In a second step the current
In a second step, the current study aimed to assess the level of social cognitive and social communicative function in this sample of high-functioning children with congenital VI. As in other studies on children with VI, this study indicated that children with VI are at higher risk of social communicative problems and show an increase in behaviours associated with autism spectrum disorder (ASD) on a variety of parent-reported measures. 2 out of 17 (12%) met the clinical cut-off (score >15) for ASD and a total of 3 out of 17 (18%) scored above the elevated cut-off. Previous studies used a range of different behavioural measures so it GSK2126458 manufacturer is difficult to compare ‘incidence’ but this number appears lower than previously reported (Brown et al., 1997; Mukkades et al., 2007; Rogers and Newhart-Larson, 2008; Williams et al., 2013; Jutley-Neilson et al., 2013; Parr et al., 2010; Jure et al., 2016). However, in previous studies likelihood of meeting ASD criteria was associated with lower vision level and lower verbal ability (Brown et al., 1997). The current sample was selected for good verbal abilities to avoid confounding effects of additional learning disabilities. Further, half of the sample consisted of children with mild to moderate VI, while most previous studies focused on severe to profound VI. The lower incidence in this higher-functioning sample may suggest that better verbal ability and greater visual function may play a protective role as suggested by other authors (Brown et al., 1997) and that severity of vision level, particularly profound VI (light perception at best), is a risk factor for early social communicative difficulties and ASD (Absoud et al., 2010). Nonetheless, the 3 children who met ASD/AS criteria were neither the children with the lowest vision level nor the lowest verbal ability. This may indicate that other factors may be involved in aetiology or maintenance of these difficulties. The results of the pragmatic language and strengths and difficulties questionnaire indicated that there were more widespread subtle difficulties or deficits in social function in Selection group of higher functioning children with VI (Harris and Lord, 2016) similar to previously reported findings in an independent sample with similar characteristics (Tadic et al., 2009). These difficulties included problems with peer relationships, deficits in emotional regulation, insufficient use of context in conversation, and stereotyped language among other difficulties. This may indicate that children with congenital VI show similarities to children that fall within the wider autism spectrum (Reisinger et al., 2011; Taylor et al., 2013). However, elevated scores have also been found for neurodevelopmental disorders like ADHD (Cooper et al., 2013), preterm birth (Johnson et al., 2010), and children with pragmatic language impairment (Reisinger et al., 2011), suggesting that milder tendencies towards the wider autistic spectrum or certain aspects of the autistic spectrum may be a common feature of atypical development that is also present in children with congenital VI. The mechanisms leading to differences in social processing and increased risk of social deficits in congenital VI are currently not known. Following an interactive specialisation view (Johnson, 2011), by which differences in one function may have cascading effects on the development of other functions, we speculate that absent access to visual social cues, specifically eye gaze and facial expression, may play an important role in the aetiology of atypical social development in children with congenital VI (Campbell et al., 2006) mirroring some theories that have been proposed in the ASD literature (Klin et al., 2002). Eye gaze discrimination is believed to be key for the development of joint attention in infancy with important consequences for sociocognitive development (Moore and Dunham, 1994). Reciprocal interaction between mother and infant has been linked to the development of social communication and social cognition (Moore and Dunham, 1994).