Adaptive, social, and repetitive behaviors in children with autism spectrum disorder and comorbid amblyopia and/or strabismus

BACKGROUND: Children with autism spectrum disorder (ASD) have higher rates of visual disorders, such as amblyopia and strabismus, but the impact of these disorders on autism symptoms is unknown. We assessed adaptive, social, and repetitive behaviors in children with ASD with and without binocular vision disorders (amblyopia and strabismus). METHODS: Children aged 3-17 years were categorized into one of two groups: ASD with comorbid amblyopia or strabismus (ASD+/BVD+) or ASD without a visual disorder (ASD+/BVD-). All participants underwent a complete ophthalmologic examination to inform group assignment. Parents or guardians completed standardized questionnaires to assess participants' adaptive functioning (Vineland Adaptive Behavior Scales, 3rd ed [VABS-III]), social responsiveness (Social Responsiveness Scale, 2nd ed [SRS-2]), and repetitive behaviors (Repetitive Behavior Scale-Revised [RBS-R]). ASD+/BVD+ and ASD+/BVD- groups were compared using multivariable regression analysis correcting for age and sex. RESULTS: We recruited 14 children in the ASD+/BVD+ group and 29 children in the ASD+/BVD- group. Groups were matched on age, sex, IQ, and overall autism severity. ASD+/BVD+ children had lower scores on the VABS-III Composite and Socialization domain. On the RBS-R, ASD+/BVD+ children exhibited greater insistence on sameness. There were no differences between groups on SRS-2 scores. CONCLUSIONS: Our findings suggest that children with ASD and comorbid amblyopia or strabismus have worse adaptive behaviors than children with ASD without visual disorders, particularly with regard to socialization.