Visual impairment and autism: Does social engagement hold the key Visual impairment and autism: Does social engagement hold the key? Peter Hobson and Tony Lee Tavistock Clinic and Institute of Child Health, UCL.

Autism Autism involves: A profound impairment in interpersonal engagement Characteristic abnormalities in language A severe restriction in symbolic and flexible thinking

Hobson (1993): The Relatedness Triangle Someone else Child Thing

Are there autistic like features in congenitally blind children Are there autistic like features in congenitally blind children? Brown, R., Hobson, R.P., Lee, A., and Stevenson, J., (1997) Journal of Child Psychology and Psychiatry, 38, 693-703 Participants: 24 congenitally blind children aged 3 and 9 years Totally blind or minimal light perception from birth, no identifiable neurological impairment Selected from six schools in England 15 with VIQ>70, 9 with VIQ<70 Upper ability were compared with 10 sighted children matched for age and IQ Lower ability compared with 9 sighted children with autism, matched for age and IQ

Group of 24 children with congenital blindness: Scores on Childhood Autism Rating Scale

All 9 children satisfied DSM-III-R criteria for autism Hobson, R.P., Lee, A., and Brown, R., (1999) Are there autistic like features in congenitally blind children? Journal of Autism and Developmental Disorders, 29, 45-56. Participants: On the basis of a seeded cluster analysis of clinical features from the DSM-III-R, 9 congenitally blind children from the study were placed in the cluster with the children with autism All 9 children satisfied DSM-III-R criteria for autism 4 boys and 5 girls, with diagnoses of congenital optic atrophy (4), ROP (3), bilateral retinal dysplasia(1) and Leber’s amaurosis (1) These participants were compared with a newly constituted group of 9 sighted children with autism (all male), matched according to age and VMA (verbal subtests of WISC or WIPPSI)

Hobson, R. P. , Lee, A. , and Brown, R Hobson, R.P., Lee, A., and Brown, R., (1999) Are there autistic like features in congenitally blind children? Journal of Autism and Developmental Disorders, 29, 45-56. Chronological Age Verbal Mental Age Mean yr;mo SD mo Range Non-sighted with autism n = 9 6;06 16 5;00 - 8;10 4;02* 8 3;03 - 5;01 Sighted with autism 7;08 17 5;02 - 9;06 4;08 11 2;11 - 5;07

Study 1: DSM-III-R clinical features among non-sighted and sighted children with autism

Study 1: DSM-III-R clinical features among non-sighted and sighted children with autism

Reversible autism among children with congenital blindness Reversible autism among children with congenital blindness? A controlled follow-up study. Hobson, R.P., & Lee, A. (2010). Journal of Child Psychology and Psychiatry, 51, 1235-1241. Chronological Age years; months Verbal mental age TIME 2 Mean SD Range Non-sighted with autism n = 9 15;00 1;01 13;06-16;04 10;00 2;01 6;06 - 13;07 Sighted with autism n = 7 15;07 1;09 13;03-17;09 10;07 2;03 8;00 - 13;07 * n = 8

Continue to meet DSM criteria Fail to meet DSM criteria Diagnosis of autism at T2, according to DSM criteria Continue to meet DSM criteria Fail to meet DSM criteria Non sighted (n = 9) 1 8 Sighted (n = 7) 7 Fisher’s exact p = 0.01 (2-tail)

Study 2: DSM-III-R clinical features among non-sighted and sighted children with autism

Study 2: DSM-III-R clinical features among non-sighted and sighted children with autism

Childhood Autism Rating Scale: T1 vs T2 3 point + improvement on CARS < 3 point improvement on CARS Non-sighted 9 Sighted 1 6 Fisher’s exact p = 0.01 (2-tail) CARS 1 vs CARS 2 Non-sighted Sighted t 6.794 -0.078 df 8 6 p (2 tail) >0.001 0.940

What happens to verbal ability? VIQ1 vs VIQ 2 Non-sighted (note: n = 8) Sighted (n = 7) t = -2.495 t = -1.146 df 7 df 6 p < .05 ns (p < .3)

Conclusions Autism is a syndrome This syndrome is heterogeneous in pathogenesis as well as aetiology Congenitally blind children who fulfil the diagnostic criteria for autism early in childhood may no longer satisfy those criteria 8 years later – and in this respect, there is a contrast with sighted children with autism What are the pros and cons to considering autism among VI children ‘autism-like’?

So…Visual impairment and autism: Does social engagement hold the key? We are left with the possibility that both in sighted children with autism and for different reasons, visually impaired children who develop clinical features considered typical of autism - ‘autism’ arises through impediments to interpersonal engagement vis-à-vis a shared, visually specified world.