Functional vision and cognition in infants with congenital disorders of the peripheral visual system

Challenges Faced by Mothers With Visual Impairment From the Preconception Period Through the Postpartum Period

INTRODUCTION

There is a misperception in society that individuals with visual impairment are asexual and cannot marry, have children, or take care of children. In addition, individuals with visual impairment face difficulties in many aspects of life due to accessibility issues. Although it is expected that visually impaired individuals experience difficulties when having children, very few studies have focused on understanding the challenges women with visual impairment face in the process of having children. The aim of this study was to identify the challenges faced by mothers with visual impairment from preconception through the postpartum period in Turkey.

METHODS

Semistructured interviews were conducted with a purposive sample of 17 mothers with visual impairment. Participants were from 28 to 38 years of age, and their youngest children were 2 years old or younger. Participants were asked about their experiences with the decision to have children, pregnancy, birth, and postpartum. Content analysis was used to analyze and present the data.

RESULTS

Participants had 1 to 3 children and a mean age of 32.4 years. Eleven themes were identified within 4 periods: preconception, pregnancy, birth, and postpartum. Themes related to the experience of the preconceptional period included concern about the decision to have a child and the social pressure on the decision to have a child. Themes related to the experience of pregnancy included inaccessible pregnancy tests, emotional reactions to pregnancy, dissatisfaction with health care providers, and unmet expectations. Themes related to labor and birth included mixed feelings about labor dissatisfaction with health care providers and unmet expectations. Themes related to the postpartum period included personal care, infant care, reaction of the social network, and unmet expectations.

DISCUSSION

The mothers with visual impairment faced many challenges in the process of becoming a parent. Mothers expressed the need for accessible health services from institutions and health professionals.

Blindness affects the developmental trajectory of the sleeping brain

Sleep plays a crucial role in brain development, sensory information processing, and consolidation. Sleep spindles are markers of these mechanisms as they mirror the activity of the thalamocortical circuits. Spindles can be subdivided into two groups, slow (10-13 Hz) and fast (13-16 Hz), which are each associated with different functions. Specifically, fast spindles oscillate in the high-sigma band and are associated with sensorimotor processing, which is affected by visual deprivation. However, how blindness influences spindle development has not yet been investigated. We recorded nap video-EEG of 50 blind/severely visually impaired (BSI) and 64 sighted children aged 5 months to 6 years old. We considered aspects of both macro- and micro-structural spindles. The BSI children lacked the evolution of developmental spindles within the central area. Specifically, young BSI children presented low central high-sigma and high-beta (25-30 Hz) event-related spectral perturbation and showed no signs of maturational decrease. High-sigma and high-beta activity in the BSI group correlated with clinical indices predicting perceptual and motor disorders. Our findings suggest that fast spindles are pivotal biomarkers for identifying an early developmental deviation in BSI children. These findings are critical for initial therapeutic intervention.

Visual Function and Neuropsychological Profiling of Idiopathic Infantile Nystagmus

Though considered a benign condition, idiopathic infantile nystagmus (IIN) may be associated with decreased visual acuity and oculo-motor abnormalities, resulting in developmental delays and poor academic performance. Nevertheless, the specific visual function profile of IIN and its possible impact on neuropsychological development have been poorly investigated. To fill this gap, we retrospectively collected the clinical data of 60 children presenting with IIN over a 10-year period (43 male; mean age of 7 years, range of 2 months-17 years, 9 months). The majority of the subjects in our cohort presented with reduced visual acuity for far distances and normal visual acuity for near distances, associated with oculo-motor abnormalities. The overall scores of cognitive and visual-cognitive tests were in the normal range, but revealed peculiar cognitive and visual-cognitive profiles, defined by specific frailties in processing speed and visual-motor integration. The same neuropsychological profiles characterize many neurodevelopmental disorders and may express a transnosographic vulnerability of the dorsal stream. As the first study to explore the neuropsychologic competencies in children with IIN, our study unveils the presence of subclinical frailties that need to be addressed to sustain academic and social inclusion.

