A Systematic Review of the Literature on Parenting of Young Children with Visual Impairments and the Adaptions for Video-Feedback Intervention to Promote Positive Parenting (VIPP)

Development and initial validation of a screening tool for visual ability/performance of people with polyhandicap

BACKGROUND

Visual impairments are common in people with polyhandicap although they are poorly assessed. However, evaluation of the visual abilities of these people is critical to determining treatment for impairments.

OBJECTIVES

To develop and validate an easy-to-use visual-behavioural scale for assessing the visual abilities of people with polyhandicap.

METHODS

The development of the Visual Assessment for People with Polyhandicap (VA-PLH) involved 2 steps: i) construction of the scale and ii) field validation. Participant selection criteria were aged > 3 years, age at onset of cerebral lesion < 3 years, a combination of motor impairment and profound intellectual impairment associated with restricted mobility (Gross Motor Function Classification System levels [GMFCS] III, IV or V), and everyday life dependence (Functional Independency Measure [FIM] <55). Vision assessment by both an orthoptist and an ophthalmologist was the reference against which were analysed the items of the scale completed by local health care workers. Acceptability, validity, and reliability were analysed.

RESULTS

Amongst the 232 participants included, 217 had a complete assessment, and 33% were < 18 years of age. Ocular abnormalities were reported in 83% of participants. Visual ability was altered or insufficient in 60% of participants. The final version of the VA-PLH included 3 items related to visual reaction (Area Under Curve Receiver Operating Characteristic = 0.83). Participants were considered at-risk if they had at ≥ 1 of 3 signs present (sensitivity 83% and specificity 73%). The scale's reliability was satisfactory CONCLUSION: The VA-PLH scale provides an easy-to-use, reliable and valid measure of visual status for people with polyhandicap and may be used both in clinical practice and clinical research. In addition, this study provides an overview of the diversity of visual impairments in a large population of people with polyhandicap, showing that most experience visual challenges.

Children's total blindness as a risk factor for early parent-child relationships: preliminary findings from an Italian sample

Background

Vision provides crucial information for parent-child attunement that scaffolds social development from the first months of life. Congenital blindness might affect both parental wellbeing and children's behavior during parent-child interaction. In this study, we compared families of young children with total versus partial blindness to understand the link between residual vision, parenting stress and perceived social support, and children's behavior during parent-child interaction.

Methods

Participants were 42 white parents (21 fathers and 21 mothers) and their congenitally blind children (14 females, mean age = 14.81 months, SD = 10.46) with no co-occurring disability, recruited at the Robert Hollman Foundation rehabilitation centers in Italy. Parents' scores on the Parenting Stress Index and Multidimensional Scale of Perceived Social Support questionnaires, as well as children's behaviors signaling joint engagement during video-recorded episodes of parent-child interaction, were compared between the Total Blindness (TB, n = 12 children with no light perception or light perception in the dark but no quantifiable visual acuity) and Partial Blindness (PB, n = 9 children with a residual visual acuity below 3/60) groups.

Results

We found that parents of TB children had higher parenting stress and lower perceived social support scores than parents of PB children. In fathers, total stress and stress linked to perceiving the child as difficult negatively correlated with perceived support from friends. There was no difference in the time TB and PB children spent displaying joint engagement behaviors during parent-child interaction. However, TB children directed their gaze and face less often toward their parents than PB children. We observed a trend of association between this behavior and maternal stress.

Conclusion

These preliminary results suggest that the complete absence of vision from birth has adverse effects on stress linked to parenting and parental perceived social support. These findings support the importance of early family-centered interventions that extend to the parents' communities and facilitate the parent-child dyad's communication through non-visual behaviors. Replication is warranted in larger and more diverse samples.

Sensory processing in young children with visual impairments: Use and extension of the Sensory Profile

BACKGROUND

Children with visual impairments (VI) are at risk for sensory processing difficulties. A widely used measure for sensory processing is the Sensory Profile (SP). However, the SP requires adaptation to accommodate for how children with VI experience sensory information.

AIMS

(1) To examine sensory processing patterns in young children with VI, (2) to develop VI-specific items to use in conjunction with the SP and to determine internal consistency and construct validity of these newly developed items, and (3) to examine the association between sensory processing and and emotional and behavioral problems.

