The Behavioral and Cognitive Manifestations of Blindness in Children

Abstract

Ground-breaking progress in the field of neurodevelopmental disorders has allowed us far more insight into blindness and visual impairment (VI). The field of cognitive neuroscience has now established itself solidly in the literature, combining the knowledge from cognitive psychology, clinical studies related to brain damage, and neuroscience to open the way to significant advances in understanding. In recent years, the optimism engendered from the adult studies has played a large part in providing the impetus for developmental studies and in particular developmental neuroscience (Johnson 2005; Tager-Flusberg 1999). It is from this developmental neuroscience perspective that we can begin to understand the cognitive and behavioral manifestations associated with blindness and VI; albeit with the proviso that children with VI present particularly heterogeneous developmental patterns when compared to typically developing children (Fraiberg 1971). In considering the effects of blindness and VI, this chapter will focus on social understanding, language, cognition, and motor development. However, it begins with brief introductions to epidemiology and the effects of blindness on the functional and structural organization of the brain, which it is hoped will provide a useful context in which to consider the development of children who cannot see. Today the number of blind people in the world stands at 45 million, even though up to 75% of blindness could be avoided either by treatment or by prevention. The number of people with avoidable blindness will have doubled from 1990 to 2020 unless there is rapid and effective intervention, and the total number of the blind is projected to be as many as 76 million by 2020. To prevent this scenario, the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) have jointly initiated Vision 2020, a project that aims to eliminate the main causes of avoidable blindness by the year 2020, with the ultimate long-term goal of a world in which all avoidable blindness is eliminated and in which everyone with unavoidable vision loss reaches their full potential. The top priority of Vision 2020 is the prevention of childhood blindness. At present there are 1.4 million children under the age of 15 who are blind.

An Update on Pediatric Keratoprosthesis

“…Further, childhood blindness requires resources from and collaboration between medical, community, and educational services to nurture the growing child. Providing sight to a child who may otherwise go blind is thus more than just about restoring vision [2].…”

“…While studies have not shown any significant IQ differences in blind children compared to their seeing counterparts, they have indicated that children with congenital visual impairment have discrepancies in language presentation. Though they may develop normal grammar, vocabulary, and other components that allow a person to communicate, their pragmatic language skills may be hindered, as these develop with visual cues from interactions in various social contexts [2].…”

Observing the use of tactile schedules

“…Lack of visual cues may lead to greater inactivity (Martinsen, 1994; Pérez-Pereira and Conti-Ramsden, 1999) and, in many settings, children with blindness are described as passive (Dale and Salt, 2007; Martinsen, 1994; Pérez-Pereira and Conti-Ramsden, 1999; Sandler, 1963; Sandler and Hobson, 2001). Signals of attention, interest and activity in children with congenital blindness may also be idiosyncratic and difficult to recognize (Fraiberg, 1977; Martinsen, 1994; Pérez-Pereira and Conti-Ramsden, 1999; Pring and Tadic, 2010). Many individuals with congenital blindness have other co-morbid disorders, like intellectual disability and autism spectrum disorders (ASDs) (Mukaddes et al, 2007; Sonksen and Dale, 2002).…”

Enhancing activity by means of tactile symbols

“…Children with congenital blindness comprise a heterogeneous group of individuals with differences in general cognitive level, activity, mobility skills, communication and social and linguistic skills, amongst others things (Fraiberg, 1977; Gense and Gense, 2005, Pring and Tadic, 2010; Warren,1994). As a result of their loss of sight and the inhibitions this has on the children’s physical activity, the children are to a great degree dependent on their caregivers to organise the environment and structure their interaction to promote meaningful activity (Erin, 2000; Fraiberg, 1977; Gense and Gense, 2005; Howley and Preece, 2003; Jordan, 2005; Von Tetzchner and Martinsen, 2000).…”

“…To succeed in getting children with autism and blindness to participate in activities, it is important to assess what may be of interest to each individual (Bruce and Vargas, 2007; Gense and Gense, 2005). A complicating feature in this respect is that the child’s behaviour is often less legible than that of a sighted child (Fraiberg, 1977; Martinsen, 1994; Pérez-Pereira and Conti-Ramsden, 1999, 2005; Pring and Tadic, 2010), and the children often show their interest in ways other than sighted children (Erin, 2000; Gense and Gense, 2005), which in turn makes it more difficult to understand the children. It can result in the environment getting fewer cues to react and respond to the child’s behaviour and initiatives (Fraiberg, 1977; Martinsen, 1994; Pérez-Pereira and Conti-Ramsden, 2005; Rogers and Puchalski, 1984; Warren, 1994).…”