A novel multisensory device for the assessment and rehabilitation of perceptual and attentional competencies

The present study aims to assess a novel technological device suitable for investigating perceptual and attentional competencies in people with or without sensory impairment. The TechPAD is a cabled system including embedded sensors and actuators to enable visual, auditory, and tactile interactions and a capacitive surface receiving inputs from the user. The system is conceived to create multisensory environments, using multiple units controlled separately and simultaneously. We assessed the device by adapting a spatial attention task comparing performances in different cognitive load conditions (high or low) and stimulation (unimodal, bimodal, or trimodal). 28 sighted adults were asked to monitor both the central and peripheral parts of the device and to tap a target stimulus (either visual, auditory, haptic, or multimodal) as fast as they could. Our results suggest that this new device can provide congruent and incongruent multimodal stimuli and quantitatively measure parameters such as reaction time and accuracy, allowing to investigate perceptual mechanisms in multisensory environments.Clinical Relevance-The TechPad is a reliable tool for the assessment of spatial attention during interactive tasks. its application in clinical trials will pave the way to its role in multisensory rehabilitation.

Prognostic value of transient pattern visual evoked potentials in children with cerebral visual impairment

AIM

To investigate whether pattern reversal visual evoked potentials (PRVEPs) could predict future visual acuity in infants with cerebral visual impairment (CVI).

METHOD

Fifty-five children (27 males, 28 females) with severe CVI seen in the ophthalmology department of a specialist children's hospital were identified retrospectively. Behavioural visual acuity and visual evoked potentials (VEPs) at presentation (time 1, T1) were compared with final visual acuity at late preschool/early school age (time 2, T2). Predictors of visual acuity at T2 were identified using univariate and multivariate logistic and linear regression analysis.

RESULTS

Median age was 14 months at T1 (range: 6-44mo) and 63 months at T2 (range: 29-150mo). The presence of a PRVEP produced by a check width of 50' (minutes of arc) or smaller (T1) predicted (p=0.05) the presence of measurable preferential looking acuity at T2. The presence of PRVEP to check widths of 25' or smaller (T1) predicted (p=0.02) better preferential looking acuity (logMAR-equivalent) scores at T2. The latter association was independent of presenting acuity at T1.

INTERPRETATION

The presence of PRVEPs to check widths of 50' and 25' in infancy provided useful information. VEPs in young children with CVI may have prognostic value regarding future acuity.

The relation between visual orienting functions, daily visual behaviour and visuoperceptual performance in children with (suspected) cerebral visual impairment

BACKGROUND

Children with cerebral visual impairment (CVI) present heterogeneous visual orienting functions (VOF) and higher-order perception. Multiple assessment methods evaluate CVI, but the relations between them remain unclear.

AIM

To investigate the relations between VOF and (1) daily life behaviour and (2) visuoperceptual tests in children with (suspected) CVI.

METHODS AND PROCEDURES

VOF were tested with a validated eye tracking-based paradigm. Visual perception was assessed using the children's visual impairment test for 3- to 6-year olds (CVIT 3-6) and (retrospective) visuoperceptual dimension results. Caregivers completed the Flemish cerebral visual impairment questionnaire (FCVIQ) and an expert panel scored relations between VOF and the other methods. We compared experts' survey responses with data-based results (linear mixed models and correlations).

OUTCOMES AND RESULTS

Fourty-four children (23 boys, 21 girls; median age = 7y11mo, SD = 2y7mo) participated. Twenty-one experts completed the survey. Slower VOF was significantly associated with (1) object and face processing impairments, (2) visual (dis)interest, (3) worse visual spatial perception (to local motion and form stimuli), and (4) worse CVIT 3-6 object and scene recognition (to cartoon stimuli).

