Autonomy in children and adolescents with visual impairment: Validation of the Visual Impairment Developmental Autonomy scale

Abstract

Aim

To validate the Visual Impairment Developmental Autonomy (VIDA) scale, a questionnaire to assess the autonomy level of children with visual impairment.

Method

The primary outcome measures included internal consistency, convergent validity, cross‐informant concordance, and descriptive statistics of autonomy profiles across three age groups (age 3–5 years; age 6–10 years; age 11–18 years). Internal consistency was assessed using Cronbach's Alpha coefficient. Convergent validity was evaluated against established measures such as the TNO‐AZL Children's Quality of Life questionnaire (TACQOL) and the TNO‐AZL Preschool Children's Quality of Life questionnaire (TAPQOL) using bivariate Pearson's correlation indexes.

Results

Internal consistency coefficients ranged between 0.708 and 0.938 across all subscales and age versions of the instrument. The VIDA subscales showed consistent correlations with comparable dimensions of the TACQOL/TAPQOL (correlations index >0.3). The cross‐informant concordance was significant with weak‐to‐moderate effect sizes. Descriptive statistics showed different profiles of autonomy in the three age groups: clothing and orientation/mobility emerged as areas of vulnerability for adolescents. Visual acuity was significantly correlated with many VIDA scale scores, whereas no significant associations emerged with the quality of life.

Interpretation

The VIDA scale is effective and reliable in providing both insights on the actual needs of children and quantitative measures of the visual impairment impact on everyday life. Autonomy level affects quality of life, whereas visual impairment does not.

This original article is commented by Matsuba on pages 1378–1379 of this issue.

Abbreviations

PROM

patient‐reported outcome measures

TACQOL

TNO‐AZL Children's Quality of Life questionnaire

TAPQOL

TNO‐AZL Preschool Children's Quality of Life questionnaire

VIDA

Visual Impairment Developmental Autonomy

What this paper adds

• The Visual Impairment Developmental Autonomy (VIDA) scale is a promising patient‐reported outcome measure for the assessment of adaptive behaviour in children and adolescents with visual impairment.

• The autonomy profiles in a large cohort of children and adolescents with peripheral visual impairment are presented.

• Severity of visual impairment affects achieving functional independence, but not quality of life

Early‐onset visual impairment has a remarkable impact on the families and the health care system because it is a chronic condition requiring lifelong care. ¹ , ² Its influence on development, social and academic inclusion, developmental autonomy (i.e. functional independence), and quality of life has been documented. ³ , ⁴ , ⁵ , ⁶ Increasingly, experts are calling for multidisciplinary care based not only on ophthalmological diagnosis and treatment, but also on comprehensive functional assessment and rehabilitation, as promoted by the International Classification of Functioning, Disability and Health (ICF) guidelines. ⁷ , ⁸ , ⁹ Assessment and rehabilitation of children with visual impairment has traditionally focused on visual function (i.e. the ability to locate, perceive, and process sensory information), ¹⁰ with the goal of improving and utilizing residual vision. This approach only partially addresses the real needs of patients and their families. The ICF framework ⁷ , ⁸ , ⁹ encourages moving the level of care beyond the impaired organ or system, extending assessment and intervention to daily functioning. For professionals, it is critical to integrate as rehabilitation targets the two distinct but interrelated domains of visual function (i.e. how the eye functions) and functional vision (i.e. how the person functions in the context of their visual impairment). ¹¹ Few tools have been developed to assess functional vision. ¹² The lack of standardized and comprehensive scales complicates goal setting and outcome measurement, hinders both clinical and research progress, and makes our current knowledge of the developmental profiles of individuals with visual impairment inaccurate. ¹² , ¹³

