Health, education, and social care provision after diagnosis of childhood visual disability

Abstract

Childhood visual impairment confers significant potential adversity on the individual, their family, and on wider society. 1,2 To address this at societal and individual levels, primary (preventing blinding disease from occurring), secondary (treatment of established disease to reduce negative impact), and tertiary prevention approaches are required. [3][4][5] Tertiary prevention approaches comprise interventions that mitigate the impact of established visual disability or associated disorders on the life of the child and the adult they become. These interventions may be simple, such as the provision of low vision aids, or more complex, such as the provision of parenting support, or the development of individualized 'packages' of multidisciplinary care for the additional physical, educational, psychological, and social developmental needs of the affected child. 6 In recognition of the high burden of the numerous developmental and non-ophthalmic disorders that coexist in children with impaired vision, multidisciplinary assessment of children newly diagnosed with visual disability is advocated. 1,3,7 Almost two decades ago, the British Childhood Visual Impairment and Blindness Study (BCVIS; 2003) confirmed that in the UK most children newly diagnosed with severe visual impairment and blindness (SVIBL; vision worse than 1.0 logMAR [logarithm of the minimum angle of

Findings from the British Childhood Visual Impairment and Blindness Study 2: Implications for children in low‐income countries

“…Children with ASD commonly receive a wide range of therapies in educational settings where on-site professionals can reliably deliver interventions with consistency over multiple days per week. Thus, the study by Auvichayapat et al 1 is of interest because it investigates the use and dosing of tDCS as an adjunct to other therapies children with ASD receive while in attendance at school. This research is important for demonstrating the potential of tDCS as a school-based therapy modality.…”

“…This research is important for demonstrating the potential of tDCS as a school-based therapy modality. However, there are important implications for clinical practice and research that must be considered when working with children with ASD in school-based settings, such as the need for: (1) prioritizing the development of individualized treatment plans before the development of research designs;…”

“…Thus, individualized school-based treatment approaches cover a wide range that may include providing educational accommodations and modifications, academic interventions, behavioral and/or pharmaceutical treatments, and receipt of related therapy services from speech-language pathologists, occupational therapists, recreational therapists, physical therapists, and/or psychologists. The complex nature of individualized treatment plans may be at odds with research design, as in the study by Auvichayapat et al 1 where children with ASD were randomly assigned to tDCS control groups as though they were receiving a one-size-fits-all treatment plan, which they were not. To prioritize individualized treatment plans for children with ASD in school-based settings, researchers may need to employ design approaches such as repeated measures where the participants act as their own controls.…”

“…It is therefore concerning that the British Childhood Visual Impairment and Blindness Study 2 found a significant proportion of children newly diagnosed as blind or severely visually impaired in the UK had not received an Education, Health, and Care Plan or support from multidisciplinary teams/appropriately trained education specialists. 1 Children with moderate visual impairments had even less access to such provision. In the light of these findings, Solebo et al make a persuasive case for increased investment in health, education, and social care provision.…”

“…Solebo et al refer to the challenges faced by service providers in middle-income countries where there are growing numbers of children with visual impairments with additional support needs (a consequence of improved survival rates). 1 It is also worth considering the case of low-income countries such as Malawi. Although no comprehensive situation analysis has been carried out of services for children with visual impairments in this country, the available evidence suggests that they are few and far between and often of poor quality.…”