Adaptive behavior of children and adolescents with visual impairments

Adaptive behavior of children and adolescents with visual impairments

Konstantinos Papadopoulos a,*, Katerina Metsiou b,1, Ioannis Agaliotis a,2

a Department of Educational and Social Policy, University of Macedonia, 156 Egnatia st., P.O. Box 1591, 54006 Thessaloniki, Greeceb Department of Educational and Social Policy, University of Macedonia, 156 Egnatia st., 54006 Thessaloniki, Greece

1. Introduction

Adaptive behavior has been defined as ‘‘the performance of the daily activities required for personal and socialsufficiency’’ (Sparrow, Balla, & Cicchetti, 1984), as well as ‘‘the ability to meet daily living responsibilities and to respond tothe needs of others’’ (Ditterline & Oakland, 2009). Examples of domains in which individuals strive for sufficiency include:self-help, interpersonal relationships, home-management, recreation, work, and community life (Ditterline, Banner,Oakland, & Becton, 2008).

Adaptive behavior is diverse by definition, as it mirrors a person’s efforts to adjust to the various environmental demandshe/she is faced with (Denrell, 2007). This diversity necessitates the conceptualization of adaptive behavior not only as aunitary construct, but also as a composite one, in order for the results of studies looking at the different expressions ofbehavior to be fully exploited and rightly generalized. An example of how adaptive behavior can be approached both as asingle-dimensional and a multi-dimensional construct is given by one of the most popular instruments of measuringadaptive behavior, namely by the Vineland Adaptive Behavior Scale (VABS) (Sparrow et al., 1984; Sparrow, Balla, & Cicchetti,2005). VABS, which was the instrument used in the present study, measures total adaptive behavior (adaptive behavior

Research in Developmental Disabilities 32 (2011) 1086–1096

A R T I C L E I N F O

Article history:

Received 7 January 2011

Accepted 12 January 2011

Available online 12 February 2011

Keywords:

Visual impairments

Adaptive behavior

Communication

Daily Living Skills

Socialization

A B S T R A C T

The present study explored the total adaptive behavior of children and adolescents with

visual impairments, as well as their adaptive behavior in each of the domains of

Communication, Daily Living Skills, and Socialization. Moreover, the predictors of the

performance and developmental delay in adaptive behavior were investigated.

Instrumentation included an informal questionnaire and the Vineland Adaptive Behavior

Scales (Survey Form). Forty-six children and adolescents with visual impairments

participated. The results reveal the effect of age on total adaptive behavior and on each of

the domains of Communication, Daily Living Skills, and Socialization; the older individuals

with visual impairments present better performance but also a higher rate of delay in

comparison with younger individuals. Moreover, the ability of independent movement is a

predictor of performance and developmental delay on the Daily Living Skills and

Socialization. The more independent the mobility of individuals with visual impairments

is the better the performance and the lower the level of developmental delay. Moreover,

the educational level of parents is a predictor of performance and developmental delay on

the Communication and Socialization. The higher the educational level of parents the

better the performance and the lower the developmental delay.

� 2011 Elsevier Ltd. All rights reserved.

* Corresponding author. Tel.: +30 2310 891403.

E-mail addresses: [email protected] (K. Papadopoulos), [email protected] (K. Metsiou), [email protected] (I. Agaliotis).1 Tel.: +30 2310 891403.2 Tel.: +30 2310 891383.

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composite) as well as adaptive behavior in the domains of Communication, Daily Living Skills, Socialization and Motor Skills(Sparrow et al., 1984).

The issue of adaptive behavior of students with visual impairments is important for purposes of classification andplacement, as well as for program planning and intervention (Ditterline & Oakland, 2009; Meacham, Kline, Stovall, & Sands,1987). Adaptive behaviors are part of the Expanded Core Curriculum (EEC) for learners with visual impairments (seeAmerican Foundation for the Blind, 2010).

Research shows that students with visual impairments may present considerable difficulties in their total adaptivebehavior (Bradway, 1937; Maxfield & Fjeld, 1942; Parsons, 1987) or in each of the sub-domains of Communication (Dodd &Conn, 2000; Douglas, Grimley, Hill, Long, & Tobin, 2002; James & Stojanovik, 2007), Daily Living Skills (Haymes, Johnston, &Heyes, 2002; Lewis & Iselin, 2002), and Socialization (Celeste, 2006; Leyser & Heinze, 2001; Lifshitz, Hen, & Weisse, 2007).

2. Impact of visual impairment on adaptive behavior

Few studies have assessed the total adaptive behavior of children with visual impairments using standardized measures.In the study of Bradway (1937) the Vineland Social Maturity Scale (Doll, 1935) was used to assess children and adolescentswith visual impairments, aged 5 to 20 years. It was pointed out that younger children had an age-appropriate Social Quotient(SQ), but as chronological age increased SQ declined. In the study of Maxfield and Fjeld (1942), an adaptation of VinelandSocial Maturity Scale was used with children with visual impairments aged from 9 months to 7 years. Items that presentedthe greatest difficulties fell into self-help category (eating, dressing) and occupation category (play, cutting with scissors).Moreover, the SQ variability within the group was wide. Parsons (1987) studied adaptive behavior of children withcongenital visual impairments who were all students of a residential school. Using VABS, she found that younger children(under 13 years old) had lower age equivalent scores in daily living skills, socialization and adaptive behavior composite (aglobal measure of an individual’s adaptive functioning).

Summarizing a series of studies, Warren (1994) argues that social adaptation of visually impaired children is influencedby a number of factors traced both to the child’s environment and the visual impairment itself. According to Warren (1994),factors relative to the visual impairment constitute the ‘‘status variables’’ which cannot be modified through intervention.These variables are the severity of the visual impairment, the age of visual loss, the presence of any residual vision, thepresence of additional disabilities, and the cause of the visual impairment.

