Age of the emergence of negative attitudes toward strabismus

Introduction: Strabismus impacts a variety of psychosocial variables in both children and adults. Poor self-esteem, lack of confidence, altered interpersonal relationships, and difficulty with employment procurement have been reported. The purpose of this study was to determine the age at which children perceive strabismus in dolls and to evaluate their reactions. Methods: Three identical dolls were altered so that one was orthotropic, one esotropic, and one exotropic. Thirty-four naïve children between 3 and 7 years of age were individually placed in a waiting room with the 3 dolls as the only toys with which to play. A one-way mirror allowed a hidden observer to tabulate the number of positive and negative behaviors exhibited toward each doll. After a 10-minute observation period, the children were asked a short series of questions about their preferences and attitudes toward the dolls. Odds ratios were then determined for both the observed behaviors and the expressed responses to the strabismic dolls compared with the orthotropic dolls. Results: Children aged 53/4 years and older were 73 times more likely than younger children to express a negative feeling about the strabismic dolls when asked (P = .003). Additionally, when comparing the strabismic dolls with the orthotropic doll, children aged 3 to 41/4 years did not notice a difference, children aged 41/2 to 51/4 years tended to describe the eyes as "different," and children aged 53/4 years or older almost uniformly gave a negative description of the strabismic dolls. Conclusions: A negative attitude toward strabismus appears to emerge at approximately 6 years of age. The biopsychosocial determinants of dislike and hostility toward ocular deviations are apparently acquired, learned responses.