Blind children's language: resolving some differences

The role of vision in the acquisition of words: Vocabulary development in blind toddlers

What is vision's role in driving early word production? To answer this, we assessed parent-report vocabulary questionnaires administered to congenitally blind children (N = 40, Mean age = 24 months [R: 7-57 months]) and compared the size and contents of their productive vocabulary to those of a large normative sample of sighted children (N = 6574). We found that on average, blind children showed a roughly half-year vocabulary delay relative to sighted children, amid considerable variability. However, the content of blind and sighted children's vocabulary was statistically indistinguishable in word length, part of speech, semantic category, concreteness, interactiveness, and perceptual modality. At a finer-grained level, we also found that words' perceptual properties intersect with children's perceptual abilities. Our findings suggest that while an absence of visual input may initially make vocabulary development more difficult, the content of the early productive vocabulary is largely resilient to differences in perceptual access. RESEARCH HIGHLIGHTS: Infants and toddlers born blind (with no other diagnoses) show a 7.5 month productive vocabulary delay on average, with wide variability. Across the studied age range (7-57 months), vocabulary delays widened with age. Blind and sighted children's early vocabularies contain similar distributions of word lengths, parts of speech, semantic categories, and perceptual modalities. Blind children (but not sighted children) were more likely to say visual words which could also be experienced through other senses.

Children's total blindness as a risk factor for early parent-child relationships: preliminary findings from an Italian sample

Background

Vision provides crucial information for parent-child attunement that scaffolds social development from the first months of life. Congenital blindness might affect both parental wellbeing and children's behavior during parent-child interaction. In this study, we compared families of young children with total versus partial blindness to understand the link between residual vision, parenting stress and perceived social support, and children's behavior during parent-child interaction.

Methods

Participants were 42 white parents (21 fathers and 21 mothers) and their congenitally blind children (14 females, mean age = 14.81 months, SD = 10.46) with no co-occurring disability, recruited at the Robert Hollman Foundation rehabilitation centers in Italy. Parents' scores on the Parenting Stress Index and Multidimensional Scale of Perceived Social Support questionnaires, as well as children's behaviors signaling joint engagement during video-recorded episodes of parent-child interaction, were compared between the Total Blindness (TB, n = 12 children with no light perception or light perception in the dark but no quantifiable visual acuity) and Partial Blindness (PB, n = 9 children with a residual visual acuity below 3/60) groups.

Results

We found that parents of TB children had higher parenting stress and lower perceived social support scores than parents of PB children. In fathers, total stress and stress linked to perceiving the child as difficult negatively correlated with perceived support from friends. There was no difference in the time TB and PB children spent displaying joint engagement behaviors during parent-child interaction. However, TB children directed their gaze and face less often toward their parents than PB children. We observed a trend of association between this behavior and maternal stress.

Conclusion

These preliminary results suggest that the complete absence of vision from birth has adverse effects on stress linked to parenting and parental perceived social support. These findings support the importance of early family-centered interventions that extend to the parents' communities and facilitate the parent-child dyad's communication through non-visual behaviors. Replication is warranted in larger and more diverse samples.

The recognition of emotional prosody in students with blindness: Effects of early visual experience and age development

This study examined the role of early visual experience and age in the recognition of emotional prosody among students with visual impairments in China. A total of 75 primary and junior high school students participated in the study. The ability of participants to recognize the prosody of four basic emotions (sadness, anger, happiness, and neutrality) was explored. The findings were as follows. (1) Early visual experience had a significant effect on the recognition of emotional prosody. The accuracy rate of students with congenital blindness was lower than that of students with adventitious blindness, and the performance of students with congenital blindness was lower than that of sighted students. The students with congenital blindness exhibited the slowest recognition speeds. (2) Age had a significant effect on the emotional prosody recognition accuracy of the sighted students, but it had no effect on the students with blindness.

The effect of audio description on film comprehension of individuals with visual impairment: A case study in Turkey

The present study aimed to investigate the extent to which audio description contributes to the visually impaired individuals’ comprehension of a film by examining the visually impaired and sighted participants’ comprehension of two versions of the same film, one with and the other without supplementary audio description. The results of the study showed that the visually impaired participants were able to comprehend and narrate the events to the same extent as the sighted participants did when the film was supplemented with audio description. The qualitative analysis validated this finding and demonstrated that the visually impaired participants were able to comprehend the film to a great extent with the assistance of audio description. These findings emphasized the role of audio description assistance and its effects as an important resource in converting visual information to vocal information, which greatly aids the visually impaired individuals’ film comprehension. Also, the use of “Causal Network Model” showed that understanding the plot better could enable the audio description creators to provide better assistance for the visually impaired if they applied this model.