2.1. Communication

Previous studies have shown that blind children have fewer opportunities to practice their language skills (Kekelis & Prinz,1996), present qualitative difficulties in vocabulary development (Webster & Roe, 1998), and their language is related more topast experiences than to the ongoing activities of their peers, thus leading to breakdowns in communication (Kekelis, 1992).Furthermore, children and adolescents with visual impairments had lower than average performance on language structureand pragmatics (James & Stojanovik, 2007). Moreover, students with visual impairments have been found to use gestureswithout any communicational function for a longer time than their sighted peers. These gestures were negatively correlatedwith the severity of visual impairment, and there was a decline in their use as the school grade increased (Frame, 2000)

According to the findings of project PRISM (Ferrell, 1998), a longitudinal study of developmental patterns of children withvisual impairments aged birth to 5 years, five milestones that required expressive and receptive communication wereacquired within the range for typically developing children. Also, the milestone ‘relating past experiences’ was acquiredearlier than typical children.

In reference to reading performance of children and adolescents with visual impairments, several studies have revealedthat in many cases it is severely compromised, and has a negative impact on these persons’ communicative ability (Dodd &Conn, 2000; Douglas et al., 2002; Douglas, Hill, Long, & Tobin, 2001; van Bon, Adriaansen, Gompel, & Kouwenberg, 2000). Inthe study of van Bon et al. (2000), the participants were 15 blind children who were braille readers. The other three studies(Dodd & Conn, 2000; Douglas et al., 2001, 2002) included a higher number of participants with low vision (between 150 and480 students in approximate) who were allowed to use low vision aids during the administration of the tests.

2.2. Daily living skills

Little information is available concerning the daily living skills of children with visual impairments. Bishop (2004)mentions that sighted children learn many activities of everyday life naturally through imitation (e.g. dressing, washing, andeating). In order to perform these activities, though, they have to possess the necessary motor skills. Thus, children withvisual impairments who have difficulties in observing the activities of others are likely to show a delay in daily living skills.

Jan, Freeman, and Scott (1977) pointed out that children with visual impairments encountered difficulties in dressing,walking, washing and feeding. Children with low vision became independent in these domains earlier compared to blindchildren. Lewis and Iselin (2002) addressed the matter of independent living skills of twenty children (ten with visualimpairments and ten with normal vision), aged 6–9 years. They concluded that the children with visual impairmentsperformed independently only 44% of the 101 daily living activities, compared with 84% of their sighted peers, while the levelof competence was higher for the sighted children.

K. Papadopoulos et al. / Research in Developmental Disabilities 32 (2011) 1086–1096 1087

Lamoureux, Hassell, and Keeffe (2004) found that distance visual acuity, mental and physical health were significantdeterminants of participation in daily activities in adults with impaired vision. These three determinants explained morethan a third of the variance of the overall score. A relationship was also found between distance visual acuity and restrictionof participation. Distance visual acuity was a significant risk factor for self-reported difficulty with everyday activities andphysical function.

Hapeman, Ottowitz, and McLennan (2008) presented a case of cooking training for high school students with visualimpairments. The school worked collaboratively with a community agency that provided rehabilitation services to adultswith visual impairments. Nineteen students aged fourteen to 21 years old participated during the years 2005–2006. Manystudents had additional disabilities. Firstly, students with the instruction of teachers set the cooking goals. Various activitieswere arranged, such as shopping, usage of cooking items and menu preparation. Kitchen safety received special attentionduring the training and adaptations were made according to the individual needs of the students (visual, cognitive andphysical). Hapeman et al. (2008) stress the cooperation and partnership developed among the students, the cooking skillsthey acquired and the opportunity to exercise their skills through a luncheon organized.

2.3. Socialization

Children with disabilities appear to be more prone to social isolation because of fewer positive responses to theirinitiatives for social interaction or because of their fewer attempts to engage in social interactions. Thus, children withdisabilities demonstrate less interest in their peers, which results to the social isolation (Celeste & Grum, 2010).

Individuals with visual impairments present deficits in socialization (Celeste, 2006; Kekelis, 1992; Kekelis & Sacks, 1992;Kroksmark & Nordell, 2001; Leyser & Heinze, 2001; Lifshitz et al., 2007; Mulford, 1983; Pring, Dewart, & Brockbank, 1998;Rosenblum, 1998; Sacks, 2006; Tinti, 2003). In contrast to sighted children, who develop socially by observing interactions indifferent contexts, children with visual impairments have limited opportunities to learn social skills incidentally (Sacks,2006). Eye contact, gestures, facial expressions and contextual information are some important facets of social interactions,which are influenced by vision (Kekelis, 1992). According to Mulford (1983), blind children might use socially unacceptablemeans in order to get and maintain the listener’s attention; moreover, they ask many questions, which are irrelevant to theactivities that take place in their surroundings. Furthermore, blind children have been found to exhibit more frequent andsocially unmasked facial expressions than sighted children, probably due to the less control these children exert over theirfacial expressions in comparison to their sighted counterparts (Tinti, 2003).

According to Kekelis and Sacks (1992), only a small percentage of children with visual impairments gained socialacceptance or participated in social interactions in general education environments. According to Webster and Roe (1998),children with visual impairments display more solitary and manipulative play than symbolic one in play activities.Moreover, Celeste (2006) mentions that in social interactions these children prefer adults over peers.

On the other hand, George and Duquette (2006) refer to a case study in which the psychosocial experiences of apreadolescent boy with low vision were examined. It was found that the student enjoyed social success in the school and thecommunity. This finding is emphasizing the heterogeneity among the population of students with visual impairments.

Rosenblum (1998) investigated the best friendships of adolescents with visual impairments. There was evidence thatadolescents with visual impairments could establish intimate friendships, although the visual impairment affected theirmutual activities on some occasions (e.g. going to the cinema and participating in sports). Moreover, adolescents with visualimpairments reported a smaller number of best friends than their best friends themselves, while 30% of the best friends ofadolescents with visual impairments had also disabilities (Rosenblum, 1998). In a study by Lifshitz et al. (2007), adolescentswith visual impairments spent less leisure time with their friends than did the sighted adolescents. In addition, Kroksmarkand Nordell (2001) reported that adolescents with low vision performed fewer leisure activities, which were also morepassive (e.g. watching television and doing homework).

A major concern of the parents of children with visual impairments is their need to travel quite a long distance to providespecial services to their children. Thus, their children’s participation in extracurricular and community activities is impeded,leading to their social isolation (Leyser & Heinze, 2001).

