Developmental Growth Curves of Preschool Children with Vision Impairments

An Examination of Early Intervention Services for Children With Visual Impairments During the COVID-19 Pandemic

Introduction: In the early spring of 2020, governments were beginning to react to the news of a global pandemic being caused by COVID-19. The purpose of this study was to examine the effect of COVID-19 on early intervention services for young children with visual impairments and their families. Methods: Parents of children with visual impairments aged birth to 3 years were asked a series of questions contained in a larger Access and Engagement survey that investigated the experiences of families of children and young adults with visual impairments aged birth to 21 years and professionals that provided educational services. Results: Three overall themes emerged from the data: (1) many changes occurred in the home, (2) early intervention services changed, and (3) planning for the transition to preschool was affected. Discussion: Overall, the changes in education due to the pandemic and initial shutdown resulted in much parental stress. Parents reported that they were stressed and sometimes overwhelmed by the sudden and dramatic changes in their daily lives and how best to help their children in continuing to learn and develop their skills while simultaneously working from home, being caregivers to the other children in the family, and serving as educators and sometimes informal therapists to their children. Many services moved to an online format and were provided remotely. Implications for Practitioners: Service providers should continue to provide services to families and children who have been affected by the COVID-19 pandemic and resulting shutdown while continuing to provide ways to support the social and emotional well-being of their families. Service providers and families should monitor their children's development and learning both now and in the future.

A Study of Improving Independent Walking Outcomes in Children Who Are Blind or Have Low Vision Aged 5 Years and Younger

Walking alone (without assistance) is considered by the World Health Organization as the terminal independent walking milestone, typically achieved by 18 months. Children born with severe visual impairment and blindness (visual impairments) do not achieve independent walking milestones on time. This study examined independent walking in 35 children with visual impairments (VIs) aged 14–69 months. Before treatment, they had limited to no anticipatory control. Wearing the pediatric belt cane (PBC) provided them with consistent, tactile anticipatory control. Thirty-five participants with VIs’ independent walking milestones were analyzed using pre- and post-video recordings provided weekly 1 month before and the 3 months after obtaining the PBC. The PBC consisted of a rectangular frame that connects to a custom-made belt with magnets. The PBC provided no weight support. While none of the participants had motor impairments, 80% of them were receiving physical therapy services prior to obtaining a PBC. Fifty-four percent were receiving orientation and mobility services, and half were equipped with hand-held mobility tools (long canes, adaptive mobility devices, push toys, and reverse walkers). A paired samples t-test indicated a significant difference between the before and with PBC scores ( N = 35, t = −13.0, df = 34, p = .000). Participants demonstrated significantly improved independent walking after wearing their PBC regularly over 3 months. Before PBC, the participants demonstrated delayed independent walking milestones. Most participants walked only with assistance. Those who walked independently experienced unavoidable bodily collisions and used a slow pace with poor gait patterns. After being provided PBCs, these same participants’ independent walking milestones improved, all but three were walking independently and five were observed independently running. Wearing their PBCs allowed them to perform motor skills, like running, often described as needing to be specifically taught to learners with VIs due to their inability to learn incidentally through visual observation.

A scoping review of longitudinal studies of children with vision impairment

In past comparative studies, children with vision impairment were often shown a developmental delay compared to sighted children in several developmental domains. Medical treatments of vision impairments and societal attitudes toward disabilities changed considerably. Besides, within the rehabilitation practices, a stronger integration of multiple perspectives and increased focus on social inclusion and participation in society is present. The main goal of this scoping review was to investigate what is known about the development in cognition, language and communication, motor, social–emotional, and adaptive skills development of children with vision impairment by longitudinal studies. Besides, the results of the past studies were related to a contemporary view on disability, the participation concept. This was done by applying the family of participation-related constructs (fPRC) framework to examine which factors were covered and which not. A systematic literature search was performed in Web of Science, PsycInfo, ERIC, and Medline. Studies were included if they have been published in peer-reviewed journals between 1994 and 2020 had a longitudinal design and examined the development of children with vision impairment with no additional impairments up to 18 years of age. From the 2698 identified studies, 32 studies were included. The most commonly assessed variables concerned cognition and language and communication development. To a lesser extent, studies examined adaptive skills, motor, and social–emotional development. The majority used vision status as a predictor variable for developmental outcomes. In terms of the fPRC framework, most studies included variables related to the factor activity competences. The factors preferences, sense of self, environment, and involvement were studied far less often. The review suggested a positive impact on developmental outcomes for including variables that can mediate the relation between vision status and developmental outcomes and variables that are related to the fPRC factors environment, sense of self, and preferences.