Along with increased sensitivity to children's global functioning, interest in the active involvement of patients and their families in the care process has grown in recent years. ¹⁴ Health care professionals are being asked to engage with patients and caregivers to develop and validate tools (patient‐reported outcome measures [PROMs]) to measure the efficacy and effectiveness of treatments. PROMs are particularly appropriate for chronic conditions requiring rehabilitation because they support adherence and help prioritize interventions based on the patient and caregiver feedback on aspects such as health status, functional improvement, and quality of life. This approach has been shown to be effective also for the paediatric population and has been used successfully in those with visual impairment. ¹⁵ , ¹⁶ , ¹⁷

Our group previously developed a PROM tool to assess autonomy in children and adolescents with visual impairment from an ICF perspective. ¹⁸ The Visual Impairment Developmental Autonomy (VIDA) scale was developed using the Delphi method ¹⁶ with a stakeholder pool composed of parents of children and adolescents with visual impairment. The VIDA scale is composed of 102 items categorized into five domains (table manners, clothing, personal hygiene, orientation and mobility, and socio‐affectivity).

The present study aims to (1) present the psychometric characteristics of the VIDA scale (i.e. internal consistency and convergent validity), and (2) provide a description of the developmental autonomy profile of a large cohort of children and adolescents with early‐onset visual impairment.

METHOD

The study was approved by the local Ethics Committee (Pavia Area, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy) on 5th June 2021, with the protocol number p‐20200048762, and was presented in a previous article. ¹⁸ All the procedures followed the ethical principles of the Declaration of Helsinki for research involving human participants. Participants or their legal guardians signed an informed consent form before participating in the study.

Recruitment

Children and adolescents with visual impairment along with their parents were enrolled from five institutions in northern Italy dedicated to the care and rehabilitation of visual impairment: Developmental Neuro‐ophthalmology Unit of the IRCCS Mondino Foundation (Pavia, Italy), Fondazione David Chiossone (Genoa, Italy), IRCCS Eugenio Medea (Bosisio Parini, Italy), Fondazione Robert Hollman (Padova, Italy), AbilNova Cooperativa Sociale (Trento, Italy). Inclusion criteria were age between 3 years and 18 years; mastery of Italian language; disorders of the peripheral visual system (i.e. involving pregeniculate structures and pathways) resulting in low vision. Visual acuity was assessed, defined, and categorized after multidisciplinary evaluation, at 3m distance according to the Italian legislative system (G.U. Serie Generale, n. 93 del 21 Aprile 2001). Best corrected visual acuity was tested with standardized symbolic or literal optotypes, chosen based on age, and categorized as mild (0.7–0.5 logMAR), moderate (0.7–1 logMAR), severe (1–1.30 logMAR) low vision, or blindness (>1.30 logMAR). Exclusion criteria included a diagnosis of developmental delay/intellectual disability based on standardized evaluations selected according to the age and degree of visual impairment (Griffiths Scales of Child Development, Reynell‐Zinkin Scales, Wechsler Intelligence Scales). Other exclusion criteria were the presence of neuromotor disorders, central nervous system involvement, chronic comorbidities, or a diagnosis of a neurodevelopmental disorder.

Procedures

After the oral presentation of the study, the investigators distributed an email to the caregivers, which included a link to the software Qualtrics XM (Qualtrics, Provo, UT). A unique identifier was assigned to each participant after the commencement of data collection in the software, to ensure the anonymity of the participants. The adolescents were associated with the same code as their parents. Participants were requested to complete the following: (1) a form containing sociodemographic information, (2) the VIDA scale (see Appendix S1), (3) a questionnaire on quality of life for convergent validity (the TNO‐AZL Preschool Children Quality of Life [TAPQOL] and the TNO‐AZL Children's Quality of Life [TACQOL], ¹⁹ , ²⁰ see ‘Measures’). Reading and accepting an informed consent was required to fill the questionnaires. The time required to complete the questionnaires was found to be below 30 minutes, which made participation feasible. The questionnaires were accessible to voice synthesis software to guarantee accessibility for adolescents with visual impairment. For a subgroup of participants, the VIDA scale was also completed by professionals with expertise in childhood visual impairment and directly involved in their rehabilitation.

