The Vision and Living Skills Research Project:

The effects of personal and family characteristics on the development of independence in 3 to 18 year olds

Focus: School Years

Topic: Living Skills

Rosemary Flavel

Senior Research Officer

Department of Family and Community Nursing M02

University of Sydney

New South Wales 2006

Australia

61 2 9351.0606

rflavel@nursing.usyd.edu.au

Additional Authors: Helen Lunn (Royal Blind Society), Christine Johnston (University of Sydney) and Elaine Chapman (University of Sydney)

Background

The Vision and Living Skills (VaLS) Research Project was initiated by an approach to The University of Sydney by Royal Blind Society to assist with an identified service delivery problem. A 1996 survey by Royal Blind Society of the needs of 122 families of children aged 5 to 12 years, pointed strongly to parents’ concerns about their children’s abilities to cope with the skills of daily living. 64.5% reported that their child was having difficulties at home in areas such as eating, personal care and chores. This finding presented a significant challenge for service provision. Because of the low incidence of vision impairment, the group was geographically scattered across New South Wales and the Australian Capital Territory, diverse in culture and language background and presented highly specialised needs for intervention. Royal Blind Society did not have the resources to provide regular, one-to-one intervention on a state-wide basis and it was not clear that, even with such resources, this was the preferred mode of service delivery. In addition, the children were, in general, attending regular schools where daily living skills were unlikely to form part of the curriculum. The literature (e.g. Sacks & Pruett, 1992) also suggested that alternate approaches, such as intensive training programmes, did not always lead to skills generalisation from the training environment to home.

The major aims of the project were to better understand the factors affecting the development of daily living skills and to design a range of flexible, innovative and effective service delivery models to accommodate differing child and family needs. As already discussed in Johnston, Flavel and Lunn (2002), initial findings from the project confirmed the critical impact of vision impairment upon the development of daily living skills and were consistent with those reported by Hatton, Bailey, Burchinal and Ferrell (1997) who had looked at more general aspects of development in young children. They found that there appeared to be a threshold effect, with the development of children whose visual functioning is 20/800 (6/240) or worse being significantly different from those with better vision. It is important to also note that Hatton et al. found that developmental patterns varied markedly among the children and that this appeared to be due both to the presence of co-occurring disabilities and to the children’s resiliency. Statements about the impact of vision impairment on functioning must, therefore, take sufficient account of individual differences.

Furthermore, children’s development can only be understood within the family and community context in which they live. The disability field in general, and the early childhood intervention area in particular, have moved in recent years to the realisation that if intervention is to be successful, the individual can not be seen in isolation (Dunst, Trivette & Deal, 1988; Hanson & Lynch, 1995). Research occurring within this framework is increasingly guided by the ecocultural paradigm, which has also derived from a family systems approach and the ecological theory expounded by Bronfenbrenner (1979).

Ecocultural theory has particular relevance to the development of daily living skills since it extends the notions of family systems approaches by taking the perspectives of the family into account, in a context which looks explicitly at the meanings they give to their experience, and analyses the daily routines that are created by environmental and cultural forces (Bernheimer, Gallimore & Weisner, 1990). This emphasis upon the ways in which families negotiate daily life and routines has clear and crucial links with the ways in which children and young adults learn the routines and skills of daily living. The approach was therefore adopted for the present study.

This phase of the project addressed the following questions:

What impact does severe vision impairment have on the development of daily living skills?
What other factors in the individual, the family and the community affect the development of daily living skills in children and young adults with vision impairment or blindness?

METHODOLOGY

Both quantitative and qualitative approaches were used in exploring these questions. In the quantitative phase the intent was to look at not just the impact of individual factors but how they might interact to affect the acquisition of daily living skills. Of relevance here was Hatton et al.’s (1997) finding that intelligence had an additive effect on young children’s development when coupled with vision impairment. This was then a factor that warranted further exploration. Gender and age were also seen as potentially important and were included for consideration.

In the qualitative phase data from interviews and focus groups together with additional child measures (e.g. self-concept) were gathered to enable the affect of family attitudes and characteristics and child personality and views of self to be studied.

Sample

The sample for the quantitative phase comprised 221 children and adolescents drawn from Royal Blind Society’s client data base and living in both city and country areas of NSW and the ACT. Their ages ranged from 3 to 18 years and they included 102 females and 119 males. Those identified as having either a severe intellectual disability or a significant physical disability were not included in the sample, as it was anticipated that this degree of additional disability would have a major impact on the acquisition of independent living skills.

