1
|
Sallum JMF, Pellissari MC, Carreiro LR, de Vasconcellos CFC. Screening for Autism Spectrum Disorder in Children and Adolescents With Leber's Congenital Amaurosis. Am J Ophthalmol 2024; 265:257-274. [PMID: 38777102 DOI: 10.1016/j.ajo.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To investigate autism spectrum disorder (ASD) indicators in children with Leber congenital amaurosis (LCA). STUDY DESIGN Cross-sectional, prospective, and correlational study. METHODS Setting: It was conducted at the Institute of Ocular Genetics, the Department of Ophthalmology at Federal University of São Paulo (UNIFESP), and the Autism Spectrum Disorder Laboratory, in São Paulo, Brazil. PATIENT POPULATION Participants included patients aged 2 to 16 years with LCA confirmed by genetic testing. There were 20 individuals with ciliopathies (LCA cilio) and 26 with other gene mutations (LCA other). As intervention, the instrument used for ASD screening was the Autism Behavior Checklist (ABC). Marginal descriptive analyses, non-parametric tests, and a linear regression model were conducted. The main outcomes were the scores on the tests correlated with clinical variables. RESULTS Of the 46 participants, 6 had ASD scores. There was no statistically significant correlation between the different groups (LCA cilio and LCA other) (p = 0.438). There was no statistically significant correlation between age and ASD (p = 0.308). However, there was a statistically significant correlation between visual acuity and ASD (p = 0.008) and between male gender and ASD (p = 0.025). CONCLUSIONS This study suggests that there is no correlation between LCA cilio, LCA other and ASD. These findings bring new insights to the existing literature, which previously lacked robust data on the relationship between LCA and ASD. These data demonstrate that visual acuity plays a crucial role in the development of children with visual impairment as poorer visual acuity is associated with a higher incidence of ASD. Based on this study, early interventions can be designed, especially for individuals without light perception, with the aim of maximizing their developmental outcomes. Furthermore, such data indicates that any improvement in visual acuity outcomes in treatment clinical trials become relevant for child development.
Collapse
Affiliation(s)
- Juliana Maria Ferraz Sallum
- From the Department of Ophthalmology, Federal University of São Paulo-UNIFESP (JMFS, CFCdV, MCP), São Paulo, SP, Brazil.
| | - Marina Cruz Pellissari
- From the Department of Ophthalmology, Federal University of São Paulo-UNIFESP (JMFS, CFCdV, MCP), São Paulo, SP, Brazil
| | - Luiz Renato Carreiro
- Postgraduate Program in Human Development Sciences, Mackenzie Presbyterian University-Mackenzie (LRC), São Paulo, SP, Brazil
| | | |
Collapse
|
2
|
Lulu C, Xie H, Wang P, Zhang T. Impacts of visual impairment on pragmatic impairment: A systematic review and meta-analysis. PLoS One 2023; 18:e0294326. [PMID: 38064440 PMCID: PMC10707542 DOI: 10.1371/journal.pone.0294326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Consideration for patients with visual impairment, from low vision to blindness, is an important part of building a barrier-free society. Some authors have elaborated that visual impairment can indeed lead to delayed development in theory of mind, thereby causing pragmatic knowledge deficiency. Verifying whether those with eye conditions have pragmatic impairment is an essential way for their clinical evaluation, intervention and rehabilitation. OBJECTIVE We primarily carry out a meta-analysis of visual impairment from low vision to blindness and pragmatic impairment in people with low vision or blindness to verify visual impairment may cause pragmatic impairment. DATA SOURCES Electronic databases Pubmed, Medline, MesH, Psychinfo, Ovid, EBSCO and CNKI and the reference sections of previous reviews. STUDY ELIGIBILITY CRITERIA Studies were included when they built on primary data from clinical questionnaire surveys or field trials anywhere in the world, and when they reported impacts of visual impairment on social cognition, communication, skills, behavior and intelligence. In total, 25 original studies were included, in which 25735 people were evaluated. RESULTS Statistically, visual impairments and pragmatic impairment exist correlation due to the significant p value(p = 0.0005 < 0.05) in group and the subgroup sorted in the light of 18 years old (p < 0.0001 and p = 0.003 < 0.05). Psychologically, because people with visual impairment can not normally get non-verbal information, they can not get a complete pragmatic knowledge system. Pragmatic knowledge deficiency leads to abnormal in executive functions and development delay from the perspective of theory of mind, inducing pragmatic impairment. Therefore, visual impairment has an impact on pragmatic impairment. CONCLUSION The meta-analysis reveals robust evidence on the relationship of vision impairment and pragmatic impairment in children or adults. Such evidence may help to gradually improve the clinical evaluation, intervention and rehabilitation of these people.
