Impact of visual impairment severity on working memory and executive function in children and adolescents

Visual impairment (VI) affects millions of children worldwide and may influence neurodevelopmental processes beyond sensory functioning. Although cross-modal plasticity has been proposed as a compensatory mechanism, the extent to which VI severity affects verbal learning and executive functioning during development remains unclear. This study examined verbal and executive function profiles in children and adolescents with different degrees of VI.

Eighty-six children and adolescents with VI, aged 6-16 years, were assessed using standardized measures. Verbal comprehension and working memory were evaluated with the Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV). Executive functioning was assessed through caregiver reports using the Behavior Rating Inventory of Executive Function (BRIEF), and auditory-verbal memory was explored using the Rey Auditory Verbal Learning Test (RAVLT). Participants were categorized according to VI severity: mild-to-moderate versus severe-to-profound. Group differences were analyzed using Mann-Whitney U tests, with statistical significance set at p < 0.05.

Participants with severe-to-profound VI showed significantly lower Verbal Comprehension Index scores in both childhood and adolescence compared with those with mild-to-moderate VI. In adolescence, greater VI severity was also associated with significantly poorer adaptive functioning across communication, daily living skills, socialization, and the overall Adaptive Behavior Composite. Group differences in caregiver-reported executive functioning and Working Memory Index scores did not reach statistical significance. A group difference was observed in a specific auditory-verbal learning measure during adolescence, with higher scores in the severe-to-profound VI group. However, this finding should be interpreted cautiously as task-specific.

VI severity is associated with differences in cognitive and adaptive functioning in pediatric populations, with a particularly consistent association with verbal comprehension and age-dependent effects on adaptive behavior. These findings highlight the importance of considering severity levels in neurodevelopmental assessment and in the design of targeted educational and rehabilitative strategies.