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Original Investigation
November 15, 2018

Self-perception of School-Aged Children With Amblyopia and Its Association With Reading Speed and Motor Skills

Author Affiliations
  • 1Retina Foundation of the Southwest, Dallas, Texas
  • 2Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas
  • 3ABC Eyes, Dallas, Texas
  • 4School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
JAMA Ophthalmol. Published online November 15, 2018. doi:10.1001/jamaophthalmol.2018.5527
Key Points

Question  How does amblyopia influence self-perception in children ages 8 to 13 years?

Findings  In this cross-sectional study, children with amblyopia had lower scholastic, social, and athletic competence scores as derived from the Self-perception Profile for Children than control children. Among children with amblyopia, the self-perception of scholastic competence was associated with reading speed, and the self-perception of scholastic, social, and athletic competence was associated with aiming and catching skills.

Meaning  These results suggest lower self-perception and its association with reading speed and motor skills highlight the potentially wide-ranging influence of altered visual development in children in their everyday lives.

Abstract

Importance  Reading and eye-hand coordination deficits in children with amblyopia may impede their ability to demonstrate their knowledge and skills, compete in sports and physical activities, and interact with peers. Because perceived scholastic, social, and athletic competence are key determinants of self-esteem in school-aged children, these deficits may influence a child’s self-perception.

Objective  To determine whether amblyopia is associated with lowered self-perception of competence, appearance, conduct, and global self-worth and whether the self-perception of children with amblyopia is associated with their performance of reading and eye-hand tasks.

Design, Setting, and Participants  This cross-sectional study was conducted from January 2016 to June 2017 at the Pediatric Vision Laboratory of the Retina Foundation of the Southwest and included healthy children in grades 3 to 8, including 50 children with amblyopia; 13 children without amblyopia with strabismus, anisometropia, or both; and 18 control children.

Main Outcomes and Measures  Self-perception was assessed using the Self-perception Profile for Children, which includes 5 domains: scholastic, social, and athletic competence; physical appearance; behavioral conduct; and a separate scale for global self-worth. Reading speed and eye-hand task performance were evaluated with the Readalyzer (Bernell) and Movement Assessment Battery for Children, 2nd Edition. Visual acuity and stereoacuity also were assessed.

Results  Of 50 participants, 31 (62%) were girls, 31 (62%) were non-Hispanic white, 6 (12%) were Hispanic white, 3 (6%) were African American, 4 (8%) were Asian/Pacific Islander, and 3 (6%) were more than 1 race/ethnicity, and the mean [SD] age was 10.6 [1.3] years. Children with amblyopia had significantly lower scores than control children for scholastic (mean [SD], 2.93 [0.74] vs 3.58 [0.24]; mean [SD] difference, 0.65 [0.36]; 95% CI, 0.29-1.01; P = .004), social (mean [SD], 2.95 [0.64] vs 3.62 [0.35]; mean [SD] difference, 0.67 [0.32]; 95% CI, 0.35-0.99] P < .001), and athletic (mean [SD], 2.61 [0.65] vs 3.43 [0.52]; mean [SD] difference, 0.82 [0.34]; 95% CI, 0.48-1.16; P = .001) competence domains. Among children with amblyopia, a lower self-perception of scholastic competence was associated with a slower reading speed (r = 0.49, 95% CI, 0.17-0.72; P = .002) and a lower self-perception of scholastic, social, and athletic competence was associated with worse performance of aiming and catching (scholastic r = 0.48; 95% CI, 0.16-0.71; P = .007; social r = 0.63; 95% CI, 0.35-0.81; P < .001; athletic r = 0.53; 95% CI, 0.21-0.75; P = .003). No differences in the self-perception of physical appearance (mean [SD], 3.32 [0.63] vs 3.64 [0.40]), conduct (mean [SD], 3.09 [0.56] vs 3.34 [0.66]), or global self-worth (mean [SD], 3.42 [0.42] vs 3.69 [0.36]) were found between the amblyopic and control groups.

Conclusions and Relevance  These findings suggest that lower self-perception is associated with slower reading speed and worse motor skills and may highlight the wide-ranging effects of altered visual development for children with amblyopia in their everyday lives.

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