Mother-infant interactions with infants with congenital visual impairment and associations with longitudinal outcomes in cognition and language

BACKGROUND

This study investigated mother-infant interactions, including maternal maintaining of infant attentional focus and sensitivity, with infants with congenital severe and profound visual impairment (VI) and the association with developmental trajectories from one to three years.

METHOD

Fifty-five infants and mothers were video-recorded playing together with a standard set of toys at Time 1 (T1) mean age 12.95 months (8.13-17.05 months). Maintain was categorized as the mother following and maintaining the child's focus, and Sensitivity, the mother's responsiveness and contingency to infant behaviour. Vision level was measured using the Near Detection Scale. Cognition and language were measured at T1, 12 months later (T2) and 24 months later (T3) using the Reynell-Zinkin Scales.

RESULTS

Cross-sectional analyses showed that mothers of infants with severe VI (basic form vision) produced higher rates of Maintain compared to those with children with profound VI (light perception at best). Linear mixed-effects models examining developmental progression from T1 to T3 (controlling for vision level) showed an average increase of 5 DQ points (CI 95%: 1.03-9.08) in verbal comprehension for higher Sensitivity. No significant findings were found for Maintain.

CONCLUSIONS

The findings suggest that mother-infant interactions (maternal Maintain) are associated with level of vision at infancy, but only maternal Sensitivity has a long-term positive association with advances in verbal comprehension from infancy to about three years. They highlight the need for incorporating strategies related to parent-infant interactions, including increased sensitivity, into early intervention for children with visual impairment.

Blind and Sighted Children with Their Mothers: The Development of Discourse Skills

This study examined the effects of blindness on the conversational patterns of families and on the development of discourse skills, assessing children's ability to respond contingently to questions and directives. The conversations of four mothers and their blind and sighted children, aged 27–36 months, were analyzed during three play sessions in their homes. During the seven-month study, conversational parameters that included the length of speakers’ turns, balance between partners’ contributions, and mothers’ use of questions and directives were investigated. Conversational analyses revealed that the average lengths of speaking turns of the sighted children and their mothers were comparable, but those of the blind children were considerably shorter than their mothers’ turns.

Behaviors of Preschoolers with Visual Impairments in Indoor Play Settings

This article reports on a study of the interaction, play, and other behaviors of 24 preschoolers with visual impairments and no other disabilities in the indoor play areas of two programs. The study found that the children interacted and played at lower levels than expected for 2–5 year olds and that their learning medium (visual or tactile) seemed to affect both the amount of interaction and the amount and type of play in which they engaged.

Relationship between the Development of Language and Thought in Young Blind Children

The relationship between the development of object permanence and early words was studied in three young boys, two totally blind from birth and one severely visually impaired. Auditory and tactile tasks analogous to traditional visual object-permanence tasks were presented to the children at monthly intervals, and their first 50 words and the context in which the words were said were recorded by their mothers and collected monthly. All three boys acquired early words within the age range for sighted children, but their usage of the words was different. The two blind boys but not the visually impaired boy were delayed in their development of object permanence. The relationship between the acquisition of early words and the development of object permanence suggests that the emergence of language is not dependent on a stable understanding of the existence and permanence of objects.

Blind Children's Concepts of how People See

Two totally blind children, ages 4 and 5, were asked to show objects to sighted people and to each other. The children's performance indicated that they were aware that blind people see differently than sighted people; blind persons need to feel objects in order to gain a sense of them but sighted persons do not. The younger child conceded that sighted persons could see at a distance yet he did not orient objects correctly to consider another's perspective. The older child oriented objects correctly for others but responded as if sighted persons could see objects only if the objects were within 5 feet of them.

Training Pragmatic Language Skills through Alternate Strategies with a Blind Multiply Handicapped Child

A blind multiply handicapped preschool child was taught to respond appropriately to two adjacency pair types. Where Question - Answer and Comment - Acknowledgement. Training involved teaching manual searching behavior as an alternate strategy for visual searching in response to “where” questions. Echolalic responses to comments initially served only a turn-taking function but, through explicit modification, gradually evolved into more appropriate and communicative responses. The blind child's appropriate responses to trained adjacency pair types increased significantly over the 14-week treatment period. The success of this program augers well for future efforts to develop communication-based interventions that incorporate the alternate language acquisition strategies available to blind children.

