Adaptive functioning and relationship to visual behavior in children with cerebral/cortical visual impairment

Cerebral/cortical visual impairment (CVI) is a leading cause of pediatric visual impairment in developed countries and is associated with neurologic conditions that may impair adaptive functioning or skills required to perform everyday tasks (eg, communication, socialization, and daily living skills). Adaptive behavior in children with CVI has not been systematically studied, and the relationship between visual function and adaptive function in CVI is unknown.

We prospectively recruited 49 children with CVI (mean age, 4 ± 3 years). Adaptive behavior was evaluated using the Vineland Adaptive Behavior Scale, 3rd edition (VABS-III). Visual acuity was assessed by a pediatric neuro-ophthalmologist using the six-level Visual Behavior Scale (VBS). The relationship between VBS and VABS-III scores was assessed using a Spearman correlation coefficient and a multiple regression model to correct for age, sex, and neurologic and ophthalmologic comorbidities.

In our cohort, mean adaptive behavior scores in children with CVI were below the 1st percentile on all VABS-III domains and subdomains. Visual acuity, as assessed by VBS, was significantly associated with VABS-III total adaptive behavior composite score (P = 0.04), socialization (P = 0.03) domain, and interpersonal (P = 0.04), play and leisure (P = 0.04), and personal (P = 0.01) subdomains.

Children with CVI have significantly reduced adaptive functioning. Visual behavior is correlated with socialization and some daily living skills. Future longitudinal studies should evaluate whether adaptive functioning increases as visual acuity improves in children with CVI, which may have prognostic implications.