Language development in children with visual impairments (i.e., blindness or low vision) has received significant attention, particularly regarding its pragmatic component. Controversy surrounds the development of the structural aspects of language in this population, which are crucial for fostering neurodevelopmental skills. This review aims to assess the existing literature on both structural and pragmatic language abilities in infants and children with visual impairments, considering implications for treatment.
Method
A systematic literature search adhering to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines and the PICO (Population, Intervention, Comparator, and Outcome) framework yielded 13 relevant studies (1995–2022) from PubMed, PsycINFO, and Cochrane Library. Data synthesis focused on structural language skill development concerning social interactions, perceptual experience, parallels with Autism Spectrum Disorder, and pragmatic language skills in children with visual impairments aged birth to 12 years. Implications for language intervention were discussed.
Results
All selected articles (n = 13) originated from high-income countries, predominantly featuring English-speaking participants. Studies often had small sample sizes and included children with heterogeneous causes and types of visual impairment, ranging from moderate visual impairment to blindness. Various tests and questionnaires assessed structural and pragmatic language skills. According to the American Speech-Language-Hearing Association (ASHA) classification, eight, two, and three articles were classified as having evidence levels IIa, IIb, and III, respectively.
Conclusion
The role of language is pivotal in the educational development of children with visual impairments, facilitating their understanding of the environment and compensating for the lack of visual experiences. Although studies typically suggest no need for direct intervention targeting structural language components, integrating parent training approaches focused on dyadic interaction characteristics and environmental organization can effectively promote language and communication development.
American Speech-Language-Hearing Association. (2004). Evidence-based practice in communication disorders: An introduction (Technical report). http://www www.asha.org/policy
2.
AndersenE. S.DunleaA.KekelisL. (1993). The impact of input: Language acquisition in the visually impaired. First Language, 13(37), 23–49. https://doi.org/10.1177/014272379301303703
3.
AndersenE. S.DunleaA.KekelisL. S. (1984). Blind children’s language: Resolving some differences. Journal of Child Language, 11(3), 645–664. https://doi.org/10.1017/s0305000900006000
4.
BatheltJ.DaleN.de HaanM. (2017). Event-related potential response to auditory social stimuli, parent-reported social communicative deficits and autism risk in school-aged children with congenital visual impairment. Developmental Cognitive Neuroscience, 27, 10–18. https://doi.org/10.1016/j.dcn.2017.07.003
5.
BeelmannA.BrambringM. (1998). Implementation and effectiveness of a home-based early intervention program for blind infants and preschoolers. Research in Developmental Disabilities, 19(3), 225–244. https://doi.org/10.1016/s0891-4222(98)00004-3
6.
BehlD.WhiteK. R.EscobarC. M. (1993). New Orleans early intervention study of children with visual impairments. Early Education and Development, 4(4), 256–274. https://doi.org/10.1207/s15566935eed0404_4
BishopD. (2003). Children’s communication checklist (CCC-2). Pearson.
9.
CamaioniL. (1997). The emergence of intentional communication in ontogeny, phylogeny, and pathology. European Psychologist, 2(3), 216–225. https://doi.org/10.1027/1016-9040.2.3.216
10.
CarboneV. J.O’BrienL.Sweeney-KerwinE. J.AlbertK. M. (2013). Teaching eye contact to children with autism: A conceptual analysis and single case study. Education and Treatment of Children, 36(2), 139–159. https://doi.org/10.1353/etc.2013.0013
11.
ChenD. (2001). Visual impairment in young children: A review of the literature with implications for working with families of diverse cultural and linguistic backgrounds (Technical Report No 7). Early Childhood Research Institute on Culturally and Linguistically Appropriate Services, University of Illinois at Urbana-Champaign.
12.
ChokronS.DuttonG. N. (2023). From vision to cognition: Potential contributions of cerebral visual impairment to neurodevelopmental disorders. Journal of Neural Transmission, 130(3), 409–424. https://doi.org/10.1007/s00702-022-02572-8
13.
Conti-RamsdenG.Pérez-PereiraM. (1999). Conversational interactions between mothers and their infants who are congenitally blind, have low vision, or are sighted. Journal of Visual Impairment & Blindness, 93(11), 691–703. https://doi.org/10.1177/0145482X9909301102
14.
DaleN. J.SakkalouE.O’ReillyM. A.SpringallC.SakkiH.GlewS.PissaridouE.De HaanM.SaltA. T. (2019). Home-based early intervention in infants and young children with visual impairment using the developmental journal: Longitudinal cohort study. Developmental Medicine and Child Neurology, 61(6), 697–709. https://doi.org/10.1111/dmcn.14081
15.
DaleN.SakkalouE.O’ReillyM.SpringallC.De HaanM.SaltA. (2017). Functional vision and cognition in infants with congenital disorders of the peripheral visual system. Developmental Medicine and Child Neurology, 59(7), 725–731. https://doi.org/10.1111/dmcn.13429
16.