METHODS

Twenty-six VI-specific items were added to the SP. The SP and these items were completed by caregivers of 90 children with VI between 3 and 8 years old. The Child Behavior Checklist (CBCL) was used to assess emotional and behavioral problems.

RESULTS

Three- to five-year-old children with VI have significantly more difficulties in three quadrants of the SP as compared to the norm group. Six- to eight-year-old children with VI have more difficulties in all quadrants. A reliable and valid VI-specific set of 15 items was established following psychometric evaluation. Age-related differences were found in the associations between the SP and CBCL.

CONCLUSION

Although further validation is recommended, this evaluation of the VI-specific item set suggests it has the potential to be a useful measure for children with VI.

Applicability of a Novel Attunement Instrument and Its Relationship to Parental Sensitivity in Infants With and Without Visual Impairments

This study investigated the applicability of a novel instrument to assess parent–child attunement in free play interactions, in dyads with an infant with and without visual impairments (VI). We here report the findings on the reliability and applicability of the newly developed Attune & Stimulate Mother–Infant 56-items Instrument (A&S M-I) in two separate samples: one with infants with VI (N = 20) and one with typically sighted infants (N = 24). In addition, we assessed the contribution of parental sensitivity to attunement in dyadic interactions. The A&S M-I is an observational comprehensive instrument of behaviors that captures different body parts and their motility (i.e., finger movements, arm waving, and foot kicking), and different senses (i.e., audio, tactile, and visual). The appropriate responding of a parent to the child’s signal (i.e., matching and containing) reflects the ability to attune in the dyad as well as parent’s ability to stimulate the child to become engaged in the contact or activity. Consistency assessments revealed good reliability for maternal and infant behaviors, acceptable internal consistency and good test–retest reliability. Furthermore, both samples scored significantly above chance level on attunement, suggesting that the instrument captures parent–infant behavioral coordination, and VI was not related to parent–infant attunement. Lastly, a relation between parental sensitivity and attunement was found only in the TS sample. Altogether, these findings provide promising initial evidence of the applicability of the A&S M-I instrument for assessing dyadic attunement across different populations and ages. Having assessed the applicability of this observational instrument, future work should corroborate these findings in larger samples.

Testing the Efficacy of Family Health-Model of REBT on Family Values and Quality of Family Life Among Parents of Children with Visual Impairment

The high rate of negative thinking in family circles due to the presence of children with visual impairment has grossly affects the quality of family life. In the case of Nigeria, low quality of family life is prevalent among parents of children with visual loss. This study attempts to validate the efficacy of a rational emotional family health therapy in addressing family values and quality of life among parents of children with visual impairment in Enugu state Nigeria. A group randomized controlled design, participants comprised 132 parents whose children were living with visual impairment in Enugu state, Nigeria. The participants in REFHP-group were exposed to a 12-session treatment programme whereas their counterparts in the waitlisted control group did not receive this intervention. Two measures-Family Quality of Life Scale and Family Value Scale were utilized in assessing the participants at three time points. Data analyses were completed using repeated measures ANOVA. Findings revealed that rational emotive family health therapy had a significantly positive effect on increasing family values and quality of family life among the study participants of the treatment group. This study contributes to the scholarship on the efficacy of rational emotive family health therapy in improving family values and quality of family life among parents of children with visual impairment.

Togetherness, beyond the eyes: A systematic review on the interaction between visually impaired children and their parents

BACKGROUND

Parent-child interaction is essential to promote adaptive emotional, cognitive, and social development. The majority of previous research on parent-child interaction is largely dependent on face-to-face exchanges that require the interactive partners to visually recognize reciprocal communicative bids. Therefore, previous findings in the field can only partially apply to the early interactive patterns occurring between visually impaired infants and their parents. The present study was aimed to systematically review the available evidence on parent-child interaction in the context of developmental visual impairment.

METHODS

Fourteen papers were finally selected after literature search on PubMed and Scopus. Data synthesis was focused on three core topics: visually impaired children's contribution to the interaction, parental caregiving behaviors with visually impaired children, and the association between parents' behaviors and the developmental outcomes of children with visual impairment.

