Event-related potential response to auditory social stimuli, parent-reported social communicative deficits and autism risk in school-aged children with congenital visual impairment

Modification and Validation of an Autism Observational Assessment Including ADOS-2® for Use with Children with Visual Impairment

Children with visual impairment (VI) are at risk of autism spectrum disorder (ASD); however standard observational diagnostic assessments are not validated for this population. The primary objective of the study is to validate a modified version of the Autism Diagnostic Observation Schedule (ADOS-2®, Module 3), for children with VI. A cross-sectional observational study was undertaken with 100 (mean 5½ years, SD 10.44 months, range 4-7 years; 59 (59%) males) children with congenital disorders of the peripheral visual system with moderate/severe-profound VI. As the primary objective, 83 (83%) who were 'verbally fluent' were assessed with the modified ADOS-2® (Module 3). Their scores were investigated for reliability, construct and criterion validity against expert clinician formulation and parent-rated social and communication questionnaires (Social Responsiveness Scale-2, SRS-2; Children's Communication Checklist-2). The secondary objective with the total sample was to report on frequency and distribution of ASD ratings in this VI population. The modified ADOS-2® (Module 3) was found to have strong internal coherence and construct validity (two factor model) and inter-rater reliability. A new VI diagnostic algorithm was established which showed high sensitivity and specificity against clinician formulation. Using the best cut-off threshold for 'High Risk for ASD', strong concurrent criterion validity was found according to parent-rated scores on the SRS-2. The modified ADOS-2® (Module 3) was shown to have promising reliability and validity in establishing children at 'High Risk of ASD' in this vulnerable population. Elevated rates of ASD were found across the sample, in line with previous estimates.

Oculocutaneous albinism: the neurological, behavioral, and neuro-ophthalmological perspective

Oculocutaneous albinism (OCA) is a group of rare, genetic disorders caused by absent/reduced melanin biosynthesis. The aim of this study was to explore the neurovisual, cognitive, adaptive, and behavioral profile of children affected by OCA, also evaluating any possible effect of the visual acuity deficit on the clinical profile and genotype-phenotype correlations. Eighteen children (9 males, mean age 84 months ± 41; range 18-181 months) with a molecular confirmed diagnosis of OCA were enrolled in the study. We collected data on clinical history, neurodevelopmental profile, neurological and neurovisual examination, and cognitive, adaptive, and emotional/behavioral functioning. A global neurodevelopmental impairment was detected in 56% of the children, without evolving into an intellectual disability. All the patients showed signs and symptoms of visual impairment. Low adaptive functioning was observed in 3 cases (17%). A risk for internalizing behavioral problems was documented in 6 cases (33%), for externalizing problems in 2 (11%), and for both in 5 (28%). Twelve children (67%) showed one or more autistic-like features. Correlation analyses revealed significant associations between the visual acuity level and performance intelligence quotient (p = 0.001), processing speed index (p = 0.021), Vineland total score (p = 0.020), Vineland communication (p = 0.020), and socialization (p = 0.037) domains. No significant correlations were found between genotype and phenotype.

CONCLUSION

Children with OCA may present a global neurodevelopmental delay that seems to improve with age and emotional/behavioral difficulties, along with the well-known visual impairment. An early neuropsychiatric evaluation and habilitative training are recommended to improve vision-related performance, neurodevelopment, and any psychological difficulties.

WHAT IS KNOWN

• Children with oculocutaneous albinism show dermatological and ophthalmological problems. • An early visual impairment may have negative implications on motor, emotional, and cognitive processes that would allow the child to organize his or her experiences.

WHAT IS NEW

• In addition to a variable combination of ocular signs and symptoms, children with oculocutaneous albinism may present an early neurodevelopmental delay and emotional/behavioral difficulties. • An early visual treatment is recommended to improve vision-related performance, neurodevelopment, and any psychological difficulties.