CONCLUSIONS AND IMPLICATIONS

Integration of VOF with existing visual assessments provides a better clinical picture of CVI and can prevent misdiagnosing children as inattentive, incapable, or unmotivated.

Early visual training and environmental adaptation for infants with visual impairment

AIM

To evaluate the effectiveness of early visual training and environmental adaptation on visual function and neurological development in infants with visual impairment.

METHOD

This was a pilot intervention clinical trial study. Thirty infants (mean age 5.9mo, SD 2.1mo, range 4-11mo; 16 males, 14 females) with peripheral visual impairment (PVI, n=15) or cerebral visual impairment (CVI, n=15) participated in a 6-month visual intervention programme. Thirty matched infants (mean age 6mo, SD 1.4mo, range 4-9mo; 18 males, 12 females) served as a comparison group. Primary outcome measures were visual acuity, contrast sensitivity, and qualitative ocular motor functions. Secondary outcomes were scores on the Griffiths Mental Developmental Scales (GMDS).

RESULTS

The treatment group showed a significant improvement in all the primary outcomes (p<0.01). The comparison group improved only in visual acuity and contrast sensitivity (p<0.01). The treatment group showed greater improvement than the comparison group in visual fixation (p=0.033) and smooth pursuit (p<0.01). The CVI subgroup showed greater improvement in visual acuity than the PVI subgroup (p<0.01). GMDS subscales of hand-eye coordination (p=0.01) and performance (p<0.01) increased in the treatment group, while the total score of the comparison group decreased, driven by language (p=0.039) and hand-eye coordination (p=0.025) subscales.

INTERPRETATION

Results suggest that, in infants with visual impairment, visual function and certain developmental outcomes improve in response to early visual training and environmental adaptation, in an interactive context. What this paper adds Early visual training and environmental adaptation are associated with enhanced visual acuity and smooth pursuit. Early visual training and environmental adaptation are associated with an improvement of neurological developmental outcome. Performance, hand-eye coordination, and language scores in Griffiths Mental Developmental Scales increase after visual training. After training, visual acuity improves more in infants with cerebral rather than anterior visual impairment. Type and complexity of visual impairment contribute to determine infants' response to training.

Mother-infant interactions with infants with congenital visual impairment and associations with longitudinal outcomes in cognition and language

BACKGROUND

This study investigated mother-infant interactions, including maternal maintaining of infant attentional focus and sensitivity, with infants with congenital severe and profound visual impairment (VI) and the association with developmental trajectories from one to three years.

METHOD

Fifty-five infants and mothers were video-recorded playing together with a standard set of toys at Time 1 (T1) mean age 12.95 months (8.13-17.05 months). Maintain was categorized as the mother following and maintaining the child's focus, and Sensitivity, the mother's responsiveness and contingency to infant behaviour. Vision level was measured using the Near Detection Scale. Cognition and language were measured at T1, 12 months later (T2) and 24 months later (T3) using the Reynell-Zinkin Scales.

RESULTS

Cross-sectional analyses showed that mothers of infants with severe VI (basic form vision) produced higher rates of Maintain compared to those with children with profound VI (light perception at best). Linear mixed-effects models examining developmental progression from T1 to T3 (controlling for vision level) showed an average increase of 5 DQ points (CI 95%: 1.03-9.08) in verbal comprehension for higher Sensitivity. No significant findings were found for Maintain.

CONCLUSIONS

The findings suggest that mother-infant interactions (maternal Maintain) are associated with level of vision at infancy, but only maternal Sensitivity has a long-term positive association with advances in verbal comprehension from infancy to about three years. They highlight the need for incorporating strategies related to parent-infant interactions, including increased sensitivity, into early intervention for children with visual impairment.