Collapse
Affiliation(s)
- Cheng Lulu
- School of Foreign Studies, China University of Petroleum (East China), Qingdao, China
- Shanghai Center for Research in English Language Education, Shanghai International Studies University, Shanghai, China
| | - Hong Xie
- School of Foreign Studies, China University of Petroleum (East China), Qingdao, China
| | - Peng Wang
- School of International Education, Guizhou Normal University, Guiyang, China
| | - Ting Zhang
- College of Engineering, Beijing University, Beijing, China
| |
Collapse
|
3
|
Nwaordu G, Charlton RA. Repetitive Behaviours in Autistic and Non-Autistic Adults: Associations with Sensory Sensitivity and Impact on Self-Efficacy. J Autism Dev Disord 2023:10.1007/s10803-023-06133-0. [PMID: 37751091 DOI: 10.1007/s10803-023-06133-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Restricted and repetitive behaviours are a core feature of autism diagnoses but have not been widely studied in adulthood. This study examined the rates of and associations between repetitive behaviours and sensory sensitivity in autistic and non-autistic adults; and whether repetitive behaviours described as "stimming" impacted coping with difficulties (self-efficacy). METHODS Diagnosed autistic (n = 182), undiagnosed autistic (n = 163) and non-autistic (n = 146) adults completed online measures of repetitive behaviours, sensory sensitivity, and self-efficacy for when able and not able to stim. RESULTS Repetitive behaviours and sensory sensitivity correlated significantly in each group, although ratings were higher in autistic compared to non-autistic groups. When people were able to stim, no differences between the groups were observed on self-efficacy ratings. However when unable to stim, autistic people reported lower self-efficacy than non-autistic people. CONCLUSIONS Results suggest that repetitive behaviours are significantly associate with sensory sensitivities. Rather than repetitive behaviours being viewed as negative, stimming was associated with increased self-efficacy. Results suggest that stimming may have beneficial effects. Further work is needed to better understand how repetitive behaviours and stimming manifest in adulthood, how they change over time and their effects for autistic adults.
Collapse
Affiliation(s)
- Gabrielle Nwaordu
- Department of Psychology, Goldsmiths University of London, New Cross, London, SE14 6NW, UK.
| | - Rebecca A Charlton
- Department of Psychology, Goldsmiths University of London, New Cross, London, SE14 6NW, UK
| |
Collapse
|
4
|
Moroe N, Masuku K, Shirame L. Rehabilitation healthcare professionals' competence and confidence in differentially diagnosing deafblindness from autism spectrum disorders: a cross-sectional survey in South Africa. BMC MEDICAL EDUCATION 2022; 22:194. [PMID: 35313865 PMCID: PMC8939183 DOI: 10.1186/s12909-022-03258-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Early diagnosis and management of children who are deafblind is important to alleviate the effects of deafblindness on the development of the child who is deafblind and their families. However, children who are deafblind are often misdiagnosed or diagnosed late. The misdiagnosis or late diagnosis has been attributed to many factors, one of which is the competence and confidence of healthcare professionals in differentially diagnosing deafblindness from other conditions, in most cases, autism spectrum disorder (ASD). The study therefore aimed to establish the competence and confidence of rehabilitation healthcare professionals in differentially diagnosing deafblindness from ASD in the South African context. METHODS A cross-sectional survey design was employed for the study. An online questionnaire was distributed to rehabilitation healthcare professionals (N = 78) via Survey Monkey. Data were analyzed using descriptive and inferential statistics. Ethical clearance and permission were obtained from relevant stakeholders prior to the commencement of the study. RESULTS Regarding the rehabilitation healthcare professionals in this study, 54% were competent in diagnosing ASD, while only 35% could correctly diagnose deafblindness. In some instances, symptoms were classified as associated with both ASD and deafblindness, when they were just those of deafblindness. Of all the rehabilitation healthcare professionals in this study, speech language therapists displayed the most knowledge of deafblindness. Furthermore, healthcare professionals who had between one and nine years of working experience had more knowledge of deafblindness than other professionals with more or less experience. CONCLUSION Deafblindness is often underdiagnosed or misdiagnosed as ASD. This is due to the lack of competence and confidence of rehabilitation healthcare professionals in diagnosing it. The findings therefore highlight the need for training of rehabilitation healthcare professionals. Training on deafblindness could be included as part of the curriculum in the various undergraduate programs. Deafblindness could also form part of the Continuous Professional Development (CPD) training programs at various healthcare facilities. A team approach to the training would be ideal as it would facilitate peer learning and support. More research is required as it would inform evidence-based assessment, and management and support strategies for children who are deafblind and their families.
