Attentional processes in young children with congenital visual impairment

Sleep Patterns in Children With Blindness: A Comparison With Normally Sighted Peers

Purpose

Studies showing problematic sleep patterns in blind and visually impaired children are often based on (parent) self-report. The purpose was to compare sleep patterns of blind children to normally sighted peers using objective measures.

Methods

In this cross-sectional study, 100 blind (best-corrected visual acuity <3/60) and 100 age- and gender-matched normally sighted children aged 7 to 17 years wore a digital activity monitoring device for 1 week. Sleep quantity (i.e., total sleep time and total time in bed) and sleep quality (number of awakenings, latency, efficiency, wake after sleep onset [WASO], and sleep fragmentation index) were measured. Adjusted linear regression analyses were used to model group differences in sleep parameters.

Results

Data of 163 children were included. Blind children spent significantly less total time in bed in minutes (β, -31; 95% confidence interval, -56 to -6) and had a lower total sleep time (-41; -66 to -17), smaller number of awakenings (-2.8; -4.5 to -1.0), a lower WASO (-10; -16 to -5), and a more efficient sleep pattern (1.5; 0.1 to 2.8) compared to normally sighted children.

Conclusions

Although sleep quantity and recommended hours of sleep per night were lower among blind children than normally sighted children, their sleep quality was better. This contradicts findings of self-report studies and warrants further studies to measure sleep objectively. Further, the discrepancy between previous findings and our findings regarding sleep quality may be explained by the house rules of the boarding schools attended by blind children, which may facilitate improved sleep hygiene.

Visual and cognitive profiles in children with and without cerebral visual impairment

Reliable differentiation of visual-perceptual difficulties in children with and without cerebral visual impairment (CVI) can often pose a diagnostic challenge. We, therefore, assessed the visual-perceptual profile in 94 children with and 77 children without suspected CVI between the ages of 8 and 17 years in a non-clinical setting, using a screening questionnaire and standardized visual-perceptual tests. Children with suspected CVI reported more frequently greater visual difficulties, had lower visual acuity, and were significantly impaired in visual search tests, in visual form and object perception, in visual space perception, and in visual text processing. There were no significant differences between groups in stereopsis, fixation stability, motility, horizontal saccadic eye movements, and convergence and accommodation. Cognitive performance in auditory attention and verbal short-term and working memory was similar in both groups. Our results indicate that the use of an appropriate questionnaire and specific visual-perceptual tests enables valid diagnostic detection of CVI. The additional use of cognitive tests also allows differentiation between primary and secondary impairments in visual perception.

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.

Retinoblastoma and vision

The assessment of vision has a growing importance in the management of retinoblastoma in the era of globe-conserving therapy, both prior to and after treatment. As survival rates approach 98-99% and globe salvage rates reach ever-higher levels, it is important to provide families with information regarding the visual outcomes of different treatments. We present an overview of the role of vision in determining the treatment given and the impact of complications of treatment. We also discuss screening and treatment strategies that can be used to maximise vision.

One-year effects of bifocal and unifocal glasses on executive functions in children with Down syndrome in a randomized controlled trial

Appropriate glasses can improve visual functioning of children with Down syndrome (DS), but it is unknown if such interventions influence their cognitive impairments. In a randomized controlled trial with 1-year follow-up. Children with DS (2-16 years) were provided either bifocal glasses (add +2.5 Dioptres; n = 50) or unifocal glasses (n = 52). Executive functions were assessed pre- and post-intervention with the task-based Minnesota Executive Function Scale (MEFS) and with questionnaires, BRIEF-P and BRIEF, parents' and teachers' version. Intervention effects and associations between executive functions, (near) vision and ocular alignment were analysed. Intervention improved MEFS-Total-scores in the bifocal group (p = 0.002; Cohen's d = 0.60) but not in the unifocal group (p = 0.191; Cohen's d = 0.24). Post-intervention, there was no intergroup difference (p = 0.120; Cohen's d = 0.34). Post-intervention, higher MEFS-scores were associated with better visual acuities (crowded near p = 0.025; uncrowded near p = 0.019; distant p = 0.045). Pre-post changes in MEFS-scores correlated significantly with improved ocular alignment (p = 0.040). Exploratory analysis of the questionnaires showed improved teacher-rated BRIEF-scores in both groups (bifocals: p = 0.014, Cohen's d = 1.91; unifocals: p = 0.022, Cohen's d = 1.46), with no intergroup difference (p = 0.594; Cohen's d = 0.23). These results demonstrate positive effects of wearing better-correcting glasses on executive functioning in children with DS, suggesting a link between their visual and executive functioning. However, the relative contributions of distant and near vision need further study.