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.

Model Registry of Early Childhood Visual Impairment: First-Year Results

This study obtained information on 406 children from birth to age 3 with visual impairments at the point of entry into specialized early intervention programs in nine states. It found that the majority of the children were legally blind and had disabilities in addition to visual impairment. Cortical visual impairment, retinopathy of prematurity, and optic nerve hypoplasia were the three most prevalent eye conditions in the sample. Furthermore, about a six-month mean lag was found between the diagnosis of children's visual impairment and referral for services.

The Interaction between Mothers and their Visually Impaired Infants: An Intersubjective Developmental Perspective

In this article, an intersubjective developmental theory that focuses primarily on the development of the interworld between the caregiver and the infant is used to integrate and interpret the seemingly incoherent and contradictory research findings on the interactions between mothers and their infants with visual impairments. The implications for further research and early intervention practices are presented.

Emotional Status and Development in Children who are Visually Impaired

This study examined the developmental attainments of children with visual impairments, aged 6–59 months, with and without emotional deficits, behavioral deficits, or both. It found that an emotional or behavioral deficit was significantly related to gross motor and visual motor integration, expressive and receptive language, and social or personal development, and that there was an interaction between the effect of the mother's education and the child's age on the child's perception of language.

A National Survey of Service Providers who Work with Young Children with Visual Impairments

This survey sought to determine which service providers work with young children with visual impairments, the children they serve, their roles and responsibilities, and the professional competencies they consider important. The findings emphasized the need for service providers to develop strategies for working with families from culturally and linguistically diverse backgrounds and young children with multiple disabilities, to collaborate and consult effectively with other professionals and agencies, and to support caregiver-infant interactions.

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.

Divergent Development of Gross Motor Skills in Children who are Blind or Sighted

This empirical study compared the average ages at which four congenitally blind children acquired 29 gross motor skills with age norms for sighted children. The results indicated distinct developmental delays in the acquisition of motor skills and a high degree of variability in developmental delays within and across the six subdomains that were analyzed.

Divergent Development of Manual Skills in Children who are Blind or Sighted

This empirical study compared the average ages at which four children with congenital blindness acquired 32 fine motor skills with age norms for sighted children. The results indicated that the children experienced extreme developmental delays in the acquisition of manual skills and a high degree of variability in developmental delays within and across six categories of fine-motor skills.

Assessment and Instruction of Object Permanence in Children with Blindness and Multiple Disabilities

Introduction

This article discusses the impact of blindness and low vision on the development of object permanence and provides suggestions for assessment and instruction.

Methods

The reviewed literature was identified by searching both ERIC and Psych Info using combinations of search terms such as object permanence and visual impairment or low vision and blindness. Books, assessment tools, and nonpeer-reviewed literature were also reviewed.

Results

Although children with low vision use vision as the basis to master object permanence, children who are blind rely primarily on their tactile experiences of objects. Recommended instructional practices include the consistent and repeated naming of the concealed object, concealment of motivating and varied objects, and direct reinforcement.

Discussion

Direct instruction that is grounded in careful assessment may accelerate the mastery of object permanence, with unique strategies being applied to the instruction of children who are blind, including the coactive concealment of objects.

Implications for practitioners

Practitioners may use the structured informal assessment and the identified items within commercially produced assessment tools to identify a child's current knowledge of object permanence. Practitioners may integrate the research-based and promising practices to improve instruction.

Severe Visual Impairments in Infants and Toddlers in the United States

Introduction

This article describes the most prevalent visual conditions and other demographic characteristics of 5,931 young children with severe visual impairments in 28 states in the United States, the largest sample reported to date. The information presented in this article can assist in planning and implementing programs.

Method

The data were collected at the time of entry into specialized early intervention programs for young children with visual impairments through reviews of records, interviews, and direct observations. They were sent to Babies Count: The National Registry for Children with Visual Impairments, Birth to 3 Years at the American Printing House for the Blind. The data were collected and entered between January 2005 and April 2011.

