Children with Vision Impairment: Assessment, Development, and Management

From the foreword:

Worldwide, the causes of impaired vision are changing, with ocular causes diminishing and cerebral aetiologies increasing in prevalence. Impairment of sight, or blindness, is fortunately rare in children but poses enormous challenges for the affected young people and their families, who very much depend upon skilled professional support from a range of agencies to optimise their chances in life. This book, with its up-to-date, broad collection of salient information about the diverse characteristics and needs of visually impaired children and how to cater for them, provides a welcome contribution to the knowledge and skills needed by paediatric and educational psychologists, occupational therapists, physiotherapists, and speech and language specialists working with visually impaired children.

The book is divided into four parts which address in turn, the range of causes of visual impairment, the impact of visual impairment on child development, approaches to habilitation, and the social consequences of low vision and ways to address them.

This book is a must read for all paediatric and educational psychologists, occupational therapists, physiotherapists, speech and language specialists, and clinicians with responsibility for optimising the development and life opportunities of children with low vision in order to help bring about this aspiration.

Gordon N Dutton, Emeritus Professor of Visual Science Glasgow Caledonian University

In their new book, editors Dale, Salt, Sargent, and Greenaway have produced a comprehensive series of chapters describing theory, evidence-based knowledge, and practice guidelines with respect to the assessment, development, and management of children living with visual impairment. Expert opinions are drawn from not only the editors’ UK collaborators, but also from international contributors. The book covers a broad spectrum of types and profiles of pediatric and childhood visual impairment, including ocular as well as brain-based causes. Particular focus is given to functional and habilitative needs of these children, and the multidisciplinary approach needed toward improving function, learning, and activity.

The book is organized into four parts, and each chapter highlights relevant background theory and research evidence before moving to practice guidelines and future perspectives, and then culminating with a summary of key points. The first section (Eye Disorders, Vision, and Brain) discusses the broad and heterogeneous causes of visual impairment. It provides a very useful overview of key concepts on the topics of vision function and assessment, discussions on ocular and brain-based (i.e. cerebral visual impairment) visual impairments, as well as brain development and neuroplasticity. A key underlying theme of this section is that visual impairment can arise from injury and/or maldevelopment anywhere along the visual system; from the optics of the eye to the image processing stages of the retina, subcortical structures, and early and higher order cortical areas. The section closes with an important discussion on understanding the potential and constraints of neuroplasticity (i.e. the brain’s ability to adapt and change throughout a lifetime) and how this remains a crucial area of future investigation to help optimize an individual’s development potential.

Part Two discusses child development and learning from early years to later childhood. Here, the potential impact of visual impairment is discussed within the realm of motor and language development, along with cognition and communication abilities. This section also provides key insight as to how early visual impairment can lead to social consequences such as isolation and potential mental health issues, as well as the crucial roles played by family members, educators, and health care providers to ensure that children living with visual impairment thrive and remain connected within society.

Part Three (Further Approaches to Habilitation) delves into aspects related to the development of independence skills such as orientation and mobility training and literacy.
The chapters in this section provide an overview of current approaches as well as available assistive technologies (e.g. for mobility and accessing printed materials) to help promote the learning of compensatory skills and maintaining
autonomy.

Finally, Part Four provides insight into issues related to social relationships and participation as the child transitions into adulthood. This includes psychological well-being as well as quality of life, and wraps up with a unique personal perspective from a young individual who describes their challenges and triumphs living with visual impairment. This book is meant to serve as an up-to-date resource and provides practical and evidence-based guidance for a broad readership including clinicians, therapists, and other
health care providers. The content is also highly relevant for educators and parents. Dale et al. have provided an important addition to the growing literature on childhood visual impairment, as well as a welcome update regarding the challenges associated with brain-based visual impairment.

One key contribution this book provides is a parallel, but nonetheless integrated, exposition of visual impairment in relation to ocular as well as brain-based visual impairment. Indeed, we know that the profile of children with visual impairment has changed dramatically recently, and this book provides a valuable discussion regarding the evolving challenges and complexities associated with the care of these individuals. It is crucial that the profile, nuances, and needs of each child be comprehensively characterized as well as understood. The challenge moving forward will be to provide specialized, yet individualized, care for each child in order to maximize their learning potential and independence so that they can develop and become fully integrated in a rapidly evolving world.

Lotfi B. Merabet Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA DOI: 10.1111/dmcn.15166

In Children with Vision Impairment: Assessment, Development and Management, the authors have developed a practical guide for practitioners from all backgrounds who are interested in the holistic management of children and young people with vision impairment and associated disabilities. The book is divided into 21 chapters distributed over 4 clear sections and considers everything from the causes and complex physiology leading to vision impairment, to the social consequences and personal experiences of young people and their families. Each chapter begins with theory and contemporary research, followed by practical guidance and strategies for assessment and management, including the reasoning behind each intervention.

