and ASD are not yet understood in the visually impaired population, early evidence points towards interactions of multiple factors (visual, age, sex, psychological, neurological) at different levels. 6 Because of the availability and potential importance of early intervention strategies in both visual impairment and ASD, 8,9 early accurate identification of social communication difficulties and ASD in children with visual impairment is desirable.…”