Differences between children with Down syndrome and typically developing children in adaptive behaviour, executive functions and visual acuity

In children with Down syndrome (DS) development of visual, motor and cognitive functions is atypical. It is unknown whether the visual impairments in children with DS aggravate their lag in cognitive development. Visual impairment and developmental lags in adaptive behaviour and executive functions were assessed in 104 children with DS, 2–16 years, by comparing their adaptive behaviour, executive functions and visual acuity (distant and near) scores against published age-matched norm scores of typically developing children. Associations between these lags were explored. Mean (± SEM) differences to age-matched norms indicated reduced performance in DS: Vineland Screener questionnaire, − 63 ± 3.8 months; task-based Minnesota Executive Function Scale (MEFS), − 46.09 ± 2.07 points; BRIEF-P questionnaire, 25.29 ± 4.66 points; BRIEF parents’ and teachers’ questionnaire, 17.89 ± 3.92 points and 40.10 ± 3.81 points; distant and near visual acuity, 0.51 ± 0.03 LogMAR and 0.63 ± 0.03 LogMAR (near − 0.11 ± 0.04 LogMAR poorer than distant). Adaptive behaviour (Vineland-S) correlated with the severity of visual impairment (r = − 0.396). Children with DS are severely impaired in adaptive behaviour, executive functions and visual acuities (near visual acuity more severely impaired than distant visual acuity). Larger impairment in adaptive behaviour is found in children with larger visual impairment. This supports the idea that visual acuity plays a role in adaptive development.

Lights Out: Examining Sleep in Children with Vision Impairment

Sleep is crucial for development across cognitive, physical, and social-emotional domains. Sleep quality and quantity impact domains of daytime functioning, attainment, and global development. Previous work has explored sleep profiles in typically developing children and children with developmental disorders such as Down syndrome and Williams Syndrome, yet there is a complete absence of published work regarding the sleep profiles of children with vision impairment aged 4–11 years. This is the first known study that examines the sleep profiles in children with vision impairment (n = 58) in comparison to 58 typically developing children (aged 4–11 years) in the UK. Sleep was measured using the Childhood Sleep Habits Questionnaire (CSHQ; parental report), actigraphy and sleep diaries. Results showed group differences in subjective CSHQ scores but not objective actigraphy measures. Surprisingly, the findings revealed disordered sleep (namely, poor sleep quantity) in both groups. Discordance between CSHQ and actigraphy measures could represent heightened awareness of sleeping problems in parents/caregivers of children with vision impairment. The implications of this study extend beyond group comparison, examining disordered sleep in ‘typically developing’ children, exploring the potential role of light perception and the importance of sleep quality and quantity in both groups.

Knowledge, attitude and practice of Ethiopian pediatricians concerning childhood eye diseases

BACKGROUND

Eye examination and vision assessment are vital for the detection of conditions that result in blindness. Childhood blindness seriously impacts the development, education, and future employment opportunities of affected children. Pediatricians' knowledge of eye diseases is critical for the prevention of blindness through early diagnosis, allowing proper treatment and identification of conditions requiring referral to an ophthalmologist to preserve or restore vision. This study aimed to assess the knowledge, attitude, and practice of Ethiopian pediatricians concerning childhood eye diseases.