RESULTS

Visually impaired children may exhibit reduced reactivity to maternal stimuli and less-than-optimal levels of interactive initiations in social exchanges. Parents of children with visual impairment may use more descriptive communicative acts and greater directiveness compared to mothers of sighted counterparts. Specific caregiving behaviors (e.g., responsiveness and goal setting) of parents of children with visual impairment may significantly support language and socio-emotional development as well as sensorimotor integration.

DISCUSSION

Children with visual impairment may be less responsive and they may produce less clear communicative bids while interacting with their parents. Their parents may face specific challenges while engaging with them and they may become increasingly directive and intrusive. Nonetheless, even in the presence of visual impairment, the quality of parental caregiving behaviors appears to play a potential preventive role in the face of children's socio-emotional and cognitive outcomes. These results suggest that early interventions focused on parent-child interactions are especially needed in this population.

What support is beneficial for caregivers of individuals with vision impairment?

Previous studies and reviews have documented the stress and challenges that may be associated with providing informal care for individuals with vision impairment (IVI). This scoping review was therefore conducted in order to synthesise published literature about forms of support which may benefit the informal caregivers of both adults and children with vision impairment (VI), and to identify research gaps in the support available for this population. A systematic literature search was carried out using CINAHL, Medline, PsycINFO and PsycARTICLES, followed by citation tracking. A total of 23 published studies met the eligibility criteria and were included in the review. The included studies focused on: exploring caregiver support needs (8/23); novel interventions supporting caregivers of IVI (10/23); evaluating usual care (2/23); and exploring how treatment for IVI directly impacts the caregiver (3/23). Overall, support for caregivers of IVI is a relatively new research topic, with no eligible studies identified before 1999. Twelve of the 23 studies (52%) focused on support for caregivers of adults with VI, while 11 (48%) focused on support for caregivers of children with VI. The studies illustrate that support groups may generally help to improve caregivers' knowledge and awareness of VI, although benefits for emotional wellbeing are more modest. Support interventions for parents of children with VI appear to reduce stress effectively; however, evidence regarding the value of interventions for caregivers of adults with vision impairment is less clear, partly due to small samples and a lack of standardised, comparable outcome measures. Caregivers often express a need for better information about the condition of the IVI, even when information is apparently available. Further research is required comparing the benefits of different support modalities for caregivers of people with VI over longer follow-up periods.

Development and feasibility of the prenatal video-feedback intervention to promote positive parenting for expectant fathers

Objective: the transition period in which men become fathers might provide an important window of opportunity for parenting interventions that may produce long-term positive effects on paternal care and, consequently, child development. Existing prenatal programs traditionally focus on maternal and infant health and seldom involve the father.Study design: This paper describes an interaction-based prenatal parenting intervention program for first-time fathers using ultrasound images, the Prenatal video Feedback Intervention to promote Positive Parenting (VIPP-PRE). We randomised a group of expectant fathers (N = 73) to either the VIPP-PRE or a control condition.Results: Expectant fathers thought the VIPP-PRE was more helpful and influenced their insights into their babies to a greater extent than the control condition. Expectant fathers receiving the VIPP-PRE reported that they particularly liked seeing and interacting with their unborn children as well as receiving feedback on these interactions. The intervention was well received and was considered feasible by both expectant fathers and sonographers and midwives.Discussion: We discuss the VIPP-PRE based on the experiences and perspectives of fathers, interveners, and sonographers and midwives.

Analysis of the Coping Process among Visually Impaired Individuals, Using Interpretative Phenomenological Analysis (IPA)

There is a lack of research based on in-depth theoretical and scientific knowledge to understand the visually impaired, and there has been little effort in the application of strategies for early intervention to minimize the risk these people might encounter during development. This study used semi-structured interviews from eight persons with visual impairments who had various experiences of coping process. Three coping processes based on life experiences were identified: (1) self-awareness and adaptation process: "self-awareness of disability" and "adaptation to disability and the environment"; (2) facing the circumstance process: "the exposure to concealment and abuse," "the suppression of potential," "denial and abandonment by family," "poverty and disability," "expansion of thinking," and "opportunities of special participation"; and (3) the positive reinforcement process: "self-disclosure and jump-starting life," "maintain satisfaction and achievement," and "socioeconomic independence." These findings expand the understanding of the factors common to the coping process experienced by individuals with visual impairment and highlight the importance of psychological support, family, education, and social support.

