When a baby is born with visual impairment the effects are many and
often very significant. Of course, it is not only the baby who is affected;
there may be a huge impact on the parents and, indeed, on the whole
family. Just how significant the effects are depends on many factors,
including whether the baby has any vision, and, if so, how much. This
article examines the impact of being born with visual impairment on the
acquisition of early communication skills. These are the very important
skills that emerge in typically developing babies during the first few
months of life. They are essential for understanding and producing
It is important to note that having visual impairment does not inevitably
lead to significant difficulties with acquiring communication, and some
babies who have visual impairment later become very effective
Because communication is connected with so many other skills and
aspects of life, this article has many sections. Some deal with other
aspects of development that are closely linked with communication.
Other sections examine aspects of early communication that are affected
in babies who have visual impairment.
It is, of course, important to carry out research into the development of
babies and children who have visual impairment. This enables
practitioners to have a better understanding of the impact of visual
impairment on development. In turn, this means that it is possible to
provide more effective support in the form of education and other
services. Unfortunately, it is very difficult to carry out research into the
development of babies and children who have visual impairment. Many
factors are involved here. In due course, I hope to deal with this topic in a
separate article. For now, it is sufficient to state that it is important to be
cautious when considering the findings of research into the development
of babies and children who have visual impairment.
Many new-born babies who have visual impairment have a prolonged
spell in hospital. This period may be extended if the baby is born very
prematurely, as is the case, for example, with those who have
retinopathy of prematurity. Prolonged separation after birth can be
important as there is a risk that it will interfere with attachment (the
establishment in the baby of an emotional bond with the parents; see
also the section on Emotional development, p.10). Attachment typically
develops in the first few days and weeks of life.
Separation from the parents that results from being in hospital is not
unique to babies who have visual impairment, of course. But this early
separation may be particularly significant for these babies: they depend
very much on touch for their early learning, and this is severely reduced
for many babies who spend time in hospital.
Learning that the baby has visual impairment can have a profound affect
on the parents. There are many potential emotional reactions, several of
which may be present together: they include shock, sadness, grief,
anxiety, and depression. These natural responses may also interfere
with the establishment of the close relationship between the baby and
parents that typically develops in the first few days and weeks of life.
Many caregivers of a baby who has visual impairment are given
numerous appointments to attend hospitals or clinics. It is also common
for various practitioners to make home visits. Although appointments and
support are provided from the best of motives, frequent contact with
practitioners may reduce the confidence caregivers have in their childrearing
skills; indeed, it may have a negative impact on the child-rearing
skills themselves. This is especially so if the support is fragmented and
advice differs from one practitioner to another. If there is no other impact,
all this support reduces the time and energy available for the caregivers
to spend at home with the baby. This may interfere with the acquisition of
early communication skills.
Auditory (hearing and listening) skills
Hearing and listening are mentioned here as they are clearly linked with
the development of spoken language. Unfortunately, there has been little
research into the development of auditory skills in babies who have
visual impairment. A commonly held view is that people with poor sight
have good hearing. This view is based on what is known as sensory
compensation. But sensory compensation is a myth: there is no reason
for babies who have visual impairment to possess naturally better
hearing and listening skills than their fully sighted counterparts.
Some babies who have visual impairment may go on to develop
enhanced listening skills later in life. But this will only happen if the skills
are systematically taught, or if the child is very motivated by some aspect
of sound. Hearing acuity itself cannot be enhanced.
Orientation to sound may be delayed in babies who have visual
impairment, but there is some disagreement about this. Reaching for
objects by sound is delayed, but there is a general delay in reaching for
objects, so the significance of this is not clear.
Some babies who have visual impairment withdraw from some sounds
as though they are fearful. This may arise because, with little or no sight,
the baby cannot readily identify the sounds and has no control over
them. In fact, it is not surprising that a baby who has visual impairment is
afraid of sounds like those of the vacuum cleaner and the washing
The mouth is very important to babies for exploring items and learning
about the world. Gradually, vision and hearing take over as the main
ways to learn about the world. Babies who have visual impairment may
continue to use the mouth as the main way to perceive the world until
well into their second year. However, it is difficult to be sure of this as
there is also a claim that babies who have visual impairment explore
objects less with their lips and tongues than sighted babies. This may
illustrate the wide differences between babies who have visual
An important distinction has been made between active and passive
touch. Active touch is the process of manipulating an object in order to
identify and learn about it. Passive touch is being touched by another
person or being in contact with an object, without manipulating it.
