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Visually Induced Dizziness in Children and Validation of the Pediatric Visually Induced Dizziness Questionnaire
Marousa Pavlou1, Susan L Whitney2, Abdulaziz A Alkathiry2,3
1Centre of Human and Aerospace Physiological Sciences, King's College London, London, United Kingdom.
Insights
Visually induced dizziness (ViD) is prevalent in children diagnosed with concussion, migraine, or vestibular disorders. The new Pediatric Visually Induced Dizziness Questionnaire (PVID) effectively identifies and quantifies these symptoms in pediatric patients.
Area of Science:
- Pediatric Neurology
- Vestibular Disorders
- Sensory Integration
Background:
- Visually induced dizziness (ViD) is a common but often underdiagnosed condition in children.
- Symptoms can be triggered by visual stimuli like crowds or digital screens, impacting daily life.
- Validated tools for assessing ViD in pediatric populations are limited.
Purpose of the Study:
- To develop and validate the Pediatric Visually Induced Dizziness Questionnaire (PVID).
- To quantify the presence and severity of ViD in children.
- To assess the correlation between ViD and other health conditions in children.
Main Methods:
- The study included 169 healthy children and 114 children with diagnoses of migraine, concussion, or vestibular disorders, aged 6-17 years.
- Participants completed the PVID, assessing dizziness and unsteadiness in various situations.
- The Strength and Difficulties Questionnaire (SDQ) was also administered to assess behavioral aspects.
Main Results:
- The PVID demonstrated high internal consistency (Cronbach's alpha = 0.90).
- Patients reported significantly higher PVID scores compared to healthy children (p < 0.001).
- An optimal cut-off score of 0.45 on the PVID identified abnormal ViD levels with 83% sensitivity and 75% specificity.
Conclusions:
- ViD is a common issue in children with concussion, migraine, or vestibular disorders.
- The PVID is a valid and reliable tool for identifying and quantifying ViD in children.
- Management should include specific interventions, such as exposure to optokinetic stimuli.
Aims:
To develop and validate the Pediatric Visually Induced Dizziness Questionnaire (PVID) and quantify the presence and severity of visually induced dizziness (ViD), i.e., symptoms induced by visual motion stimuli including crowds and scrolling computer screens in children.
Methods:
169 healthy (female n = 89; recruited from mainstream schools, London, UK) and 114 children with a primary migraine, concussion, or vestibular disorder diagnosis (female n = 62), aged 6-17 years, were included. Children with primary migraine were recruited from mainstream schools while children with concussion or vestibular disorder were recruited from tertiary balance centers in London, UK, and Pittsburgh, PA, USA. Children completed the PVID, which assesses the frequency of dizziness and unsteadiness experienced in specific environmental situations, and Strength and Difficulties Questionnaire (SDQ), a brief behavioral screening instrument.
Results:
The PVID showed high internal consistency (11 items; α = 0.90). A significant between-group difference was noted with higher (i.e., worse) PVID scores for patients vs. healthy participants (U = 2,436.5, z = -10.719, p < 0.001); a significant difference was noted between individual patient groups [χ2(2) = 11.014, p = 0.004] but post hoc analysis showed no significant pairwise comparisons. The optimal cut-off score for discriminating between individuals with and without abnormal ViD levels was 0.45 out of 3 (sensitivity 83%, specificity 75%). Self-rated emotional (U = 2,730.0, z = -6.169) and hyperactivity (U = 3,445.0, z = -4.506) SDQ subscale as well as informant (U = 188.5, z = -3.916) and self-rated (U = 3,178.5, z = -5.083) total scores were significantly worse for patients compared to healthy participants (p < 0.001).
Conclusion:
ViD is common in children with a primary concussion, migraine, or vestibular diagnosis. The PVID is a valid measure for identifying the presence of ViD in children and should be used to identify and quantify these symptoms, which require specific management incorporating exposure to optokinetic stimuli.