Measures

VIDA scale

For each item of the VIDA scale, participants were asked to assign a score of 0 (indicating that the individual is unable to perform the task), 1 (indicating that the individual can perform the task with assistance), or 2 (indicating that the individual can perform the task independently). ¹⁸ Mean subscores for each area (table manners, clothing, personal hygiene, orientation and mobility, and socio‐affectivity) and a total mean score were calculated for each age version of the instrument (i.e. 3–5 years; 6–10 years; 11–18 years).

Quality of life

In accordance with the child's age, participants completed either the TAPQOL ¹⁹ or the TACQOL. ²⁰ The TAPQOL is a 43‐item questionnaire designed to assess parents' perceptions of their children's health‐related quality of life. It comprises 12 scales, which collectively encompass four domains: physical, social, cognitive, and emotional functioning. The 56‐item TACQOL encompasses seven domains of health‐related quality of life: physical complaints, motor functioning, autonomous functioning, cognitive functioning, social functioning, positive moods, and negative moods. Parents completed the parent‐report version of the questionnaires and adolescents completed the self‐report version. Correlations were tested between subscales of the VIDA and the TAPQOL/TACQOL representing similar constructs as well as between visual acuity and both the VIDA and the TAPQOL/TACQOL. It was not possible to administer the more specific Vision‐Related Quality of Life Instrument for Children and Young People with Visual Impairment ¹⁵ as it was not available in our country at the time of the study.

Statistical analyses

Descriptive statistics, including frequencies, means, and standard deviations, were employed to characterize the demographic and clinical variables as well as score distributions of the questionnaire's items. The internal consistency of the VIDA scale was verified using Cronbach's alpha coefficient. ²¹ Convergent validity was evaluated comparing the results of the VIDA scale as assessed by parents, with those of the TACQOL or the TAPQOL. Specifically, bivariate Spearman's correlation indexes (with SPSS tie correction in Spearman's correlation) were performed between VIDA scale scores and related subscales of TAPQOL for preschool children (liveliness, problem behaviour, social functioning, motor functioning, and communication) and TACQOL for older participants (motor functioning, cognitive functioning and school performance, and positive moods). The degree of concordance between the VIDA scale completed by the patient/parent and the one completed by the therapist was evaluated using intraclass correlation coefficients (intraclass correlation coefficient F‐distribution based methods). ²² The analyses were conducted using IBM SPSS software (version 25.0; IBM Corp., Armonk, NY, USA).

RESULTS

A total of 160 families and 42 adolescents consented to participate in the study. A final sample of 110 parents (70%) and 18 adolescents (43%) actively participated in the study, providing complete responses to the questionnaires. Moreover, four professionals participated providing reports for 72 patients (17 in the age range 3–5 years, 30 in the age range 6–10 years, and 25 in the age range 11–18 years). All the participants reported having undergone rehabilitation, specifically designed for children with visual impairment. The interventions were delivered in cycles with goals and activities tailored to the specific needs of each patient at various points in their development. These activities were focused on enhancing neuropsychological, relational, spatial, and adaptive skills.

Table S1 presents a summary of the clinical and demographic characteristics. Table S2 and Figure 1 illustrate the adaptive skills of the three age groups. The levels of autonomy for each area are represented in terms of mean values, in accordance with the scoring system and the specific items for each age range.

FIGURE 1.

Autonomy trends for the three age groups.

The internal consistency was deemed satisfactory based on Cronbach's alpha values, which exceeded 0.70 for each area and age range (Table 1).

TABLE 1.

