1. 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.

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

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

4. 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,
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

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

6. 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,
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)

7. 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,
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

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

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

10. 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,
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; ;07
Sighted
with autism
n = 7
15;07
1;09
13;03-17;09
10;07
2;03
8; ;07
* n = 8

11. 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)

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

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

14. 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

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

16. 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’?

17. 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.