There has been little research in this area. However, there is some
evidence of a delay in early perception through active touch in babies
who have visual impairment.
For babies with very little or no sight, touch is likely to be a very
important way of learning about the world. A delay in the use of touch
may have an impact on communication. This is because the acquisition
of communication skills is closely linked with learning about the world.
Although babies who have visual impairment are not delayed in postural
control, they are generally slower to crawl and walk than sighted babies.
A factor here is likely to be the lack of incentives: babies who cannot see
that there are interesting things to explore are not likely to be motivated
to move about.
Fine motor skills are affected in babies who have visual impairment. This
is not surprising, as many of these skills rely heavily on vision in typically
developing babies. In babies who have visual impairment delays have
been observed in holding objects with one hand, grasping objects, pincer
grasping, scrawling and fitting pieces in holes.
Typically developing babies seem to have a strong drive to be active and
to explore the world. In contrast, many babies who have visual
impairment are passive; these babies
are less inclined to search for new experiences
may learn to be helpless
do not demand much of caregivers
are content to lie in their cots seemingly uninterested in social
and environmental stimuli.
But this learned helplessness is not necessarily directly due to the lack of
vision; rather, as noted above, the lack of vision means the baby is not
attracted by items in the environment which a sighted baby would find
Another factor is that caregivers may not interact with the baby who has
visual impairment in the most supportive ways. This is explored in a little
more detail in the section on Caregiver responsiveness.
A vicious circle may result:
the baby’s inclination to be passive means he or she is rather
this means caregivers have less to respond to
caregivers may adopt a child-rearing style that is not supportive
positive social interactions are reduced
therefore, the child becomes socially isolated.
A lack of drive can have a very serious affect on the acquisition of
communication. A crucial skill necessary for being an effective
communicator is taking the lead. Typically developing babies become
effective communicators because caregivers respond to them and follow
their lead. A baby who has visual impairment who is very passive may
fail to learn that he or she can influence what other people do. Thus the
baby is less likely to learn how to make requests and may even fail to
reject items he or she does not want.
Cognitive skills (those related to understanding the world) matter here
because they are closely linked with the acquisition of communication. A
delay in understanding the world may hold back the development of
In the first 3 to 4 months, babies who have visual impairment are similar
to sighted babies. But sighted babies typically begin to reach for objects
at this age. Babies who have visual impairment take longer to do this,
and then lag behind. This delay continues for some years. As long as the
child’s communication skills progress reasonably well this may not be a
problem in the long term. This is because later on language appears to
have a compensatory function; it enables children who have visual
impairment to learn about the world indirectly and they no longer show a
delay in their reasoning abilities. The early difficulties are probably due to
their restricted exploration of the environment.
An important cognitive skill as far as communication is concerned is
object permanence. This is understanding that an object or other person
still exists when it is not immediately accessible. Sighted babies acquire
object permanence largely through vision. Initially, when they see objects
disappear, they lose interest, treating those objects as if they no longer
exist. But sometimes an object or person that has disappeared reappears
almost immediately, and the baby begins to understand that it
is, indeed, the same object or person. It is possible to tell that a baby has
acquired object permanence when he or she looks for an object that has
disappeared; for example, the baby may remove a cushion to find a
favourite toy that has been hidden.
In the very early stages of learning to speak, children only refer to things
that are accessible, that is things they can see, touch, smell or hear.
Unless they have object permanence, they will never learn to talk about
things that are inaccessible, that is things they cannot see, touch, smell
Unfortunately, research results are difficult to interpret. However, there is
evidence that some babies who have visual impairment are late to
acquire object permanence. Those who have some vision have an
The ability to understand cause and effect is another cognitive skill that is
important for communication. Although there is no research evidence, it
seems possible that a lack of visual experience can cause a delay in
understanding cause and effect. In addition, being passive (see the
previous section on Drive, p.6), will make it harder to learn that doing
something may result in another person responding – in other words,
that doing something may cause an effect.