Visual Impairment Developmental Autonomy scale internal consistency (Cronbach's alpha measures).

	n items	Cronbach's alpha	Version, age range, years	n items	Cronbach's alpha
Table manners	20	0.903	3–5	7	0.753
			6–10	9	0.778
			11–18	4	0.809
Clothing	16	0.916	3–5	6	0.740
			6–10	7	0.848
			11–18	3	0.895
Personal hygiene	19	0.938	3–5	5	0.803
			6–10	7	0.903
			11–18	7	0.879
Orientation and mobility	20	0.862	3–5	7	0.738
			6–10	7	0.769
			11–18	6	0.708
Socio‐affectivity	24	0.902	3–5	9	0.847
			6–10	6	0.757
			11–18	9	0.780
Total	99	0.973	3–5	34	0.919
			6–10	36	0.938
			11–18	29	0.936

Results on convergent validity are reported in Tables 2 and 3 (note: only tested correlations between VIDA scales and similar quality of life scales were displayed). Correlations index greater than 0.3 are considered adequate for convergent validity. ²³ The significant concordances between VIDA scale and TAPQOL/TACQOL are reported in bold. Overall, we found a good performance when comparing similar constructs. Furthermore, a positive correlation was identified between visual acuity and VIDA scale scores (Figure 2), whereas no significant associations were observed between visual acuity and TAPQOL/TACQOL (Tables 2 and 3).

TABLE 2.

Correlations (Spearman) between VIDA scale and visual acuity levels with TAPQOL subscales (preschool children) (n = 19). Grey boxes indicate the correlation between visual acuity and respectively VIDA scale and TACQOL domains.

	Visual Acuity	Table	Clothing	Hygiene	Mobility	Socio‐affectivity	Autonomy Total
Visual Acuity	1	0.357 a	0.410 a	0.286 a	0.195 b	0.126	0.353 a
Liveliness	−0.17					0.692 a	0.557 b
Problem behaviour	0.054					−0.460 b	−0.191
Social functioning	0.133		0.456 b	0.505 b	0.537 b	0.413	0.646 b
Motor functioning	0.128	0.515 b	0.631 a		0.526 b		0.614 a
Communication	0.454				0.484 b		0.304

Note: Significant correlations are in bold.

Abbreviations: TAPQOL, TNO‐AZL Preschool Children's Quality of Life questionnaire; VIDA, Visual Impairment Developmental Autonomy.

^a p <0.01.

^b p <0.05.

TABLE 3.

Correlations (Spearman) between VIDA scale and visual acuity levels with TACQOL subscales. Grey boxes indicate the correlation between visual acuity and respectively VIDA scale and and TACQOL domains.

		VIsual Acuity	Table	Clothing	Hygiene	Mobility	Socio‐affectivity	Autonomy Total
Age 6–10 years (n = 43)	Visual Acuity	1	0.409 a	0.452 a	0.355 b	0.081	0.301 b	0.357 b
	Motor functioning	0.06	0.526 a	0.505 a	0.404 a	0.357 b		0.491 a
	Cognitive functioning and school performance	−0.18	0.395 a		0.385 b	0.438 a		0.400 a
	Social contacts	0.227					0.196	0.205
	Positive moods	0.047	0.094	0.233	0.398 a	0.293	0.102	0.286
Age 11–18 years (n = 48)	Visual Acuity	1	0.319 b	0.519 a	0.327 b	0.225	0.139	0.403 a
	Motor functioning	0.006	0.28	0.243	0.275	0.380 a		0.348 b
	Cognitive functioning and school performance	−0.113				0.385 a	0.315 b	0.263
	Social contacts	0.202					0.321 b	0.196
	Positive moods	0.172	0.172	0.297 b	0.254	0.363 b	0.196	0.345 b

Note: Significant correlations are in bold.

Abbreviations: TACQOL, TNO‐AZL Children's Quality of Life questionnaire; VIDA, Visual Impairment Developmental Autonomy.

^a p <0.01.

^b p <0.05.

FIGURE 2.

Correlations between visual acuity and Visual Impairment Developmental Autonomy scale scores into the three age groups. Visual impairment categories: 1 = blindness. 2 = severe visual impairment. 3 = moderate visual impairment. 4 = mild visual impairment. Clo, clothing; Hyg, personal hygiene; Mob, orientation and mobility; Soc‐aff, socio‐affectivity; Tab, table manners; TOT, total.