Information on the individuals’ vision impairment, based on their most recent assessment, was obtained from their Royal Blind Society file with their own or their parent’s permission. Based upon the clinical experience of the staff from Royal Blind Society and the results of the Hatton, Bailey, Burchinal and Ferrell (1997) study, four categories were generated to take account of potential functional vision differences, namely:

1. No light perception à <3/120 (Level 1 – Blind)

2. 3/120à <6/60 (Level 2 – Partially sighted 1)

3. 6/60 à <6/18 (Level 3 – Partially sighted 2)

4. 6/18 à 6/6 (Level 4 – Mild vision impairment to normal)

The sample for the qualitative phase comprised children from the blind group included in the first phase of the study. Data are still being gathered for this group with, to date, approximately 20 parental interviews conducted.

Procedure

In the quantitative phase, all children were administered a verbally-based cognitive screening test (either the Slosson Intelligence Test-Revised, Reynell-Zinkin Developmental Scales for Young Visually Handicapped Children - Comprehension or Reynell Developmental Language Scales III – Comprehension, depending on age and vision level).

As discussed in Johnston, Flavel & Lunn (2002), information regarding participants’ independent living skills was obtained through parent / caregiver interviews (undertaken either face-to-face or by telephone), during which the Personal Living Skills cluster from the Scales of Independent Behavior-Revised (Bruininks, Woodcock, Weatherman & Hill, 1996) was administered. Testers were experienced allied health or early special education professionals. All scoring of test materials was undertaken by one member of the research team.

Qualitative data were obtained through parental interviews, parental report (to assess perceived child attributes), a series of focus groups with adults who are blind, parents of children who have a significant vision impairment and experienced service delivery staff (from both Royal Blind Society and inclusive preschools). All group and individual interviews were recorded either on audiotape or by written record and the transcriptions analysed for emerging themes. Self-concept measures (discussed in Johnston, Flavel & Lunn, 2002) have been administered by the same staff involved in the quantitative phase.

Results

As noted above, data collection and analysis of the qualitative data are continuing. The formal presentation of results will, therefore, be restricted to the quantitative analyses. Some trends in the interview data which have been observed will be set out in the discussion section.

For the purpose of these analyses, the difference scores which can be obtained from the SIB-R were utilised. These scores take the form of a discrepancy measure between what might be expected from the norms for an individual of that age and what has been achieved. Analyses were conducted for each of the five sub-scales of the Personal Skills cluster and for the cluster score itself. To determine whether vision category correlated significantly with Eating, Dressing, Self-care, Toiletting, and Domestic Skills, a multivariate analysis of covariance (MANCOVA) was performed. In this analysis, gender was also entered as an independent variable to determine whether the impact of vision on these skills differed across males and females, producing a 2 (gender: male vs. female) by 4 (vision category: Level 1 vs. Level 2 vs. Level 3 vs. Level 4) factorial design. To reduce error variance and assess the effects of these factors on each of the sub-scales after taking into account the effects of intellectual level and age, the latter two factors were entered as covariates in the model. Table 1 presents means and standard deviations by each of the factors within the model.

