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Battistin T, Mercuriali E, Zanardo V, Gregori D, Lorenzoni G, Nasato L, Reffo ME. Distance support and online intervention to blind and visually impaired children during the pandemic COVID-19. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 108:103816. [PMID: 33271446 PMCID: PMC7682482 DOI: 10.1016/j.ridd.2020.103816] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 05/12/2023]
Abstract
The COVID-19 pandemic imposed dramatic changes to everyone's daily routines, but especially to children with developmental disabilities. The Robert Hollman Foundation decided not to interrupt its service to all the visually impaired children and initiated a Distance Support Project. It was an online process covering all aspects of support for the children and involving audio-video calls, videos and tailored-made multisensory material created specifically for each child. A questionnaire, carried out after the 5-month project duration, was created to collect feedback from parents and professionals to understand the impact this project had on everyone involved. Overall both parents and professionals indicated high levels of satisfaction, but in a significant number of questions parents reported consistently higher levels of satisfaction (p-value <0.001). It was shown that parents felt reassured at this otherwise very difficult time because their children were able to continue their treatment, even if in a very different way. This fact encourages us to consider enriching our existing programmes of support and care, integrating this online approach when necessary. At the same time, it seems clear that the responses of the professionals indicate their belief that the benefits of the traditional ways of working remain of unquestionable importance for children with sight deprivation.
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Affiliation(s)
- Tiziana Battistin
- Robert Hollman Foundation "Consultation and Support for the Development of Visually Impaired Children", Via Siena 1, Padova, Italy.
| | - Elena Mercuriali
- Robert Hollman Foundation "Consultation and Support for the Development of Visually Impaired Children", Via Siena 1, Padova, Italy
| | - Vincenzo Zanardo
- Robert Hollman Foundation "Consultation and Support for the Development of Visually Impaired Children", Via Siena 1, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Laura Nasato
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Maria Eleonora Reffo
- Robert Hollman Foundation "Consultation and Support for the Development of Visually Impaired Children", Via Siena 1, Padova, Italy
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Molinaro A, Micheletti S, Rossi A, Gitti F, Galli J, Merabet LB, Fazzi EM. Autistic-Like Features in Visually Impaired Children: A Review of Literature and Directions for Future Research. Brain Sci 2020; 10:E507. [PMID: 32752249 PMCID: PMC7465914 DOI: 10.3390/brainsci10080507] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 12/16/2022] Open
Abstract
There remains great interest in understanding the relationship between visual impairment (VI) and autism spectrum disorder (ASD) due to the extraordinarily high prevalence of ASD in blind and visually impaired children. The broad variability across individuals and assessment methodologies have made it difficult to understand whether autistic-like symptoms shown by some children with VI might reflect the influence of the visual deficit, or represent a primary neurodevelopmental condition that occurs independently of the VI itself. In the absence of a valid methodology adapted for the visually impaired population, diagnosis of ASD in children with VI is often based on non-objective clinical impression, with inconclusive prevalence data. In this review, we discuss the current state of knowledge and suggest directions for future research.
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Affiliation(s)
- Anna Molinaro
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, 25121 Brescia, Italy
| | - Serena Micheletti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, 25121 Brescia, Italy
| | - Andrea Rossi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, 25121 Brescia, Italy
| | - Filippo Gitti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, 25121 Brescia, Italy
| | - Jessica Galli
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, 25121 Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
| | - Lotfi B Merabet
- Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02115, USA
| | - Elisa Maria Fazzi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, 25121 Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
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Fazzi E, Micheletti S, Galli J, Rossi A, Gitti F, Molinaro A. Autism in Children With Cerebral and Peripheral Visual Impairment: Fact or Artifact? Semin Pediatr Neurol 2019; 31:57-67. [PMID: 31548026 DOI: 10.1016/j.spen.2019.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to evaluate the occurrence and clinical characteristics of autism spectrum disorder in visually impaired children. In total, 273 participants, 214 with cerebral causes of vision impairment and 59 with peripheral causes, were assessed using multiple assessment methods and adapted for individuals with vision loss. We found that autism spectrum disorder was more prevalent in the visually impaired compared to general population, and that the prevalence varied according to the type of visual disorder (2.8% for cerebral and 8.4% for peripheral visual impairment). In subjects with cerebral visual impairment, the presence of autistic symptoms was consistent with the diagnosis of autism spectrum disorder. In children with peripheral visual impairment, certain symptoms related to visual loss overlapped with the clinical features of autism spectrum disorder, thus making clinical diagnosis more challenging. The development of assessment tools that take into account the type and level of visual impairment and validation testing in a larger population sample are needed in order to confirm these initial findings regarding the diagnosis of autism spectrum disorder in visually impaired children.
