Challenge Of Early Intervention Research Articles

The challenges for early intervention and its effects on the prognosis of autism spectrum disorder: a systematic review.

To establish what challenges are still present in the implementation of early intervention (EI) and its effects on the prognosis of ASD. A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma) methodology was carried out in the PubMed and ScienceDirect databases in January 2023. The search keywords were "autism spectrum disorder", "early intervention" and "prognosis". Sixteen studies were included, two randomized and 14 non-randomized. Knowledge about the signs of ASD, diagnostic and therapeutic methods, age at the start of treatment, and socioeconomic factors were the main challenges encountered in the implementation of the EI. EI is capable of modifying the prognosis of ASD and challenges in its implementation persist, especially in developing regions with low socioeconomic status.

Unmet Needs and Perceived Challenges in Early Intervention for Psychosis: A Qualitative Study of Three Groups of Stakeholders

NAVIGATE is a coordinated specialty care program for people who have experienced first-episode psychosis. The current study aims to explore the unmet needs of NAVIGATE stakeholders for the purpose of guiding the optimization of the program. Data from 24 semistructured interviews with NAVIGATE clients, family caregivers, and practitioners were conducted and analyzed using inductive thematic analysis. Clients expressed needs for emotional support between sessions and for peer support. Family caregivers expressed needs for guidance between sessions, better access to information, peer support, and updates regarding clients’ recovery. All stakeholders reported challenges working with the program’s manual. In addition, four general challenges related to the aftermath of a first-episode psychosis were identified. Exploring ways to better address these unmet needs may improve treatment satisfaction and outcome.

A Qualitative Study Exploring Parental Perceptions of Telehealth in Early Intervention.

Using telehealth as a mode of service delivery has the potential to address some long-standing challenges in early intervention (EI) services such as waiting lists to access services. Yet, little is known about parent perceptions of telehealth in EI based on their lived experiences partnering with EI practitioners. The purpose of this study was to explore parent perceptions on using telehealth, especially on family-professional partnerships and coaching. Interviews were conducted with 15 parents of children receiving EI services via telehealth from June to August of 2021. Almost half of the participants reflected under-represented racial and ethnic backgrounds. Constant comparative analysis and emergent coding were used for data analysis. The findings showed that the advantages outnumbered the disadvantages regarding telehealth. Participants reported that telehealth provided a safe and flexible option and eliminated the wait to access EI services. However, participants identified some disadvantages to telehealth including telehealth precluded substantive interactions with therapists and limited access to technology. The findings also indicated that telehealth enhanced family-professional partnerships. Nearly all participants valued coaching during telehealth. Participants suggested initial supports to facilitate EI via telehealth, including stable internet access, telehealth training, and an initial in-person visit. Implications for research and practice are discussed. Supplementary InformationThe online version contains supplementary material available at 10.1007/s10882-022-09853-w.

Progress and challenges in early intervention of autism spectrum disorder in China

Autism spectrum disorder (ASD) is a neurodevelopmental disorder whose prevalence has increased rapidly in recent decades. Advances in the fields of intervention for ASD have contributed to a more optimistic outcome for children with ASD. Furthermore, the development of early detection, screening, and diagnosis has highlighted the importance of early intervention for young children with ASD. The present article reviews commonly used intervention approaches for children with ASD in China, including recently introduced approaches and originally developed Chinese models for early intervention, and then briefly summarizes the progress and challenges of intervention in combination with associated services and supports.

Advances and challenges in early intervention in psychosis

Advances and challenges in early intervention in psychosis

Current Challenges in Early Intervention for Children with Autism Spectrum Disorder (ASD): A Narrative Review

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that involves global impairments in social skills and in verbal and non-verbal communication, as well as the presence of stereotyped patterns of behaviors and interests. ASD imposes an enormous burden on society including lifelong disability, high medical care, and increased mental health problems in caregivers. Evidence demonstrates that very early intervention delivered immediately after diagnosis during the first three years of life has higher impact on outcomes in comparison to later start. Early intervention has positive impact on verbal and nonverbal skills, adaptive skills, and quality of life of caregivers. Unfortunately, the majority of children in the world either start intervention after 4 years of age or never receive specialized intervention. The aim of this paper is to discuss current issues related to research and clinical implementation in the field of early intervention for your children with ASD.