Vision

SIB-R

Level 1

Ms n = 26

Fs n = 29

n = 55

Level 2

Ms n = 30

Fs n = 17

n = 47

Level 3

Ms n = 41

Fs n= 39

n = 80

Level 4

Ms n = 22

Fs n = 17

n= 39

Total

Ms n= 119

Fs n = 102

n = 221

Eating

Males

M= -38.35

sd= 17.86

M= -15.43

sd= 15.45

M= -16.00

sd= 17.6

M= -17.23

sd= 20.29

M= -20.97

sd= 19.75

Females

M= -32.17

sd= 16.85

M= -12.35

sd= 14.43

M= -16.31

sd= 14.49

M= -11.18

sd= 17.78

M= -19.30

sd= 17.64

Total

M= -35.09

sd= 17.45

M= -14.32

sd= 15

M= -16.15

sd= 16.06

M= -14.59

sd= 19.23

M= -20.2

sd= 18.78

Toiletting

Males

M= -12.69

sd= 10.94

M= -3.2

sd= 8.62

M= -12.63

sd= 20.23

M= -5.64

sd= 15.21

M= -8.97

sd= 15.55

Females

M= -11.21

sd= 9.8

M= -5.71

sd= 9.64

M= -8.87

sd= 17.15

M= -9.65

sd= 13.66

M= -9.14

Sd= 13.6

Total

M= -11.91

sd= 10.29

M= -4.11

sd= 8.98

M= -10.8

sd= 18.77

M= -7.38

sd= 14.51

M= -9.05

sd= 14.65

Dressing

Males

M= -33.5

sd= 16.07

M= -15.27

sd= 13.87

M= -18.07

sd= 18.01

M= -15.5

sd= 19.24

M= -20.26

sd= 18.13

Females

M= -23.97

sd= 15.34

M= -9.06

sd= 11.98

M= -16.28

sd= 20.30

M= -7.29

sd= 19.93

M= -15.76

sd= 18.58

Total

M= -28.47

sd= 16.27

M= -13.02

sd= 13.43

M= -17.20

sd= 19.06

M= -11.92

sd= 19.72

M= -18.19

sd= 18.43

Self-Care

Males

M= -20.77

sd= 13.88

M= -11.53

sd= 9.88

M= -12.05

sd= 12.94

M= -8.91

sd= 14.32

M= -13.24

sd= 13.24

Females

M= -16.34

sd= 14.53

M= -5.94

sd= 7.74

M= -8.92

sd= 11.51

M= -6.76

sd= 15.14

M= -10.18

sd= 13.07

Total

M= -18.44

sd= 14.27

M= -9.51

sd= 9.48

M= -10.53

sd= 12.29

M= -7.97

sd= 14.53

M= -11.83

sd= 13.22

Domestic

Skills

Males

M= -17.23

sd= 11.27

M= -4.2

sd= 7.4

M= -6.88

sd= 10.11

M= -9.68

sd= 13.31

M= -8.98

sd= 11.36

Females

M= -12.93

sd= 12.14

M= -5.76

sd= 11.64

M= -10.21

sd= 12.57

M= -5.35

sd= 11.71

M= -9.43

sd= 12.34

Total

M= -14.96

sd= 11.83

M= -4.77

sd= 9.07

M= -8.50

sd= 11.43

M= -7.79

sd= 12.66

M= -9.19

sd=11.80

Key: Level 1: No light perception à <3/120; Level 2: 3/120à <6/60; Level 3: 6/60 à <6/18; Level 4: 6/18 à 6/6

Table 1: Means and standard deviations for the five sub-scales of the Personal Skills Cluster (SIB-R) by vision and gender

Initial screening tests indicated adequate conformity to all univariate and multivariate assumptions (e.g., normality, homogeneity of variance) for all five subtests. Outcomes of the multivariate analysis are presented in Table 2 below. As indicated, there were significant multivariate main effects for all of the entered factors, but no significant interaction effect between gender and vision.

Follow-up univariate ANCOVAs were conducted. Using a Bonferroni-corrected alpha level of 0.01, intellectual level had significant effects on all subscales apart from the Domestic Skills test, while age had significant effects on the Eating, Self-Care, and Domestic Skills scales. Vision had significant effects on Eating, Dressing, and Domestic Skills, while the effect on Self-Care approached significance (p = 0.02).

Effect	V	F	Hypothesis df	Error df	Sig.	Eta Squared
Intercept	0.465	35.978(a)	5	207	0.000	0.465
Intellectual Ability	0.374	24.746(a)	5	207	0.000	0.374
Age	0.342	21.475(a)	5	207	0.000	0.342
Gender	0.082	3.722(a)	5	207	0.003	0.082
Vision	0.226	3.412	15	627	0.000	0.075
Gender*Vision	0.083	1.185	15	627	0.278	0.028

Table 2: Multivariate Outcomes for 2 by 4 MANCOVA

The means and standard deviations for the Personal Skills cluster are given in Table 3 below.

Gender	Vision	M	SD	N
Males	Level 1	-21.23	17.54	26
	Level 2	-10.27	8.5	30
	Level 3	-13.44	12.19	41
	Level 4	-11.59	13.86	22
	Total	-14	13.56	119
Females	Level 1	-19.69	11.87	29
	Level 2	-7.41	9.23	17
	Level 3	-12.36	11.52	39
	Level 4	-8.18	12.05	17
	Total	-12.92	12.15	102
Total	Level 1	-20.42	14.7	55
	Level 2	-9.23	8.78	47
	Level 3	-12.91	11.81	80
	Level 4	-10.1	13.05	39
	Total	-13.5	12.91	221

Table 3:Means and standard deviations for cluster scores

Outcomes of the univariate ANCOVA are presented in Table 4. As indicated, age, intellectual level, and vision all had significant effects on overall cluster scores, with the effect for gender approaching significance.