Part one provides a useful overview of the relevant theory behind vision, vision function, disorders of the eye and causes of cerebral vision impairment which provides a base upon which to build knowledge and understanding. Some chapters touch on the assessment of children using evidence-based, standardised protocols and consideration of developmental age, capabilities and environment. Others explore research behind the benefits of identification of visual problems in patients with complex neurodisability and the theory of neural plasticity and how this directs management strategies to enhance the positive impact of early vision and developmental interventions. In this section, it is established early on the theme of holistic management and the effect of consistent intervention on vision potential.

Part two considers the significant impact visual impairment can have on all areas of development and cognition, particularly in the early years. This section clearly addresses the potential difficulties faced in each developmental domain, modes of assessment and identification and practical habilitation from infant to schoolaged children. There are clear sections explaining the impact, identification and management of visual impairment on motor, language and social development. The benefits of regular clinical assessment to not only manage existing delays, but identify developing difficulties for prompt management are also discussed. They highlight the fundamental role that parents, caregivers and the integrated health education network have in identifying and acting upon issues early in order to provide accessible and meaningful experiences from infancy.

The third section further discusses habilitation approaches and their role in establishing independence. These chapters focus on back-tobasics strategies to promote the development of mobility, orientation and independence with everyday tasks such as self-care, organisation and problem-solving. Technological aids for spatial perception and mobility, vision aids, assistive technologies for reading and learning and braille are all discussed in this section. It highlights the huge impact the multidisciplinary team can have by providing practical developmental resources to enable those who are visually impaired to fully participate in society.

The fourth and final part focuses on social participation, accessibility strategies and the necessity for a collective understanding of the meaning of visual impairment by society and how that impacts mental health, social relationships and quality of life. These chapters introduce the idea of self-concept and selfesteem; how these can be affected by vision difficulties and are in turn valuable predictors of many behaviour aspects. It provides the reader with the tools to generate practical support and management plans, underpinned by research, to guide children and their families from infancy through to adult services. The chapter concludes with an account from a young person with low to no vision which beautifully personalises what has been discussed in the previous chapters.

To conclude, this book provides insight into the science of vision disorders in children, the impact on development and learning, assessment, management and habilitation strategies. Its structure is such that that it could easily be picked up and referenced or read from cover to cover. The strong themes of early assessment and intervention, the importance of multidisciplinary action and familial involvement are punctuated throughout and create a cohesive text that is useful for a wide range of practitioners.

BACCH News March 2022

The editors of this volume are eminent Clinical Child psychologists/Pediatric Neuropsychologists and Consultant Pediatricians (Neurodisability Service) at the Great Ormond Street Hospital for Children/University College London Great Ormond Street Institute of Child Health, London. The text reflects their experience (over decades) of the multidisciplinary Developmental Vision Clinic service. The faculty includes national (British) and international experts.

The book is designed as a practical guide to support practitioners (from all disciplines and backgrounds) in their management of care of children with vision impairment and disability. Vision impairment is a long-term condition caused by disorders of the eye, optic pathways, and brain, thus of very heterogeneous underlying causes of different severity. Vision impairment may influence facets of development (as motor, language, and cognition), social interaction and relationships, schooling, transition to adulthood, gaining autonomy, and independence. Obviously, assessment, support, and habilitation are complex tasks. A holistic approach with inclusion of the families is required. Voices of parents and children are included in the text.

The book is divided into four parts (with 21 chapters) following the International Classification of Functioning, Disability and Health: Children and Youth version. Part 1, Eye Disorders, Vision, and Brain, is focusing on body functions and structure; Part 2, Child Development and Learning From Birth to Older Childhood, is highlighting child function and development and learning across childhood; Part 3, Further Approaches to Habilitation, deals with functional activity and leisure and participatory activities; and Part 4, Social Relationships and Participation, looks at social relating and participation in everyday contexts. Each chapter covers relevant theories, contemporary research evidence, and practice insights. At the end of each chapter, a Summary and Key Points are provided, as well as adequate literature references.

The book provides insight into the complex and challenging tasks when confronted with a child with very low or no vision. For me (having no practical experience in this field), Part 3 was of particular interest (covering habilitation approaches for orientation and mobility, technical aids for spatial perception, low-vision aids, and reading approaches for the Braille readers). The chapter on Social Communication and Autism Spectrum Disorder in children with vision impairment was also of great interest.

I agree with the notion by Prof. G. N. Dutton (the Emeritus Professor of Visual Science Glasgow Gordon University in the foreword, “This book is a must have for all pediatric and educational psychologists, occupational therapists, speech and language specialists, and clinicians with responsibility for optimizing the development and life opportunities of children with low vision.”

Eugen Boltshauser © Georg Thieme Verlag KG