The Development of Social Understanding in Children with Visual Impairments

This article reports on the performance of 16 visually impaired children, aged 4–12, on tasks designed to assess their understanding of false belief, a central aspect of social understanding. The study found that the development of understanding of another's false belief is delayed in children with severe visual impairments and that the degree of vision loss seems to be a key variable in that development.

Blind Children's Ability to Predict What Another Sees

Totally blind, visually impaired, and normally sighted children were asked to determine whether an observer could see the front or back of a toy better from her position and to make it so the observer could do so. The totally blind children were older than the other children when they mastered the tasks, made the highest percentage of errors before mastery, and made different errors.

The Use of Language in Simple Classification Tasks by Children who are Blind

Two groups of classification tasks, verbal and figurative, were presented to 30 blind children and 30 sighted children aged 6–11. Although the younger blind children were significantly less efficient on both groups of tasks and on the vocabulary test, those who were age 11 had reached or were close to the level of the sighted children. The analysis illustrates how the blind children adjusted their conceptual knowledge to their lexicon, or vice versa (borrowing some linguistic patterns from the experimenter, if necessary).

Intelligence Profiles of Low Vision and Blind Children

This article reports on an analysis of the WISC-R and WPPSI profiles of 118 visually impaired children without additional neurological problems. A consistent response pattern on the Wechsler batteries emerged, suggesting that the verbal as well as the performance tests can provide useful assessment information.

Conversational Interactions between Mothers and their Infants who are Congenitally Blind, Have Low Vision, or are Sighted

This study of the conversational interactions of three mothers and their infants—one who was sighted, one with low vision, and one who was congenitally blind—found similarities between the sighted and low vision dyads. However, the mother of the blind infant talked more and used more directives, and her directives contained more descriptions and were more likely to occur in clusters. The complex nature of directives and their adaptive role with infants who are blind are discussed.

The use of Directives in Verbal Interactions between Blind Children and their Mothers

Verbal interactions between three mothers and their young blind children, with special attention to the use of maternal directives, were examined. It was found that a simple analysis of maternal directives can be misleading. Thus, counting single occurrences of directives ignores the possible adaptive role that directive sequences may have in conversational interactions with blind children.

Examining Communicative Behaviors in a 3-Year-Old Boy who is Blind

The communication patterns of a 3-year-old boy who is blind were observed during 35 videotaped classroom sessions to determine if his echolalic responses varied according to school activity and message category. The observations revealed that although C. M. was expressive with adults, he had difficulty communicating with his peers and in producing spontaneous speech in general.

Play Behaviors and Social Interactions of a Child who is Blind: In Theory and Practice

This case study describes the play behaviors and social interactions of a preschool-age girl who is blind and has no additional disabilities. The data obtained from the assessment protocol indicated that although the participant was developmentally at or above age level in most domains, she demonstrated limited play behaviors and compromised social interactions. The results reinforce the variability of social competence skills in young children with visual impairments.

Literacy in Early Intervention for Children with Visual Impairments: Insights from Individual Cases

A qualitative case study design was used to investigate the ways in which two early interventionists supported emergent literacy development for infants and toddlers with visual impairment. Three themes are addressed: (1) the importance of a family-centered approach in addressing emergent literacy in early intervention; (2) the role of the early interventionist in language and concept development; and (3) the need to focus on the senses as they relate to literacy. The findings provide practical insights into the role of the early interventionist in supporting early literacy development.

Divergent Development of Verbal Skills in Children who are Blind or Sighted

This empirical study compared the average ages at which four children with congenital blindness acquired 29 verbal skills with given age norms for sighted children. The results indicated only small developmental delays in the acquisition of verbal skills in the four children, but a high degree of variability in developmental delays within and across nine categories of verbal skills.

Expanding Understanding of Emergent Literacy: Empirical Support for a New Framework

Emergent literacy in young children with visual impairments is examined using a conceptual framework proposed by Sénéchal, LeFevre, Smith-Chant, and Colton (2001). The utility of this framework for young children with visual impairments is illustrated using data from a field study of preschool classes for children with visual impairments.