Effectiveness of Health-Centered Life Skills Training on Health-Related Quality of Life in Mothers with Blind Children: A Randomized Controlled Interventional Study

BACKGROUND

Child visual impairment is one of the disabilities that influence the Health Related Quality of Life (HRQOL) of mothers. Therefore, it is necessary to establish appropriate interventions for enhancing their HRQOL. This study was conducted to assess the efficiency of a Health-Centered Life Skills Training (HCLST) program on the HRQOL of mothers with visually impaired children aged 7 to 12 years.

MATERIALS AND METHODS

The present study was a nonblinded, randomized, controlled trial on 52 mothers with visually impaired children studying at an educational complex. The participants were selected using convenience sampling method and were randomly divided into intervention and control groups using balanced block randomization method. The intervention group participated in a HCLST program, but the control group did not. Data were collected using a demographic questionnaire and the 36-item Short Form (SF-36) Health Survey, which were completed by the participants of both groups before, immediately after, and 3 months after the intervention.

RESULTS

There was no significant difference between the intervention and control groups in terms of total mean score of HRQOL before the intervention; however, it increased significantly immediately (Z = -5.73, p < 0.001) and 3 months (Z = -5.84, p < 0.001) after the intervention in the intervention group. A statistically significant increase was observed in the mean scores of the two main domains of the HRQOL, which were physical health (Z = -3.61, p < 0.001) and emotional health (Z = -6.19, p < 0.001) domains, only in the intervention group.

CONCLUSIONS

HCLST program can be used as an effective technique for the improvement of the HRQOL in mothers with blind children.

Video feedback for parental sensitivity and attachment security in children under five years

BACKGROUND

Children who are securely attached to at least one parent are able to be comforted by that parent when they are distressed and explore the world confidently by using that parent as a 'secure base'. Research suggests that a secure attachment enables children to function better across all aspects of their development. Promoting secure attachment, therefore, is a goal of many early interventions. Attachment is mediated through parental sensitivity to signals of distress from the child. One means of improving parental sensitivity is through video feedback, which involves showing a parent brief moments of their interaction with their child, to strengthen their sensitivity and responsiveness to their child's signals.

OBJECTIVES

To assess the effects of video feedback on parental sensitivity and attachment security in children aged under five years who are at risk for poor attachment outcomes.

SEARCH METHODS

In November 2018 we searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, nine other databases and two trials registers. We also handsearched the reference lists of included studies, relevant systematic reviews, and several relevant websites SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs that assessed the effects of video feedback versus no treatment, inactive alternative intervention, or treatment as usual for parental sensitivity, parental reflective functioning, attachment security and adverse effects in children aged from birth to four years 11 months.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