Sensitive period for the plasticity of alpha activity in humans

Visual experience is crucial for the development of neural processing. For example, alpha activity development is a vision-dependent mechanism. Indeed, studies report no alpha activity is present in blind adults. Nevertheless, studies have not investigated the developmental trajectory of this activity in infants and children with blindness. Here, we hypothesize that the difference in neural activity of blind compared to sighted subjects is: absent at birth, progressive with age, specifically occipital and linked to a gradual motor impairment. Therefore, we consider spectral power of resting-state EEG and its association with motor impairment indices, in blind subjects and in sighted controls between 0 and 11 years of age. Blind subjects show posterior alpha activity during the first three years of life, although weaker and slower maturing compared to sighted subjects. The first great differentiation between blind and sighted subjects occurs between 3 and 6 years of age. Starting in this period, reduced alpha activity increases the probability of motor impairment in blind subjects, likely because of impaired perception/interaction. These results show that visual experience mediates the neural mechanisms generating alpha oscillations during the first years of life, suggesting that it is a sensitive period for the plasticity of this process.

The associations between vision level and early hand use in children aged 6–36 months with visual impairment: A cross-sectional, historical case note review

Vision level varies within the population of children born with visual impairment (VI). Children with profound visual impairment (PVI – with light awareness at best) are more developmentally vulnerable than peers born with typical sight or those with severe visual impairment (SVI – basic form vision). Many children with VI are dependent on their hand skills to support their development. However, the impact of vision level on the development of hand use is poorly understood. The aim of the study was to describe the associations between vision level and early hand use in children between 6 and 36 months of age with SVI and PVI. A historical case note review, including video footage of 19 children with SVI ([Formula: see text] = 19 months) and 12 children with PVI ([Formula: see text] = 16 months), was completed. Hand use was observed while the children completed the Reynell-Zinkin Scales. Observations were recorded using a data collection tool designed for the study. The tool included a checklist of developmentally appropriate hand skills expected to emerge in the first 3 years of life. The observer marked each skill as present, absent or emerging in the video clips. Children with SVI used 80.2% (95% confidence interval [CI] = [75.0, 87.5]) of the hand skills under observation. Those with PVI used 57.1% (95% CI = [46.4, 67.9]) of these skills. Vision level and hand use were positively correlated: rs  = .564 (95% CI = [.263, .765]), p < .01. This correlation was stronger than the association between developmental level and hand use: r  = .364 (95% CI = [.012, .636]), p < .05. Furthermore, 15.8% (95% CI = [0.0, 31.6]) of the children with SVI and 66.7% (95% CI = [41.7, 91.7]) with PVI showed some reluctance to touch objects ( p < .05) by withdrawing their hands actively from items offered to them. Vision level and developmental level influenced hand use; however, vision level appeared to have the greater impact. Interventions that are tailored to promote hand use according to vision level have the potential to improve functional participation.

Visuo-haptic transfer for object recognition in children with peripheral visual impairment

It is well known how early visual experience is critical for the development of multisensory processing abilities, and for this reason an early vision impairment could hinder the transfer of different sensory information during the exploration and recognition of the surrounding environment. Recently, we verified that visuo-haptic transfer for object recognition emerges early in typically developing children but matures slowly during the school-age period. Subsequently we verified the presence of a slower trend of development in unisensory and multisensory skills in children with early abnormal motor and sensory experiences due to brain lesions. Now, we investigated unimodal visual information, unimodal haptic information and visuo-haptic information transfer in children with a diagnosis of low-vision, due to congenital visual impairment. Unimodal and bimodal processes for object recognition were explored in 11 children with low-vision and the results were matched with those of 22 controls. Participants were tested using a clinical protocol involving visual exploration of black-and-white photographs of common objects, haptic exploration of real objects and visuo-haptic transfer of these two types of information. Results show a normal development in haptic unisensory processing in children with low vision and a significant difference in multisensory transfer between the two groups. In children with visual impairment, multisensory processes do not facilitate the recognition of common objects as in typical children, probably because early visual impairment may impact the cross-sensory calibration of vision and touch.