Results

Cortical visual impairment, retinopathy of prematurity (ROP), and optic nerve hypoplasia were the three most prevalent diagnoses. Approximately 60% were identified as being legally blind, and 65% had disabilities in addition to visual impairments. The mean age of the children at the time of diagnosis was 4.9 (SD = 5.7) months, referral to specialized programs was at 10.5 (SD = 7.8) months, and entry into specialized programs was at 11.6 (SD = 8.0) months. There was an average lag of 5.6 months between the diagnosis and referral.

Discussion

Cortical visual impairment, ROP, and optic nerve hypoplasia continue to be the leading causes of severe, uncorrectable visual impairments in children in the United States. ROP appears to be decreasing in prevalence; however, more children with ROP appear to have additional disabilities. The lag of 5.6 months between diagnosis and referral, a longer lag than was previously reported, is of concern.

Implications for practitioners

Information about the characteristics of children with severe uncorrectable visual conditions is valuable for communicating with families, planning and implementing early intervention and educational programs, and collaborating with medical professionals.

Divergent Development of Verbal Skills in Children who are Blind or Sighted

This empirical study compared the average ages at which four children with congenital blindness acquired 29 verbal skills with given age norms for sighted children. The results indicated only small developmental delays in the acquisition of verbal skills in the four children, but a high degree of variability in developmental delays within and across nine categories of verbal skills.

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.

Adaptation of a Developmental Test to Accommodate Young Children with Low Vision

Introduction

This study analyzed the effects of accommodations for children with low vision in the Griffiths Mental Development Scales–Extended Revised (GMDS-ER).

Methods

The sample comprised 25 children with low vision and chronological ages between 28 and 76 months. There were two assessment phases: in the first, the Griffiths Scales were administered according to the procedures described in the manual; about two to four weeks later, a second assessment was performed with the same instrument that had been adapted for low vision.

Results

The results indicated that there were some favorable differences in the use of item accommodations for children with low vision, including statistically significant improvements of scores in sub-scales A, locomotor; C, language; and E, performance, as well as in the full scale. All children, except one, increased their full scale score; in the subscales, the number of children that increased their scores varied. The combination of different types of accommodations (materials, administration conditions, and success criteria) generated the best results. Still, many children increased their scores with only accommodations to materials (for instance, enhancement of contours and greater visual contrast).

Discussion

The results demonstrated the importance of adapting developmental standardized tests for children with low vision. Future studies should increase the sample size and control variables related to type of visual impairment.

Implications for practitioners

Test developers and test users should consider accommodations for young children with low vision. That way, the developmental level could be described more precisely and intervention could be better adjusted to each child's abilities. Furthermore, a more accurate developmental assessment of effective child's competencies and difficulties may be useful in terms of eligibility criteria for special education services.

Social-emotional competences in very young visually impaired children

Social-emotional competences are an important developmental domain for children with a visual impairment (VI). Therefore, early diagnosis in this regard is needed to ensure that VI children receive appropriate support. In this study, we used two preliminary German versions of the Infant–Toddler Social Emotional Assessment (ITSEA) and the Social-Emotional Assessment/Evaluation Measure (SEAM) to assess social-emotional competences in 92 VI infants and toddlers aged 12–36 months. Our results indicate that both instruments provide valid, reliable data and are suitable for use in practice. The results still reveal that understanding the emotions of other persons, paying attention to things around them and engaging with their environment, in addition to relating to other peers, seem to be the most important challenges for early intervention in VI toddlers. An additional disability is yet another condition that poses a specific challenge for VI education. The data also corroborate well-known findings from other research on the education of children with different conditions; in particular, the role of parental responsivity for the development of social-emotional competences is confirmed. Overall, the results suggest that the two instruments employed provide important information for educational practice, but further research is needed to demonstrate their full value.