This review includes 22 studies from seven countries in Europe and two countries in North America, with a total of 1889 randomised parent-child dyads or family units. Interventions targeted parents of children aged under five years, experiencing a wide range of difficulties (such as deafness or prematurity), or facing challenges that put them at risk of attachment issues (for example, parental depression). Nearly all studies reported some form of external funding, from a charitable organisation (n = 7) or public body, or both (n = 18). We considered most studies as being at low or unclear risk of bias across the majority of domains, with the exception of blinding of participants and personnel, where we assessed all studies as being at high risk of performance bias. For outcomes where self-report measures were used, such as parental stress and anxiety, we rated all studies at high risk of bias for blinding of outcome assessors. Parental sensitivity. A meta-analysis of 20 studies (1757 parent-child dyads) reported evidence of that video feedback improved parental sensitivity compared with a control or no intervention from postintervention to six months' follow-up (standardised mean difference (SMD) 0.34, 95% confidence interval (CI) 0.20 to 0.49, moderate-certainty evidence). The size of the observed impact compares favourably to other, similar interventions. Parental reflective functioning. No studies reported this outcome. Attachment security. A meta-analysis of two studies (166 parent-child dyads) indicated that video feedback increased the odds of being securely attached, measured using the Strange Situation Procedure, at postintervention (odds ratio 3.04, 95% CI 1.39 to 6.67, very low-certainty evidence). A second meta-analysis of two studies (131 parent-child dyads) that assessed attachment security using a different measure (Attachment Q-sort) found no effect of video feedback compared with the comparator groups (SMD 0.02, 95% CI -0.33 to 0.38, very low-certainty evidence). Adverse events. Eight studies (537 parent-child dyads) contributed data at postintervention or short-term follow-up to a meta-analysis of parental stress, and two studies (311 parent-child dyads) contributed short-term follow-up data to a meta-analysis of parental anxiety. There was no difference between intervention and comparator groups for either outcome. For parental stress the SMD between video feedback and control was -0.09 (95% CI -0.26 to 0.09, low-certainty evidence), while for parental anxiety the SMD was -0.28 (95% CI -0.87 to 0.31, very low-certainty evidence). Child behaviour. A meta-analysis of two studies (119 parent-child dyads) at long-term follow-up found no evidence of the effectiveness of video feedback on child behaviour (SMD 0.04, 95% CI -0.33 to 0.42, very low-certainty evidence). A moderator analysis found no evidence of an effect for the three prespecified variables (intervention type, number of feedback sessions and participating carer) when jointly tested. However, parent gender (both parents versus only mothers or only fathers) potentially has a statistically significant negative moderation effect, though only at α (alpha) = 0.1 AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that video feedback may improve sensitivity in parents of children who are at risk for poor attachment outcomes due to a range of difficulties. There is currently only little, very low-certainty evidence regarding the impact of video feedback on attachment security, compared with control: results differed based on the type of measure used, and follow-up was limited in duration. There is no evidence that video feedback has an impact on parental stress or anxiety (low- and very low-certainty evidence, respectively). Further evidence is needed regarding the longer-term impact of video feedback on attachment and more distal outcomes such as children's behaviour (very low-certainty evidence). Further research is needed on the impact of video-feedback on paternal sensitivity and parental reflective functioning, as no study measured these outcomes. This review is limited by the fact that the majority of included parents were mothers.

The effects of a bioresponse system on the joint attention behaviour of adults with visual and severe or profound intellectual disabilities and their affective mutuality with their caregivers

BACKGROUND

The subtle communicative behaviour of individuals with visual and severe/profound intellectual disabilities hinders the success of their interaction with professional caregivers. The bioresponse system, a tool to raise caregivers' awareness of the client's communicative behaviour, may improve the client's joint attention behaviour and the dyad's affective mutuality.

METHOD

Four client-caregiver dyads participated in a randomized multiple baseline study with repeated baseline, intervention and follow-up observations. The bioresponse system's effect was evaluated with measures of joint attention and affective mutuality.

RESULTS

Two clients showed a significant difference on one or two joint attention subscales (including one significant decrease), and for all clients, at least one joint attention subscale revealed a positive trend. Positive trends in affective mutuality scores were observed in two dyads.

CONCLUSIONS

The results stress the importance of further research to the effects of using the bioresponse system's in daily care for persons with severe/profound intellectual disabilities.

The efficacy of VIPP-V parenting training for parents of young children with a visual or visual-and-intellectual disability: a randomized controlled trial

Video-feedback Intervention to promote positive parenting-visual (VIPP-V) or visual-and-intellectual disability is an attachment-based intervention aimed at enhancing sensitive parenting and promoting positive parent-child relationships. A randomized controlled trial was conducted to assess the efficacy of VIPP-V for parents of children aged 1-5 with visual or visual-and-intellectual disabilities. A total of 37 dyads received only care-as-usual (CAU) and 40 received VIPP-V besides CAU. The parents receiving VIPP-V did not show increased parental sensitivity or parent-child interaction quality, however, their parenting self-efficacy increased. Moreover, the increase in parental self-efficacy predicted the increase in parent-child interaction. In conclusion, VIPP-V does not appear to directly improve the quality of contact between parent and child, but does contribute to the self-efficacy of parents to support and to comfort their child. Moreover, as parents experience their parenting as more positive, this may eventually lead to higher sensitive responsiveness and more positive parent-child interactions.