3. Study

The aim of the present study was to examine the adaptive behavior of children and adolescents with visual impairments.To this end, the performance of children and adolescents with visual impairments was compared to the performance ofsighted ones and to that of individuals with visual impairments, according to the norms provided by the instrument used. Inaddition, the predictors of the performance and developmental delay in adaptive behavior were investigated.

4. Method

4.1. Participants

The sample derives from the country’s two largest cities (Athens and Thessaloniki), which have approximately 5 and 1million inhabitants respectively. The researchers obtained from the Local Educational Authorities a list of primary school

K. Papadopoulos et al. / Research in Developmental Disabilities 32 (2011) 1086–10961088

students with visual impairments, who attended either a special school for individuals with visual impairments or amainstream school. Then the researchers contacted the parents/caregivers and the teachers of these students, explainedthem the aim of the study and asked them to participate in it. Prerequisite for including a student in the study was theabsence of any additional disabilities, apart from the visual impairment. Prerequisite for including an adult was theircapability of providing the researchers with accurate information on each child with visual impairments and their consent toparticipate in the research. Forty-six children and adolescents with visual impairments (blind and individuals with lowvision), who fulfilled the above preconditions finally participated in the study. Twenty-six of the participants were boys(56.5%) and 20 girls (43.5%), aged from 5 years and 4 months to 18 years old (M = 12.24, SD = 3.77). Twenty-seven (58.7%) ofthe participants were blind (visual acuity worse than 20/400), and 19 (41.3%) of the participants were individuals withresidual vision (visual acuity better than 20/400). In thirty-four participants the vision loss has existed since birth, in 6individuals it occurred before they were 3 years old, in 5 individuals between the ages of three and six and in the remaining 3participants the loss of vision occurred after the age of six. Concerning the educative level, 4 of the participants werepreschool-students, 25 of the participants are primary school-students, 9 are secondary school students and 8 are highschool students. The majority of the individuals (n = 37) were living with their families, whereas some of them (n = 9) wereliving in residential facilities.

4.2. Measures

The Vineland Adaptive Behavior Scales (VABS) —Survey Form (Sparrow et al., 1984) and an informal questionnaire wereused for collecting the data.

Selection of VABS (Sparrow et al., 1984) for data gathering in the present study was based on the fact that it containsnorms for individuals with visual impairments. Moreover, VABS provides information for both the total adaptive behaviorand the domains and sub-domains it examines. Meacham et al. (1987) have alleged the fact that VABS is appropriate for theassessment of individuals with visual impairment. In their review of adaptive behavior instruments, Meacham et al. (1987)mention a variety of measures that have been used in the research of children with visual impairments and recommend thatthe VABS is an appropriate instrument for this population.

The decision to use the 1984 edition of VABS instead of the one of 2005 (Sparrow et al., 2005) was based on the extensiveuse of various forms of this particular edition in studies involving both participants with visual impairments (e.g. Celeste,2006, 2007) and participants with other impairments or disabilities (e.g. Baker-Ericzen, Stahmer, & Burns, 2007; Gabriels,Ivers, Hill, Agnew, & McNeill, 2007; Jahr, Eikeseth, Eldevik, & Aase, 2007; Klin et al., 2007; Roberts, Weisenfeld, Hatton, Heath,& Kaufmann, 2007; Saulnier & Klin, 2007).

The VABS assesses personal and social sufficiency of individuals from birth to adulthood. The Survey Form is administeredin the form of a semi-structured interview to an adult respondent who is familiar with the individual’s behavior.

The norms of the Survey Form were based on a national standardization sample of 3000 individuals between birthand 18 years 11 months. On the other hand, the supplementary norm groups of the Survey Form consisted of nationalsamples of individuals with disabilities. The supplementary norms for children with visual impairments included 200children, aged from 6 years to 12 years, 11 months and 30 days, who were clients of residential facilities(Sparrow et al.,1984).

The VABS measures total adaptive behavior (Adaptive Behavior Composite) as well as adaptive behavior in the followingfour domains and eleven sub-domains: Communication (Receptive, Expressive, Written), Daily Living Skills (Personal,Domestic, Community), Socialization (Interpersonal Relationships, Play and Leisure Time, Coping Skills) and Motor Skills(Gross and Fine).

Motor skills sub-scale can be administered optionally for ages over 6 years old, as it was found that motor development ofthe standardization sample reaches a peak at that age, showing little growth beyond this point. When the subjects of aresearch using VABS are individuals aged 6 years old or more – as it is the case in the present study – the Adaptive BehaviorComposite results from the sum of standard scores of the three adaptive behavior domains only (Communication, DailyLiving Skills and Socialization) (Sparrow et al., 1984).

In the present study, the Survey Form of the VABS was translated into Greek by two specialists in the field of SpecialEducation. A back-translation from Greek to English followed by a native speaker of English language. Then, a comparisonwas made between the original scale and the back-translated scale on the basis of their conceptual equivalence. The non-equivalent items were corrected and retranslated. Examples (sample items) of way VABS was finally worded are: reads atleast 10 words silently or aloud (communication domain), bathes or showers without assistance (daily living skills domain),participates in non-school sports (socialization domain).

The informal questionnaire used in the present study was structured by the researchers, and includes questions about thefollowing demographic/personal data of the participants: gender, age, age at loss of sight, vision status, place of residence,ability of independent movement, educational level of parents, brothers and sisters (number), brothers or/and sisters withvisual impairments, brothers or/and sisters without visual impairments, completion of orientation and mobility trainingprograms or/and programs in daily living skills.

With regard to the participants’ ability for independent movement, the question posed was ‘‘how frequently do you moveindependently, without a sighted guide?’’ which was answered using a 4-point scale (1 = seldom moves by him-/herself,2 = sometimes moves by him-/herself, 3 = usually moves by him-/herself and 4 = always moves by him-/herself). On the basis


of the answers two groups of participants were created: the first group included the participants that move independentlyalways or usually, and the second group the participants that move independently sometimes or rarely.

4.3. Procedure

In the present study, the ethical principles of Declaration of Helsinki have been followed. Additionally, consent wasobtained from the subjects, using the appropriate forms and according to the procedure suggested by the World MedicalAssociation.

