The inter-relationships between cerebral visual impairment, autism and intellectual disability

Abstract

From birth, vision guides our movement, facilitates social interaction and accords recognition and understanding of the environment. In children, vision underpins development of these skills, and is crucial for typical development. Deficits in visual processing may lead to impairment of cognitive, motor, and social development, placing children at risk of developing features of autism.Severe early onset visual dysfunction accords the greatest risk. Cerebral Visual Impairment (CVI) can lead to disorders of cognitive and social development that resemble Autism Spectrum Disorder (ASD). Similarly, children who appear primarily affected by cognitive and social developmental disorders, can manifest a range of visual and perceptual deficits that may be contributory to their disorder. This dual perspective highlights the need for links between impaired vision and neurodevelopmental disorders to be identified and acted upon by means of applying appropriate social and educational strategies. There is good evidence to show that targeted systematic screening for visual and perceptual impairments, and implementation of long-term management approaches, is now required for all at risk children.

Autistic-Like Features in Visually Impaired Children: A Review of Literature and Directions for Future Research

“…Vision is implicated in general language development, as visually driven joint attention experiences in early childhood provide a framework within which language learning occurs [64]. Despite marked variability in visual profiles, children with both peripheral and central VI may exhibit the presence of language and communication disorders [37,64]. This can be a reflection of the visual deficit itself on early interactive experiences, or represent an associated neurodevelopmental condition that occurs independently of the VI or, more frequently a consequence of the two conditions [19].…”

“…In children with VI due to central origin, language disorders have been described [37], and may be influenced by both the degree of visual loss and by widespread brain damage that impacts brain network organization and consequently, the development of general neurocognitive functions including language [19].…”

“…Blind children seem to start to productively use pronouns very late (around age 4), and they produce a great proportion of reversal errors (1st person for 2nd person pronouns and vice versa) [7,81]. On the other hand, language can be delayed in children with CVI [64], whose ability to respond to stimuli has been described by parents as altered [37].…”

“…Regardless of the ophthalmological diagnosis, the potential vulnerability may partially be caused by early blindness and may not only be limited to a lack of vision, but also to severe and early damage to the visual system, threatening the development of mental and emotional processes that allow children to organize experiences and develop different areas of learning [37].…”

The Clinical Dilemma of Autism Spectrum Disorder Diagnosis in a Child with 9p Deletion

“…Further complicating the overlap of visual impairments with ASD is that children with visual impairments can present with stereotypic "blindisms" such as rubbing or pressing of the eyes. 8 An awareness of these features is essential for clinicians conducting assessments for neurodevelopmental disorders, as semi-structured observational assessments may need adaptation, and referrals for specialist ophthalmologic or other sensory evaluation may be required. 8…”