To become an effective communicator, babies need the cognitive skill of
understanding symbols. A symbol is simply something that stands for
something else. Words are symbols. But babies who have visual
impairment do not understand symbols in the way that sighted babies do.
In particular, babies who have visual impairment do not realise that
miniatures stand for (that is, are symbols for) the real items. For
example, a sighted baby can see a definite similarity between a teddy
bear and a human: it has eyes, nose, arms, legs, etc. But a baby who
has very little or no vision is unlikely to notice any similarities: a teddy
bear does not feel like a real person, either to the hands or to the mouth;
it does not make the sounds a real person makes; it does not smell like a
real person; it does not do any of the things that a real person does.
Sighted babies almost constantly have symbols around them in the form
of pictures, but, of course, these are either totally inaccessible to the
babies who have visual impairment, or very difficult to access.
Memory is another cognitive skill linked with communication. There is
evidence that there is nothing wrong with memory in babies who have
visual impairment. Indeed, in older children who have visual impairment,
memory may be better than in sighted children. In particular, some
children who have visual impairment seem to have a good memory for
words, and speech sounds; some develop an excellent memory for
So, to sum up, several important cognitive skills closely linked with
communication may be delayed in babies who have visual impairment.
The evidence on play in babies and children who have visual impairment
is confused and confusing. Many subjective reports indicate that the play
of babies and children who have visual impairment is adversely affected
by their lack of vision. However, not all objective research supports this.
It seems that, compared with sighted babies and children, some babies
and children who have visual impairment
are more inward and isolated in their play
play in a less creative and imaginative manner
spend more time in repetitive, manipulative or explorative
involve their own bodies in their play, rather than objects or
are more dependent on adults in their play.
Symbolic play can be delayed by limited experience which can stem from
the restricted mobility caused by the visual impairment
a lack of motivation, resulting from not being aware that there
are interesting items which could be played with (see the
section on Drive, p.6)
lack of opportunity for imitation (see the section on Imitation,
delays in understanding symbols (see the section above on
Cognitive skills, p.7)
being over-protected by caregivers who are fearful that the
baby may come to harm if allowed to explore.
Play may remain concrete and manipulative in some babies and children
who have visual impairment. Pretend play does not seem to appear until
towards the end of the second year, and symbolic play may be delayed
until 3 years of age.
Emotional development (understanding and interacting effectively with
other people) is important for communication.
Attachment is the development in the baby of an emotional bond with
another human being. Typically, the first and probably most significant
attachment is to the mother. With little or no sight, babies who have
visual impairment are at risk, and attachment may be delayed. A baby
who has visual impairment who spends a long period in hospital is
particularly at risk (see the section on Hospitalisation, p.3). The risks can
be reduced by the parents if they encourage and respond to the baby’s
interactive behaviours as soon as that is possible.
Another skill that is important for emotional development is that of
differentiating the self from the world. Not surprisingly, with little or no
vision, this is delayed in some babies who have visual impairment.
An important emotional skill linked with communication is that of
recognising other people's feelings. However, this may be more difficult
for babies and children who have visual impairment: with little or no sight,
it is very hard, or impossible, to see other people’s facial expressions.
But, of course, facial expression is an important indicator of how another
person is feeling.
Eye contact with people and objects
One of the most important features of communication is that it enables
us to have some control over other people. In fact, vision provides
sighted babies with some “control” almost from birth: the baby can look
towards a caregiver and can then look away; thus the child can "turn on"
and "turn off” the caregiver. From the very beginning, then, caregivers
are able to respond to the baby: when the baby looks towards the
caregiver, the caregiver responds by alerting, showing interest and by
cooing or speaking; when the baby looks away again, the caregiver
responds by pausing, waiting for the baby to look again.
A new-born baby who has little or no vision is unlikely to behave in the
same way as a sighted baby; thus the caregivers are deprived of the
signals which indicate how they should respond. It would be surprising if
the typical pattern of baby / caregiver interaction were not affected.
If the baby who has visual impairment rarely or never looks towards
people, and later fails to make eye contact, the caregivers may come to
believe that the baby has no interest in them. This can be very difficult for
the caregivers, especially for the parents; they may feel that the baby
does not love them; they may also feel inadequate, and wonder what it is
they are doing wrong.