A Multidimensional, Multisensory and Comprehensive Rehabilitation Intervention to Improve Spatial Functioning in the Visually Impaired Child: A Community Case Study

Congenital visual impairment may have a negative impact on spatial abilities and result in severe delays in perceptual, social, motor, and cognitive skills across life span. Despite several evidences have highlighted the need for an early introduction of re-habilitation interventions, such interventions are rarely adapted to children’s visual capabilities and very few studies have been conducted to assess their long-term efficacy. In this work, we present a case study of a visually impaired child enrolled in a newly developed re-habilitation intervention aimed at improving the overall development through the diversification of re-habilitation activities based on visual potential and developmental profile, with a focus on spatial functioning. We argue that intervention for visually impaired children should be (a) adapted to their visual capabilities, in order to increase re-habilitation outcomes, (b) multi-interdisciplinary and multidimensional, to improve adaptive abilities across development, (c) multisensory, to promote the integration of different perceptual information coming from the environment.

Detection vision development in infants and toddlers with congenital vision disorders and profound-severe visual impairment

AIM

To investigate detection vision development in infants and toddlers with congenital disorders of the peripheral visual system (CDPVS) and severe to profound visual impairment (SVI/PVI).

METHOD

This was a longitudinal observational investigation of a cohort of infants with CDPVS (entry age 8-16mo) followed up 12 months later. Detection vision (Near Detection Scale [NDS]) and resolution acuity (Keeler Acuity Cards [KAC]) were assessed at each time point. Relationships between detection vision, resolution acuity, and age were investigated.

RESULTS

The study cohort comprised 80 children (39 females, 41 males), mean age 13 months (Time 1) and 26 months (Time 2); 22 (27.5%) with PVI (light perception at best) and 58 (72.5%) with SVI (basic 'form' vision) at Time 1. All children achieved a measure with the NDS, however only 35 per cent and 56 per cent at Time 1 and Time 2 respectively did so on KAC. Those with PVI at Time 1 showed no further improvement at Time 2, but 87 per cent of children with SVI showed improvement in vision. The median change in NDS score was 1.0 (range 1-7, SD 1.68).

INTERPRETATION

Vision development continues after 12 months of age in many toddlers if they have basic 'form' vision. A measure of detection vision is feasible in very young children when resolution acuity measurement is not achievable.

WHAT THIS PAPER ADDS

The Near Detection Scale (NDS) can measure low levels of vision when acuity is not otherwise measurable. Vision can improve in toddlers with severe visual impairment who have some 'form' vision. Infants with light perception at best by 12 months are unlikely to show improvement in vision. There is a moderate negative relationship between the NDS and resolution acuity results.

The development of vision between nature and nurture: clinical implications from visual neuroscience

BACKGROUND

Vision is an adaptive function and should be considered a prerequisite for neurodevelopment because it permits the organization and the comprehension of the sensory data collected by the visual system during daily life. For this reason, the influence of visual functions on neuromotor, cognitive, and emotional development has been investigated by several studies that have highlighted how visual functions can drive the organization and maturation of human behavior. Recent studies on animals and human models have indicated that visual functions mature gradually during post-natal life, and its development is closely linked to environment and experience.

DISCUSSION

The role of vision in early brain development and some of the neuroplasticity mechanisms that have been described in the presence of cerebral damage during childhood are analyzed in this review, according to a neurorehabilitation prospective.

Brain structure in children with congenital visual disorders and visual impairment

AIM

To examine if congenital visual impairment is associated with differences in brain anatomy in children.

METHOD

Ten children (8-12y) with congenital disorders of the peripheral visual system with severe visual impairment (SVI; >0.8 logMAR) or mild-to-moderate visual impairment (MVI; 0.6-0.8 logMAR) were compared to 21 typically sighted comparison (TSC) children. Thalamus volume, grey matter density, white matter microstructure, and integrity of visual tracts were investigated in SVI, MVI, and TSC groups with anatomical and diffusion-weighted magnetic resonance imaging.

