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The Over-Stimulated, Visually Impaired Child

Visual loss in infancy and in early childhood can have many causes. Typical reasons or causes of vision loss in young children include those related to prematurely (e.g., intracranial hemorrhages), seizure disorders, genetics abnormalities, birth trauma, accidental head injury, lack of oxygen and abuse, among others.

In the scientific literature, it is well established that vision stimulation is critical for proper and normal development of the visual centers of the brain. It is also well known that vision and visual perception slowly develop over the first few years of life. As a consequence, the mainstay of therapy for visually impaired young children is to engage them in tasks that stimulate their residual vision in order to maximize vision development. Early infant stimulation programs as well as early infant vision stimulation programs are specifically geared toward stimulating the young patient’s residual vision. Activities in these programs may include the use of light boxes, various colored lights and patterns, high contrast targets including checkerboards and gratings (alternating series of black and white strips) and moving or rotating objects of various color and brightness. Often, visual stimuli are paired with tactile stimuli or/and auditory stimuli to try to attract the visually impaired child’s attention to the object(s) of interest. In school and rehabilitation centers, where these vision stimulation programs are undertaken, it may be rather noisy, crowded, and a number of different activities may be taking place.

While vision stimulation and early infant stimulation programs are appropriate for the vast majority of visually impaired infants and young children, there is a subgroup of visually impaired children that cannot handle such stimulation. These children often have a medical history of brain damage or seizure activity. Many of these children are diagnosed as having "cortical blindness" or "cortical visual impairment" as well as CP (cerebral palsy). For lack of better terminology, we will refer to these children as having over-stimulation syndrome (OSS).

An important characteristic of OSS children is that they appear to better function, in general, at home than at school or at the rehabilitation center. OSS children do not like distractions. OSS children will appear to be more aware of their surroundings, will tend to open their eyes more, will engage in more visually guided behaviors, etc., when lights are low, when there are no "distracting" noises or sounds (talking, radio, fans, background noise) and when they are not held. Some OSS children do not like to be held, even by a loving parent or grandparent. If you try to hold their hands they may even pull away from you. OSS children may even not like having siblings around. Please do not misunderstand these behaviors of the OSS child; they are not rejecting you or their siblings, rather, they simply cannot handle the stimulation or sensory input.

While one may hypothesize about the reasons why OSS children behave like they do, it appears as though these children are unable to control the amount of sensory stimulation impinging upon them. It is as if they cannot ignore background sounds or lights and are overwhelmed by tactile stimulation. They appear to be truly overwhelmed by different types of stimuli – visual, auditory and tactile. As an example, as you read these words, stop for a minute and listen to the sounds around you. Now feel the clothes as they hug your body. Feel the watch on your wrist and the shoes on your feet. Now, as your eyes view these words, pay attention for a moment to the objects that are impinging on your side or peripheral vision. Now image, for a moment, that you have no way to turn-off all of those sensations. You can’t ignore the sounds, you feel everything touching your skin and you see everything impinging on your eyes and not just what you want to look at. Now you may have an idea as to what OSS children might be experiencing.

In neurology and brain research, it is well established that with any sensory input, such as with vision, there exists an extensive amount of inhibition or suppression that takes place to limit, control and refine the amount of sensory excitation or response. OSS children act as though this sensory inhibition or suppression is not present or is limited. As a consequence, the sensory input appears to overwhelm the child and, as a consequence, the child uses any means available to reduce the sensory excitation. [This hypothesis is currently under investigation.]

Standard rehabilitation efforts for OSS children may do just the opposite of their intended purpose – standard rehabilitation efforts may actually cause the OSS child to withdraw from the stimulation rather than be attracted toward it. When confronted with regular infant stimulation or visual stimulation programs, OSS children may close their eyes, actively avoid loud, flashy objects or appear to withdraw inside themselves. At the same time, OSS children may appear more comfortable at home or in dimly lighted rooms. They may open their eyes and "pay attention" when the room lights are dim, when there are no sounds and when the parent is not speaking. They prefer not to be held and not to have other children around (because of the added stimulation). In a nutshell, OSS children like it best when they are not over stimulated. And it doesn’t take much to over stimulate them.

What is a rehabilitation specialist or parent to do with an OSS child? There is no easy solution. There needs to be a balancing act between providing the child with needed and necessary sensory stimulation and, at the same time, not over doing it. If the objective is to provide vision stimulation, then stimulation of the other senses (i.e., touch, hearing) should be kept to a minimum. Multisensory objects; that is, objects that are visually salient, make noise and touch the child should not be totally avoided but should be kept to a minimum.

Pay attention to what the child tells you – not by words but by his or her behaviors. If the OSS child appears to "like" his or her surroundings than emphasize such surroundings. If the child appears to withdraw into himself, try changing the environment by turning down the lights, turn-off or minimize distractions and even ask other adults and children to leave the room.

As far as we can tell, there is no scientific literature available regarding the specific type of special needs children as outlined in this brief report; thus the reason for this featured article. Based on personal experience (Dr. Leguire), it is estimated that about 1 in 100 cortically visually impaired or cortically blind children may have OSS. As noted previously, some children with cortical blindness or with cortical visual impairment may have some of the symptoms that are described in this report and scientific literature exists about these conditions. However, by recognizing the OSS child, rehabilitation efforts may be geared toward maximizing his or her potential

 

 

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