Prevalence and situational causes of stereotyped behaviors in blind infants and preschoolers.

Parents of 85 blind children aged from 10 months to the 6th year of life were asked regarding the frequency, duration and typical situations of the occurrence of various stereotypic behaviors in their children. The Bielefeld Parents' Questionnaire for Blind and Sighted Infants and Preschoolers was used as the instrument of measurement. All of the children displayed at least one stereotypic behavior; most displayed several stereotypic behaviors according to the parents' reports. Eye poking and body rocking dominated within the prevalence hierarchy. Four typical situations could be identified in which stereotypic behaviors were shown: monotony, arousal, demand, and during feeding or eating. The results suggested that repetitive hand and finger movements, stereotypic manipulation of objects, and making a face(s) mainly occur within arousal situations whereas eye poking, whimpering, and sucking thumbs or fingers especially are linked to monotony.

Implementation and effectiveness of a home-based early intervention program for blind infants and preschoolers.

This article presents results from a comprehensive evaluation of a home-based early intervention project for congenitally blind young children. Five full-term and five preterm blind children, who had a mean age of 12 months at the beginning of the project, were visited at home with their families every 2 weeks over a 2-year period. Results showed that an individualized, handicap-specific early intervention using different types of parent involvement (cotherapist, parent counseling) could be implemented successfully. Compared with controls, developmental test data from the ages of 12 to 36 months showed an accelerating impact on the full-term children. However, no intervention effects could be found in the preterm children. This finding was mainly due to methodological limitations (e.g., selection bias). The best results among full-term children were found on blindness-specific scales (e.g., orientation and mobility). It is concluded that the outcomes in full-term children confirm the success of this type of early intervention.

[Interrater reliability of a German version of the "International Classification of Impairments, Disabilities, and Handicaps (ICIDH)" of the World Health Organization]. / Beurteilurübereinstimmung einer deutschen Version der "International Classification of Impairments, Disabilities, and Handicaps (ICIDH)" der Weltgesundheitsbehörde.

A German version of the "International Classification of Impairments, Disabilities, and Handicaps (ICIDH)" edited by the World Health Organization (1980) has tested in respect to the interrater reliability. The investigation was carried out with 36 staff members from three rehabilitation institutions for the blind or partially sighted, who rated in pairs a visually impaired child or adult with the classification system. The calculation of the interrater reliability was based both on the method of the relative agreement between the raters and on the measure "kappa". Altogether, the KAPPA-calculation yielded unsatisfactory interrater agreements. The reasons for the low reliability figures can be seen on one hand in the classification system itself, on the other hand in motivational barriers within the group of raters. The investigation however also indicates, that by modifying the classification system and by intensively training the raters, improvement concerning the reliability figures can be expected.

[Sleep disorders in visually handicapped children in infancy and preschool age]. / Schlafstörungen bei sehgeschädigten Kindern im Kleinkind- und Vorschulalter.

A parents' questionnaire was used to assess sleep disorders (night waking, settling difficulties) in 265 visually impaired and 67 nondisabled 10- to 72-month-olds. Results showed that multiply handicapped blind children (n = 57), blind children with no additional impairments (n = 56) and multiply handicapped partially sighted children (n = 71) more frequently had difficulties in getting to sleep (more than once a week) and in sleeping through the night (night waking more than once per week and taking more than 5-10 minutes to get back to sleep) than nonhandicapped children, whereas the frequency of sleep disorders (night waking, settling difficulties) in partially sighted children with no additional neurological or physical impairments (n = 81) did not differ from that of nonhandicapped controls. Blind children, whether they were multiply handicapped or not, exhibited sleep disorders more frequently than partially sighted children. The results indicated relationships between sleep disorders and the regularity of children's daily routines, the activities in the evening before going to bed, and the children's sleeping habits.

Integration of children with visual impairment in regular preschools.

The current practice in Germany is to integrate children who are blind or partially sighted into regular preschools providing they exhibit no further severe impairments. The present study asked 72 regular preschool teachers about their experiences in integrating 24 children who were blind and 16 who were partially sighted. Results showed that integration seemed to be unproblematic except for greater emotional difficulties in children who are partially sighted. According to preschool teachers, integrating children who are blind is far more complex and difficult than integrating the partially sighted. One fifth of the blind exhibited marked to serious problems in 10 out of 28 preschool activities surveyed. Most of these difficulties involved manual, cognitive, interactive and daily living skills. When asked about difficulties that had not been anticipated before integration commenced, preschool teachers emphasized four domains: the increase in their own workload; the children's problems with concentration and motivation; fixation on one preschool teacher; and difficulties in the fine- and gross-motor domain as well as in daily living skills. Findings indicate the need for improved preparations and support when integrating the blind into regular preschool.