METHODS

We carried out a cross-sectional descriptive study of pediatricians working in various hospitals and clinics in Ethiopia. Participants were selected via a convenient sampling technique. Data were collected using both closed and open-ended semi-structured questionnaires. Responses were entered into EpiData 3.1 and transferred to SPSS version 21.0 software for analysis.

RESULTS

A total of 79 pediatricians participated in the study. Our findings showed that the attitude of all but 2 participants towards improving the management of childhood eye diseases was positive, even though this was not reflected in actual knowledge or practice. Even though attitudes were positive, knowledge was often poor and practice inadequate owing to barriers such as inadequate undergraduate training, lack of ophthalmology options during pediatric residency, and unavailability of ophthalmic equipment.

CONCLUSIONS

Participants' attitudes towards improving treatment for childhood eye diseases are positive, but their insufficient knowledge of eye diseases makes their practice poor in this respect.

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.

Promoting a balanced early years curriculum for young children with vision impairment: Developing and sustaining personal agency through a bioecological systems perspective

Through the use of their developing vision, young children develop increasingly sophisticated ways of establishing control within different learning environments, thereby helping them to exert influence as active ‘agents’. Vision impairment can present significant barriers to a child developing personal agency through reducing access to visual information. In this article, we present the parameters of a conceptual framework to inform the design of intervention approaches that can help to reduce these barriers. We draw on a dual model of ‘access’, contextualised within a bioecological systems perspective, to examine how young children with vision impairment can establish increasing personal agency through intervention approaches that promote progressive independence access skills within an ‘ethos of empowerment’. In presenting new conceptual foundations for examining the development of personal agency in young children with vision impairment, the article has significance for research, policy, and practice in vision impairment education and offers a theoretical reference point for related areas of early childhood inclusive education.

The assistance of electronic visual aids with perceptual learning for the improvement in visual acuity in visually impaired children

PURPOSE

To investigate the effect of electronic visual aids (EVA) combined with perceptual learning (PL) for the improvement in visual acuity for moderate to severe visually impaired and blind children.

METHODS

Twenty-eight 6- to 14-year-old visually impaired children (19 boys and 9 girls) were divided into two groups: PL under the assistance of EVA (Group A, 14 children) and simple PL without EVA (Group B, 14 children). The content of PL was to search the inversed "E" in the crowding strings and connected with lines, 30 minutes a day for 6 months. EVA can provide 5-10 times magnification on the 4.3-inch screen. Uncorrected distance visual acuity (UCVA), best-corrected visual acuity (BCVA), near visual acuity (NVA) and refractive error were evaluated before and 3 and 6 months after training.

RESULTS

Baseline UCVA, BCVA or NVA was comparable between the two groups. Three months after training, UCVA, BCVA and NVA improved significantly in Group A (p < 0.05). At the end of training, UCVA and BCVA continued progressing in Group A compared to 3 months (p = 0.01, 0.02), but visual acuity did not show significant improvement in Group B during the same time, except that UCVA improved at the first follow-up. Refractive error had no significant change post-training in both groups.

CONCLUSIONS

Visually impaired children can benefit more from the combination of PL with EVA than simple PL, and the improvement in visual acuity accompanied no significant myopic shift. It may provide a new method of treatment and rehabilitation in visually impaired children.

Theory of Mind Development in Children with Visual Impairment: The Contribution of the Adapted Comprehensive Test ToM Storybooks

Research that focused on Theory of Mind (ToM) development in blind children showed that they were delayed, but not permanently deficient, in various types of false belief tasks. More recent studies reported first evidence of typical ToM development in blind children and suggested that more comprehensive tools to evaluate ToM had to be used. The current paper analyzed ToM development in blind children, using the adapted version of the ToM Storybooks; this is a standardized comprehensive test developed to provide a reliable and stable measurement, in comparison with the false belief tasks. Results showed that blind children's ToM performances were very similar to the ones of matched typically developing children, matched on chronological age and gender. The current finding supported the importance of the use of a more comprehensive tool to assess ToM in atypical population.

