Clinical Summary: Vision Care Pathway Measures and Vision Outcomes in US Children With Mental, Emotional, Developmental, or Behavioral Problems: National Survey of Children’s Health 2019–2023
Children with mental, emotional, developmental, or behavioral problems often already carry heavy functional and family burdens, and vision problems can add another layer of impairment. This analysis matters clinically because it shows that these children are reaching screening and eye care more often, yet still have a higher burden of nonrefractive vision disorders and persistent visual symptoms.
Key Findings
- Across 2021–2023, children with mental, emotional, developmental, or behavioral problems had higher reported rates than children without mental, emotional, developmental, or behavioral problems for every vision care pathway step measured, with statistically significant between-group differences in each year measured (all <.001 for pathway measures across 2021–2023).
- Recommendation for an eye exam or additional services remained higher in the mental, emotional, developmental, or behavioral problems group but narrowed in 2023: 34.9% in 2021, 35.4% in 2022, and 33.6% in 2023, with Δ=9.5% in 2021; 10.5% in 2022; 7.2% in 2023.
- In 2023, parent-reported diagnosis of a nonrefractive vision disorder was more common in children with mental, emotional, developmental, or behavioral problems than in peers without these problems (P=.005).
- Functional vision limitation despite correction remained numerically higher in children with mental, emotional, developmental, or behavioral problems across 2019–2023, with absolute gaps ranging from 1.4 to 3.4 percentage points, but in 2023 the between-group difference was not statistically significant (P=.274).
- Unmet vision care need stayed low in both groups across 2019–2023 and reached statistical significance only in 2020; in 2023 there was no significant between-group difference (P=.599).
Children with mental, emotional, developmental, or behavioral problems are entering the vision care pathway more often, but that higher system contact does not eliminate their higher burden of nonrefractive vision disorders and ongoing visual difficulty. For practice, the priority is not just screening but targeted follow-up and coordination after referral.
Practice Implications
- Do not assume that prior screening or an eye doctor visit resolves vision risk in children with mental, emotional, developmental, or behavioral problems; persistent symptoms can remain despite correction, with absolute gaps of 1.4 to 3.4 percentage points across 2019–2023.
- When caring for children with mental, emotional, developmental, or behavioral problems, ask specifically about whether visual difficulty persists even when wearing glasses or contact lenses, because unmet need was uncommon but functional limitation remained higher numerically.
- Use a low threshold to reinforce follow-up after screening or referral, since the pathway appears active in this population (all <.001 for pathway measures across 2021–2023) but nonrefractive vision disorder diagnoses remained higher.
- Discuss with caregivers the importance of continuity after referral and escalation to comprehensive evaluation when concerns persist, especially because recommendation rates in the mental, emotional, developmental, or behavioral problems group remained high at 34.9% in 2021, 35.4% in 2022, and 33.6% in 2023.