RESULTS

Compared to the TSC group, the SVI group had lower white matter integrity in tracts of the visual system (optic radiations: SVI 0.35±0.015, TSC 0.39±0.007 [p=0.022]; posterior corpus callosum: SVI 0.37±0.019; TSC 0.42±0.009 [p=0.033]) and lower left thalamus volume (SVI 4.37±0.087; TSC 4.99±0.339 [p=0.015]). Neuroanatomical differences were greater in the SVI group, while no consistent differences between the MVI and TSC group were observed.

INTERPRETATION

Posterior tracts of the visual system are compromised in children with congenital visual impairment versus those who are typically sighted. The severity of visual input appears to have affected neuroanatomical development as significant reductions were only found in the SVI group.

WHAT THIS PAPER ADDS

Severe visual impairment in mid-childhood is associated with reduced integrity of visual pathways and reduced thalamus volume.

Cerebral Visual Impairment and Clinical Assessment: The European Perspective

This paper summarizes the multidisciplinary pediatric assessment methods of 3 European centers for identifying and assessing cerebral visual impairment in childhood. It describes a comprehensive neurodevelopmental assessment evaluation in which visual aspects play an important part. Developmental trajectories and the heterogeneity of the clinical picture are emphasized. Multidisciplinary ophthalmology and neurodisability/neurology teamwork together with the parent and teachers, to reach an integrated and individualized perspective for the individual child, are described. This comprehensive assessment is the starting point for habilitation programs and interventions, that can support and meet the child's needs and help them reach their optimal potential. Future developments in classification of the cerebral visual impairment conditions, building on the child's individual assessment profile, will further enhance the direction of clinical, educational, and research progress.

Evaluation of the role of the colour tent in vision stimulation for children with complex disabilities and cerebral visual impairment: A feasibility study

Children with profound and multiple disabilities commonly have their visual impairment overlooked when seeking to meet their complex health needs. The act of surrounding a child with little or no apparent visual function by a monochromatic translucent tent can serve to ‘switch on’ a child’s visual system. The aim of the project was to investigate the role of using colour tents to bring about attentional responses in children with complex disabilities including cerebral visual impairment.

The evaluation comprises three phases, repeated on four occasions over the space of 4 weeks. The child’s visual attention prior to entering the tent and during the 5 minutes after leaving the tent was recorded. Moreover, the child’s responses and behaviours while in the tent were recorded. Nine children participated in the evaluation, mean age 6 years (range: 5–9 years). All children showed a change in visual behaviour on at least one occasion while in the colour tent. Most children required more than one session before a change in visual behaviour was noted. Only two children showed increase in visual awareness after any session, and there was no sustained effect demonstrated.

This feasibility study has demonstrated that a short series of sessions in a colour tent is insufficient to demonstrate the effectiveness of a colour tent in stimulating visual awareness in children with complex needs. The methodology was acceptable to parents and teachers and lessons have been learned which will inform future studies.

Home-based early intervention in infants and young children with visual impairment using the Developmental Journal: longitudinal cohort study

AIM

To investigate the effects of home-based early intervention in children with severe visual impairment (SVI) using the Developmental Journal for babies and young children with visual impairment (DJVI).

METHOD

A longitudinal observational study was undertaken with a national cohort (OPTIMUM) of infants with congenital disorders of the peripheral visual system (CDPVS) and profound-SVI; and followed up after 12 months and 24 months. Intervention was categorized according to the practitioner diary records of their usual practice over 12 months from baseline comparing those receiving the DJVI and those receiving 'Other Support'. Outcome measures of cognition and language, behaviour difficulties, parenting stress, and satisfaction with parent-practitioner partnership were collected.