Visual Experience Shapes the Neural Networks Remapping Touch into External Space

Localizing touch relies on the activation of skin-based and externally defined spatial frames of reference. Psychophysical studies have demonstrated that early visual deprivation prevents the automatic remapping of touch into external space. We used fMRI to characterize how visual experience impacts the brain circuits dedicated to the spatial processing of touch. Sighted and congenitally blind humans performed a tactile temporal order judgment (TOJ) task, either with the hands uncrossed or crossed over the body midline. Behavioral data confirmed that crossing the hands has a detrimental effect on TOJ judgments in sighted but not in early blind people. Crucially, the crossed hand posture elicited enhanced activity, when compared with the uncrossed posture, in a frontoparietal network in the sighted group only. Psychophysiological interaction analysis revealed, however, that the congenitally blind showed enhanced functional connectivity between parietal and frontal regions in the crossed versus uncrossed hand postures. Our results demonstrate that visual experience scaffolds the neural implementation of the location of touch in space.SIGNIFICANCE STATEMENT In daily life, we seamlessly localize touch in external space for action planning toward a stimulus making contact with the body. For efficient sensorimotor integration, the brain has therefore to compute the current position of our limbs in the external world. In the present study, we demonstrate that early visual deprivation alters the brain activity in a dorsal parietofrontal network typically supporting touch localization in the sighted. Our results therefore conclusively demonstrate the intrinsic role that developmental vision plays in scaffolding the neural implementation of touch perception.

A Systematic Review of the Literature on Parenting of Young Children with Visual Impairments and the Adaptions for Video-Feedback Intervention to Promote Positive Parenting (VIPP)

Secure parent-child attachment may help children to overcome the challenges of growing up with a visual or visual-and-intellectual impairment. A large literature exists that provides a blueprint for interventions that promote parental sensitivity and secure attachment. The Video-feedback Intervention to promote Positive Parenting (VIPP) is based on that blueprint. While it has been adapted to several specific at risk populations, children with visual impairment may require additional adjustments. This study aimed to identify the themes that should be addressed in adapting VIPP and similar interventions. A Delphi-consultation was conducted with 13 professionals in the field of visual impairment to select the themes for relationship-focused intervention. These themes informed a systematic literature search. Interaction, intersubjectivity, joint attention, exploration, play and specific behavior were the themes mentioned in the Delphi-group. Paired with visual impairment or vision disorders, infants or young children (and their parents) the search yielded 74 articles, making the six themes for intervention adaptation more specific and concrete. The rich literature on six visual impairment specific themes was dominated by the themes interaction, intersubjectivity, and joint attention. These themes need to be addressed in adapting intervention programs developed for other populations, such as VIPP which currently focuses on higher order constructs of sensitivity and attachment.

Schizophrenia and cortical blindness: protective effects and implications for language

The repeatedly noted absence of case-reports of individuals with schizophrenia and congenital/early developed blindness has led several authors to argue that the latter can confer protective effects against the former. In this work, we present a number of relevant case-reports from different syndromes that show comorbidity of congenital and early blindness with schizophrenia. On the basis of these reports, we argue that a distinction between different types of blindness in terms of the origin of the visual deficit, cortical or peripheral, is crucial for understanding the observed patterns of comorbidity. We discuss the genetic underpinnings and the brain structures involved in schizophrenia and blindness, with insights from language processing, laying emphasis on the three structures that particularly stand out: the occipital cortex, the lateral geniculate nucleus (LGN), and the pulvinar. Last, we build on previous literature on the nature of the protective effects in order to offer novel insights into the nature of the protection mechanism from the perspective of the brain structures involved in each type of blindness.

Verbal definitions of familiar objects in blind children reflect their peculiar perceptual experience

BACKGROUND

The aim of the present study was to examine to what extent the verbal definitions of familiar objects produced by blind children reflect their peculiar perceptual experience and, in consequence, differ from those produced by sighted children.

METHODS

Ninety-six visually impaired children, aged between 6 and 14 years, and 32 age-matched sighted children had to define 10 words denoting concrete animate or inanimate familiar objects.

RESULTS

The blind children evoked the tactile and auditory characteristics of objects and expressed personal perceptual experiences in their definitions. The sighted children relied on visual perception, and produced more visually oriented verbalism. In contrast, no differences were observed between children in their propensity to include functional attributes in their verbal definitions.

CONCLUSIONS

The results are discussed in line with embodied views of cognition that postulate mandatory perceptuomotor processing of words during access to their meaning.