The informal questionnaire was administered firstly and the interview using the Survey Form of the VABS followed. Allthe interviews were conducted individually. The questions about the demographic characteristics were administered to aparent or a member of the school personnel that could provide accurate information. The interviews using the Survey Formof the VABS were conducted individually with a parent or a member of the school personnel. More specifically, for 17participants the respondent was a parent, for 18 participants a teacher, for 5 participants a psychologist, for 4 participants asocial worker and for 2 participants a (school) nurse. All the interviewees were in every-day contact with children andadolescents with visual impairments.

The administration and scoring of the VABS scale followed the recommended procedures of the manual. More specifically,the starting point for each individual was based on his/her chronological age, as in most occasions there were no other dataconcerning mental or social age to determine a different starting point. Each item of the Survey Form may be scored with 2when the activity is satisfactorily or habitually performed, although in a somewhat different way because of a disability (e.g.the use of braille by students with visual impairments), with 1 when the activity is performed sometimes or with partialsuccess and with 0 when it is never performed due to a sensory disability or a number of other reasons. An example is thedifficulty engaging in sports for an individual with a physical disability (Sparrow et al., 1984). In addition, a score of N for ‘‘Noopportunity’’ is assigned when the activity is not performed because of limiting external circumstances, and a score of DK for‘‘Don’t know’’ when the respondent has no knowledge of the individual’s performance in a behavior or skill.

5. Results

The adaptive level for Adaptive Behavior Composite, as well as the adaptive level for each domain (Communication, DailyLiving Skills, and Socialization) and each sub-domain was calculated (see Table 1). Adaptive levels represent a non-numerical, qualitative, categorical classification system. Adaptive levels for domains and Adaptive Behavior Composite fornational standardization sample consist of five descriptive categories (high, moderately high, adequate, moderately low, andlow). In the present analysis these categories valued as follows: 1 = low, 1.5 = moderately low, 2 = adequate, 2.5 = moderatelyhigh, 3 = high. Adaptive levels for supplementary norm groups consist of three descriptive categories (above average,average, below average). In the present analysis these categories valued as follows: 1 = below average, 2 = average, 3 = aboveaverage (see Table 1).

In order to determine the predictors of the performance (raw scores) two analyses were performed. Firstly, the Pearson’sproduct-moment correlation coefficients (see Table 2) between the raw scores in each domain and various variables werecalculated. Then, the variables that showed statistically significant correlations with the raw scores were used as possiblepredictors in three linear multiple regression analyses, in order to define the predictors of performance in each domain.

In particular, the Pearson’s product–moment correlation coefficients between the raw scores in each domain and thefollowing variables were calculated: gender (male vs. female), age, age at loss of sight, vision status (blindness vs. lowvision), place of residence (home vs. residential setting), ability of independent movement (moves independently alwaysor usually vs. moves independently sometimes or rarely), educational level of parents, brothers or/and sisters (yes/no),brothers or/and sisters with visual impairments (yes/no), brothers or/and sisters without visual impairments (yes/no),

Table 1

Means (M) and standard deviations (SD) of the adaptive level concerning the national and supplementary norms.

National norms Supplementary norms

N M SD N M SD

Adaptive behavior (total) 46 1.35 .38 25 2.76 .44

Communication 46 1.44 .42 25 2.84 .37

Receptive 46 1.95 .19 25 2.72 .46

Expressive 46 1.73 .36 25 2.72 .46

Written 46 1.50 .38 25 2.60 .50

Daily living 46 1.32 .41 25 2.72 .46

Personal 46 1.59 .52 25 2.44 .51

Domestic 46 1.36 .42 25 2.60 .58

Community 46 1.52 .43 25 2.72 .46

Socialization 46 1.79 .39 25 2.96 .20

Interpersonal relationships 46 1.79 .29 25 2.72 .46

Play and leisure Time 46 1.87 .34 25 2.96 .20

coping skills 46 1.75 .33 25 2.72 .46


completion of orientation and mobility training programs or/and programs in daily living skills (yes/no). For the calculationof the Pearson’s product-moment correlation coefficients the method of first-order Partial Correlation Analysis was used,using the variable ‘‘age’’ as control variable, because the relationship between age and adaptive skills is indisputable(Parsons, 1987; Sparrow et al., 1984). Additionally, in the present study there was a strong correlation between the age ofthe participants and their performance (raw scores) in the domains of Communication (r = .656, p< .01), Daily Living Skills(r = .729, p< .01), and Socialization (r = .715, p< .01). The educational setting was not used as a possible predictor, as inGreece secondary special education units for children with visual impairments (high school, lyceum) do not exist. Thus, it isnot possible to make comparisons based on the sample of our study, which includes 17 students of secondary schools withvisual impairments.

Then, the variables that correlated with the raw scores were included in three linear multiple regression analyses topredict the performance in each domain. These variables are age, ability of independent movement, and educational level ofparents.

Concerning the performance in communication, the analysis yielded an adjusted R2 of 0.507 (F = 16.086, p< .01).Significant individual predictors of raw scores in communication were age (b = .683, p< .01) and the educational levelof parents (b = .335, p< .01) (Table 3). Concerning the performance in daily living skills, the analysis yielded an adjusted R2 of0.578 (F = 21.052, p< .01). Significant individual predictors of performance were age (b = .658, p< .01) and ability ofindependent movement (b = .261, p< .05) (Table 4). Regarding the performance in socialization, the analysis yielded anadjusted R2 of 0.638 (F = 26.854, p< .01). Significant individual predictors of performance were age (b = .667, p< .01), abilityof independent movement (b = .249, p< .05) and the educational level of parents (b = .280, p< .01) (Table 5).

Raw scores represent the performance of the participants in each domain, but they do not represent the delay in eachdomain. For instance, it is predictable that the performance improves with the age. However, no one could deduce that withthe increase of age there may appear a reduction to the delay. Thus, it is useful to examine in which way age is related todelay and which are the factors that influence delay in each domain.