Cross‐informant concordance (see Table 4) revealed intraclass correlation coefficient values between the autonomy levels observed by parents and therapists, indicating a moderate level of agreement, except for the table manner and clothing scales, which demonstrated poor levels of agreement between the two observers.

TABLE 4.

Agreement between parent‐reported and professional‐reported VIDA scale scores.

	Mean (SD)
VIDA scale	Parent	Professional	Intraclass correlation coefficient	95% confidence interval
Table manner	1.62 (0.35)	1.37 (0.51)	0.350	0.000	0.584
Clothing	1.34 (0.59)	1.61 (0.41)	0.415	0.083	0.630
Personal hygiene	1.53 (0.47)	1.59 (0.46)	0.657	0.452	0.785
Orientation and mobility	1.44 (0.45)	1.47 (0.41)	0.640	0.424	0.775
Socio‐affectivity	1.51 (0.36)	1.25 (0.47)	0.505	0.171	0.700
Total	1.48 (0.35)	1.52 (0.36)	0.717	0.548	0.823

Abbreviation: VIDA, Visual Impairment Developmental Autonomy.

DISCUSSION

This paper presents the validation process of the VIDA scale, ¹⁸ a PROM tool measuring the impact of visual impairment on the main domains of everyday life functioning in children and adolescents. Assessing a person's functional profile, along with their strengths and weaknesses, is crucial to implement a tailored intervention and monitor its efficacy. The VIDA scale was codeveloped with patients and their families, resulting in two notable outcomes: (1) to expand the availability of specific tools to assess a person's functioning in the context of visual impairment (i.e. functional vision), ¹¹ and (2) to shed light on the actual needs of children and their families.

Psychometric evaluation

The VIDA scale has been codeveloped with patients, families, and professionals. ⁹ As in previous studies, ²⁴ such a multidisciplinary cooperation ensured content validity of the PROM. The participation in the study and the degree of completion of questionnaires proved the feasibility of the VIDA scale.

The internal consistency, which reflects the extent to which items assess different aspects of a single construct, is deemed adequate when considering both autonomy areas and age ranges (see Table 1). Convergent validity was tested by correlating the scores of similar subscales selected a priori from the TAPQOL/TACQOL and the VIDA scale. In preschool children, measures of quality of life reflecting positive energy, interactions, and engagement in activities (liveliness and social functioning subscales) correlate with VIDA scale socio‐affectivity area (based on self‐regulation and socialization competencies) and other domains, such as clothing, hygiene, and mobility. The acquisition of competencies in this population is based on imitation and observance of simple rules and explanations, which necessitate a positive engagement and predisposition on the part of the child. The convergent validity for this age range is further evidenced by the significant correlation between the TAPQOL communication subscale (which reflects the ability to speak clearly, inquire, and comprehend verbal communication) and the VIDA mobility subscale (which reflects the capacity to request assistance and comprehend directives). The sole correlation that did not achieve statistical significance in this analysis was between social functioning and socio‐affectivity. This result may be attributed to the sample size and the particularities of the VIDA scale questionnaire items. While the TAPQOL/TACQOL items concentrate on children's dynamism and emotional states, our scale broadens this domain to encompass tasks necessitating proficient executive and motor functioning.

Significant correlations were observed between TAPQOL/TACQOL motor functioning and all VIDA scale domains involving both fine‐motor and gross‐motor skills. These correlations were evident across a range of activities, from simple movement games to autonomy and mobility in an urban setting. ²⁵ Similarly, TACQOL cognitive functioning and school performance demonstrated correlations with various domains of the VIDA scale. These correlations reflected tasks that demanded cognitive abilities, including participating in conversations with adults, following social rules, planning complex actions, and exploring an urban environment. Such competencies are contingent upon the performance of high‐order cognitive functions, which are frequently diminished in individuals with visual impairment. ²⁵ , ²⁶

The VIDA scale is designed to be completed by both the parent or caregiver and the health care professional. In this study, cross‐informant correlation of the VIDA scale was preliminarily tested in a subgroup of participants, all attending the same rehabilitation centre. Good correlation was found between the parents' scores (i.e. perceived level of autonomy) and the professionals' scores (i.e. observed level of autonomy). Given the limitations of the sample size and the involvement of single‐centre professionals, these results appear promising for the potential use of the VIDA scale as a tool for families and clinicians to share ideas about rehabilitation goals and outcomes.