RESULTS

In the 54 children (26 males, 28 females, baseline mean age 13.5mo, SD 2.3mo, range 8-17mo) with 'total' CDPVS (including 16 'complex' and 38 'simple' with or without known brain disorder respectively), linear mixed effects pointed towards acceleration in sensorimotor understanding and expressive language especially in the 'simple' subsample (11.72 developmental quotient, 95% confidence interval -1.17 to 24.61, p>0.05) in those receiving the DJVI. Vision level also predicted outcomes (p<0.05). The DJVI group showed improvements in behavioural withdrawal (η² =0.20, p=0.02, 'simple') and parenting stress (d=0.78, d=0.92, p=0.02 total and 'simple' respectively) and perceived practitioner-parent relationship (η² =0.16, p=0.01).

INTERPRETATION

Infants and young children with visual impairment receiving home-based early intervention using the DJVI with a structured developmental approach had better outcomes than those receiving 'other' home-based early interventions. Moderate to large effect improvements were found in child cognition and language, behaviour and parenting stress and the perceived practitioner-parent relationship, although cognition did not reach 5% significance level.

WHAT THIS PAPER ADDS

Early intervention using the Developmental Journal for babies and young children with visual impairment was associated with enhanced developmental outcomes compared to other approaches. Improvements were also found in child behaviour, parenting stress, and perceived parent practitioner outcomes. Type and complexity of visual impairment also influenced outcomes.

Combining visual sensory functions and visuospatial orienting functions in children with visual pathology: A longitudinal study

BACKGROUND

Peripheral and central visual processing development highly depends on the integrity of the visual sensory system and the allocation of visuospatial attention.

METHOD

We quantitatively followed visual sensory functions (VSF) and visuospatial orienting functions (VOF) over two years in 77 children (1-13 years) with different types of visual pathology.

RESULTS

Within the clinical groups, VSF were relatively constant over two years, except visual acuity, and VOF were characterized by longer reaction time, shorter fixation duration, and lower fixation accuracy than normal for their age. Children with peripheral pathology had high rates of abnormal VSF, of changes to abnormal visual acuity at 1-6 years, and larger and more abnormal VOF (fixation inaccuracy). Children with central pathology had relatively good VSF, whereas two-third had delayed orienting reaction times that differed from other groups mainly at 1-6 years.

CONCLUSION

The distinct patterns of quantitative VSF and VOF over time between the visual pathology groups, and the finding that both methods provided complementary information, argues for combining both types of assessments to provide comprehensive monitoring of visual functioning in children from a young age.

Resting-state functional MRI studies on infant brains: A decade of gap-filling efforts

Resting-state functional MRI (rs-fMRI) is one of the most prevalent brain functional imaging modalities. Previous rs-fMRI studies have mainly focused on adults and elderly subjects. Recently, infant rs-fMRI studies have become an area of active research. After a decade of gap filling studies, many facets of the brain functional development from early infancy to toddler has been uncovered. However, infant rs-fMRI is still in its infancy. The image analysis tools for neonates and young infants can be quite different from those for adults. From data analysis to result interpretation, more questions and issues have been raised, and new hypotheses have been formed. With the anticipated availability of unprecedented high-resolution rs-fMRI and dedicated analysis pipelines from the Baby Connectome Project (BCP), it is important now to revisit previous findings and hypotheses, discuss and comment existing issues and problems, and make a "to-do-list" for the future studies. This review article aims to comprehensively review a decade of the findings, unveiling hidden jewels of the fields of developmental neuroscience and neuroimage computing. Emphases will be given to early infancy, particularly the first few years of life. In this review, an end-to-end summary, from infant rs-fMRI experimental design to data processing, and from the development of individual functional systems to large-scale brain functional networks, is provided. A comprehensive summary of the rs-fMRI findings in developmental patterns is highlighted. Furthermore, an extensive summary of the neurodevelopmental disorders and the effects of other hazardous factors is provided. Finally, future research trends focusing on emerging dynamic functional connectivity and state-of-the-art functional connectome analysis are summarized. In next decade, early infant rs-fMRI and developmental connectome study could be one of the shining research topics.