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Affiliation(s)
- Elisa Fazzi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Serena Micheletti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Brescia, Italy
| | - Jessica Galli
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Rossi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Brescia, Italy
| | - Filippo Gitti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Brescia, Italy
| | - Anna Molinaro
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Kooiker MJG, Verbunt HJM, van der Steen J, Pel JJM. Combining visual sensory functions and visuospatial orienting functions in children with visual pathology: A longitudinal study. Brain Dev 2019; 41:135-149. [PMID: 30301589 DOI: 10.1016/j.braindev.2018.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 09/05/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Marlou J G Kooiker
- Vestibular and Oculomotor Research Group, Dept. Neuroscience, Erasmus MC, Rotterdam, the Netherlands.
| | - Hélène J M Verbunt
- Royal Dutch Visio, Centre of Expertise for Partially Sighted and Blind People, Huizen, the Netherlands
| | - Johannes van der Steen
- Vestibular and Oculomotor Research Group, Dept. Neuroscience, Erasmus MC, Rotterdam, the Netherlands; Royal Dutch Visio, Centre of Expertise for Partially Sighted and Blind People, Huizen, the Netherlands
| | - Johan J M Pel
- Vestibular and Oculomotor Research Group, Dept. Neuroscience, Erasmus MC, Rotterdam, the Netherlands
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Dale N, Sakkalou E, O'Reilly M, Springall C, De Haan M, Salt A. Functional vision and cognition in infants with congenital disorders of the peripheral visual system. Dev Med Child Neurol 2017; 59:725-731. [PMID: 28439876 DOI: 10.1111/dmcn.13429] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 11/26/2022]
Abstract
AIM To investigate how vision relates to early development by studying vision and cognition in a national cohort of 1-year-old infants with congenital disorders of the peripheral visual system and visual impairment. METHOD This was a cross-sectional observational investigation of a nationally recruited cohort of infants with 'simple' and 'complex' congenital disorders of the peripheral visual system. Entry age was 8 to 16 months. Vision level (Near Detection Scale) and non-verbal cognition (sensorimotor understanding, Reynell Zinkin Scales) were assessed. Parents completed demographic questionnaires. RESULTS Of 90 infants (49 males, 41 females; mean 13mo, standard deviation [SD] 2.5mo; range 7-17mo); 25 (28%) had profound visual impairment (light perception at best) and 65 (72%) had severe visual impairment (basic 'form' vision). The Near Detection Scale correlated significantly with sensorimotor understanding developmental quotients in the 'total', 'simple', and 'complex' groups (all p<0.001). Age and vision accounted for 48% of sensorimotor understanding variance. Infants with profound visual impairment, especially in the 'complex' group with congenital disorders of the peripheral visual system with known brain involvement, showed the greatest cognitive delay. INTERPRETATION Lack of vision is associated with delayed early-object manipulative abilities and concepts; 'form' vision appeared to support early developmental advance. This paper provides baseline characteristics for cross-sectional and longitudinal follow-up investigations in progress. A methodological strength of the study was the representativeness of the cohort according to national epidemiological and population census data.
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Affiliation(s)
- Naomi Dale
- Neurodisability Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Clinical Neurosciences, UCL Institute of Child Health, London, UK
| | - Elena Sakkalou
- Clinical Neurosciences, UCL Institute of Child Health, London, UK
| | | | - Clare Springall
- Neurodisability Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michelle De Haan
- Cognitive Neuroscience and Neuropsychiatry, UCL Institute of Child Health, London, UK
| | - Alison Salt
- Neurodisability Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Clinical Neurosciences, UCL Institute of Child Health, London, UK
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Yang HK, Hwang JM, Park SS, Yu YS. Brain imaging studies in Leber's congenital amaurosis: new radiologic findings associated with the complex trait. KOREAN JOURNAL OF OPHTHALMOLOGY 2010; 24:360-3. [PMID: 21165235 PMCID: PMC2992564 DOI: 10.3341/kjo.2010.24.6.360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 07/07/2010] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the incidence and new findings of abnormal brain imaging studies associated with patients initially diagnosed with Leber's congenital amaurosis (LCA) without definite systemic abnormalities and to determine the need for brain imaging studies in these patients. Methods A retrospective review of medical records was performed in 83 patients initially diagnosed as LCA and without definite systemic abnormalities before the age of 6 months in 2 tertiary referral centers. Brain magnetic resonance imaging was performed in 31 of 83 patients (37.3%). Results Six of 31 patients (19%) had radiologically documented brain abnormalities. Two patients had cerebellar vermis hypoplasia, 1 patient showed an absence of septum pellucidum, 2 subjects showed mild external hydrocephalus, and 1 patient was found to have a small cerebellum. Conclusions Approximately one fifth of the LCA patients in whom brain imaging was performed were associated with brain abnormalities, including the absence of septum pellucidum, which has not been documented in the literature. Brain imaging is mandatory in patients primarily diagnosed with LCA, even without definite neurologic or systemic abnormalities.