Development of adaptive communication skills in infants of blind parents

A fundamental question about the development of communication behavior in early life is how infants acquire adaptive communication behavior that is well-suited to their individual social environment, and how the experience of parent-child communication affects this development. The current study investigated how infants develop communication skills when their parents are visually impaired and cannot see their infants’ eye gaze. We analyzed 6-min video recordings of naturalistic interaction between 14 sighted infants of blind parents (SIBP) with (a) their blind parent, and (b) a sighted experimenter. Data coded from these interactions were compared with those from 28 age-matched sighted infants of sighted parents (controls). Each infant completed two visits, at 6–10 months and 12–16 months of age. Within each interaction sample, we coded the function (initiation or response) and form (face gaze, vocalization, or action) of each infant communication behavior. When interacting with their parents, SIBP made relatively more communicative responses than initiations, and used more face gaze and fewer actions to communicate, than did controls. When interacting with a sighted experimenter, by contrast, SIBP made slightly (but significantly) more communicative initiations than controls, but otherwise used similar forms of communication. The differential communication behavior by infants of blind versus sighted parents was already apparent by 6–10 months of age, and was specific to communication with the parent. These results highlight the flexibility in the early development of human communication behavior, which enables infants to optimize their communicative bids and methods to their unique social environment.

The Incidence of Binocular Visual Impairment and Blindness in Children with Bilateral Retinoblastoma

Purpose

The study aimed to assess the incidence of and risk factors leading to visual impairment and legal blindness in children with retinoblastoma.

Procedures

This is a single-center, retrospective case series of all patients with bilateral retinoblastoma presenting from 2010 to 2014.

Results

A total of 44 patients were included in the study. Visual impairment was present in 14 (38%) children, legal blindness was present in 7 (19%) children. Bilateral macular tumors (BMT) were associated with visual impairment (12 of 18 patients with BMT, 2 of 19 patients without BMT, p = 0.0006) and legal blindness (7 of 18 patients with BMT, 0 of 19 patients without BMT, p = 0.003). The International Intraocular Retinoblastoma Classification (IIRC) of the better eye also predicted visual impairment (16% in IIRC Group a, b, c, 75% in IIRC Group D, E, p = 0.004) and blindness (3% eye in IIRC Group a, b, c, 50% in Group D, E, p = 0.005). Various non-Snellen visual acuity measures were able to predict visual impairment in pre-verbal children, providing them with early assistance.

Conclusions

The rates of visual impairment and blindness reported in this paper can be used to counsel families regarding the risk of binocular visual impairment. Early detection and support for visually impaired infants are essential as development can be affected by severe visual impairment.

Effect of Yogic Breathing on Accommodate Braille Version of Six-letter Cancellation Test in Students with Visual Impairment

Context:

Attentional processes tend to be less well developed in the visually impaired, who require special training to develop them fully. Yogic breathing which alters the patterns of respiration has been shown to enhance attention skills. Letter cancellation tests are well-established tools to measure attention and attention span. Here, a modified Braille version of the six-letter cancellation test (SLCT) was used for students with visual impairment (VI).

Aim:

This study aimed to assess the immediate effects of Bhramari Pranayama (BhPr) and breath awareness (BA) on students with VI.

Methods:

This study was a self-as-control study held on 2 consecutive days, on 19 participants (8 males, 11 females), with a mean age of 15.89 ± 1.59 years, randomized into two groups. On the 1^st day, Group 1 performed 10 min breath awareness and Group 2 performed Bhramari; on the 2^nd day, practices were reversed. Assessments used a SLCT specially adapted for the visually impaired before and after each session.

Results:

The Braille letter cancellation test was successfully taken by 19 students. Scores significantly improved after both techniques for each student following practices on both days (P < 0.001). BhPr may have more effect on attention performance than BA as wrong scores significantly increased following BA (P < 0.05), but the increase in the score after Bhramari was not significant.