Models of marine molluscan diseases: Trends and challenges

Disease effects on host population dynamics and the transmission of pathogens between hosts are two important challenges for understanding how epizootics wax and wane and how disease influences host population dynamics. For the management of marine shellfish resources, marine diseases pose additional challenges in early intervention after the appearance of disease, management of the diseased population to limit a decline in host abundance, and application of measures to restrain that decline once it occurs. Mathematical models provide one approach for quantifying these effects and addressing the competing goals of managing the diseased population versus managing the disease. The majority of models for molluscan diseases fall into three categories distinguished by these competing goals. (1) Models that consider disease effects on the host population tend to focus on pathogen proliferation within the host. Many of the well-known molluscan diseases are pandemic, in that they routinely reach high prevalence rapidly over large geographic expanses, are characterized by transmission that does not depend upon a local source, and exert a significant influence on host population dynamics. Models focused on disease proliferation examine the influence of environmental change on host population metrics and provide a basis to better manage diseased stocks. Such models are readily adapted to questions of fishery management and habitat restoration. (2) Transmission models are designed to understand the mechanisms triggering epizootics, identify factors impeding epizootic development, and evaluate controls on the rate of disease spread over the host’s range. Transmission models have been used extensively to study terrestrial diseases, yet little attention has been given to their potential for understanding the epidemiology of marine molluscan diseases. For management of diseases of wild stocks, transmission models open up a range of options, including the application of area management, manipulation of host abundance, and use of scavengers and filter feeders to limit the concentration of infective particles. (3) The details of host population processes and pathogen transmission dynamics are blended in models that evaluate the effects of natural selection and/or genetic modification in developing disease resistance in the host population. Application of gene-based models to marine diseases is only now beginning and represents a promising approach that may provide a mechanistic basis for managing marine diseases and their host populations. Overall disease models remain both uncommon and underutilized in addressing the needs for managing molluscan diseases and their host populations.

Connecting the dots: Twenty-first century technologies to tackle twenty-first century challenges in early intervention

Connecting the dots: Twenty-first century technologies to tackle twenty-first century challenges in early intervention

Beyond psychosis: The challenge of early intervention in bipolar disorders

Beyond psychosis: The challenge of early intervention in bipolar disorders

The challenge of early intervention: How do you identify low performance?

As predicted, regression-based methods picked up on variability not captured by norms, which may prove helpful for identifying early decline in those who start out as high performers. However, in our relatively young sample, it is still unclear which of these approaches will do the best job of targeting AD-specific change. Additional followup of this sample is needed to determine the overall sensitivity and specificity of these approaches for identifying patients who are on a trajectory to develop MCI and AD. In the meantime, clinicians may want to consider both absolute and relative low performance for a given individual when assessing patient risk of AD. Distribution of classifications: In general, Method 1 identified fewer people as performing worse or better than expected than did either of the other methods. The average percentage (worse, better) across the seven outcomes was (4, 6) for Method 1, (6, 9) for Method 2, and (6, 10) for Method 3. Furthermore, the average performance of those identified by Methods 2 and 3 was less extreme (Table 1). This suggests that Methods 2 and 3 allow one to identify more subtle declines. Model agreement: The classifications made by Models 2 and 3 had good to very good agreement for all outcomes (weighted kappa values .71-.83). However, Model 1 did not agree well with either of the other two (weighted kappa values .08-.38), suggesting that norm-based methods and regression-based methods do not identify the same people as low performers (Fig. 1-4). Overlap of cognitive indicators: Poor performance on one outcome did not generally transfer to poor performance on another outcome. Figure 5 shows the relative proportion of low performers who were classified as “Worse” on multiple composite score outcomes by Methods 1, 2, or 3. TaBleS & figureS