Caregivers typically respond when a baby looks towards them. Although
a baby who has visual impairment is unlikely to do this, he or she may
show interest in caregivers in some other way; for example, the baby
may become very still, or may turn very slightly towards the caregiver.
However, such subtle behaviours are very difficult to detect, and may go
un-noticed by the caregiver. If this happens, it may well strengthen any
tendency on the part of the baby to be passive.
As noted in the section on Drive, the lack of vision makes it difficult
for the baby to take an interest in objects in the environment. This also
makes it difficult for caregivers to respond to the baby. This is because
caregivers respond when the baby shows an interest in something; with
sighted babies, this is by following the baby’s line of gaze: caregivers
assume if the baby is looking at an object, that he or she is interested in
it. (See further the sections on Joint attention, p.16, and Intentional
Eye contact with other people and with objects, then, both play a very
important role in the development of communication in sighted babies.
With little or no sight, the baby who has visual impairment is at risk. As
well as the features discussed in this section, joint attention and
intentional communication are likely to be harder for babies who have
In the section on Emotional development there was mention of the
fact that, with little or no sight, it is very hard, or impossible, for babies
who have visual impairment to see other people’s facial expressions.
Effective communicators, of course, also use facial expressions
themselves. Some researchers have reported that babies who have
visual impairment lack facial expressions; however, others have reported
that they have the full range of facial expressions. It seems likely that the
ability to use facial expressions varies from baby to baby, though it does
seem unlikely that babies who have visual impairment use the full range
of facial expressions available to sighted babies.
It has been reported that babies who have visual impairment adopt a
passive expression when spoken to, and this can give the impression
that they are uninterested. This could result in caregivers finding it
difficult to speak to the baby, and could reduce such behaviour.
This facial expression is discussed in a section of its own as it is so
important in the early stages of a child’s life. Smiling develops differently
in babies who have visual impairment compared with their sighted peers:
Babies who have visual impairment
smile less often
produce smiles which seem muted
do not automatically smile in response to the caregiver’s face
smile more frequently after 2 months, but the mother's voicedoes not regularly elicit it, as is the case with sighted babies
do not initiate contact by smiling
tend not to smile unless the mother coaxes it; vigorously
touching or moving the baby seems best.
Little or no smiling on the part of the baby who has visual impairment
may indicate to the caregivers that the baby is unfriendly, even unloving,
and unresponsive. Caregivers, perhaps parents in particular, may feel
inadequate, if they think the baby is failing to smile through some fault of
Quite early on, the sighted baby makes movements of anticipation as a
caregiver approaches. These movements signal to the caregiver that the
baby is the excited at the prospect of receiving contact. However, the
baby who has visual impairment may well fail to make such movements.
By about the age of 5 months, the typical baby is extending his / her
arms to be picked up. In babies who have visual impairment, this is
delayed, and more typically occurs at about 12 months. The absence of
excited movements as a caregiver approaches and the delay in asking to
be picked up can again result in caregivers gaining the impression that
the baby is not interested, or even unloving.
In fact, some babies who have visual impairment startle when they are
picked up. This is because, with very little or no vision, they are unaware
that someone is approaching and preparing to pick them up. This is most
likely to happen when the caregiver fails to speak as he / she
approaches. Startling in this way may be another reason for caregivers
to believe the baby dislikes contact.
Movement is an important way for some babies who have visual
impairment to signal meaning. The following have been observed:
using the hands very expressively
initiating contact and attracting attention partly through body
using gestures to participate in, or request routines
using a rejection gesture, in which the baby turns the face away
from an object, at the same time pushing it aside
signalling displeasure by turning the face.
These behaviours may be quite subtle, and caregivers may well fail to
understand their potential importance. If this is the case, they are unlikely
to respond positively to the baby, who may, therefore, become frustrated
and become less inclined to seek contact and to attempt to interact.
Many totally blind babies do not use conventional, communicative
gestures such as pointing, showing, nodding, and waving. The lack of
these behaviours further exacerbates the difficulties caregivers may have
interacting with a baby who has visual impairment.
Babies who have visual impairment begin to babble at between 6 and 7
months, at the same age as sighted babies. However, babies who have
visual impairment seem to vocalise less than sighted babies: they
rarely vocalise to greet
rarely initiate dialogues by vocalising
vocalise less while the caregiver is interacting with them
are noticeably silent when the caregiver stops interacting.