Collapse
Affiliation(s)
- Nomfundo Moroe
- Department of Speech Pathology and Audiology, University of the Witwatersrand, Johannesburg, South Africa.
| | - Khetsiwe Masuku
- Department of Speech Pathology and Audiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Lebogang Shirame
- Department of Speech Pathology and Audiology, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
5
|
Pili R, Zolo B, Farris P, Penna V, Valinotti S, Carrogu GP, Gaviano L, Berti R, Pili L, Petretto DR. Autism and Visual impairment: A First Approach to a Complex Relationship. Clin Pract Epidemiol Ment Health 2021; 17:212-216. [PMID: 35173790 PMCID: PMC8728560 DOI: 10.2174/1745017902117010212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/22/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022]
Abstract
Since the first half of the 20th century there has been an interest in the study of the relationship between autism and autistic-like clinical features and with visual impairments. Autism Spectrum disorders are one of the more worldwide-studied neurodevelopmental disorder with an increasing prevalence in the last ten years. Visual impairment is a condition which derives from several causes (genetic, constitutional, injuries, nutritional and environmental ones). Again, it is a kind of spectrum and an overarching category, because visual impairments range from refractive errors (myopia, hyperopia, astigmatism), to amblyopia, strabismus, and to partial and total blindness. Since the first study of Keeler (1956) which described autistic-like patterns in five preschool children who were totally blind due to retinopathy of prematurity (ROP), a growing number of researchers addressed the relationship between autism and visual impairment. In this paper we focused on it, aiming to discuss on some lessons learned in this field and to discuss some open questions since the first research in this field.
Collapse
Affiliation(s)
- Roberto Pili
- IERFOP Onlus, University of Cagliari, Cagliari, Italy
| | - Bachisio Zolo
- IERFOP Onlus, University of Cagliari, Cagliari, Italy
| | | | | | | | - Gian Pietro Carrogu
- Department of Education, Psychology and Philosophy, University of Cagliari, Via Is Mirrionis 1, 09127 Cagliari, Italy
| | - Luca Gaviano
- Department of Education, Psychology and Philosophy, University of Cagliari, Via Is Mirrionis 1, 09127 Cagliari, Italy
| | - Roberta Berti
- Department of Education, Psychology and Philosophy, University of Cagliari, Via Is Mirrionis 1, 09127 Cagliari, Italy
| | - Lorenzo Pili
- Department of Education, Psychology and Philosophy, University of Cagliari, Via Is Mirrionis 1, 09127 Cagliari, Italy
| | - Donatella Rita Petretto
- Department of Education, Psychology and Philosophy, University of Cagliari, Via Is Mirrionis 1, 09127 Cagliari, Italy
| |
Collapse
|
6
|
Suhumaran S, Yeleswarapu SP, Daniel LM, Wong CM. Congenital blindness and autism spectrum disorder (ASD): diagnostic challenges and intervention options. BMJ Case Rep 2020; 13:13/2/e232981. [PMID: 32051159 DOI: 10.1136/bcr-2019-232981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The case of a 6-year-old boy with congenital blindness and features suggestive of autism spectrum disorder (ASD) is reported. He presented to a developmental paediatrician with global developmental delay, worsening self-injurious behaviours and difficulties in social interaction, transitions and interactive play. He demonstrated poor response to his name, rigidity, repetitive behaviours and had a sensory profile suggestive of ASD. This paper discusses the challenges in diagnosing and managing ASD in visually impaired children.