In order to calculate the delay age equivalents were used. The age equivalent represents the raw score that was theaverage performance of individuals of a given chronological age in the national standardization sample (Sparrow et al.,1984). For example, an age equivalent of 7–10 (7 years 10 months) indicates that the raw score corresponding to the ageequivalent was the average raw score for individuals aged 7 years 10 months in the standardization sample (Sparrow et al.,1984). Age equivalents range from 0 years 1 month to 18 years 11 months and are available for the adaptive behaviordomains and sub-domains. The age equivalent for the Adaptive Behavior Composite is the mean or median of the ageequivalents for the domains. By subtracting age equivalent from the participants’ actual age, the variable ‘‘delay’’ was

Table 2

Pearson’s product–moment correlation coefficients revealed by partial correlation analyses using the age as controlling variable.

Raw scores (communication) Raw scores (daily living) Raw scores (socialization)

Gender .269 .233 .066

Vision status .120 .202 .110

Age at onset �.107 .070 .013

Independent movement .108 .298* .378*

Place of residence .230 .033 .193

Completion of training programs .066 .022 .104

Educational level of parents .446** .211 .458**

Brothers/sisters �.059 �.028 �.025

Brothers/sisters with VI �.099 �.165 �.049

Brothers/sisters without VI .196 .228 .229* p< .05.** p< .01.

Table 3

Linear multiple regression for variables as predictors of performance in communication.

Variable B Std. error b T p

Age 2.665 .439 .683 6.074 .000

Independent movement .772 3.359 .026 .230 .819

Educational level of parents 3.772 1.219 .335 3.093 .004

Note: Adjusted R2 = .507, p< .01.

Table 4

Linear multiple regression for variables as predictors of performance in daily living skills.


Age 4.429 .700 .658 6.328 .000

Independent movement 13.402 5.359 .261 2.501 .016

Educational level of parents 1.925 1.945 .099 .990 .328



calculated. Calculations included developmental delay: (a) in total adaptive behavior and (b) in each domain(Communication, Daily Living Skills, Socialization) separately.

Moreover, the variables of age, ability of independent movement and educational level of parents, which were also usedin the previous analysis, were used in four linear multiple regression analyses to predict the developmental delay in eachdomain, as well as the developmental delay in Adaptive Behavior Composite.

Concerning the developmental delay in total adaptive behavior, the analysis yielded an adjusted R2 of 0.672 (F = 31.044,p< .01). Significant individual predictors of delay were age (b = .777, p< .01), ability of independent movement (b =�.296,p< .01) and the educational level of parents (b =�.266, p< .01) (see Table 6). Concerning the delay in communication, theanalysis yielded an adjusted R2 of 0.776 (F = 51.862, p< .01). Significant individual predictors of delay in communicationwere age (b = .851, p< .01) and the educational level of parents (b =�.230, p< .01) (Table 7). Concerning the delay in dailyliving skills, the analysis yielded an adjusted R2 of 0.584 (F = 21.625, p< .01). Significant individual predictors of delay wereage (b = .779, p< .01) and ability of independent movement (b =�.383, p< .01) (Table 8). Regarding the delay insocialization, the analysis yielded an adjusted R2 of 0.498 (F = 15.521, p< .01). Significant individual predictors of delay wereage (b = .532, p< .01), ability of independent movement (b =�.373, p< .01) and the educational level of parents (b =�.377,p< .01) (Table 9)

6. Discussion

The aims of the present study were to examine the adaptive behavior of children and adolescents with visualimpairments, as well as to examine the predictors of performance and developmental delay in adaptive behavior. Thedescriptive statistics revealed that the total adaptive behavior level of participants is between ‘‘low’’ and ‘‘moderately low’’(M = 1.35). The adaptive level for domains ranged approximately from 1.32 for daily living skills domain to 1.79 forsocialization domain. Concerning the supplementary norms, the total adaptive level of participants is between ‘‘average’’ and‘‘above average’’ (M = 2.76). The adaptive level for domains ranged approximately from 2.72 for daily living skills domain to2.96 for socialization domain (see Table 1).

Table 5

Linear multiple regression for variables as predictors of performance in socialization.


Age 2.370 .342 .667 6.932 .000

Independent movement 6.749 2.618 .249 2.578 .014

Educational level of parents 2.860 .950 .280 3.010 .004

Note. Adjusted R2 = .638, p< .01.

Table 6

Linear multiple regression for variables as predictors of developmental delay in adaptive behavior (total).


Age .538 .063 .777 8.478 .000

Independent movement �1.564 .486 �.296 �3.219 .003

Educational level of parents �.530 .176 �.266 �3.003 .005


Table 7

Linear multiple regression for variables as predictors of developmental delay in communication.


Age .648 .058 .851 11.244 .000

Independent movement �.499 .441 �.086 �1.131 .265



Table 8

Linear multiple regression for variables as predictors of developmental delay in daily living skills.


Age .588 .078 .779 7.552 .000


Educational level of parents �.207 .216 �.095 �.957 .344



The participants’ lowest adaptive level appeared in the domain of daily living skills. Because of the paramountimportance of these skills in the context of everyday activities, their instruction in school should be intense and aimed atkey abilities, like orientation and mobility (Ponchillia & Ponchillia, 1996). Research shows that a comprehensive programaimed at living skills may prove effective (Pavey, Douglas, McLinden, & McCall, 2003), provided that it will take intoconsideration important parameters, like the environmental and individual factors, which may be associated with thevisual impairment, (Lewis & Iselin, 2002), the stimulation offered in the child’s environment (Jan et al., 1977), as well as thepositive attitudes and the opportunities that parents create for the enhancement of these skills (Douglas, Pavey, McLinden,& McCall, 2003).

In reference to communication, the lowest performance occurs in the sub-domain ‘‘Written’’. ‘‘Written’’ sub-domain inthe VABS examines various skills, including reading ability in different kinds of texts (simple stories, magazines and schooltexts). Previous studies have noticed also difficulties in reading performance for children and adolescents with visualimpairments, both braille readers and students using low vision aids (Dodd & Conn, 2000; Douglas et al., 2001, 2002; van Bonet al., 2000). In addition, braille readers may have difficulty in finding written material in braille, so as to exercise theirreading skills.