Parenting stress, anxiety, and depression in mothers with visually impaired infants: a cross-sectional and longitudinal cohort analysis

AIM

This study examined cross-sectional and longitudinal patterns of parenting stress, adult anxiety, and depression in mothers of children with profound or severe visual impairment (PVI or SVI) at 1 year and 2 years of age.

METHOD

Mothers of a national longitudinal cohort (OPTIMUM Project) of infants with congenital disorders of the peripheral visual system and PVI (light perception at best) or SVI (basic 'form' vision of non-light reflecting objects) participated. Infant age at baseline (T₁ ) was 8 to 16 months. Mothers completed the Parenting Stress Index - Short Form and the Hospital Anxiety and Depression Scale at T₁ (n=79) and at follow-up 12 months later (T₂ ) (n=73).

RESULTS

Mothers of the total group had higher parenting stress levels (34.6% in clinical range) than community normative data at T₁ (p=0.017). Mothers of infants in the PVI subgroup had elevated stress at T₁ (p=0.014) and T₂ (p=0.009). The PVI subgroup was also elevated in the Difficult Child subscale at T₂ (p=0.001). Within-sample differences in parenting stress between the visual impairment subgroups were found at T₂ only: the PVI subgroup scored higher than the SVI subgroup (p=0.029). Adult anxiety and depression in the total group were not elevated compared with community normative data at T₁ and T₂ ; however, higher parenting stress was related to raised adult anxiety and depression levels at T₁ and T₂ (p=0.001). Regression analysis found parenting stress and lower child vision level (T₁ ) predicted parenting stress (T₂ ) (p=0.001; 42% variance).

INTERPRETATION

Mothers of 1-year-old infants with visual impairment showed raised risk for parenting stress, which continued to be elevated for children with PVI and those perceived as 'difficult' at 2 years. This was also a psychological risk, with greater adult anxiety and depression in those mothers with raised parenting stress. The clinical significance is that identification of parenting stress and targeted parenting, and behavioural support of the child in the first years of life is highly indicated.

WHAT THIS PAPER ADDS

Mothers of infants with visual impairment are at increased risk of parenting stress. Parenting stress was higher in mothers of children with profound visual impairment than those with severe visual impairment. High levels of parenting stress and lower infant vision at 1 year of age predicted higher parenting stress at 2 years of age.

Frontal EEG asymmetry and later behavior vulnerability in infants with congenital visual impairment

OBJECTIVE

Young children with congenital visual impairment (VI) are at increased risk of behavioral vulnerabilities. Studies on 'at risk' populations suggest that frontal EEG asymmetry may be associated with behavioral risk. We investigated frontal asymmetry at 1year (Time 1), behavior at 2years (Time 2) and their longitudinal associations within a sample of infants with VI. Frontal asymmetry in the VI sample at 1year was also compared cross-sectionally to an age-matched typically sighted (TS) group.

METHODS

At Time 1, 22 infants with VI and 10 TS infants underwent 128-channel EEG recording. Frontal asymmetry ratios were calculated from power spectral density values in the alpha frequency band. At Time 2, Achenbach Child Behavior Checklist data was obtained for the VI sample.

RESULTS

63.6% of the VI sample and 50% of the TS sample showed left frontal asymmetry; no significant difference in frontal asymmetry was found between the two groups. 22.7% of the VI sample had subclinical to clinical range 'internalizing' behavior difficulties. Greater left frontal asymmetry at one year was significantly associated with greater emotionally reactive scores at two years within the VI sample (r=0.50, p=0.02).

CONCLUSIONS

Left frontal asymmetry correlates with later behavior risk within this vulnerable population.

SIGNIFICANCE

These findings make an important first contribution regarding the utility of frontal EEG asymmetry as a method to investigate risk in infants with VI.