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Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
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Parr JR, Dale NJ, Shaffer LM, Salt AT. Social communication difficulties and autism spectrum disorder in young children with optic nerve hypoplasia and/or septo-optic dysplasia. Dev Med Child Neurol 2010; 52:917-21. [PMID: 20370811 DOI: 10.1111/j.1469-8749.2010.03664.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM the aim of this study was to study systematically social, communication, and repetitive/restrictive (SCRR) behavioural difficulties and clinical autism spectrum disorder (ASD) in children with optic nerve hypoplasia (ONH) and/or septo-optic dysplasia (SOD), and to investigate the relationship between visual impairment, SCRR difficulties, ASD, and cognition. METHOD a case-note study of clinic records from a specialist developmental vision service was completed. Standardized assessments of vision and development and clinician judgements about SCRR difficulties and clinical ASD were made by a multidisciplinary team. RESULTS a total of 45 females and 38 males (mean age 3y 5mo; range 10mo-6y 10mo) with ONH or SOD and profound visual impairment (PVI) or severe visual impairment (SVI) were assessed. A total of 58% of children had at least one SCRR difficulty, and 31% had a clinical diagnosis of ASD. The prevalence of ASD was slightly higher in children with SOD than in children with ONH (36% vs 26%) also slightly more frequent in children with PVI than in children with SVI (36% vs 27%). The prevalence of SCRR difficulties was statistically higher in children with PVI than in children with SVI (p=0.003). Clinical ASD was most likely to be diagnosed between 2 years 4 months and 4 years 6 months. Development was significantly delayed in children with ASD compared with children without social communication difficulties (p=0.001). INTERPRETATION children with SVI or PVI are at risk of SCRR difficulties and clinical ASD. Children with ONH and/or SOD and visual impairment have a similar risk of developing clinical ASD as other visual impairment groups. However, ASD prevalence data from this study are a minimum estimate, as some young children may have developed ASD behaviours in later childhood. Developmental surveillance for children with ONH and/or SOD should continue until at least the age of 4 years 6 months.
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Affiliation(s)
- Jeremy R Parr
- The Wolfson Neurodisability Service, Great Ormond Street Hospital for Children NHS Trust, London, UK
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Dale N, Salt A. Social identity, autism and visual impairment (VI) in the early years. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2008. [DOI: 10.1177/0264619607088282] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article explores how visual impairment might impact on early social and emotional development including self-awareness and communication with others. Some children show a 'developmental setback' and other worrying developmental trajectories in the early years, including autistic related behaviours and autistic spectrum disorders. Research is beginning to reveal the risk factors and most vulnerable processes in the early years, including in social communication, joint attention and joint referencing. The new Developmental Journal for Visually Impaired Babies and Children draws on the research to date and provides a new framework for early intervention and habilitation.
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Affiliation(s)
- Naomi Dale
- Great Ormond Street Hospital/University College London Institute of Child Health, UK,
| | - Alison Salt
- Great Ormond Street Hospital/University College London Institute of Child Health, UK,
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Dale N, Salt A. Early support developmental journal for children with visual impairment: the case for a new developmental framework for early intervention. Child Care Health Dev 2007; 33:684-90. [PMID: 17944777 DOI: 10.1111/j.1365-2214.2007.00798.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Congenital visual impairment has serious consequences for early development, particularly in those with the most profound impairment. Although there is individual variation, developmental delays and risks, including 'developmental setback', are widespread. There is no scientifically robust developmental framework grounded in contemporary theory and scientific knowledge to guide early intervention which may prevent or minimize the risk factors and developmental difficulties. The UK governmental initiative, Early Support, gave the impetus for developing a new developmental framework for babies and young children with visual impairment. METHODS This paper reports on the scientific literature that underpins the new framework and the limitations of existing intervention materials. The case for focusing on particular vulnerable areas and developing a new developmental framework, the Early Support Developmental Journal for babies and children with severe visual impairment, is presented. CONCLUSIONS The future direction for service delivery and evaluation is briefly described.