In the daily living skills domain, the lowest performance occurs in the sub-domain ‘‘Domestic’’. The lowest performancein the sub-domain ‘‘Domestic’’ compared to the ‘‘Personal’’ and ‘‘Community’’ sub-domains could be explained by theoverprotectiveness of the parents of children with visual impairments, and the expectations they held for the abilities of theirchildren. In particular, as appeared in the process of the personal interviews, some parents viewed domestic skills (e.g.cleaning his/her own room or house, sweeping, using cleaning products, using the oven, cooking, sewing buttons) as moredifficult and dangerous than the other daily living skills. They referred feelings of fear and insecurity if their children were tobe engaged in these tasks. Another reason could be that parents view as more imperative the need to teach to their childrenpersonal skills, such as dressing, washing and eating. It is important to notice, as well, that domestic skills require morespecialized training, which in Greece can be provided only in a special school for children with visual impairments. Hapemanet al. (2008) also stress the need for targeted instruction in cooking skills.

In reference to socialization, the lowest performance occurs in the sub-domain ‘‘Coping Skills’’. Concerning ‘‘CopingSkills’’ sub-domain, high performance may require more independent and responsible behavior on the part of the childin comparison with the ‘‘Play and Leisure Time’’ and ‘‘Interpersonal Relationships’’ sub-domains. Examples of copingskills are the following: independently weights consequences of actions before making decisions, apologizes formistakes, keeps secrets and controls anger. Other examples of coping skills such as making appropriate comments andending conversations appropriately may be more difficult for children with visual impairments as they depend onvisual feedback.

The results of linear multiple regression analyses reveal the effect of age, both on total adaptive behavior and on each ofthe domains of Communication, Daily Living Skills, and Socialization—the older individuals with visual impairments presentbetter performance but also a higher rate of delay in comparison with younger individuals.

Comparing Parson’s (1987) results with the results of the present study, an agreement can be observed. Namely, theaverage sum of raw scores and the average age equivalents of younger children are lower than those performed by olderchildren. Parsons does not provide any further information regarding the average age of the two age groups participating inher study, in order to confirm the group with the greater delay. The lower age equivalents for the younger children do notnecessarily signify a greater delay than older children. According to Doll (1953), adaptive behavior is developmental innature, as it varies according to the individual’s age. Consequently, it is predictable that older children will possess increasedand more complex adaptive skills than younger children. Sparrow et al. (1984) mention that adaptive skills increase andbecome more complex as an individual grows older. Therefore, lower age equivalents for the younger children are anexpected finding. Moreover, it can be assumed that the results in Parsons’ study are affected by the higher percentage ofparticipants with low vision, whereas as Parsons noticed, the sample of her study was heterogeneous, thus leading to limitedgeneralization of the results to children that attend other than residential schools.

The effect of age on developmental delay may be attributed either to the progressive increase of the difficulty level of theskills evaluated through the VABS or to the insufficient education of the students with visual impairments. Obviously, visionplays an important role in the acquisition of adaptive skills at all age levels, but its importance may become critical in thecase of complex skills usually used at older ages. Insufficient education may be another explanation for the higher rate ofdelay presented by older students with visual impairments, as scholastic achievement is often over-emphasized in school tothe detriment of adaptive behavior. Of course, a combination of both reasons may also be a basis for the explanation of thisfinding, which should be further pursued in future research.

Table 9

Linear multiple regression for variables as predictors of developmental delay in socialization.


Age .416 .089 .532 4.690 .000





According to the results, the ability of independent movement is a predictor of performance and of developmental delayon the Daily Living Skills and Socialization. The more often individuals with visual impairment move the better theperformance and the lower the level of the developmental delay. High frequency of independent movement provides thechild with opportunities to participate in social circumstances, and to move into the community in general. Thus, the childcan exercise a range of social skills and, also, participate in leisure time activities. Concerning daily living skills, the ability ofindependent movement is a prerequisite for the completion of many daily activities without assistance. As Bishop (2004)mentioned, sighted children have to possess the necessary motor skills in order to perform activities of everyday life (e.g.dressing, washing, and eating) that they learn naturally through imitation. Thus, children with visual impairments who havedifficulties in observing the activities of others are likely to show a delay in daily living skills.

According to the results, the educational level of parents is a predictor of performance and developmental delay on theCommunication and Socialization. The higher the educational level of parents the better the performance and the lower thelevel of the developmental delay. The effect of educational level of parents on adaptive behavior domain and AdaptiveBehavior Composite standard scores was observed also during the standardization procedure of the VABS. Specifically,Sparrow et al. (1984) found that standard score means increased with the level of parental education in a range from about 6to 10 points. They also mention that for the Daily Living Skills domain the increase between the lowest and the highesteducational categories was slight (approximately 2 points). As Sparrow et al. (1984) comment ‘‘differences in scores betweencategories of socioeconomic status, such as parental education, are often found in measures of human development orbehavior, but the differences exhibited for Vineland scores are much smaller than the differences reported for intelligencetest scores.’’

The performance and difficulties of the children and adolescents with visual impairments in the aforementioned adaptivebehavior domains, stress the importance of the instruction of the necessary skills in the school context. Wagner (2004)developed and implemented a curriculum for the development of social competence of students with visual impairments.Four major units constitute the framework of this curriculum: (a) Career education, which includes information onemployment as well as practical training in a structured and natural environment. (b) Social interaction and leisureactivities, which involve the instruction of strategies for interaction with the others and information on recreationalopportunities. (c) Personal management and self-care, which refer to the description of visual impairments and theirlimitations and encompasses information on proper behavior. (d) Activities of daily living in combination with theorientation and mobility, which include the provision of firsthand experiences, both positive and negative. According toWebster and Roe (1998), the concept of lifetime learning has to gain a prominent position in the education and rehabilitationof individuals with special needs. Lifetime learning refers to the provision of learning opportunities in the school context andbeyond school, so that each individual can gain appropriate and meaningful personal, social, academic and vocational skillsin order to correspond to the demands of the society. Moreover, the instruction of these skills can increase personaleffectiveness and independence, self-direction, vocational awareness and self-advocacy.