Collapse
Affiliation(s)
- Sharline Suhumaran
- Department of Child Development, KK Women's and Children's Hospital, Singapore
| | | | - Lourdes Mary Daniel
- Department of Child Development, KK Women's and Children's Hospital, Singapore
| | - Chui Mae Wong
- Department of Child Development, KK Women's and Children's Hospital, Singapore
| |
Collapse
|
7
|
Geier DA, Kern JK, Sykes LK, Geier MR. Mercury-associated diagnoses among children diagnosed with pervasive development disorders. Metab Brain Dis 2018; 33:949-960. [PMID: 29512044 DOI: 10.1007/s11011-018-0211-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/25/2018] [Indexed: 12/27/2022]
Abstract
Nelson and Bauman (Pediatrics 111:674-679, 2003) previously hypothesized that pervasive developmental disorder (PDD) was not associated with mercury (Hg) exposure because the medical conditions associated with Hg exposure were not associated with PDD. A hypothesis-testing longitudinal case-control study evaluated the frequency of medically diagnosed conditions previously associated with Hg poisoning, including: epilepsy, dysarthria, failure to thrive, cerebral palsy, or contact dermatitis and other eczema among children preceding their eventual PDD diagnosis (cases) compared to controls. A retrospective examination of medical records within the Vaccine Safety Datalink (VSD) was undertaken. Cases diagnosed with PDD (n = 534) were born from 1991 to 2000 and continuously enrolled until their PDD diagnosis. Controls (n = 26,367) were born from 1991 to 1993 and continuously enrolled from birth for 7.22 years. Within the first 5 years of life, cases compared to controls were significantly (p < 0.0001) more likely to be assigned a diagnosis of contact dermatitis and other eczema (odds ratio (OR) = 2.033), dysarthria (OR = 23.992), epilepsy (OR = 5.351), failure to thrive (OR = 25.3), and cerebral palsy (OR = 4.464). Similar results were observed when the data were separated by gender. Overall, the results of the present study and recently published studies provide direct evidence supporting a link in twelve of twelve categories (100%) of Hg poisoning associated symptoms as defined by Nelson and Bauman (Pediatrics 111:674-679, 2003) and symptoms observed in those with a PDD diagnosis. The results of this study support the biological plausibility of Hg poisoning to induce PDD diagnoses and rejection of the Nelson and Bauman (Pediatrics 111:674-679, 2003) hypothesis because those with a PDD diagnosis have an increased frequency of conditions previously associated with Hg poisoning.
Collapse
Affiliation(s)
- David A Geier
- The Institute of Chronic Illnesses, Inc, 14 Redgate Ct, Silver Spring, MD, USA
| | - Janet K Kern
- The Institute of Chronic Illnesses, Inc, 14 Redgate Ct, Silver Spring, MD, USA.
- CoMeD, Inc, Silver Spring, MD, USA.
- CONEM US Autism Research Group, Allen, TX, USA.
| | | | - Mark R Geier
- The Institute of Chronic Illnesses, Inc, 14 Redgate Ct, Silver Spring, MD, USA
| |
Collapse
|
8
|
de Vaan G, Vervloed MPJ, Peters-Scheffer NC, van Gent T, Knoors H, Verhoeven L. Assessing Autism Spectrum Disorder in People with Sensory Impairments Combined with Intellectual Disabilities. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2018; 30:471-487. [PMID: 30100694 PMCID: PMC6061084 DOI: 10.1007/s10882-018-9597-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
People with sensory impairments combined with intellectual disabilities show behaviours that are similar to Autism Spectrum Disorder (ASD). The instrument Observation of Autism in people with Sensory and Intellectual Disabilities (OASID) was developed to diagnose ASD in this target group. The current study focuses on the psychometric properties of OASID. Sixty individuals with intellectual disabilities in combination with visual impairments and/or deafblindness participated in this study. The OASID assessment was administered and rated by three independent observers. By means of expert consensus cut-off scores for OASID were created. To determine the concurrent validity OASID was compared with the Pervasive Developmental Disorder for People with Mental Retardation (PDD-MRS) and the Childhood Autism Rating Scale second edition (CARS-2). The intra-rater reliability, the inter-rater reliability, internal consistency and concurrent validity of OASID were good to excellent. Cut-off scores were established based on criteria from the DSM-5. OASID was able to differentiate between four severity levels of ASD.