Source	Type III Sum of Squares	df	Mean Square	F	Sig.	Eta Squared
Corrected Model	11217.994(a)	9	1246.444	10.334	0.000	0.306
Intercept	7517.182	1	7517.182	62.325	0.000	0.228
Age	1641.83	1	1641.83	13.612	0.000	0.061
Intellectual Ability	5851.927	1	5851.927	48.518	0.000	0.187
Gender	360.136	1	360.136	2.986	0.085	0.014
Vision	1614.805	3	538.268	4.463	0.005	0.06
Gender * Vision	220.275	3	73.425	0.609	0.610	0.009
Error	25449.255	211	120.613

Table 4: Outcomes of the univariate ANCOVA

Discussion

The following points can be made with respect to the factors included in the quantitative analyses:

Vision, not surprisingly, was found to affect Eating, Dressing and Domestic Skills while the results for Self-care approached significance. It is the group classified as blind (Level 1) in the present study whose scores were generally below those of the other groups. These data reinforce the view that there is a critical threshold below which development will be significantly different compared to those with better vision.

Intellectual ability emerged as a potent factor and was found to affect all of the areas tested except Domestic Skills. It should be noted that it was the only factor found to have a significant effect on Toiletting. As argued by Hatton et al. (1997), its effect would appear to be additive when coupled with vision impairment.

Age was an important factor with respect to Eating, Self-care and Domestic Skills. That it did not affect Dressing is interesting. Further analysis is being undertaken to investigate this relationship.

Gender was found to be a significant factor, with girls outperforming boys, for Dressing and Self-care, but not for the other areas where perhaps the expectations are less gender specific. In this connection it is interesting that gender was not found to interact significantly with vision.

As noted, analyses have still to be completed on the qualitative data. However, some general points can be made:

The child’s temperament and family expectations are both significant factors and interact in the acquisition of independent living skills. This is a theme that has emerged consistently in the interviews and focus groups. The importance of characteristics in the child variously described as persistence, stubbornness, determination and curiosity are emphasised while the child’s willingness to try new experiences and to place him or herself in new situations are seen as critical indicators of their level of independence. Related to this would seem to be the family’s expectations of what the child should be able to do for him or herself and even their willingness to encourage the child to attempt what might be seen as risky or challenging experiences. The examples given ranged from encouraging the child to try new foods that might be more difficult to manage to riding bikes or ironing. It is the interaction between the child’s personality and the family expectations which is seen, however, as of importance.

Families differ considerably in the focus they give to the development of independence. This is felt to be particularly true for families with young children. Indeed, when faced with many competing priorities demanding early intervention, independent living skills may not be a primary focus for families. In most instances it would appear that parents are either able to find ways around difficulties related to daily living skills (e.g. providing the child with easily manageable foods at preschool) or are prepared to assist the child for a longer period of time (as might be the case with dressing or bathing/showering). Children in the preschool years typically display a range of independence, whether they have a disability or not and no negative connotations are seen as attached to the child’s being dependent at this stage. Difficulties are seen as arising as the child gets older and moves into the school system. It is then that families report seeing daily living skills as more problematic.

The results obtained thus argue strongly for the conclusion that an individual’s level of independence is affected by many factors. Vision, while critical, is only one of those. If intervention is to be successful it must take full account of child and family characteristics.

References

Bernheimer, L.P., Gallimore, R. & Weisner, T.S. (1990) Ecocultural Theory as a Context for the Individual Family Service Plan, Journal of Early Intervention, 14, 3, pp. 219-233.

Bronfenbrenner, U. (1979) The Ecology of Human Development: Experiments by Nature and Design, Harvard Uni. Press, Cambridge, MA.

Bruininks, R.H., Woodcock, R.W., Weatherman, R.F. & Hill, B.K. (1996). Scales of Independent Behavior – Revised. Itasca, Ill.: Riverside Publishing.

Dunst, C., Trivette, C. & Deal, A. (1988). Enabling and Empowering Families: Principles and Guidelines for Practice. Brookline Books, Cambridge, MA.

Hanson, M.J. & Lynch, E.W. (1995). Early Intervention: Implementing Child and Family Services for Infants and Toddlers Who Are At Risk or Disabled. 2nd ed., Pro-Ed, Austin, Texas.

Hatton, D.D., Bailey, D.B., Burchinal, M.R. and Ferrell, K.A. (1997). Developmental Growth Curves of Preschool Children with Vision Impairments. Child Development, 68, 5, pp. 788-806.

Johnston, C., Flavel, R. & Lunn, H. (2002). The Vision and Living Skills Research Project: Levels of daily living skills and self-concept in children and adolescents with severe vision impairment. In Proceedings of the 11^th World Conference of the International Council for Education of People with Visual Impairment. Noordwidjhout, The Netherlands. July-August.

Sacks, S.Z. & Pruett, K.M. (1992). Summer transition training project for professionals who work with adolescents and young adults. Journal of Visual Impairment and Blindness, 86, 5, 211-214.