It is possible that babies who have visual impairment are quieter than
sighted babies because listening is so important to them. With little or no
sight, babies who have visual impairment rely a great deal on listening to
monitor the world and to receive stimulation. However, if they vocalise
themselves, it is harder for them listen to what is going on around them.
A fundamental feature of communication is reciprocity: taking turns with
another person and so jointly participating in an interaction which
changes as each person responds to what the other offers. Reciprocal
behaviour may have its origins in the burst-pause pattern of sucking
typically established by the newborn baby. However, vision would seem
to play an important part in this process for sighted babies, so it may be
more difficult for a baby who has visual impairment to establish the burstpause
pattern of sucking. This may be particularly true for those who
have a prolonged period in hospital early in life.
In the first few months, so much interaction between a sighted baby and
the caregivers depends on vision: as noted in the section on Eye contact
with people and objects, a sighted baby can very effectively “turn
on” and “turn off” caregivers by looking towards them and then looking
away. But a baby who has very little or no sight lacks this ability.
Furthermore, it may be more difficult for a baby who has visual
impairment to recognise reciprocity when it occurs in the course of
interaction. Because so many early interactive (that is reciprocal)
routines typically rely on vision, babies who have visual impairment have
fewer opportunities than their sighted counterparts to practise reciprocal
acts. Give-and-take games feature quite prominently in the lives of many
sighted babies around the end of the first year: for example, they
frequently offer, give and then receive back an item; they roll a ball to-and-fro with a partner.
Without vision, anticipatory games may contain too much surprise for the
baby. In addition, such games may deny the baby who has visual
impairment sufficient opportunities to control events. The baby, therefore,
may be reluctant to participate.
There are various cues the babies who have very little or no sight can
use to engage in reciprocal interaction based on sound, touch and
vestibular stimulation, provided the adult is attuned.
It is possible for babies who have visual impairment and their caregivers
to become well tuned-into each other, but this may depend on the
caregivers being naturally very responsive and observant or on receiving
very effective support.
Imitation is considered to be important in communicative development,
presumably playing a part, for example, in babies learning to produce the
speech sounds of their native language. But sighted babies and young
children also participate in many imitative games with caregivers which
involve vision. This means that babies who have visual impairment have
fewer opportunities to imitate than sighted babies.
Imitation is one way to establish turn-taking, reciprocal interactions which
are like later communication. Therefore, having fewer opportunities to
imitate, may be another barrier to babies who have visual impairment
becoming effective communicators.
Furthermore, imitative games enable the sighted baby and caregiver to
develop mutual understandings, another essential for successful
Babies who have visual impairment have few behaviours with which they
can initiate social exchange. They do not
initiate contact by smiling
initiate affectionate games
produce many spontaneous vocalisations or
indicate with gestures the desire to be held.
A baby who has visual impairment may depend on physical contact to
initiate interaction. As the baby will not be independently mobile, the
baby is only able to initiate when a caregiver has made him- or herself
There is some evidence that mothers respond less to the initiations of
babies who have visual impairment than to those of their sighted babies.
A difficulty here is that mothers look less at their babies who have visual
impairment than at their sighted babies. Thus, they may miss some of
the cues that their babies who have visual impairment do send.
This may be very significant, as the baby’s cues are likely to consist of
movements; see the section on Communicative movement and early
Being able to pay attention to the same thing as another person is
essential for effective communication. This ability typically develops
before the baby is 12 months old and is closely linked with the
development of intentional communication, which is discussed in the
In order to attend jointly, the baby must be able to
shift attention from an object to a person and back again
understand whether the other person is focussing on the item of
Before the sighted baby has learned to establish joint attention and
communicate with intention, caregivers are able to attend to what the
baby is interested in by following the baby’s gaze. They can then bring
the object of interest to the baby, or take the baby to the object.
By about 9 months of age, sighted babies can follow an adult's gaze:
they can attend to the same thing as the caregiver. They then learn how
to establish joint attention with another person. With very little or no
vision, learning how to establish joint attention with another person on an
item of interest may be difficult for babies who have visual impairment.