Frequency of visual impairment in autistic children of autism school of Lahore, Pakistan

Autism is a condition in which abnormal development of the brain takes place, manifesting in the first 3 years of life. Visual impairment is one of the major factors of autism spectrum disorder (ASD), and measurement of visual impairment is necessary for proper management of the disorder. The purpose of this study is to determine the frequency of visual impairment associated with ASD in Lahore Pakistan. A descriptive cross-sectional study was conducted. A convenient and purposive sample of 127 students enrolled in various autism schools of Lahore was enrolled. Written informed consent of teacher’s autistic children was taken. Children having diseases like cerebral palsy, other developmental disorders, and/or serious cognitive disability were excluded from this study. Participant’s undergone ocular assessment including visual acuity, ocular motility examination, refraction, and fundoscopy. Data analysis was performed using SPSS-20 and Pearson’s chi-square analysis was conducted to determine the associations of refractive error and squint with ASD. A total of 127 participants were included in this study, of which 77 (60.6%) were male and 50 (39.4%) were female. More than 60% were emmetropes (having no refractive errors), 19 (15%) were having myopes, 15 (11.8%) were hypermetropic, and 9 (7.1%) were Astigmatic, while 20 were diagnosed with a squint. The major cause of visual impairment in autistic children was refractive errors 33.8% and squint 15.7%. A high frequency of visual impairment was present in autistic children in Lahore autistic schools. As vision is a basic right so we have to pay attention also toward autistic children, in that way every child should have screened for factors that are responsible for visual impairments, Identifying refractive errors in these children early and providing appropriate corrective lenses may help optimize their visual functioning and impact their activities of daily life positively.

Results of a collaborative professional development for school staff working with students with visual impairments and challenging behavior

Students with visual impairments (VI) and multiple disabilities (MD) often exhibit challenging behavior, yet school staff’s use of evidence-based practices in behavior management is reportedly low. In this article, we share the results of a collaborative professional development (PD) aimed at increasing school staff buy-in and use of individualized positive behavior interventions and supports (I-PBIS) with students with VI and MD. Ten staff, including teachers, paraeducators, and related services, working in a self-contained school for students with VI participated in four weekly, collaborative small group modules on research-based I-PBIS strategies. The Covid-19 pandemic occurred mid-study, which affected implementation of the program and collection of outcome data; however, pre- to post-PD participants’ supportive beliefs regarding I-PBIS increased significantly. Participant-reported knowledge and use of I-PBIS also increased but did not reach significance. In addition, participants found the PD highly acceptable and useful in their work with students with VI and MD who engage in challenging behavior. Implications for increasing school staff support for and use of I-PBIS with students with VI and MD are discussed.

Causes of poor eye contact in infants: a population-based study

BACKGROUND

Establishing eye contact between infants and parents is important for early parent-child bonding and lack of eye contact may be a sign of severe underlying disease. The aim of the study was to evaluate the causes of poor or lacking eye contact in infants.

METHODS

Cross-sectional study reviewing all referrals of infants ≤1 year of age from January 1rst, 2016 to December 31rst, 2018. Medical information was retrieved from patient files covering pregnancy, birth, diagnostic work-up and ocular parameters such as refraction, visual acuity and structural findings.

RESULTS

We identified 99 infants with poor or lacking eye contact. The relative frequency of causes was neurologic disease 36.4% (36/99), delayed visual maturation 24.2% (24/99), ocular disease 21.2% (21/99) and idiopathic infantile nystagmus 4.0% (4/99). Fourteen infants had a visual function within age-related norms at first examination despite poor eye contact at the time of referral. Of the infants with available data, 18/27 (33.3%) with neurologic cause, 15/23 (65.2%) with delayed visual maturation and 9/21 (42.9%) with ocular cause had visual acuity within the age-related norm at latest follow-up (0-41 months). In 23 infants, a genetic cause was found.

CONCLUSION

Poor eye contact in infants may be a sign of severe underlying disease, such as neurological or ocular disease. Close collaboration between pediatric ophthalmologists and neuro-pediatricians are warranted in the management of these infants.

