Lights Out: Examining Sleep in Children with Vision Impairment

Well-being, mental health and sleep in children and young people with vision impairment: A narrative review

Multiple studies have shown that vision impairment impacts adults' well-being, mental health, and sleep. However, little attention has been given to these areas in children and young people with vision impairment. This narrative review explores the relationship between vision impairment, well-being, mental ill-health, and sleep in children and young people with vision impairment. Studies examined include children and young people with all levels of vision impairment and those with congenital or acquired vision loss. The evidence suggests that vision impairment affects children's and young people's well-being and mental health with particular links to anxiety, depression, and PTSD. Theoretical mechanisms include low self-esteem affecting mental health and well-being, and loneliness reducing well-being. The efficacy of social and psychological interventions on the mental health of children and young people with vision impairment were reviewed. Psychological therapies, sports, exercise, music, art, and relaxation have all been found to have positive impacts. Gaps in existing knowledge are highlighted, and suggestions are made for future research in this important and under-researched area.

Parental and Child Sleep: Children with Vision Impairment, Autistic Children, and Children with Comorbid Vision Impairment and Autism

BACKGROUND

Parents report associations between children's sleep disturbances and behaviors. Children with neurodevelopmental conditions (e.g., Williams Syndrome and autism) are consistently reported to experience increased sleeping problems. Sleep in children with vision impairment and children with a dual diagnosis of vision impairment and autism remains understudied.

METHODS

Our exploratory study compared sleep profiles in 52 children (aged 4-12 years) and their parents (n = 37), across four groups: children with vision impairment (VI; n = 9), autism (n = 10), comorbid vision impairment + autism (n = 6), and typically developing children (n = 27). Childhood sleep was measured using the parental report Childhood Sleep Habits Questionnaire and sleep diaries. Children's cognitive functioning was measured using digit span, semantic, and phonemic verbal fluency measures. Parental sleep was measured via the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale.

RESULTS

Clinically disordered sleep was reported in all child groups (p ≤ 0.001), particularly children with VI + autism. Age, not sleep quality/quantity, predicted cognitive task performance in TD and autistic groups, but not in VI and VI + autism groups. The child's diagnosis affected parental sleep, particularly in children with a dual diagnosis of VI + autism.

CONCLUSIONS

All participants experienced problematic sleep to varying degrees. Those most affected were children and parents in the VI + autism group, suggesting that autism may be the main driver of sleep problems in our sample.

Semantic fluency in primary school-age children with vision impairment

PURPOSE

Semantic fluency is potentially a useful tool for vocabulary assessment in children with vision impairment because it contains no visual test stimuli. It is not known whether in the primary school years children with vision impairment perform more poorly on semantic fluency tasks compared to their sighted peers.

METHOD

We compared semantic fluency performance of two groups of 5- to 11-year-old British English speaking children-one group with vision impairment and one without. We also investigated within-group differences in performance, based on severity of vision impairment. We administered one category (animals) to children with vision impairment (n = 45) and sighted children (n = 30). Participants had one minute to respond. Responses were coded for accuracy, error type, clusters, and switches.

RESULT

Correct responses increased with age within each group. Groups did not differ significantly on any outcome measure. Severity of vision impairment did not impact task performance.

CONCLUSION

Results suggested that semantic fluency performance-at least for the category animals-is not different in children with vision impairment compared to sighted children. Findings also suggest that semantic fluency could be a suitable addition to the tools that speech-language pathologists use to assess language abilities in children with vision impairment.

Sleep Patterns in Children With Blindness: A Comparison With Normally Sighted Peers

Purpose

Studies showing problematic sleep patterns in blind and visually impaired children are often based on (parent) self-report. The purpose was to compare sleep patterns of blind children to normally sighted peers using objective measures.

Methods

In this cross-sectional study, 100 blind (best-corrected visual acuity <3/60) and 100 age- and gender-matched normally sighted children aged 7 to 17 years wore a digital activity monitoring device for 1 week. Sleep quantity (i.e., total sleep time and total time in bed) and sleep quality (number of awakenings, latency, efficiency, wake after sleep onset [WASO], and sleep fragmentation index) were measured. Adjusted linear regression analyses were used to model group differences in sleep parameters.

Results

Data of 163 children were included. Blind children spent significantly less total time in bed in minutes (β, -31; 95% confidence interval, -56 to -6) and had a lower total sleep time (-41; -66 to -17), smaller number of awakenings (-2.8; -4.5 to -1.0), a lower WASO (-10; -16 to -5), and a more efficient sleep pattern (1.5; 0.1 to 2.8) compared to normally sighted children.

Conclusions

Although sleep quantity and recommended hours of sleep per night were lower among blind children than normally sighted children, their sleep quality was better. This contradicts findings of self-report studies and warrants further studies to measure sleep objectively. Further, the discrepancy between previous findings and our findings regarding sleep quality may be explained by the house rules of the boarding schools attended by blind children, which may facilitate improved sleep hygiene.