[The handicapped and public transportation]. / Behinderte und öffentlicher Transport.

The article gives an overview of efforts made in various countries (the U.S.A., Canada, Sweden, and the Federal Republic of Germany) toward achieving greater accessibility of their public transportation systems. Various initiatives are shown to have been created in the 70ies on the part of public authorities and public transport providers, that have entailed the development of special vehicles, special information systems and architectural solutions. On analyzing the policies of both the transport providers and the competent public authorities it is, however, found that, although creation of an essentially barrier-free transportation network would be possible from the technical point of view, they refrain from subscribing to this objective. This has resulted in transportation of the disabled being oriented toward special services because these are far less costly than fundementally re-designing existing public transportation systems.

Early social-emotional development in blind infants.

In order to study the impact of blindness on social and emotional development during the first year of life, the level of social-emotional development was compared in blind and sighted 9- and 12-month-old infants. The five 9-month-old and the 17 12-month-old blind infants were completely blind from birth and exhibited no further serious disabilities. Social-emotional development was assessed with a scale from the Bielefeld Developmental Test for Blind Infants and Preschoolers containing three subscales on emotions, social interaction and impulse control. Compared to non-disabled infants, blind infants exhibited a more limited repertoire of facial expressions and less responsiveness. They less frequently attempted to initiate contact with their mothers (self-initiated interactions) or comply with simple requests and prohibitions than sighted infants. These differences in the social-emotional development of blind and sighted infants are traced back to the effects of blindness on the mother-child interaction. The lack of visual perception appears to impede particularly the acquisition of a dialogue concept.

[Locomotion and traffic behavior of vision-impaired persons]. / Lokomotion und Verkehrsverhalten sehgeschädigter Personen.

After briefly differentiating the terms visual impairment, profound visual impairment, and blindness, the authors address the mobility problems of blind and visually impaired persons. The second part of the contribution presents and discusses the main findings of a study, conducted by the authors in 1982, concerning the mobility of blind and profoundly visually impaired persons, including, in particular, the problems encountered by this population in using public transport.

The age dependence of stereotyped behaviours in blind infants and preschoolers.

As part of a research programme on early intervention and family care for blind infants and preschoolers, the Bielefeld Parents' Questionnaire for Blind and Sighted Infants and Preschoolers was given to 85 parents of congenitally blind children. All 85 children (from 5 to 72 months) in the sample were totally blind and had no further serious disabilities. A comparison of five age groups of blind infants and preschoolers indicated that the repertoire of stereotyped behaviour patterns depended on age. After expanding from the first to the second year of life, the range of different stereotyped behaviours decreased from the age of 3 years up to school enrollment. The amount of stereotyped behaviours showed a similar course. Among the individual stereotyped behaviours, only the frequency of eye poking and body rocking increased from the first to the second year of life and then maintained a relatively high level across the entire preschool age range. The situational and person-specific conditions under which stereotyped behaviours could typically be observed also appeared to change with the child's age. While in the first years of life, monotony and arousal situations dominated among the elicited stereotyped behaviours, the 4- to 6-year-old blind children increasingly exhibited stereotyped behaviours in situations in which they were confronted with cognitive and concentrative demands. Various possible explanations of the age dependence of stereotyped behaviour patterns in blind infants and preschoolers are discussed.

Longitudinal study of neuropsychological outcome in blind extremely-low-birthweight children.

This study evaluated neurological and psychological development in 10 blind children over a 4-year period. Five of the children were born preterm with an extremely low birthweight (ELBW) and a diagnosis of retinopathy, whereas the other five were term. All children received their first neurological examination at a mean age of 10 months and then annual follow ups. In addition, the Bielefeld Developmental Test for Blind Infants and Preschoolers (BDTB) was administered every 6 months (from the ages of 18 to 48 months) to assess developmental outcome in different domains (e.g. cognition, language, gross motor abilities). Results showed a higher number of peri- and neonatal complications in blind ELBW children as well as a significantly higher number of neurological symptoms over the 4-year period. At the mean age of 4 years 10 months, blind ELBW children had a significantly lower body weight, body height, head circumference, and body-mass index compared with the term children. Findings on psychological development revealed that blind ELBW children also had significantly lower scores on all domains covered by the BDTB. Finally, the overall score on the BDTB correlated significantly with gestational age, birthweight, duration of mechanical respiration, and days spent in hospital after delivery.