Overall, the VIDA scale has demonstrated sufficient validity to be integrated into both clinical practice and research contexts, providing insights into the necessity and outcomes of rehabilitation. However, cross‐cultural validity has not yet been tested, and the questionnaires should be adapted before use in other countries.

Insights from the VIDA scale validation

The VIDA scale validation yielded a description of the autonomy profile of a large cohort of children and adolescents with isolated peripheral visual impairment.

Overall, results indicated that the three age groups exhibited a relatively high level of autonomy. Most participants (86.6%, n = 97) had been enrolled in a rehabilitation programme, with the majority of these participants (69.6%, n = 78) having undergone training in autonomy. As the interventions were personalized and had occurred before this study, and because of the lack of standardized intervention and evaluation protocols, we were unable to assess the impact of the type and duration of rehabilitation on development, which was, in any case, beyond the scope of this study. Nevertheless, we believe that the use of the VIDA scale could be considered in future longitudinal studies to evaluate the efficacy of rehabilitation. ⁶ , ⁷ , ⁸ , ²⁷

It is noteworthy that adolescents exhibit a less homogeneous profile in comparison to younger children. Specifically, clothing and orientation and mobility areas appear to be the most impaired. Two potential explanations may be considered. First, tasks become more demanding with growth, requiring progressively high levels of independence and social and spatial skills that may be reduced in people with visual impairment. ²⁸ Moreover, some adolescents may be less exposed to some specific tasks (e.g. using public transport) because of the caution of parents or the lack of adapted facilities. Furthermore, adolescents often refuse to accept assistive devices (e.g. white cane) that may implement their orientation and mobility. ²⁹

The degree of visual impairment plays a role on independence acquisition, specifically in domains that require precise movements and eye–hand coordination (such as table manners and clothing). Conversely, there was no evidence that visual impairment influenced quality of life, which was, on average, satisfactory in our cohort. These findings are consistent with the disability paradox construct, which posits that disability is not necessarily associated with reduced quality of life. Indeed, an individual's functioning and perception can be seen as an expression of the interconnection between the physical body, the cognitive mind, and the spiritual self. These aspects are influenced by a multitude of factors, including environmental and personal elements. ³⁰ The findings of this study indicate that the early training of adaptive skills is of paramount importance for the well‐being of patients with visual impairment and their families.

One optimal attribute of a PROM is the capacity to facilitate interpretation of results through discourse between professionals and patients/caregivers. The VIDA scale demonstrated good concordance between the parents' scores (i.e. perceived level of autonomy) and the professionals' scores (i.e. observed level of autonomy). Such a comparison allows for the sharing of therapeutic goals and strategies, thereby promoting clear communication and discussion between clinicians and families. However, some minor discrepancies were noted between the perceptions of the professionals and the parents. In our cohort, parents tend to report superior table manners and social competencies, whereas health care professionals observe better orientation and mobility as well as more proficient clothing skills. These data prompt some reflections. It is possible that therapists are not fully aware of the strengths and weaknesses that patients may display in their daily lives. Conversely, professionals may be less prone to bias and more adept at identifying indications of emotional distress or atypical social behaviours. Furthermore, in their ecological settings, children and adolescents with disabilities may not be provided with the necessary time to process the demands of their surroundings and find their own adaptive strategies, a process that training often facilitates. The VIDA scale is a valuable tool for discussing and balancing over‐ and underestimations of competencies, offering a precise, realistic, and dynamic view of functional profiles. The slight discrepancies highlight the importance of a multidimensional rehabilitative approach that includes all possible informants (e.g. teachers) and addresses various life contexts. ⁷

