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Developmental setback in severe visual impairment
H D Cass1, P M Sonksen, H R McConachie
1Wolfson Centre, Neurosciences Unit, Institute of Child Health, London.
Insights
Severe visual impairment in children can lead to developmental setbacks. Totally blind children face a significantly higher risk of developmental delay compared to those with some vision.
Area of Science:
- Ophthalmology
- Developmental Pediatrics
- Neuroscience
Background:
- Severe visual impairment in children can complicate development, even in those with initially normal cognitive potential.
- The prevalence, diagnostic specificity, clinical presentation, and contributing factors of developmental setback in visually impaired children require investigation.
Purpose of the Study:
- To systematically investigate developmental setback in children with severe visual impairment.
- To identify risk factors and clinical characteristics associated with developmental delays in this population.
Main Methods:
- Retrospective case review of 102 children (under 16 months at initial assessment, normal development, no additional disabilities, followed to at least 2.5 years) attending a developmental vision clinic.
- Categorization of children based on visual impairment severity: total blindness, initial blindness with improvement, and better vision.
- Analysis of developmental outcomes, focusing on setbacks in the second or third year of life.
Main Results:
- Developmental setback occurred in 31% of totally blind children (n=32), 4% of those with initial blindness and visual improvement (n=25), and 0% of children with better vision (n=49).
- Totally blind children demonstrated a significantly greater risk of developmental setback.
- Affected children often had visual diagnoses involving the central nervous system and 60% experienced significant social adversity.
Conclusions:
- Total blindness is a significant risk factor for developmental setback in young children.
- Adverse developmental outcomes are influenced by the degree of visual impairment, neurological factors, and psychosocial environment.
- Further research into the interplay of these factors is crucial for effective intervention.
Abstract:
Developmental setback in children initially thought to be of normal cognitive potential is a serious complication of severe visual impairment; the prevalence, diagnostic specificity, clinical presentation, and factors that contribute to its genesis require systematic investigation. The findings are reported of a retrospective case review over a 15 year period of children attending the developmental vision clinic at the Wolfson Centre of the Institute of Child Health. One hundred and two children met the inclusion criteria of a period of normal development confirmed at initial assessment when aged less than 16 months, absence of additional disabilities, and follow up to at least 2.5 years of age. Developmental setback in their second or third year occurred in 10 (31%) of 32 children who were totally blind throughout (minimal perception of light or less), one (4%) of 25 who, though blind at first assessment, showed visual improvement, and none of 49 children with better vision throughout (awareness for near, large objects). This represents a significantly greater risk for totally blind children than for the other groups. The course and characteristics of the affected children varied, but all had visual diagnoses involving the nervous elements of the visual system, and 60% had major social adversity factors. The role of primary maldevelopment of the central nervous system, the degree of visual impairment, the developmental and emotional climate, and the stage of attentional and behavioural development in the causation of adverse developmental outcome are discussed.