Blindisms, also known as restricted or repetitive behavior (RRB) in visually impaired children, and stereotyped behaviors in blind children are a set of stereotypies ( stereotyped, habitual and characteristic movements) in

visually impaired Visual or vision impairment (VI or VIP) is the partial or total inability of visual perception. In the absence of treatment such as corrective eyewear, assistive devices, and medical treatment, visual impairment may cause the individual difficul ...

children. These appear most often in those who are congenitally blind. Frequent movements include body rocking, repetitive handling of objects, hand and finger movements, eye poking, pressing and rubbing. Causes are not well understood, and treatment outcomes tend to be highly variable but generally positive.

Symptoms and presentation

RRBs in visually impaired children are categorised into mannerisms and motor stereotypes. Mannerisms include eye poking, pressing and rubbing, gazing at lights and staring. Motor stereotypes include repetitive head/body rocking, thumb sucking, jumping, swirling, and repetitive hand/finger movements. Blindism behaviors overlap with stereotypies observed in autistic people, and as some diagnostic criteria of autism depend on vision, it is particularly difficult to diagnose autism among the visually impaired, often based on a subjective clinical impression. Children displaying blindism behaviors may experience

teasing Teasing has multiple meanings and uses. In human interactions, teasing exists in three major forms: ''playful'', ''hurtful'', and ''educative''. Teasing can have a variety of effects, depending on how it is used and its intended effect. When t ...

or social isolation by other children. Additionally, in the case of eye pressing, poking and rubbing which are generally exclusive stereotypies to visually impaired children, the skin around the eye may discolor and become calloused, along with a risk of eye infection,

keratoconus Keratoconus is an eye disorder in which the cornea, the transparent front part of the eye, gradually thins and bulges outward into a cone shape. This causes distorted vision, including blurry vision, double vision, increased nearsightedness, ...

, and corneal scarring.

Causes

The causes of RRBs in visually impaired children are not well understood. Two distinct theories for causes are that it is compensation for sensory and/or social deprivation, and that it is a regulatory function in response to overstimulation and/or

anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...

. However, as of 2021 such theories do not have empirical support. The lack of visual sensory feedback in blind people is known to affect the calibration process for body movement. It is also suspected that reinforcement of behavior plays a role in the development of RRBs. There are a variety of other theories drawing from

neuroscience Neuroscience is the scientific study of the nervous system (the brain, spinal cord, and peripheral nervous system), its functions, and its disorders. It is a multidisciplinary science that combines physiology, anatomy, molecular biology, ...

Treatment

Early intervention is often helpful in preventing children from displaying blindism behaviors. In most cases, a qualified teacher arranges an early education program to help develop accurate and effective use of the child's

sense A sense is a biological system used by an organism for sensation, the process of gathering information about the surroundings through the detection of Stimulus (physiology), stimuli. Although, in some cultures, five human senses were traditio ...

s. The parents are often included in such programs alongside their visually impaired children. Overall success rates for treatment ranges from 88.9% to 68.4% depending on risk factors. However, these results have questionable reliability due to the lack of recent treatment studies for RRBs in visually impaired children, and many such past studies using

punishment Punishment, commonly, is the imposition of an undesirable or unpleasant outcome upon an individual or group, meted out by an authority—in contexts ranging from child discipline to criminal law—as a deterrent to a particular action or beh ...

as opposed to

reinforcement In Behaviorism, behavioral psychology, reinforcement refers to consequences that increase the likelihood of an organism's future behavior, typically in the presence of a particular ''Antecedent (behavioral psychology), antecedent stimulus''. Fo ...

which featured highly variable efficacy.

Prevalence

Autism has a high co-occurrence rate with visual impairment. As of 2022, prevalence of blindisms is largely inconclusive, with estimates ranging from 2% to 50% in autistic people. The prevalence of autism in children with visual impairment ranges from 20% to 38%, with a risk factor including the presence of other neurological conditions.

References

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External links