Behavioural and emotional issues among primary school pupils with congenital colour vision deficiency in the Federal Territory of Kuala Lumpur, Malaysia: A case-control study

Abstract

Background: Congenital colour vision deficiency (CCVD) is an untreatable disorder which has lifelong consequences. Increasing use of colours in schools has raised concern for pupils with CCVD. This case-control study was conducted to compare behavioural and emotional issues among age, gender and class-matched pupils with CCVD and normal colour vision (NCV). Methods: A total of 1732 pupils from 10 primary schools in the Federal Territory of Kuala Lumpur were screened, of which 46 pupils (45 males and 1 female) had CCVD. Mothers of male pupils with CCVD (n=44) and NCV (n=44) who gave consent were recruited to complete a self-administered parent report form, Child Behaviour Checklist for Ages 4-18 (CBCL/ 4-18) used to access behavioural and emotional problems. The CBCL/ 4-18 has three broad groupings: Internalising, Externalising and Total Behaviour Problems. Internalising Problems combines the Withdrawn, Somatic Complaints and Anxiety/ Depression sub constructs, while Externalising Problems combines the Delinquent and Aggressive Behaviour sub constructs. Results: Results from CBCL/ 4-18 showed that all pupils from both groups had scores within the normal range for all constructs. However, results from the statistical analysis for comparison, Mann-Whitney U test, showed that pupils with CCVD scored significantly higher for Externalising Problems (U=697.50, p=0.02) and Total Behaviour Problems (U=647.00, p= 0.01). Significantly higher scores were observed in Withdrawn (U=714.00, p=0.02), Thought Problems (U=438.50, p<0.001) and Aggressive Behaviour (U=738.00, p=0.04). Odds ratios, 95% CI, showed significant relative risk for high Total Behaviour Problem (OR:2.39 ,CI:1.0-5.7), Externalising Problems (OR:2.32, CI:1.0-5.5), Withdrawn (OR:2.67, CI:1.1-6.5), Thought Problems (OR:9.64, CI:3.6-26.1) and Aggressive Behaviour (OR:10.26, CI:3.4-31.0) scores among pupils with CCVD. Conclusion: Higher scores among CCVD pupils indicates that they present more behavioural and emotional problems compared to NCV pupils. Therefore, school vision screenings in Malaysia should also include colour vision to assist in the early clinical management of CCVD children.

Prevalence of color vision deficiency among Chinese college students and their quality of life

“…The CVD prevalence between undergraduate (2.54%) and postgraduate (1.85%) in our study was significantly different. The results of the impact of CVD on academic performance form previous studies were inconsistent [6,[15][16][17][18] . Some studies found that there was no significant difference between CVD students and normal students in academic performance.…”

Screening of Colour Vision in Paediatric Population

“…Further, there are few studies with Low prevalence rate, like 3.8% in (Niroula and Saha, 2010), 2.1% in (Shrestha et al, 2010), 2.6% in (Tabansi et al, 2008), 2.5% in (Oduntan et al, 2019), 2.3% in (Ugalahi et al, 2016). Some Studies had a higher prevalence rate like 5.4% in (Chia et al, 2008),4.9% in (Thomas et al, 2018). The variation in the results between our study and other studies is mainly due to heterogeneity of study population, Study area (Geographical location), and Screening methodologies used for the colour vision test.…”

ColourSpot, a novel gamified tablet-based test for accurate diagnosis of color vision deficiency in young children

“…We plan to explore ColourSpot's ability to classify protan and deutan CVD types by testing it in adults and older children against the anomaloscope. We aim that accurate diagnosis of CVD using ColourSpot from 4 years of age at the start of education will mitigate some of the negative impact of CVD on children's education and well-being (Grassivaro Gallo et al, 1998Gallo et al, , 2002Mehta et al, 2018;Suero et al, 2005;Thomas et al, 2018;Thuline, 1964). The ColourSpot app provides advice sheets on CVD, designed by Colour Blind Awareness, a non-profit organization to raise awareness of CVD (http://colourblindawareness.org), which aims to help parents and teachers adopt strategies to mitigate some of the potential negative effects of CVD on children.…”

“…It is important to detect CVD and identify how individuals can be supported, as it can significantly affect quality of life such as health, well-being and work (Barry et al, 2017;Chan et al, 2014;Cole, 2004Cole, , 2007Cumberland et al, 2005;Steward & Cole, 1989;Tagarelli et al, 2004). Ninety percent of adults with CVD encounter problems in their daily lives (Steward & Cole, 1989), while children with CVD are at risk of social, behavioral and emotional difficulties, and adverse educational outcomes (Grassivaro Gallo et al, 1998Gallo et al, , 2002Suero et al, 2005;Thomas et al, 2018;Thuline, 1964). Educational materials, especially those for young children, such as reading schemes or mathematics activities (Birch, 2001), typically rely on color as a learning tool (Rinaldi et al, 2020;Suero et al, 2005), which makes them less accessible for children with CVD.…”

“…This requires screening of children for CVD to take place in an optometrist's clinic or as part of a well-funded school CVD screening program. The World Health Organization does not currently recommend that color vision screening is included as part of population-based vision assessments (WHO Programme for the Prevention of Blindness and Deafness, 2003), and many countries do not always perform pediatric color vision screenings (Atowa et al, 2019), including Australia (Hopkins et al, 2013), India (Jadhav et al, 2017), Malaysia (Thomas et al, 2018), Turkey (Azizoǧlu et al, 2017), the United Kingdom (Department of Health, 2009) and 80% of states in the United States (Ciner et al, 1999). Secondly, although some tests have good sensitivity and specificity in adults, there is little evidence that they can diagnose CVD accurately in young children.…”