The coherence of autism

There is a growing body of opinion that we should view autism as fractionable into different, largely independent sets of clinical features. The alternative view is that autism is a coherent syndrome in which principal features of the disorder stand in intimate developmental relationship with each other. Studies of congenitally blind children offer support for the latter position and suggest that a source of coherence in autism is restriction in certain forms of perceptually dependent social experience.

Insights into the origins of knowledge from the cognitive neuroscience of blindness

Children learn about the world through senses such as touch, smell, vision, and audition, but they conceive of the world in terms of objects, events, agents, and their mental states. A fundamental question in cognitive science is how nature and nurture contribute to the development of such conceptual categories. What innate mechanisms do children bring to the learning problem? How does experience contribute to development? In this article we discuss insights into these longstanding questions from cognitive neuroscience studies of blindness. Despite drastically different sensory experiences, behavioural and neuroscientific work suggests that blind children acquire typical concepts of objects, actions, and mental states. Blind people think and talk about these categories in ways that are similar to sighted people. Neuroimaging reveals that blind people make such judgements relying on the same neural mechanisms as sighted people. One way to interpret these findings is that neurocognitive development is largely hardwired, and so differences in experience have little consequence. Contrary to this interpretation, neuroimaging studies also show that blindness profoundly reorganizes the visual system. Most strikingly, developmental blindness enables "visual" circuits to participate in high-level cognitive functions, including language processing. Thus, blindness qualitatively changes sensory representations, but leaves conceptual representations largely unchanged. The effect of sensory experience on concepts is modest, despite the brain's potential for neuroplasticity.

Cognitive and neuroplasticity mechanisms by which congenital or early blindness may confer a protective effect against schizophrenia

Several authors have noted that there are no reported cases of people with schizophrenia who were born blind or who developed blindness shortly after birth, suggesting that congenital or early (C/E) blindness may serve as a protective factor against schizophrenia. By what mechanisms might this effect operate? Here, we hypothesize that C/E blindness offers protection by strengthening cognitive functions whose impairment characterizes schizophrenia, and by constraining cognitive processes that exhibit excessive flexibility in schizophrenia. After briefly summarizing evidence that schizophrenia is fundamentally a cognitive disorder, we review areas of perceptual and cognitive function that are both impaired in the illness and augmented in C/E blindness, as compared to healthy sighted individuals. We next discuss: (1) the role of neuroplasticity in driving these cognitive changes in C/E blindness; (2) evidence that C/E blindness does not confer protective effects against other mental disorders; and (3) evidence that other forms of C/E sensory loss (e.g., deafness) do not reduce the risk of schizophrenia. We conclude by discussing implications of these data for designing cognitive training interventions to reduce schizophrenia-related cognitive impairment, and perhaps to reduce the likelihood of the development of the disorder itself.

Are language and social communication intact in children with congenital visual impairment at school age?

BACKGROUND

Development of children with congenital visual impairment (VI) has been associated with vulnerable socio-communicative outcomes often bearing striking similarities to those of sighted children with autism.(1) To date, very little is known about language and social communication in children with VI of normal intelligence.

METHODS

We examined the presentation of language and social communication of 15 children with VI and normal-range verbal intelligence, age 6-12 years, using a standardised language assessment and parental reports of everyday social and communicative behaviours. Their profiles were compared to those of typically developing sighted children of similar age and verbal ability.

RESULTS

Compared to their sighted peers, and relative to their own good and potentially superior structural language skills, children with VI showed significantly poorer use of language for social purposes. Pragmatic language weaknesses were a part of a broader socio-communicative profile of difficulties, present in a substantial proportion of these children and consistent with the pattern found in sighted children with autism.

CONCLUSIONS

There are ongoing socio-communicative and pragmatic language difficulties in children with congenital VI at school age, despite their good intellectual abilities and advanced linguistic skills. Further research is required to unpack the underlying causes and factors maintaining this vulnerability in such children.

Hiding in blind and sighted children

Children with varying visual abilities (totally blind, visually impaired, normally sighted) participated in a longitudinal study of the development of the ability to infer what is seen by another. The children were asked to hide themselves, a toy, and specific parts of their bodies from a sighted observer. After each hiding the observer asked, “Can I see you?” to determine whether the children associated self-exposure with what was hidden. The totally blind children were not as successful at hiding as the other children. The totally blind children associated hiding with being in contact with an obstacle but did not necessarily understand that the covering obstacle had to completely block the observer's view of what was hidden or that covering was not necessary if other obstacles already blocked the observer's view. The totally blind children and one visually impaired child associated self-exposure with exposure of the mouth, whereas the other children who associated self-exposure with a particular body part associated self-exposure with exposure of their eyes. Results suggest that lack of direct visual experience impedes blind children's understanding of what constitutes a barrier to vision, which affects their ability to infer what others see. Implications of the findings for understanding the development of the self in blind children are discussed.