DaleN.SonksenP. (2002). Developmental outcome, including setback, in young children with severe visual impairment. Developmental Medicine & Child Neurology, 44(9), 613–622. https://doi.org/10.1111/j.1469-8749.2002.tb00846.x
17.
DonahueS. P.BakerC. N.SimonG. R.BoudreauA. D. A.BakerC. N.BardenG. A.HackellJ. M.HardinA. P.MeadeK. E.MooreS. B.RichersonJ.LehmanS. S.GranetD. B.BradfordG. E.RubinS. E.SiatkowskiR. M.SuhD. W.GranetD. B. (2016). Procedures for the evaluation of the visual system by pediatricians. Pediatrics, 137(1), e20153597. https://doi.org/10.1542/peds.2015-3597
18.
DunleaA. (1989). Vision and the emergence of meaning: Blind and sighted children’s early language. Cambridge University Press.
19.
DunleaA.AndersenE. S. (1992). The emergence process: Conceptual and linguistic influences on morphological development. First Language, 12(34), 95–115. https://doi.org/10.1177/014272379201203406
EdmisterE.WegnerJ. (2015). Repeated reading, turn taking, and augmentative and alternative communication (AAC). International Journal of Disability, Development and Education, 62(3), 319–338. https://doi.org/10.1080/1034912X.2015.1020920
22.
ErinJ. N. (1986). Frequencies and types of questions in the language of visually impaired children. Journal of Visual Impairment & Blindness, 80(4), 670–674. https://doi.org/10.1177/0145482X8608000402
23.
FazziE.MichelettiS.CalzaS.MerabetL.RossiA.GalliJ., & Early Visual Intervention Study Group. (2021). Early visual training and environmental adaptation for infants with visual impairment. Developmental Medicine and Child Neurology, 63(10), 1180–1193. https://doi.org/10.1111/dmcn.14865
24.
FazziE.MolinaroA.HarmannE. (2015). The potential impact of visual impairment and CVI on child development. In LueckH.DuttonG. (Eds.), Vision and the brain: Understanding cerebral visual impairment in children (pp. 83–104). AFB Press.
25.
FraibergS.AdelsonE. (1973). Self-representation in language and play: Observations of blind children. The Psychoanalytic Quarterly, 42(4), 539–562. https://doi.org/10.1080/21674086.1973.11926648
26.
FranchiniM.DukuE.ArmstrongV.BrianJ.BrysonS. E.GaronN.RobertsW.RoncadinC.ZwaigenbaumL.SmithI. M. (2018). Variability in verbal and nonverbal communication in infants at risk for autism spectrum disorder: Predictors and outcomes. Journal of Autism and Developmental Disorders, 48(10), 3417–3431. https://doi.org/10.1007/s10803-018-3607-9
27.
GleasonJ.RatnerN. (2017). The development of language (9th ed.). Pearson.
28.
HoffE. (2020). Language development (5th ed.). Üengage Learning, Inc.
HouseS. S.DavidsonR. C. (2000). Speech–language pathologists and children with sensory impairments: Personnel preparation and service delivery survey. Communication Disorders Quarterly, 21(4), 224–236. https://doi.org/10.1177/152574010002100404
31.
HughesM.Dote-KwanJ.DolendoJ. (1999). Characteristics of maternal directiveness and responsiveness with young children with visual impairments. Child: Care, Health and Development, 25(4), 285–298. https://doi.org/10.1046/j.1365-2214.1999.00118.x
32.
IossifovaR.Marmolejo-RamosF. (2013). When the body is time: Spatial and temporal deixis in children with visual impairments and sighted children. Research in Developmental Disabilities, 34(7), 2173–2184. https://doi.org/10.1016/j.ridd.2013.03.030
33.
KasariC.FreemanS.PaparellaT. (2006). Joint attention and symbolic play in young children with autism: A randomized controlled intervention study. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 47(6), 611–620. https://doi.org/10.1111/j.1469-7610.2005.01567.x
34.
KortmannB. (2005). English linguistics: Essentials. Cornelsen.
35.
LueckA. H.ChenD.KekelisL. S. (1997). Developmental guidelines for infants with visual impairment: A manual for early intervention. American Printing House for the Blind. http://archive.org/details/developmentalgui00aman
36.
MatthewsD. (Ed.). (2014). Pragmatic development in first language acquisition. John Benjamins Publishing Company. https://doi.org/10.1075/tilar.10
37.
McConachieH. R.MooreV. (1994). Early expressive language of severely visually impaired children. Developmental Medicine and Child Neurology, 36(3), 230–240. https://doi.org/10.1111/j.1469-8749.1994.tb11836.x
38.
McginnisA. R. (1981). Functional linguistic strategies of blind children. Journal of Visual Impairment & Blindness, 75(5), 210–214. https://doi.org/10.1177/0145482X8107500505
39.