Conclusions:

Despite the small sample size improvement in attentional processes by both yoga breathing techniques was robust. Attentional skills were definitely enhanced. Long-term practice should be studied.

A novel ecological account of prefrontal cortex functional development

In this paper, we argue that prefrontal cortex ontogenetic functional development is best understood through an ecological lens. We first begin by reviewing evidence supporting the existing consensus that PFC structural and functional development is protracted based on maturational constraints. We then examine recent findings from neuroimaging studies in infants, early life stress research, and connectomics that support the novel hypothesis that PFC functional development is driven by reciprocal processes of neural adaptation and niche construction. We discuss implications and predictions of this model for redefining the construct of executive functions and for informing typical and atypical child development. This ecological account of PFC functional development moves beyond descriptions of development that are characteristic of existing frameworks, and provides novel insights into the mechanisms of developmental change, including its catalysts and influences. (PsycINFO Database Record

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

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.

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.

Executive Function and Behavioral Problems in Students with Visual Impairments at Mainstream and Special Schools

Introduction

In this study, executive function of school-aged children with visual impairments (that is, those who are blind or have low vision) is examined in the context of behavioral problems and communicative competence.

Methods

Teachers assessed the executive function of a sample of 226 visually impaired students from mainstream schools and schools for students who are visually impaired, using a German version of the Behavior Rating Inventory of Executive Function (BRIEF-D) and a questionnaire measuring communicative competence and behavioral problems (German version of the Strengths and Difficulties Questionnaire; SDQ-D).

Results

The results showed highly significant differences in all domains of executive function: the visually impaired students consistently scored more poorly compared to a normative sample of sighted children, even when visually impaired students with additional disabilities were not taken into account. A regression analysis revealed the significance of executive function for behavioral problems among students with visual impairments.

Discussion

The findings demonstrate that a wide range of executive function domains that are significant for socioemotional development are not sufficiently developed in many visually impaired students. This lack of development seems to be particularly true for students who attend special schools.

Implications for practitioners

In educational concepts for visually impaired students, a specific and early focus on competencies such as attention shifting and emotional understanding seems to be necessary, especially in the context of inclusion. Moreover, reinforcing communicative competence might also enhance the development of executive function and help to reduce behavioral problems.

A pilot study to evaluate incorporating eye care for children into reproductive and child health services in Dar-es-Salaam, Tanzania: a historical comparison study

Background

Many blinding eye conditions of childhood are preventable or treatable, particularly in developing countries. However, primary eye care (PEC) for children is poorly developed, leading to unnecessary visual loss. Activities for control by health workers entail interventions for systemic conditions (measles, vitamin A deficiency), identification and referral of children with sight threatening conditions and health education for caregivers. This pilot study evaluated integrating a package of activities to promote child eye health into Reproductive and Child Health (RCH) services in Dar-es-Salaam, Tanzania.

Methods

Design: historical comparison study. Fifteen Clinical Officers and 15 nurses in 15 randomly selected RCH clinics were trained in PEC for children in July 2010. They were given educational materials (poster and manual) and their supervisors were orientated. Knowledge and practices were assessed before and 3 weeks after training. One year later their knowledge and practices were compared with a different group of 15 Clinical Officers and 15 nurses who had not been trained.

Results

Before training staff had insufficient knowledge to identify, treat and refer children with eye diseases, even conjunctivitis. Some recommended harmful practices or did not know that cataract requires urgent referral. Eye examination, vitamin A supplementation of mothers after delivery and cleaning the eyes at birth with instillation of antibiotics (Crede’s prophylaxis) were not routine, and there were no eye-specific educational materials.

Three weeks after training several clinics delivering babies started Crede’s prophylaxis, vitamin A supplementation of women after delivery increased from 83.7% to 100%, and all staff included eye conditions in health education sessions. At one year, trained staff were more likely to correctly describe, diagnose and treat conjunctivitis (z=2.34, p=0.04)(30%-vs-60.7%). Mystery mothers observed health education sessions in 7/10 RCH clinics with trained staff, five (71.4%) of which included eye conditions.