All three steps present major barriers to babies who have visual
may be unaware of the presence of things to be interested in
may be unaware that there is another person present whose
attention could be drawn to any item of interest
are unable to draw another person’s attention to an item of
interest by transferring their gaze from the person to the item,
which is how sighted babies achieve this.
Babies who have visual impairment may not find it as difficult to pay joint
attention to an item when it is the caregiver who initiates this. However,
when another person initiates joint attention, it is likely that the baby will
only jointly attend to an item that is of very real interest.
It must also be pointed out that responding to another person’s attempt
to establish joint attention is very different from taking the initiative and
establishing joint attention yourself.
It is likely that difficulties with joint attention result in it being more
for babies who have visual impairment to learn the words for objects,
people, events and activities. Sighted babies begin to learn what some
frequently-used words mean because they repeatedly hear each word as
they see the appropriate object, person, event or activity.
However, the difficulties with learning what words mean may not be as
significant as the difficulties with establishing joint attention. Joint
attention is a crucial communication skill; being without it leads to the
social communication difficulties typical of children with autism.
It is not always easy to determine whether a baby can communicate
intentionally. Perhaps the most obvious context for observing intentional
communication is that of requesting. The ability to request an item is
closely related to that of establishing joint attention, discussed in the
The following behaviours indicate intentionality in a baby:
alternating eye gaze between an item that is wanted and
moving close to another person before trying to get a response
from him or her
indicating desire by vocalising
waiting for a response from the other person
being persistent: continuing to indicate desire until the wanted
item is obtained or failure is indicated
trying one behaviour and then another if the first fails
ceasing to indicate desire when the wanted item is obtained
displaying satisfaction when the wanted item is obtained, or
dissatisfaction when it is not.
The baby who has visual impairment is therefore at a disadvantage, as is
the baby who is not mobile.
With very little or no vision, communicating intentionally may be difficult
for babies who have visual impairment. The barriers for them are similar
to those which make it difficult for them to establish joint attention: babies
who have visual impairment
being unaware of the presence of things to be interested in,
may lack the desire for anything, and therefore have no need to
make a request
may be unaware that there is another person present to whom
they could address their request
are unable to draw another person’s attention to an item they
desire by alternating eye gaze between the item and the
Typical babies learn to make requests before they are independently
mobile. In some babies who have visual impairment, this is reversed:
they become independently mobile before they learn how to request;
thus they are able to obtain objects independently, and therefore have
less need to communicate than typically developing children. This may
be serious, contributing to significant social communication difficulties
Newborn babies who are sighted have complex behaviours for
interacting with and eliciting nurturing responses from caregivers. We
now know that typical babies develop as they do because caregivers
respond to their behaviour. Babies seemed to be programmed to behave
in certain ways and adults, when caring for babies, seem to be
programmed to respond appropriately.
However, babies who have visual impairment do not behave as
expected, making it more difficult for caregivers to provide appropriate
responses. For example, babies who have visual impairment may
not look towards caregivers
not return gaze (or not do so readily)
adopt a passive expression when spoken to
not smile in the way sighted babies do
startle on being picked up
not vocalise as sighted babies do
not show as much interest in the world as sighted babies
have difficulty sharing attention.
There is evidence that caregivers adopt a different pattern of childrearing
when confronted with the task of bringing up a baby who has
For example, babies who have visual impairment experience a greater
'ignoring rate'. This may mean the baby feels unable to control the
environment. In turn, this may lead to withdrawing from the environment
and, possibly, the development of self-stimulatory behaviours.
But even if a caregiver watches the baby who has visual impairment a
great deal, the baby will not be aware of this, unless the caregiver also
demonstrates to the baby in a non-visual way that he / she is attending.
Sighted babies explore more when they are aware of being observed by
a caregiver. Babies who have visual impairment may explore less and
feel less secure because they do not know that they are being observed.
Caregivers of babies who have visual impairment
look at their babies less, so they may miss some of the cues the
vocalise less in a positive manner
give fewer positive responses when the baby initiates (except
when the baby smiles).
Although the baby who has visual impairment may behave in ways which
could signal attention and interest, the baby’s movements may be very
slight (e.g. when attending to a sound) and difficult for caregivers to
notice. If a baby’s face and body are immobile, caregivers are likely to
think the baby is not interested. However, such immobility in a baby who
has visual impairment may be due to the baby concentrating.