The findings of the present study may be useful for the Expanded Core Curriculum (EEC). Expanded Core Curriculum is apromising, though challenging, instructional proposal, which sets a framework that can support students with visualimpairments achieve their full potential. Parameters of adaptive behavior may be a target of ECC which is an addition to theCore Curriculum (see American Foundation for the Blind, 2010). ECC is specific to the needs of children with visualimpairments and includes additional learning experiences such as: compensatory or access skills, orientation and mobilityskill, social interaction skills, independent living skills, recreation and leisure skills, career education, assistive technologyand technology skills, sensory efficiency skills, and self-determination (American Foundation for the Blind, 2010; Lohmeier,Blankenship & Hatlen, 2009). ECC must receive equal attention to the core curriculum and must be individualized to theneeds for each student with visual impairments. It is emphasized that the need for these additional skills does not diminishwith age or competency (Hatlen, 1996). According to Bishop (2004), ECC has a threefold purpose. First, to eliminate or reducethe possible developmental delays a visual impairment causes, secondly, to provide additional and compensatory skills tostudents with visual impairments so that they can compete on equal terms with their sighted peers, and third, to help thestudents with visual impairments achieve their full potential. Lohmeier et al. (2009) suggested that significant changes weremade 12 years since the ECC has been proposed, as both parents and professionals recognize the importance and the need forinstruction in ECC areas.

The VABS has already been used in non-English-speaking countries (see Goldberg, Dill, Shin, & Viet Nhan, 2009). However,it is probably the first time that VABS is applied to a sample of people with visual impairments in a non-English-speakingcountry. For that reason, the findings of the present study could prove to be particularly useful, although they should beinterpreted with caution.

7. Limitations

A probable limitation of this study is the size of the sample. A larger sample would allow the examination of othervariables’ influence (e.g. parents’ acceptance of and attitudes towards the child, the emotional environment, thesocioeconomic status of the family, the hospitalization due to the visual impairment, the learning opportunities, and thepattern of interactions between the child and others). Another limitation may result from the fact that the Survey form is notnormed for mainstream settings, but in residential settings. Generally the issue of instrumentation deserves deliberation, asWolffe and Sacks (2000) suggested that beside formal tools (like VABS) some other techniques could also be used to assess


social skills of sighted children and children with visual impairments. Future research, then, in the field of adaptive behaviorfor children with visual impairments could apply a combination of formal and informal tools. Examples of such techniquesare observations, interviews, situational role-plays, problem-solving scenarios, student self-evaluations, assessmentchecklists and sociometric techniques.

References

American Foundation for the Blind. (2010). The expanded core curriculum for blind and VI children and youths. Retrieved October 2, 2010, from the World Wide Web:http://www.afb.org/Section.asp?SectionID=44&TopicID=189&SubTopicID=4&DocumentID=2117.

Baker-Ericzen, M. J., Stahmer, A. C., & Burns, A. (2007). Child demographics associated with outcomes in a community-based pivotal response training program.Journal of Positive Behavior Interventions, 9(1), 52–60.

Bishop, V. (2004). Teaching visually impaired children. Springfield: Charles C Thomas.Bradway, K. P. (1937). Social competence of exceptional children III. The deaf, the blind, and the crippled. Exceptional Children, 4, 64–69.Celeste, M. (2006). Play behaviors and social interactions of a child who is blind: In theory and practice. Journal of Visual Impairment & Blindness, 100(2), 75–90.Celeste, M. (2007). Social skills intervention for a child who is blind. Journal of Visual Impairment & Blindness, 101(9), 521–533.Celeste, M., & Grum, D. K. (2010). Social integration of children with visual impairment: A developmental model. Elementary Education Online, 9(1), 11–22.Denrell, J. (2007). Adaptive learning and risk taking. Psychological Review, 114(1), 177–187.Ditterline, J., Banner, D., Oakland, T., & Becton, D. (2008). Adaptive behavior profiles of students with disabilities. Journal of Applied School Psychology, 24(2), 191–208.Ditterline, J., & Oakland, T. (2009). Relationships between adaptive behavior and impairment. In S. Goldstein & J. Naglieri (Eds.), Assessing impairment: From theory

to practice. Springer.Dodd, B., & Conn, L. (2000). The effect of Braille orthography on blind children’s phonological awareness. Journal of Research in Reading, 23(1), 1–11.Doll, E. A. (1935). A genetic scale of social maturity. The American Journal of Orthopsychiatry, 5, 180–185.Doll, E. A. (1953). Measurement of social competence. Circle Pines: American Guidance Service.Douglas, G., Grimley, M., Hill, E., Long, R., & Tobin, M. (2002). The use of the NARA for assessing the reading ability of children with low vision. British Journal of

Visual Impairment, 20(2), 68–75.Douglas, G., Hill, E., Long, R., & Tobin, M. (2001). The generation of standardized print reading scores for children with low vision in Great Britain. British Journal of

Visual Impairment, 19(1), 35–38.Douglas, G., Pavey, S., McLinden, M., & McCall, S. (2003). An investigation into the mobility and independence needs of children with visual impairment. Part 2: The

delivery of the mobility and independence curriculum. British Journal of Visual Impairment, 21(1), 4–9.Ferrell, K. A. (1998). Project PRISM: A longitudinal study of developmental patterns of children who are visually impaired. Greeley: University of Northern Colorado.Frame, M. J. (2000). The relationship between visual impairment and gestures. Journal of Visual Impairment & Blindness, 94(3), 155–171.Gabriels, R. L., Ivers, B. J., Hill, D. E., Agnew, J. A., & McNeill, J. (2007). Stability of adaptive behaviours in middle-school children with autism spectrum disorders.

Research in Autism Spectrum Disorders, 1, 291–303.George, A. L., & Duquette, C. (2006). The psychosocial experiences of a student with low vision. Journal of Visual Impairment & Blindness, 100(3), 152–163.Goldberg, M. R., Dill, C. A., Shin, J. Y., & Viet Nhan, N. (2009). Reliability and validity of the Vietnamese Vineland Adaptive Behavior Scales with preschool-age

children. Research in Developmental Disabilities, 30, 592–602.Hapeman, J., Ottowitz, J., & McLennan, M. N. (2008). Recipe for success: Education and rehabilitation work together to provide cooking experiences for visually

impaired students. RE:view, 39(4), 193–196.Hatlen, P. (1996). The core curriculum for blind and visually impaired students, including those with additional disabilities. RE:view, 28, 25–32.Haymes, S. A., Johnston, A. W., & Heyes, A. D. (2002). Relationship between vision impairment and ability to perform activities of daily living. Ophthalmic &