Early support developmental journal for children with visual impairment: the case for a new developmental framework for early intervention

BACKGROUND

Congenital visual impairment has serious consequences for early development, particularly in those with the most profound impairment. Although there is individual variation, developmental delays and risks, including 'developmental setback', are widespread. There is no scientifically robust developmental framework grounded in contemporary theory and scientific knowledge to guide early intervention which may prevent or minimize the risk factors and developmental difficulties. The UK governmental initiative, Early Support, gave the impetus for developing a new developmental framework for babies and young children with visual impairment.

METHODS

This paper reports on the scientific literature that underpins the new framework and the limitations of existing intervention materials. The case for focusing on particular vulnerable areas and developing a new developmental framework, the Early Support Developmental Journal for babies and children with severe visual impairment, is presented.

CONCLUSIONS

The future direction for service delivery and evaluation is briefly described.

Inferential functioning in visually impaired children

The current study explores the inferential abilities of visually impaired children in a task presented in two formats, manipulative and verbal. The results showed that in the group of visually impaired children, just as with children with normal sight, there was a wide range of inference types. It was found that the visually impaired children perform slightly better in the use of inductive and relational inferences in the verbal format, while in the manipulative format children with normal sight perform better. These results suggest that in inferential functioning of young children, and especially visually impaired children, the format of the task influences performance more than the child's visual ability.

The parent-infant dyad and the construction of the subjective self

Developmental psychology and psychopathology has in the past been more concerned with the quality of self-representation than with the development of the subjective agency which underpins our experience of feeling, thought and action, a key function of mentalisation. This review begins by contrasting a Cartesian view of pre-wired introspective subjectivity with a constructionist model based on the assumption of an innate contingency detector which orients the infant towards aspects of the social world that react congruently and in a specifically cued informative manner that expresses and facilitates the assimilation of cultural knowledge. Research on the neural mechanisms associated with mentalisation and social influences on its development are reviewed. It is suggested that the infant focuses on the attachment figure as a source of reliable information about the world. The construction of the sense of a subjective self is then an aspect of acquiring knowledge about the world through the caregiver's pedagogical communicative displays which in this context focuses on the child's thoughts and feelings. We argue that a number of possible mechanisms, including complementary activation of attachment and mentalisation, the disruptive effect of maltreatment on parent-child communication, the biobehavioural overlap of cues for learning and cues for attachment, may have a role in ensuring that the quality of relationship with the caregiver influences the development of the child's experience of thoughts and feelings.

The reinforcing effect of contingent attention on verbal perseverations of two children with severe visual impairment

The frequency of verbal perseverations of two children with severe visual impairment was reduced using differential reinforcement of appropriate speech coupled with extinction of perseverative utterances. A reversal design in which baseline and intervention were alternated in an A-B-A-B sequence was employed to show the functional relationship between the target behaviors and the treatment procedure. There was a marked increase in appropriate utterances and a correlated decrease in perseverative ones. These findings suggest that this singular feature of the language of certain children with visual impairment is, under natural conditions, probably maintained by the attention provided by their caregivers.

Symbolic play in congenitally blind children

There is controversy over the existence and nature of blind children's limitations in symbolic play. In this study we tested 13 5- to 9-year-old congenitally blind children for the ability to symbolize when an adult provided scaffolding for their play. The blind children were selected on the basis that they did not have the syndrome of autism, and they comprised two groups matched for age (MA) and verbal ability on the Wechsler Intelligence Scale for Children who contrasted in their ability to engage in social relations. We also tested a group of sighted children who were MA matched with the more socially able blind children. On the basis of an hypothesis about the social-developmental sources of symbolic play deficits in congenitally blind children, we predicted differences between the socially able and socially impaired groups of blind children in the following respects: the attribution of symbolic meanings to play materials, the ascription of individual roles to play figures, and the anchorage of play in the scenario as presented by the adult. The results accorded with these predictions. Whereas the more socially able blind children showed symbolic play that was very similar to that of sighted children, the MA- and IQ-matched socially impaired blind children were limited in the three aspects of their play. On the other hand, even the socially impaired children showed instances of symbolizing. The findings suggest a way to reconcile conflicting reports of symbolic play deficits in young blind children, and may be relevant for explaining the association between autism and congenital blindness.

