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Developmental setback in children initially thought to be of normal cognitive potential is a serious complication of severe visual impairment; the prevalence, diagnostic specificity, clinical presentation, and factors that contribute to its genesis require systematic investigation. The findings are reported of a retrospective case review over a 15 year period of children attending the developmental vision clinic at the Wolfson Centre of the Institute of Child Health. One hundred and two children met the inclusion criteria of a period of normal development confirmed at initial assessment when aged less than 16 months, absence of additional disabilities, and follow up to at least 2.5 years of age. Developmental setback in their second or third year occurred in 10 (31%) of 32 children who were totally blind throughout (minimal perception of light or less), one (4%) of 25 who, though blind at first assessment, showed visual improvement, and none of 49 children with better vision throughout (awareness for near, large objects). This represents a significantly greater risk for totally blind children than for the other groups. The course and characteristics of the affected children varied, but all had visual diagnoses involving the nervous elements of the visual system, and 60% had major social adversity factors. The role of primary maldevelopment of the central nervous system, the degree of visual impairment, the developmental and emotional climate, and the stage of attentional and behavioural development in the causation of adverse developmental outcome are discussed.

This paper presents a comparison of the early language of nine blind and nine severely visually impaired children, with no other impairments, who were recruited from paediatric vision clinics in London and assessed in the second and third year of life using the Reynell-Zinkin Developmental Scales. Further information on milestones and content of early expressive language was obtained from parents' diary recordings of their children's emerging words. It is concluded that severely visually impaired children's expressive language tends to develop later than that of sighted children. The effect of children having even a small amount of vision could be discerned in their early words. The developmental course appears to be particularly variable for blind children, with implications for parental counselling.

Much recent research on families bringing up a disabled child has explored their coping strategies to deal with stress. The major findings are reviewed, and possible implications for the structure and content of service delivery suggested. The paper emphasizes the importance of social support networks, including the relationship between the mother and father, and of quality services in enhancing parental adaptation.

This paper describes the organisation and procedures of the Communication Aids Centre for children at the Wolfson Centre, London, including a model for assessment and recommendation of appropriate aids, such as symbol charts, switches and speech synthesisers. Of the children seen over an 18-month period, most had cerebral palsy and two-thirds were wheelchair-dependent. Almost half were assessed before the age of five years. A detailed follow-up of nine children is presented which reveals how long children may have to wait for the provision of an aid in the UK. Possible problems in establishing use of an aid are discussed; these include inadequate training of children and their communication partners. Suggestions for future improvements of communication-aids services are explored.

Professional services for young children with disabilities generally expect parents (usually mothers) to carry out teaching or therapy exercises at home. Their advice often implies structuring the work into special daily sessions. In this study, parents were asked to carry out play sessions, and managed 62% of the available days. Reasons for missing sessions were primarily shortage of time or child illness. Mothers were more likely to carry out sessions where their child was of lower ability, and fathers less likely. Discussion concentrates on the need for professionals to vary their expectations and approach with individual parents' philosophies and energies.

What parents of young mentally handicapped children think about parenting and teaching can affect their response to services offered, particularly programmes of advice on how to boost their child's rate of development. The paper presents a descriptive study of 40 mothers' and fathers' perceptions of their role in their child's activities, and how these relate to daily patterns of family interaction. The individual variations have implications for intervention strategies.

Some blind children show an early facility with expressive language in advance of their true level of comprehension; children who have severely impaired vision, but use visually-directed reaching, do not. Inspection of developmental assessments of 40 blind and very severely visually impaired children with no other disability, seen at the Wolfson Centre, London, confirmed these patterns. However, a considerable number of blind children showed a lag in expressive speech relative to comprehension, which might mean first words appearing as late as 2 years of age. Later assessments of this group of children showed mixed outcomes. Further prospective research is indicated as a basis for counselling parents.

Guidelines for good practice in the assessment of children with multiple disabilities are presented. These arose from working groups of parents and professionals, drawn from a variety of theoretical orientations, who met together during a workshop sponsored by the Mary Kitzinger Trust.

This paper reports a fine-grained analysis of interaction between 21 mothers and fathers and their young mentally handicapped children. Parent-child dyads were videotaped at home on two occasions with a 'roundabout' toy. The sessions were analysed by means of a detailed coding system which reflected the reciprocal nature of interaction and which attended to sequences of behaviour. Results are reported on short-term stability of various features of communication and comparisons of dyads involving mothers and fathers. Implications of the results are outlined for interventions designed to help parents to teach their young mentally handicapped children.

Reactions of 25 parents to receiving copies of written reports concerning developmental assessment of their children were assessed. All parents wanted to have a written report.

Developmental progress, hearing, and dysmorphic features were monitored prospectively in eight babies with Norrie's disease (an X linked form of congenital blindness believed to be associated with mental retardation, regression, sensorineural deafness, and dysmorphic features) and in six congenitally blind peers during their preschool years. No evidence of sensorineural deafness or dysmorphology was found in the group with Norrie's disease. No significant difference in the rate of developmental progress occurred between the two groups. All 14 children showed continuing developmental progress and in 10 this was at a normal or superior rate. Two cases and two controls showed slowing in their rate of progress; in both groups a suboptimal developmental climate had prevailed and may have been contributory. The emphasis on serious and progressive associated disabilities in past reports has led to considerable distress for families of children with this disease. Our study suggests that these anxieties may often be illfounded. Parental depression constrains development, particularly when a baby is blind. More optimistic counselling with developmental guidance is recommended for children who are not overtly retarded in infancy until the long term developmental perspective of this disease is further clarified.