Emotional face recognition in autism and in cerebral visual impairments: In search for specificity

Autism spectrum disorder (ASD) is characterized by difficulties in the social domain, but also by hyper- and hypo-reactivity. Atypical visual behaviours and processing have often been observed. Nevertheless, several similar signs are also identified in other clinical conditions including cerebral visual impairments (CVI). In the present study, we investigated emotional face categorization in groups of children with ASD and CVI by comparing each group to typically developing individuals (TD) in two tasks. Stimuli were either non-filtered or filtered by low- and high-spatial frequencies (LSF and HSF). All participants completed the autism spectrum quotient score (AQ) and a complete neurovisual evaluation. The results show that while both clinical groups presented difficulties in the emotional face recognition tasks and atypical processing of filtered stimuli, they did not differ from one another. Additionally, autistic traits were observed in the CVI group and symmetrically, some visual disturbances were present in the ASD group as measured via the AQ score and a neurovisual evaluation, respectively. The present study suggests the relevance of comparing ASD to CVI by showing that emotional face categorization difficulties should not be solely considered as autism-specific but merit investigation for potential dysfunction of the visual processing neural network. These results are of interest in both clinical and research perspectives, indicating that systematic visual examination is warranted for individuals with ASD.

What's in a name? A preliminary event-related potential study of response to name in preschool children with and without autism spectrum disorder

The ability to selectively respond to one’s own name is important for social and language development, and is disrupted in atypically developing populations (e.g., autism spectrum disorder). Research with typically developing samples using event-related potentials (ERPs) has demonstrated that the subject’s own name (SON) is differentiated from other stimuli at both early sensory and later cognitive stages of auditory processing. While neural indices of response to name have been researched extensively in adults, no such studies have been conducted with typically developing preschool children or children with autism spectrum disorder (ASD). The present study investigated ERP response to name in a sample of typically developing (TD) preschoolers (n = 19; mean age = 4.3 years) as well as a small, exploratory comparison group of preschoolers with ASD (n = 13; mean age = 4.4 years). TD preschoolers exhibited significantly greater negativity to SON over frontal regions than to an unfamiliar nonsense name, consistent with the adult SON negativity component. This component was present whether the name was spoken by a parent or an unfamiliar adult, suggesting that it reflects SON-specific processing rather than broad self-relevant information processing. Comparing preschoolers with ASD to the TD children revealed a significant SON negativity component across both groups. The amplitude of the SON negativity response was significantly correlated with social variables in the ASD group, though these correlations did not survive correction for multiple comparisons. This study is the first to demonstrate the presence of the SON component in preschool children with and without ASD.

Adaptive behaviour and quality of life in school-age children with congenital visual disorders and different levels of visual impairment

BACKGROUND

Adaptive behaviours are vital skills that allow individuals to function independently and are potentially amenable to behavioural interventions. Previous research indicated that adaptive behaviours are reduced in children and adolescents with severe to profound VI, but it was unclear if this was also the case for children with mild to moderate VI.

AIM

The aim of the study was to assess differences in adaptive behaviour in children with congenital visual disorders and different levels of visual impairment and their influence on quality of life and everyday strengths and difficulties.

METHODS AND PROCEDURES

Questionnaires about adaptive behaviour, strengths and difficulties, and quality of life were completed by parents of school-age children with severe-to-profound VI (S/PVI, n = 9, 0.9 logMAR - light perception only), mild-to-moderate VI (MVI, n = 9, 0.1-0.7 logMAR), or typical sight (control, n = 18, -0.3 to 0.1 logMAR). Differences in questionnaire domains by the severity of VI and relationships between adaptive behaviour and quality of life were analysed in general linear models.

OUTCOMES AND RESULTS

The questionnaire ratings indicated reduced adaptive behaviour, more difficulties, and reduced quality of life in children with S/PVI compared to typically-sighted peers. Effects were smaller for children with MVI, but indicated a significant reduction in quality of life compared to typically-sighted children. The effect of visual impairment on quality of life in school was partially mediated by adaptive behaviour.

CONCLUSION AND IMPLICATION

Severe congenital visual impairment affects adaptive behaviour in children with verbal abilities in the typical range. This effect is less pronounced in children with mild-to-moderate VI, but still impacts on quality of life, particularly in school.