Impact of Early Childhood Intervention Programme (Developmental Journal VI) on Behaviour Difficulties in 3 Year Old Children with Severe Visual Impairment ‘at High Risk’ for ASD

Background:

Congenital visual impairment (VI) is associated with social communication difficulties and a high risk of later diagnosis of autism (11-40%)(Brown et al, 1997; Mukkades et al., 2007). A first national UK prospective longitudinal cohort study of infants with congenital disorders of the peripheral visual system (CDPVS) and profound-severe VI has been investigating the antecedents, pathogenesis of and impact of early intervention on developmental and social communication outcomes at 3 years in this vulnerable clinical population (Dale et al) The Developmental Journal for Young children with VI (DJ) (Dale and Salt 2008),designed specifically for children with VI, is a parent-delivered early intervention supported by practitioners, with specific guidance to facilitate parent child interactions and strategies in the context of individualised developmental goals including social. The materials are derived from extended clinical and research work of the Developmental Vision team (Great Ormond Street Hospital).

Objectives:

This part of the study investigates the impact of early community based intervention (DJ) vs other community support (CS) on early behaviour difficulties and ‘pervasive developmental difficulties’ (CBCL) which have been shown to be early risk signs for ASD in children with VI (Absoud et al 2011).

Methods:

This analysis included the subgroup of children with ‘potentially simple’ CDPVS and severe VI (N=22). Children with ‘complex’ disorders and profound VI were not included (N=14). Practitioners particularly specialist teachers for VI reported through visitation logs on the type of intervention they used with the child over a 12 month period (DJ:N = 9; CS:N = 13). At 3 years of age (M=38.73 months; SD=2.88), children's nonverbal cognition (Sensorimotor Understanding-SMU) was assessed using the Reynell-Zinkin Scales for Children with VI and parents completed the Child Behavior Checklist (CBCL).

Results:

Non-parametric Mann-Whitney U analyses with intervention type (DJ vs CS) as a grouping variable and the T-scores from 3 subscales of the CBCL as outcome variables (Withdrawn, Pervasive Developmental Problems (PDP), Internalizing composite) revealed differences between the two groups. Children receiving the DJ intervention were reported to have lower Withdrawn problems (M=51.89 SD=3.21) compared to children receiving the CS intervention (M=58.31 SD=7.66; p<.05), with an effect size of 0.52. Similarly, there were trends in the same direction for PDP, (DJ: M=53.56 SD=5.22; CS: M=58.54 SD=8.32;p=.07) and Internalizing composite, (DJ: M=43.56 SD=10.06; CS: M=51.85 SD=9.55; p=.08). The children’s cognitive level (SMU) was not significantly different across the two types of intervention (DJ: M=119.45 SD=7.73; CS: M=112.74 SD=34.15; p=.79).

Conclusions:

For the first time early childhood intervention with a VI-specific parent mediated developmental programme between 1 to 2 years has shown positive impact in reducing behaviour difficulties in 3 year olds with congenital severe VI. Community delivery of the Developmental Journal appears to provide supports to parents which help mitigate the tendency of children with VI to withdraw and become more socially disengaged in the early years. The evidence will be considered further in the context of other parent-practitioner factors such as quality of relationship and frequency of home visiting and other child associations.