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Affiliation(s)
- N Dale
- Great Ormond Street Hospital NHS Trust/UCL Institute of Child Health, Great Ormond Street, London, UK.
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McCulloch DL, Garcia-Filion P, Garcia-Fillion P, van Boemel GB, Borchert MS. Retinal function in infants with optic nerve hypoplasia: electroretinograms to large patterns and photopic flash. Eye (Lond) 2006; 21:712-20. [PMID: 16601748 DOI: 10.1038/sj.eye.6702309] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIMS Optic nerve hypoplasia (ONH), which is defined as a congenital deficiency of retinal ganglion cells, may also involve more distal layers of the retina. We investigated electrophysiological function of the retina in ONH using electroretinograms (ERGs). METHODS ERGs were recorded from 48 subjects (3.5-35 months) with unilateral or bilateral ONH. Pattern reversal (4 degrees checks) was presented under chloral hydrate sedation, using an optical system to correct a cycloplegic refraction. A photopic flash stimulus was also used. Fundus photographs were used to measure the disk diameter/disk macula ratio (DD/DM), and to document other clinical signs. Eyes were classified as moderate (0.15-0.3) or severe (<0.15) ONH, and those with DD/DM greater than 0.3 were used as reference eyes. RESULTS Pattern ERG recording was completed in 89 eyes and was detectable in 80% of eyes with ONH (61/76 tested) and in all 13 reference eyes. Photopic flash ERGs were of good quality in all eyes. The severity of ONH correlates with the amplitude of the photopic flash b-waves and with the amplitude of the N95 component of the pattern ERG (P<0.01). However, the ERGs to large patterns were well preserved (>3.5 microV) in 10 of 35 eyes with severe ONH. Tortuous retinal vessels in eyes with either moderate or severe ONH were associated with smaller amplitude photopic b-waves and markedly diminished or undetectable pattern ERGs. CONCLUSIONS This study supports the hypothesis that retinal dysfunction distal to the ganglion cells is common in ONH, but is not predictable on the basis of ONH severity alone. Additionally, tortuous retinal vessels in ONH may be a sign associated with retinal dysfunction.
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Affiliation(s)
- D L McCulloch
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Lanarkshire, UK.
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Chong WK. Imaging of developmental intracranial abnormalities. IMAGING 2002. [DOI: 10.1259/img.14.5.140374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Grönqvist S, Flodmark O, Tornqvist K, Edlund G, Hellström A. Association between visual impairment and functional and morphological cerebral abnormalities in full-term children. ACTA OPHTHALMOLOGICA SCANDINAVICA 2001; 79:140-6. [PMID: 11284751 DOI: 10.1034/j.1600-0420.2001.079002140.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To characterise the nature and degree of ocular disorders and cerebral morphological and functional abnormalities in a population-based group of visually impaired full-term pre-school children. METHODS Forty-five children who were born at full-term between 1989 and 1995 in Värmland, Sweden, were reported as being visually impaired. An ophthalmological examination was performed and clinical data regarding mental development and neurological disease were obtained for all children. Cerebral imaging was performed in 35 children. RESULTS Twenty-six per cent of the children were found to have ocular disorders only. Forty-two per cent had cerebral morphological abnormalities, verified by cerebral imaging, and 65% had signs of cerebral functional abnormalities. In total, 74% were found to have cerebral morphological and/or cerebral functional abnormalities. CONCLUSION The majority of children with visual impairment, including children with ocular disorders, were found to have cerebral morphological and/or cerebral functional abnormalities. We suggest that any child with visual impairment should therefore undergo cerebral imaging and be examined by a paediatrician in order to establish the correct diagnosis.
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Affiliation(s)
- S Grönqvist
- Department of Ophthalmology, Central Hospital, Karlstad, Sweden.
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Summary of Lecture given to the Faculty of Community Health, Annual General Meeting on 20th October 1998 by Patricia M Sonksen Severely visually impaired children. Public Health 1999. [DOI: 10.1038/sj.ph.1900534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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