Conclusions

Primary eye care for children in Dar-es-Salaam is inadequate but training RCH staff can improve knowledge in the short term and change practices. Attendance by mothers and their children is high in RCH clinics, making them ideal for delivery of PEC. Ongoing supportive supervision is required to maintain knowledge and practices, as well as systems to track referrals.

Attachment Characteristics and Behavioral Problems in Children and Adolescents with Congenital Blindness

INTRODUCTION

This study aimed to assess the behavioral problems and the attachment characteristics of children and adolescents with congenital blindness (CB).

METHOD

Forty children and adolescents aged 11-14 years with CB were included as the case group. Forty healthy children and adolescents who were matched for age, gender, and socioeconomic status with the case group served as the comparison group. Behavioral problems were assessed by the Child Behavior Checklist for ages 4-18 (CBCL 4/18). Attachment characteristics were assessed via the Short Form of Inventory of Parent and Peer Attachment (s-IPPA).

RESULTS

The case group had lower CBCL total problems scores as well as anxiety/depression, withdrawal/depression, and attention problems subscales scores with respect to the comparison group. There were no significant differences between the two groups in s-IPPA scores.

CONCLUSION

Children and adolescents with CB did not differ from the comparison group in terms of attachment, whereas, they had lower scores on behavioral problems than the comparison group. Although previous studies indicate that children and adolescents with CB may be at the risk of insecure attachment, our study suggested that adaptive mechanisms of their families together with professional help from specialized teachers and services provided by schools for children and adolescents with CB may play compensatory roles.

Social communicative variation in 1-3-year-olds with severe visual impairment

BACKGROUND

Although the social communicative domain is recognized as being at risk in young children with visual impairment (VI), few tools are available for identifying those most at risk or the aspects that are most vulnerable.

METHODS

A standard parent interview - Social Communication Interview for young children with visual impairment (SOCI-VI), was developed and tested with 55 parents of 17 profoundly, 15 severely VI and 23 normally sighted children; mean age 22 months (range 10-40 months). The 35-item SOCI-VI 35 showed adequate inter-rater and test-retest reliability (P < 0.001).

RESULTS

Thirteen of 35 items discriminated within and between the vision groups (anova P 0.008). The group with profound VI scored significantly lower than the Sighted group on the reduced 13 item SOCI-VI 13 (t-test P 0.002), the disparity being greatest for items exploring joint attention. The reduced SOCI-VI 13 showed adequate internal consistency (Cronbach alpha > 0.75) and concurrent validity with the Vineland adaptation questionnaire within a randomized VI subgroup (r 0.8, P < 0.01).

CONCLUSIONS

The study reveals trends in early social communicative development in the young VI population and provides preliminary reliability and validity testing for future research within a clinical context.

Are language and social communication intact in children with congenital visual impairment at school age?

BACKGROUND

Development of children with congenital visual impairment (VI) has been associated with vulnerable socio-communicative outcomes often bearing striking similarities to those of sighted children with autism.(1) To date, very little is known about language and social communication in children with VI of normal intelligence.

METHODS

We examined the presentation of language and social communication of 15 children with VI and normal-range verbal intelligence, age 6-12 years, using a standardised language assessment and parental reports of everyday social and communicative behaviours. Their profiles were compared to those of typically developing sighted children of similar age and verbal ability.

RESULTS

Compared to their sighted peers, and relative to their own good and potentially superior structural language skills, children with VI showed significantly poorer use of language for social purposes. Pragmatic language weaknesses were a part of a broader socio-communicative profile of difficulties, present in a substantial proportion of these children and consistent with the pattern found in sighted children with autism.

CONCLUSIONS

There are ongoing socio-communicative and pragmatic language difficulties in children with congenital VI at school age, despite their good intellectual abilities and advanced linguistic skills. Further research is required to unpack the underlying causes and factors maintaining this vulnerability in such children.