MillsA. (1993). Visual handicap. In BishopD.MogfordK. (Eds.), Language development in exceptional circumstances (1st ed., pp. 150–164). Psychology Press.
40.
MoralesM.MundyP.RojasJ. (1998). Following the direction of gaze and language development in 6-month-olds. Infant Behavior and Development, 21(2), 373–377. https://doi.org/10.1016/S0163-6383(98)90014-5
41.
Morin-LessardE.HentgesR. F.ToughS. C.GrahamS. A. (2021). Developmental pathways between infant gestures and symbolic actions, and children’s communicative skills at age 5: Findings from the All Our Families Pregnancy cohort. Child Development, 92(3), 799–810. https://doi.org/10.1111/cdev.13567
42.
OyeniranR.UwamahoroE. (2017). Impacts of reforms in Chinese educational system. International Journal of Education, 9(1), 30–48. https://doi.org/10.5296/ije.v9i1.10495
43.
ParrJ. R.DaleN. J.ShafferL. M.SaltA. T. (2010). Social communication difficulties and autism spectrum disorder in young children with optic nerve hypoplasia and/or septo-optic dysplasia. Developmental Medicine and Child Neurology, 52(10), 917–921. https://doi.org/10.1111/j.1469-8749.2010.03664.x
44.
Pérez-PereiraM. (1999). Deixis, personal reference, and the use of pronouns by blind children. Journal of Child Language, 26(3), 655–680. https://doi.org/10.1017/s0305000999003955
45.
PijnackerJ.VervloedM. P. J.SteenbergenB. (2012). Pragmatic abilities in children with congenital visual impairment: An exploration of non-literal language and advanced theory of mind understanding. Journal of Autism and Developmental Disorders, 42(11), 2440–2449. https://doi.org/10.1007/s10803-012-1500-5
46.
PlatjeE.SterkenburgP.OverbeekM.KefS.SchuengelC. (2018). The efficacy of VIPP-V parenting training for parents of young children with a visual or visual-and-intellectual disability: A randomized controlled trial. Attachment & Human Development, 20(5), 455–472. https://doi.org/10.1080/14616734.2018.1428997
47.
PreislerG. M. (1995). The development of communication in blind and in deaf infants—Similarities and differences. Child: Care, Health and Development, 21(2), 79–110. https://doi.org/10.1111/j.1365-2214.1995.tb00412.x
48.
ReynellJ.ZinkinP. (1979). Reynell–Zinkin scales: Developmental scales for young visually handicapped children. National Foundation for Educational Research in England & Wales.
49.
RohlfingK. J.GrimmingerA.LükeC. (2017). An interactive view on the development of deictic pointing in infancy. Frontiers in Psychology, 8, Article 1319. https://doi.org/10.3389/fpsyg.2017.01319
50.
SakkalouE.O’ReillyM. A.SakkiH.SpringallC.de HaanM.SaltA. T.DaleN. J. (2021). Mother–infant interactions with infants with congenital visual impairment and associations with longitudinal outcomes in cognition and language. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 62(6), 742–750. https://doi.org/10.1111/jcpp.13308
51.
SakkiH.BowmanR.SargentJ.KukadiaR.DaleN. (2021). Visual function subtyping in children with early-onset cerebral visual impairment. Developmental Medicine & Child Neurology, 63(3), 303–312. https://doi.org/10.1111/dmcn.14710
52.
SemelE.SecordW. A.WiigE. H. (1995). Clinical evaluation of language fundamentals (3rd ed.). Psychological Corporation.
53.
ShenG.WangR.YangM.XieJ. (2022). Chinese Children with congenital and acquired blindness represent concrete concepts in vertical space through tactile perception. International Journal of Environmental Research and Public Health, 19(17), 11055. https://doi.org/10.3390/ijerph191711055
54.
TadićV.PringL.DaleN. (2010). Are language and social communication intact in children with congenital visual impairment at school age?Journal of Child Psychology and Psychiatry, 51(6), 696–705. https://doi.org/10.1111/j.1469-7610.2009.02200.x
55.
TadićV.PringL.DaleN. (2013). Story discourse and use of mental state language between mothers and school-aged children with and without visual impairment. International Journal of Language & Communication Disorders, 48(6), 679–688. https://doi.org/10.1111/1460-6984.12040
56.
VinterA.FernandesV.OrlandiO.MorganP. (2013). Verbal definitions of familiar objects in blind children reflect their peculiar perceptual experience. Child: Care, Health and Development, 39(6), 856–863. https://doi.org/10.1111/cch.12002
57.
World Health Organization. (2019). International statistical classification of diseases and related health problems (Eleventh Revision). World Health Organization.
58.
World Health Organization Program for the Prevention of Blindness and Deafness. (2003). Consultation on development of standards for characterization of vision loss and visual functioning: Geneva, 4–5 September 2003 [Technical document]. World Health Organization Institutional Repository for Information Sharing. https://iris.who.int/handle/10665/68601
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