Physiological Optics, 22, 79–91.Jahr, E., Eikeseth, S., Eldevik, S., & Aase, H. (2007). Frequency and latency of social interaction in an inclusive kindergarten setting: A comparison between typical

children and children with autism. Autism, 11, 349–363.James, D. M., & Stojanovik, V. (2007). Communication skills in blind children: A preliminary investigation.. Child: Care, Health and Development, 33(1), 4–10.Jan, J. E., Freeman, R. D., & Scott, E. P. (1977). Visual impairment in children and adolescents. New York: Grune & Stratton.Kekelis, L. S. (1992). Peer interactions in childhood: The impact of visual impairment. In S. Z. Sacks, L. S. Kekelis, & R. J. Gaylord-Ross (Eds.), The development of social

skills by blind and visually impaired students: Exploratory studies and strategies. New York: American Foundation for the Blind.Kekelis, L. S., & Sacks, S. Z. (1992). The effects of visual impairment on children’s social interactions in regular education programs. In S. Z. Sacks, L. S. Kekelis, & R. J.

Gaylord-Ross (Eds.), The development of social skills by blind and visually impaired students: Exploratory studies and strategies. New York: American Foundationfor the Blind.

Kekelis, L. S., & Prinz, P. M. (1996). Blind and sighted children with their mothers: The development of discourse skills. Journal of Visual Impairment & Blindness, 90,423–436.

Klin, A., Saulnier, C. A., Sparrow, S. S., Cicchetti, D. V., Volkmar, F. R., & Lord, C. (2007). Social and communication abilities and disabilities in higher functioningindividuals with autism spectrum disorders: The Vineland and the ADOS. Journal of Autism Developmental Disorders, 37, 748–759.

Kroksmark, U., & Nordell, K. (2001). Adolescence: The age of opportunities and obstacles for students with low vision in Sweden. Journal of Visual Impairment &Blindness, 95(4), 213–225.

Lamoureux, E. L., Hassell, J. B., & Keeffe, J. E. (2004). The determinants of participation in activities of daily living in people with impaired vision. American Journal ofOphthalmology, 137(2), 265–270.

Lewis, S., & Iselin, S. A. (2002). A comparison of the independent living skills of primary students with visual impairments and their sighted peers: A pilot study.Journal of Visual Impairment & Blindness, 96(5), 335–344.

Leyser, Y., & Heinze, T. (2001). Perspectives of parents of children who are visually impaired: Implications for the field. RE:view, 33(1), 37–48.Lifshitz, H., Hen, I., & Weisse, I. (2007). Self-concept, adjustment to blindness and quality of friendship among adolescents with visual impairments. Journal of

Visual Impairment & Blindness, 101(2), 96–107.Lohmeier, K, Blankenship, K., & Hatlen, P. (2009). Expanded core curriculum: 12 years later. Journal of Visual Impairment & Blindness, 103(2), 103–112.Maxfield, K. E., & Fjeld, H. A. (1942). The social maturity of the visually handicapped preschool child. Child Development, 13, 1–27.Meacham, F. R., Kline, M. M., Stovall, J. A., & Sands, D. I. (1987). Adaptive behavior and low incidence handicaps: Hearing and visual impairments. The Journal of

Special Education, 21(1), 183–196.Mulford, R. C. (1983). Referential development in blind children. In A. E. Mills (Ed.), Language acquisition in the blind child: Normal and deficient. London:

Groom Helm.Parsons, S. (1987). Locus of control and adaptive behavior in visually impaired children. Journal of Visual Impairment & Blindness, 81(9), 429–432.Pavey, S., Douglas, G., McLinden, M., & McCall, S. (2003). An investigation into the mobility and independence needs of children with visual impairment. Part 1: The

development of a mobility and independence curriculum framework. British Journal of Visual Impairment, 21(1), 4–9.Ponchillia, P. E., & Ponchillia, S. V. (1996). Foundations of rehabilitation teaching with persons who are blind or visually impaired. New York: AFB Press.Pring, L., Dewart, H., & Brockbank, M. (1998). Social cognition in children with visual impairments. Journal of Visual Impairment & Blindness, 92(11), 754–768.Roberts, J. E., Weisenfeld, L. H., Hatton, D. D., Heath, M., & Kaufmann, W. E. (2007). Social approach and autistic behavior in children with Fragile X syndrome.

Journal of Autism Developmental Disorders, 37, 1748–1760.Rosenblum, L. P. (1998). Best friendships of adolescents with visual impairments: A descriptive study. Journal of Visual Impairment & Blindness, 92(9), 593–608.


http://www.afb.org/Section.asp%3FSectionID=44%26TopicID=189%26SubTopicID=4%26DocumentID=2117

Sacks, S. Z. (2006). The development of social skills: A personal perspective. In S. Z. Sacks & K. E. Wolffe (Eds.), Teaching social skills to students with visualimpairments: From theory to practice. New York: American Foundation for the Blind.

Saulnier, C. A., & Klin, A. (2007). Brief report: Social and communication abilities and disabilities in higher functioning individuals with autism and Aspergersyndrome. Journal of Autism Developmental Disorders, 37, 788–793.

Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (1984). Vineland adaptive behavior scales, interview edition survey form. Circle Pines: American Guidance Service.Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (2005). Vineland adaptive behavior scales second edition survey forms manual. AGS Publishing.Tinti, C. (2003). Spontaneous facial expressions in congenitally blind and sighted children aged 8–11. Journal of Visual Impairment & Blindness, 97(7), 418–428.van Bon, W., Adriaansen, L., Gompel, M., & Kouwenberg, I. (2000). The reading and spelling performance of visually impaired Dutch elementary schoolchildren.

Visual Impairment Research, 2(1), 17–31.Wagner, E. (2004). Development and implementation of a curriculum to develop social competence for students with visual impairments in Germany. Journal of

Visual Impairment & Blindness, 98(11), 703–710.Warren, D. H. (1994). Blindness in children: An individual differences approach. New York: Cambridge University Press.Webster, A., & Roe, J. (1998). Children with visual impairments: Social interaction language and learning. London: Routledge.Wolffe, K. E., & Sacks, S. Z. (2000). Focused on (vol. 2): Assessment techniques. New York: American Foundation for the Blind.


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Adaptive behavior of children and adolescents with visual impairments