Joint Attention and Play Development in Toddlers with Severe Visual Impairment: A Comparison with Sighted Peers

Background: Joint attention is a fundamental skill supporting early social communication and cognitive development. However, its development in children with severe visual impairment and its relationship with early play behaviors remain insufficiently understood. This study aimed to compare joint attention skills and play behaviors in toddlers with severe visual impairment and sighted peers, and to examine the relationship between these two developmental domains. Methods: The sample included 17 toddlers with severe visual impairment (no light perception) and 20 sighted toddlers aged 16-36 months. Groups were matched based on language developmental age scores. Joint attention skills were assessed using structured observational categories adapted to visual status, while play behaviors were evaluated with the Developmental Play Assessment. Data were collected through semi-structured play and interaction sessions in familiar environments to support natural behavior. Analyses were conducted using non-parametric tests, including the Mann-Whitney U test and Spearman correlation analysis. Results: Toddlers with severe visual impairment scored significantly lower than sighted peers across all joint attention categories. In play development, these children showed higher levels of indiscriminate actions, whereas sighted peers demonstrated more advanced play behaviors, including combinational and symbolic play. Significant associations were found between joint attention and play skills in both groups; however, these relationships were stronger in sighted children, particularly for higher-level play forms. Conclusions: These findings suggest distinct developmental trajectories and underline the importance of early intervention targeting these foundational skills in early childhood development and highlight important implications for early intervention practices.