Collapse
Affiliation(s)
- Gitta de Vaan
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Mathijs P. J. Vervloed
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Nienke C. Peters-Scheffer
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500 HE Nijmegen, The Netherlands
- Driestroom, PO Box 139, 6660 HC Elst, The Netherlands
| | - Tiejo van Gent
- Royal Dutch Kentalis, Theerestraat 42, 5271 GD Sint-Michielsgestel, The Netherlands
| | - Harry Knoors
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500 HE Nijmegen, The Netherlands
- Royal Dutch Kentalis, Kentalis Academy, Theerestraat 42, 5271 GD Sint-Michielsgestel, The Netherlands
| | - Ludo Verhoeven
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500 HE Nijmegen, The Netherlands
| |
Collapse
|
9
|
Butchart M, Long JJ, Brown M, McMillan A, Bain J, Karatzias T. Autism and Visual Impairment: a Review of the Literature. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2017. [DOI: 10.1007/s40489-016-0101-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
10
|
Comorbid Deafblindness and Autism Spectrum Disorder—Characteristics, Differential Diagnosis, and Possible Interventions. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2016. [DOI: 10.1007/s40489-016-0100-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
11
|
de Vaan G, Vervloed M, Peters-Scheffer NC, van Gent T, Knoors H, Verhoeven L. Behavioural assessment of autism spectrum disorders in people with multiple disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:101-112. [PMID: 26059997 DOI: 10.1111/jir.12206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND It is difficult to diagnose autism spectrum disorder (ASD) in people with a combination of intellectual and sensory disabilities because of overlap in behaviour. The ASD typical behaviours of people with combined intellectual and sensory disabilities are often caused by their disabilities and not by ASD. Current diagnostic tools are inadequate to differentiate between people with and without ASD when they have these combined disabilities, because tools lack norms for this population or are subjective, indirect or unable to adapt to the variety of disabilities that these people may have. Because giving a correct diagnosis is necessary for treatment and support, a new observational tool was developed to diagnose ASD in people with multiple disabilities, observation of autism in people with sensory and intellectual disabilities (OASID). METHOD Observation of autism in people with sensory and intellectual disabilities was tested on 18 participants with moderate to profound intellectual disabilities, one or dual sensory impairment, with and without ASD. Two independent experts diagnosed these participants as well in order to test the psychometric properties and differentiating abilities of OASID. RESULTS Observation of autism in people with sensory and intellectual disabilities showed high inter-rater reliability, internal consistency of scales and content and construct validity. OASID could differentiate people with and without ASD without overlap. CONCLUSIONS Observation of autism in people with sensory and intellectual disabilities could differentiate people with intellectual disabilities combined with sensory impairments, who clearly had or did not have signs of ASD. People with unclear signs of ADS scored in between those two groups with regard to their OASID scores. Psychometric properties of OASID are promising.
Collapse
Affiliation(s)
- G de Vaan
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - M Vervloed
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - N C Peters-Scheffer
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
- Driestroom, Elst, The Netherlands
| | - T van Gent
- Royal Dutch Kentalis, Sint-Michielsgestel, The Netherlands
| | - H Knoors
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
- Royal Dutch Kentalis, Sint-Michielsgestel, The Netherlands
| | - L Verhoeven
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| |
Collapse
|
12
|
Cascella PW, Bruce SM, Trief E. Sign Language, Speech, and Communication Repair Abilities by Children with Congenital Deafblindness. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2015. [DOI: 10.1177/0145482x1510900209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Paul W. Cascella
- Speech-Language Pathology & Audiology, Hunter College, City University of New York, 425 East 25th Street, New York, NY 10010
| | - Susan M. Bruce
- Teacher Education, Special Education, Curriculum and Instruction, Boston College, Campion Hall, Room 120, Chestnut Hill, MA 02467
| | - Ellen Trief
- Special Education: Blind & Visually Impaired; Severe & Multiple Disabilities, Hunter College, 695 Park Avenue, Room 911 West, New York, NY 11065
| |
Collapse
|