Disorders of face perception and recognition

Face recognition is one of the most complex visual tasks performed by the human brain. Data from monkeys suggest that area IT may play a key role in identifying faces, and functional imaging research suggests that the human homologue of IT may be located in the medial occipitotemporal cortex, where a FFA has been located. Damage to medial occipitotemporal structures on the right or bilaterally leads to prosopagnosia, the failure to recognize facial identity. Prosopagnosia is not a single functional disorder but a family of dysfunctions, with different patients having different degrees of impairments to various perceptual and memory stages involved in face processing. Understanding the perceptual basis of this disorder and epiphenomena, such as covert recognition, is a goal of current research. Deficits in face perception also may contribute to Capgras syndrome and may be related to the impaired social development of patients with Asperger syndrome. More recently, identified deficits in face processing include the false recognition of unfamiliar faces and the impaired extraction of social information from faces, independent of the recognition of identity. Many of these prosopagnosia and other face processing deficits can be placed in the context of cognitive models of face processing stages, which are being refined continually by data from neurologic patients and functional imaging in normal subjects.

Autism and congenital blindness

The nature of autism in congenitally blind children has long been a source of interest and perplexity. A group of nine congenitally blind children with an autism-like syndrome were closely matched on chronological age and verbal mental age with nine sighted autistic children, and were compared on the Childhood Autism Rating Scale (Schopler, Reichler, & Renner, 1986) and the Behavior Checklist for Disordered Preschoolers, together with the Play Items for Disordered Preschoolers (Sherman, Shapiro, & Glassman, 1983). A checklist of clinical features characteristic of autism (derived from DSM-III-R) was also completed through an interview with teachers. There was substantial similarity between the groups, but also suggestive evidence of possible group differences, specifically in the domain of social-emotional responsiveness. Research on the psychological development of congenitally blind children promises to yield insights into the nature of autism itself.

Implementation and effectiveness of a home-based early intervention program for blind infants and preschoolers

This article presents results from a comprehensive evaluation of a home-based early intervention project for congenitally blind young children. Five full-term and five preterm blind children, who had a mean age of 12 months at the beginning of the project, were visited at home with their families every 2 weeks over a 2-year period. Results showed that an individualized, handicap-specific early intervention using different types of parent involvement (cotherapist, parent counseling) could be implemented successfully. Compared with controls, developmental test data from the ages of 12 to 36 months showed an accelerating impact on the full-term children. However, no intervention effects could be found in the preterm children. This finding was mainly due to methodological limitations (e.g., selection bias). The best results among full-term children were found on blindness-specific scales (e.g., orientation and mobility). It is concluded that the outcomes in full-term children confirm the success of this type of early intervention.

Are there "autistic-like" features in congenitally blind children?

Twenty-four congenitally blind children between 3 and 9 years of age were studied for the prevalence of "autistic-like" features, as assessed by teacher reports and by systematic observations of the children's behaviour. A comparison between the 15 blind children who had IQs over 70 and 10 sighted children group-matched for age and verbal ability revealed that a number of autistic-like features were more common in the blind. When the nine blind children who had IQs less than 70 were compared with nine group-matched autistic children, the picture that emerged was of substantial overlap in clinical presentation, despite subtle differences on clinical impression. Similar results were obtained when blind subgroups were reconstituted according to the children's nonautistic or autistic-like clinical presentation, rather than IQ. These findings are discussed in relation to competing theories concerning the development of autism and "theory of mind".

A descriptive study of blind children in nurseries with sighted children

In a longitudinal descriptive and qualitative study, nine blind pre-school children have been observed in natural interactional settings in their nurseries. The objective was to give a detailed description of the blind child's activities and social situation in a group of sighted children. The results showed that the blind child's overall behaviour in the pre-school setting was different when compared with the sighted children's behaviour, as shown in activities like orientation, exploration and play. The blind children seldom participated in sighted children's play and they seldom initiated contact with the other children. The sighted children initially showed an interest in the blind child but as their initiatives were often neglected, they were not encouraged to proceed. The teachers played an important role for the blind children, both as a visual interpreter and as a play-mate. However, many of the teachers had great difficulties in understanding the blind child's way of functioning. Alternative pre-school settings for blind children are discussed.