Early parenting intervention and social communication outcomes

Early parenting intervention and social communication outcomes in infants with severe-profound congenital vision disorders

Background:
Chronic severe-profound visual impairment is a primary disability arising from congenital disorders of the anterior visual system (globe, retina and anterior optic nerve) with long-term serious consequences. The majority are still not medically treatable and behavioural habilitation treatments remain the priority. The secondary disabilities include early negative impacts on motor, cognitive, social and language development (Dale et al, 2017). The risk of autism is very high with a risk-ratio of 31 times that of the general population (Do et al  2017). Animal and human research shows that environmental enrichment methods, including parenting styles, have a positive impact on neural networks and behavioural outcomes (neuroplasticity) in neurodisabilities but there may be a window of opportunity with infancy as the most favourable age period. Recently our team demonstrated that infants whose parents received a developmental structured programme devised by our clinical team made greater longitudinal gains in sensorimotor cognition, expressive language and behaviour by three years of age (Dale et al, 2019). A substantial minority of these infants already showed behaviour problems, particularly in ‘internalising’, by two years and left leaning asymmetry in early frontal EEG networks at one year of age predicted these behaviour problems (O’Reilly et al, 2017). However our team also showed that higher maternal sensitivity at one year led to increased gains in verbal comprehension between one to three years (Sakkalou et al, in press).

Aims/Objectives:
This study aims to build on these previous studies and to design and pilot trial a new parenting programme for parents and infants of visual impairment, using established principles of video-training, and to achieve change in parenting style and to increase parental sensitivity and maximise immediate outcomes in social communication and behaviour. A tele-medicine approach is of potential interest as cost-effective and also trialled during covid-19 pandemic.

Methods:
The student will design and trial a parenting programme for parents and infants of visual impairment, drawing on established principles of video-training and feedback to parent-infant interactions during play to enhance parental sensitivity to the cues and responses of an infant with severe-profound visual impairment. The programme will be partly delivered through tele-medicine methods. A pilot controlled trial will be undertaken with parents of infants with severe-profound visual impairment aged 6-15 months, including baseline and post-intervention measures of sensorimotor understanding, response to social voice and verbal comprehension and social communication. Parents receiving the parenting programme will be compared with those receiving a general developmental programme only, with observational measures of parenting sensitivity undertaken at baseline and post-intervention. The third supervisor, Dr Elena Sakkalou, will assist in the training methods of parenting programme.

Timeline:
First year of project will be skill learning of assessments and design and trial of parenting programme, second year will involve the controlled trial, and final year for analyses and write up.

References:
1.  Dale et al, 2017 Functional vision and cognition in infants with congenital disorders of the peripheral visual system. Dev Med Ch Neurol
2.  Do et al, 2017, Systematic review and meta-analysis of the association of Autism Spectrum Disorder in visually or hearing impaired children. Ophthal and Physiol Optics
3.  Dale et al, 2019 Home‐based early intervention in infants and young children with visual impairment using the Developmental Journal: longitudinal cohort study Dev Med Ch Neurol
4.  O’Reilly et al, 2017 Frontal EEG asymmetry and later behaviour vulnerability in infants with congenital visual impairment. Clinical Neurophysiol
5.  Sakkalou et al, in press, Mother-infant interactions with congenital visual impairment and associations with longitudinal outcomes in cognition and language. J Child Psychology and Psych