Caregivers of a baby who has visual impairment are deprived of many of
the rewards obtained from a sighted baby. As already noted, babies who
have visual impairment
are unlikely to look towards people, and very unlikely to make
smile differently from sighted babies
may startle on being picked up
do not excitedly anticipate being picked
vocalise and babble less than sighted babies
tend to be passive and do not explore the world as sighted
babies do, giving the impression they are not interested.
Thus, caregivers of a baby who has visual impairment may have reduced
opportunities to join in with the baby’s activities and maintain and
develop them. As a result of this, caregivers may initiate interaction with
the baby less frequently. The baby is then likely to lack experience of
social interaction, causing difficulties in learning to become a
On the other hand, caregivers may try to coax the baby to make eye
contact, smile and vocalise and may try to stimulate the baby by bringing things
to feel, hear and touch. However, excessive coaxing, persuading
and stimulation reduce opportunities to initiate, so there is a risk that the
baby will become even more passive. A baby who rarely takes the
initiative is unlikely to become an effective communicator.
So, many babies who have visual impairment are doubly disadvantaged
in learning to communicate:
the lack of vision itself presents some significant difficulties
caregivers, by modifying the ways in which they behave with
the baby, may actually increase those difficulties.
It is important to note that a large proportion of children who have visual
impairment also have additional needs. These include
epilepsy and other medical needs.
The precise nature and severity of the additional needs varies widely.
Many children, in addition to visual impairment, have not just one, but a
combination of additional needs. The presence of one additional need
compounds the impact of the visual impairment on the acquisition of
communication. Several areas of additional need clearly have an even
greater impact. A common effect is the extension of the period during
which communication skills develop. Indeed, many children who have
visual impairment and additional needs do not progress beyond the very
early stages of communicative development. It is for this reason that
“baby” has been replaced with “child” in this section.
Of concern here is that many children who have visual impairment and
additional needs face particular difficulties as far as adult responsiveness
is concerned. These difficulties arise from the idiosyncratic ways in which
many of these children behave.
These unconventional behaviours include tongue thrusts, eye blinks and
shifts in position. Some of these behaviours may be communicative. If
they are not currently communicative, responding to them as if they are
may mean they become communicative. Unfortunately, caregivers and
practitioners respond less to unconventional behaviours than to
conventional ones such as vocalisations.
A combination of visual impairment and additional needs can make it
very difficult to interact with the child. For example, some children
do very little, offering caregivers and practitioners few
opportunities to respond
produce few behaviours, interspersed with long pauses, so it is
difficult for caregivers and practitioners to get a feel for the
behave with no rhythm – a behaviour may seem to be
continuous, lasting for a considerable time with no pauses
(e.g. those with cerebral palsy) produce movements which are
jerky and uncoordinated, and therefore difficult to interpret
(e.g. those with autism) behave in ways which can be very
confusing for caregivers and practitioners, who may easily
respond inappropriately from the best of motives
(e.g. both those with cerebral palsy and those with autism) may
take much longer to respond to a stimulus, sometimes making it
difficult for caregivers and practitioners to know whether the
child is responding, and, if so, to what.
Vision plays a predominant part in typical social interaction, and in the
acquisition of communication skills. Babies who have visual impairment
are at risk of taking longer to become effective communicators and some
experience long-term difficulties with communication.
However, having visual impairment does not inevitably lead to significant
difficulties with acquiring communication, and some babies who have
visual impairment become very effective communicators. Outcomes vary
widely, and the reasons are not properly understood.
Factors which affect outcomes seem to include:
the baby’s cognitive and learning abilities
the extent to which caregivers are able to support the baby by
compensating for the lack of vision with alternative ways to
engage in early social interaction and communication
the severity of the visual impairment: even minimal vision, or a
short period of vision early on, seem to be important positive
'The impact of visual impairment on the acquisition of early communication skills'
by IAN BELL
(Specialist Independent Speech and Language Therapist)
Article A - in the series 'Facilitating communication in people who have
visual impairment and additional needs'. All the articles are available to
download from my website at <http://ianpbell.wordpress.com/communication-in-vi-children/>
I have based this article on material used in short courses focussing on
communication in children who have visual impairment and additional
needs. I do not refer to original sources in this article, as I did not do so
in my course material.