visual impairment and autism: does social engagement hold the key? peter hobson and tony lee...
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Visual impairment and autism: Does social engagement hold the key?
Peter Hobson and Tony Lee
Tavistock Clinic and Institute of Child Health, UCL.
Autism
Autism involves:
• A profound impairment in interpersonal engagement
• Characteristic abnormalities in language
• A severe restriction in symbolic and flexible thinking
Are there autistic like features in congenitally blind children?Brown, R., Hobson, R.P., Lee, A., and Stevenson, J., (1997)
Journal of Child Psychology and Psychiatry, 38, 693-703
Participants:
24 congenitally blind children aged 3 and 9 years- Totally blind or minimal light perception from birth, no
identifiable neurological impairment- Selected from six schools in England- 15 with VIQ>70, 9 with VIQ<70
Upper ability were compared with 10 sighted children matched for age and IQ
Lower ability compared with 9 sighted children with autism, matched for age and IQ
Group of 24 children with congenital blindness: Scores on Childhood Autism Rating Scale
0
1
2
3
4
5
6
7
8
9
10
14 15 - 17 18 - 20 21 - 23 24 - 26 27 - 29 30 - 32 33 - 35 36 - 38 39 - 41
Total Score (excluding Item VII on visual responsiveness)
Num
ber
of p
artic
ipan
ts
Children with VI - IQ>70 Children with VI - IQ<70
Hobson, R.P., Lee, A., and Brown, R., (1999)Are there autistic like features in congenitally blind children?
Journal of Autism and Developmental Disorders, 29, 45-56.
Participants:
On the basis of a seeded cluster analysis of clinical features from the DSM-III-R, 9 congenitally blind children from the study were placed in the cluster with the children with autism
- All 9 children satisfied DSM-III-R criteria for autism- 4 boys and 5 girls, with diagnoses of congenital optic
atrophy (4), ROP (3), bilateral retinal dysplasia(1) and Leber’s amaurosis (1)
These participants were compared with a newly constituted group of 9 sighted children with autism (all male), matched according to age and VMA (verbal subtests of WISC or WIPPSI)
Hobson, R.P., Lee, A., and Brown, R., (1999)Are there autistic like features in congenitally blind children?
Journal of Autism and Developmental Disorders, 29, 45-56.
Chronological Age Verbal Mental Age
Meanyr;mo
SDmo
Rangeyr;mo
Meanyr;mo
SDmo
Rangeyr;mo
Non-sighted with autism
n = 9
6;06 16 5;00 - 8;10 4;02* 8 3;03 - 5;01
Sighted with autism
n = 9
7;08 17 5;02 - 9;06 4;08 11 2;11 - 5;07
Study 1
0
1
2
3
4
5
6
7
8
9
No
. par
tici
pan
ts w
ith
ab
no
rmal
ity
DSM-III-R: Impairments in Communication
Non-sighted participants Sighted participants with autism
Study 1: DSM-III-R clinical features among non-sighted and sighted children with autism
0
1
2
3
4
5
6
7
8
9N
o. p
arti
cip
ants
wit
h a
bn
orm
alit
y
DSM-III-R: Impairments in Reciprocal Social Interaction // Restricted Activities, Interest and Imagination
Non-sighted participants Sighted participants with autism
Study 1: DSM-III-R clinical features among non-sighted and sighted children with autism
Reversible autism among children with congenital blindness? A controlled follow-up study.
Hobson, R.P., & Lee, A. (2010). Journal of Child Psychology and Psychiatry, 51, 1235-1241.
* n = 8
Chronological Ageyears; months
Verbal mental ageyears; months
TIME 2 Mean SD Range Mean SD Range
Non-sighted with autismn = 9
15;00 1;01 13;06-16;04 10;00 2;01 6;06 - 13;07
Sighted with autismn = 7
15;07 1;09 13;03-17;09 10;07 2;03 8;00 - 13;07
Continue to meet DSM criteria
Fail to meet DSM criteria
Non sighted(n = 9)
1 8
Sighted (n = 7)
7 0
Fisher’s exact p = 0.01 (2-tail)
Diagnosis of autism at T2, according to DSM criteria
0
10
20
30
40
50
60
70
80
90
100
% p
arti
cip
ants
wit
h a
bn
orm
alit
y
DSM-III-R: Impairments in Communication
Non-sighted participants Sighted participants with autism
Study 2: DSM-III-R clinical features among non-sighted and sighted children with autism
0
10
20
30
40
50
60
70
80
90
100
% p
art
icip
an
ts w
ith
ab
no
rmali
ty
DSM-III-R: Impairments in Reciprocal Social Interaction // Restricted Activities, Interest and Imagination
Non-sighted participants Sighted participants with autism
Study 2: DSM-III-R clinical features among non-sighted and sighted children with autism
3 point + improvement
on CARS
< 3 point improvement on
CARS
Non-sighted 9 0
Sighted 1 6
Fisher’s exact p = 0.01 (2-tail)
CARS 1 vs CARS 2
Non-sighted Sighted
t 6.794 -0.078
df 8 6
p (2 tail) >0.001 0.940
Childhood Autism Rating Scale: T1 vs T2
VIQ1 vs VIQ 2
Non-sighted(note: n = 8)
Sighted(n = 7)
t = -2.495 t = -1.146
df 7 df 6
p < .05 ns (p < .3)
What happens to verbal ability?
Conclusions
• Autism is a syndrome• This syndrome is heterogeneous in
pathogenesis as well as aetiology• Congenitally blind children who fulfil the
diagnostic criteria for autism early in childhood may no longer satisfy those criteria 8 years later – and in this respect, there is a contrast with sighted children with autism
• What are the pros and cons to considering autism among VI children ‘autism-like’?
So…Visual impairment and autism: Does social engagement hold the key?
We are left with the possibility that -both in sighted children with autism -and for different reasons, visually impaired children who develop clinical features considered typical of autism
- ‘autism’ arises through impediments to interpersonal engagement vis-à-vis a shared, visually specified world.