This study is not without its limitations. First, our cohort may not be representative when considering epidemiological data on peripheral visual impairment in children in high‐income countries. This may reflect a referral bias as the recruiting centres are specialized in the rehabilitation of relatively rare conditions that share an elevated risk of developmental disorders (e.g. retinopathy of prematurity or optic nerve hypoplasia). The mission of these institutions is to sustain visual function and functional vision, and to prevent (or detect early) any developmental condition. The children involved in this study did not meet any criteria for any neurodevelopmental disorder. Moreover, the sample showed an overall good level of independence, which reinforces the clinical impression of regular development in these children and suggests a protective role of early and specific rehabilitation for isolated visual impairment. Nevertheless, future studies are planned to assess the VIDA scale validity in populations of children and adolescents with more complex clinical pictures and to evaluate the relative impacts of visual functions and associated developmental conditions on autonomy. For this study, visual field was assessed clinically (i.e. based on neuro‐ophthalmological examination and patient self‐report). Standardized measures such as perimetry or campimetry could have provided useful data for the interpretation of the VIDA scale results and we plan to use them in future studies. The extant self‐report version of the VIDA scale is currently only available for adolescents and does not allow for the inclusion of younger children. It is possible that this codesigned measure may be affected by cultural variables; thus, it may require adaptation before its validation and use in other countries. The use of another measure of autonomy could have been considered more suitable for the purpose of convergent validity testing instead of quality‐of‐life measures. In this study, TACQOL/TAPQOL were selected for several reasons, including their self‐report nature, their brevity, their availability in our country, and their structure, which is similar to that of the VIDA scale. Additionally, the construct of quality of life has already been studied in this population, also in relation to autonomy. ³¹ The TACQOL and TAPQOL are specifically designed for the age range we investigated (0–18 years), are reliable, and demonstrated strong correlations with the domains assessed by the VIDA scale, making them suitable for our study. Finally, despite the favourable response rate of families to our enrollment, we failed to reach the recommended sample size. ³² This is partly attributable to the decision to create a sample as homogeneous as possible, ruling out significant comorbidities, developmental delay/intellectual disability, or neuromotor disorders, with the objective of enhancing the consistency of results. Research in the field of visual impairment is challenging because of several factors, including the low prevalence of isolated peripheral visual impairment, geographical dispersion, diagnostic and clinical heterogeneity, and frequent association with comorbidities and other disabilities. ² , ³³ Furthermore, based on previous similar studies (e.g. Tadić et al.) ¹⁵ we believe that our sample size would be adequate for the tool's validation.

Conclusion

In conclusion, the VIDA scale was shown to have sufficient psychometric validity. It has the potential to be a useful tool in both clinical and research contexts. In a clinical setting, it can facilitate a standardized and quantitative assessment of a child's competencies and rehabilitation outcomes. In a research setting, it can be utilized to (1) shed light on the developmental trajectories of autonomy in populations with visual impairment, (2) serve as an outcome measure in rehabilitation trials, and (3) further investigate the influence of autonomy on other domains, such as quality of life and emotional‐behavioural profiles.

CONFLICT OF INTEREST STATEMENT

All authors declare that they have no conflicts of interest.

Supporting information

Appendix S1: The VIDA scale template.

Table S1: Sample characteristics.

Table S2: VIDA scale descriptives.

Morelli F, Grumi S, Catalano G, Scognamillo I, Reffo ME, Zumiani R, et al. Autonomy in children and adolescents with visual impairment: Validation of the Visual Impairment Developmental Autonomy scale. Dev Med Child Neurol. 2025;67:1472–1481. 10.1111/dmcn.16326

DATA AVAILABILITY STATEMENT

Raw data will be made available upon request on a repository after acceptance.