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)

Secure parent-child attachment may help children to overcome the challenges of growing up with a visual or visual-and-intellectual impairment. A large literature exists that provides a blueprint for interventions that promote parental sensitivity and secure attachment. The Video-feedback Intervention to promote Positive Parenting (VIPP) is based on that blueprint. While it has been adapted to several specific at risk populations, children with visual impairment may require additional adjustments. This study aimed to identify the themes that should be addressed in adapting VIPP and similar interventions. A Delphi-consultation was conducted with 13 professionals in the field of visual impairment to select the themes for relationship-focused intervention. These themes informed a systematic literature search. Interaction, intersubjectivity, joint attention, exploration, play and specific behavior were the themes mentioned in the Delphi-group. Paired with visual impairment or vision disorders, infants or young children (and their parents) the search yielded 74 articles, making the six themes for intervention adaptation more specific and concrete. The rich literature on six visual impairment specific themes was dominated by the themes interaction, intersubjectivity, and joint attention. These themes need to be addressed in adapting intervention programs developed for other populations, such as VIPP which currently focuses on higher order constructs of sensitivity and attachment.

Participation in an occupational therapy referral program for children with retinoblastoma

PURPOSE

Because retinoblastoma typically arises at a very young age, children are particularly vulnerable to vision impairment, associated developmental delays, and functional limitations. Limited information is available describing developmental delay and functional limitations in this population, necessitating supportive services including rehabilitation. The aims of this study were to describe the participation of children with newly diagnosed retinoblastoma in an occupational therapy program that identifies children in need of rehabilitation services. We also identify indications for referral to rehabilitation services among children with newly diagnosed retinoblastoma and enumerate the likelihood of these children receiving the recommended services.

METHODS

Twenty-two children participated in longitudinal occupational therapy assessments during the first year after diagnosis.

RESULTS

We recommended 1 or more types of rehabilitation services for 16 of 22 (72.7%) participants. Twelve of 16 (75%) received services.

CONCLUSIONS

The results of this pilot study indicate that implementing a prospective occupational therapy-screening program is feasible and results in identification and initiation of therapy services in some children with retinoblastoma. Developmental screenings and follow-up of children with retinoblastoma is strongly recommended.

Spatial navigation by congenitally blind individuals

Spatial navigation in the absence of vision has been investigated from a variety of perspectives and disciplines. These different approaches have progressed our understanding of spatial knowledge acquisition by blind individuals, including their abilities, strategies, and corresponding mental representations. In this review, we propose a framework for investigating differences in spatial knowledge acquisition by blind and sighted people consisting of three longitudinal models (i.e., convergent, cumulative, and persistent). Recent advances in neuroscience and technological devices have provided novel insights into the different neural mechanisms underlying spatial navigation by blind and sighted people and the potential for functional reorganization. Despite these advances, there is still a lack of consensus regarding the extent to which locomotion and wayfinding depend on amodal spatial representations. This challenge largely stems from methodological limitations such as heterogeneity in the blind population and terminological ambiguity related to the concept of cognitive maps. Coupled with an over‐reliance on potential technological solutions, the field has diffused into theoretical and applied branches that do not always communicate. Here, we review research on navigation by congenitally blind individuals with an emphasis on behavioral and neuroscientific evidence, as well as the potential of technological assistance. Throughout the article, we emphasize the need to disentangle strategy choice and performance when discussing the navigation abilities of the blind population. WIREs Cogn Sci 2016, 7:37–58. doi: 10.1002/wcs.1375

For further resources related to this article, please visit the WIREs website.

Using Constant Time Delay to Teach Braille Word Recognition

Introduction

Constant time delay has been identified as an evidence-based practice to teach print sight words and picture recognition (Browder, Ahlbrim-Delzell, Spooner, Mims, & Baker, 2009). For the study presented here, we tested the effectiveness of constant time delay to teach new braille words.

Methods

A single-subject multiple baseline across behaviors design was used to investigate the use of constant time delay to teach recognition of highly motivating braille words to four students with visual impairments and intellectual disabilities.

Results

Each participant learned all words taught (9–12 words each). A functional relation was demonstrated for all four participants by immediate changes in trend from baseline to intervention.

Discussion

This is the first published report of the successful use of constant time delay to teach braille word recognition to students with visual impairments and intellectual disabilities. An attending cue was introduced into the procedures for students with a low number of unprompted correct responses, and results were positive. Possible sources of variability in word retention are discussed.

Implications for practitioners

Results suggest constant time delay can be adapted and implemented with braille readers in typical teaching environments.