The promises and challenges of early intervention in psychotic disorders

A burgeoning interest in understanding and treating the early phase of psychotic disorders, especially schizophrenia, has brought forth a sense of optimism of altering the course of these disorders. McGorry et al highlight many aspects of the progress made, as well as some of the challenges to furthering the application of a broader preventive model of care based on a hierarchical model of understanding mental disorders. It may not be entirely ironic that development of early intervention theory and practice in psychiatric disorders should have started with the disorder viewed most pessimistically with poor outcome (schizophrenia). Indeed, a great deal of progress has been made since the initial seminal studies of first episode psychosis 1and the influential review by Wyatt 2. Such progress has extended beyond understanding the effects of delay in treatment to a more substantial understanding of neurobiology and outcome during early phase of psychotic disorders. It has been particularly remarkable that, while research in phenomenology, neurobiology and cognitive psychology of first episode psychosis and the putative periods preceding the onset of psychosis has flourished, there has been a parallel and equally prolific development of services specializing in treatment of early phases of the illness. Such developments have taken research out of artificial settings to real life new specialized services, thus making available large epidemiologically based cohorts of subjects for investigation. Such research is likely to be more meaningful in the long run, as the findings will be applicable to larger groups of patients. As McGorry et al suggest, it is time now to think more broadly and extend the scope of such developments in service and research to a larger group of disorders without the constraint of a strictly categorical diagnostic system. Despite the well justified enthusiasm, there are, however, a number of issues that remain either unclear or unaddressed. The term “early intervention” has often been taken to imply “earlier” intervention predicated on an association between duration of untreated psychosis (DUP) and clinical outcome. However, this is an oversimplification: there is in fact much more to “early intervention” than simply intervening early 3. The evidence to support enriched and comprehensive interventions is indeed strong and replicated in controlled studies 4-6and confirmed in a recent meta-analysis 7. While it requires no more than face validity to support quick, unencumbered and user-friendly access to specialized treatment of new cases of psychotic disorders, the evidence for more elaborate and relatively expensive interventions to improve early case detection remains either confined to specific jurisdictions 8or applicable only to a subgroup of patients 9. In order to benefit larger number of patients, it may be easier to convince mental health policy makers to apply a more effective treatment model with improved access than to expect them to support elaborate and expensive interventions to reduce DUP through active case detection. There is still a need to identify what methods of early case identification and improved access would work in which settings, given large variations in composition of populations (e.g. ethnicity, urban vs. rural setting) and nature and quality of the prevailing primary and specialist health care. On the other hand, large scale campaigns at the community level to improve general mental health literacy and engage communities in a dialogue about mental illness have heuristic value even if their direct impact on reducing delay in treatment of specific disorders may be difficult to demonstrate. McGorry et al correctly identify the greater conceptual accuracy of “ultra-high risk” as opposed to “prodromal” patients to whom interventions could be provided to prevent or delay onset of psychosis. While there has been progress in demonstrating efficacy of individual interventions in small controlled trials, we are not yet at a stage to recommend any particular approach. Apart from the need for more substantial evidence, there are several reasons for such caution. The transition from a non-psychotic high risk state to psychosis occurs in only a fraction of such patients, even without the use of antipsychotic medications, especially if they are provided with adequate care and support for the problems they present with. This raises the risk of treating many more false positives for a putative impending psychosis. Further, not enough attention has been paid to the relatively fluid and ambiguous boundary between sub-threshold and threshold level of symptoms of psychosis, creating a risk of reporting results based on a categorical fallacy. Until such time as further methodologically sound research using large samples produces clear evidence based interventions, we run the risk of encouraging clinicians to become cavalier in using antipsychotic medications for treating symptoms they observe over a single assessment, as is already happening in many jurisdictions. Other major challenges that must be faced, if “early intervention” is to benefit a larger population of patients, include the patients' refusal to accept or engage in treatment (estimate 15-50%), those who drop out early in the course of or do not adhere to treatment, and those who present with substance abuse as an additional problem. Lack of adherence to treatment and presence of substance abuse have been identified as major obstacles to achieving and maintaining symptomatic remission following treatment of first episode psychosis 10-12. Indeed, such malleable predictors of outcome overshadow the significance of delay in treatment in achieving better outcomes. Further, it appears that the gains made with specialized treatment of early phase of psychosis over the first two years are difficult to sustain 5, and further systematic study of the length of specialized treatment is required if we are to make a difference in the longterm course of psychotic disorders. Last, but not least, there is a dire need to understand the process of recovery and what promotes or hinders it during the early “critical period”. Both qualitative and quantitative research, which takes into account patients' and families' perspectives and examines the effect of various treatments on recovery 13, should be a priority for the early intervention field.

Autism in Infancy and Early Childhood

Although initially described as an inborn disorder of affective contact, information on autism as it exists in infants has been limited. Delays in diagnosis, lack of information about the condition, and reliance on retrospective research strategies have been problematic. An awareness of the increased risk for siblings is now allowing the development of new, prospective approaches. Consistent with Kanner's original hypothesis, the available information strongly suggests a fundamental difficulty in the earliest social processes, which, in turn, impacts many other areas of development. New approaches to screening have lowered the age of initial diagnosis; this presents new challenges for early intervention. Directions for future research are highlighted.

Growing up in poverty as a developmental risk: Challenges for early intervention

In the context of poverty problems in ‘First World’ countries induced at socio-economic and political levels, data are presented about child poverty in Germany. Important connections within the complex relationship of child poverty and developmental risks become apparent. Following brief comments about the value of early intervention within the multidimensional strategy to combat (child) poverty, particularly on the political level (fair compensation for family-related burdens for families with children and additional care structures as dictated by need), the conditions for effective early intervention are listed. The article concludes with references to proven plans for actions in this field and to the meaning of a low level entry system for the early discovery of developmental risks for children who grow up in poverty.

Early interventions following psychological trauma.

What is the best way to provide early interventions for psychiatric disorders after trauma? The terrorist attacks of September 11, 2001, have raised urgent concerns about the evidence for early treatments after trauma that can prevent psychiatric disorders. This review outlines the expected course of posttraumatic stress reactions and discusses the current means of identifying people who are at risk of developing disorders. A critique of psychological debriefing and an analysis of evidence for cognitive-behavioral therapy as an early intervention is provided. The major challenges for early intervention are discussed, including increasing treatment effectiveness, delivering therapy when it is required by thousands of people, and developing early interventions for a wide array of psychiatric disorders in addition to posttraumatic stress disorder that can develop following trauma.

Young children's occupations: explicating the dynamics of developmental processes.

Describing development as sequential sensorimotor, cognitive, and psychosocial milestones does not explain how children learn to do or improve their occupations. In response to changes within occupational therapy and challenges in early intervention, this article focuses on development of occupation and proposes a dynamic system perspective. Contemporary research suggests that processes are in place to ensure that children develop as occupational beings. Social participation and caregiving routines guide the child toward becoming occupational by introducing intentional acts and by endowing experiences with meaning. A self-organizing process enables children to integrate their immature capacities and engage in occupations. Simultaneously, caregiving shapes these emerging behaviors, ensuring that performance is culturally compatible. Finally, using self-organization to maintain occupational engagement enables the child to accommodate to maturing abilities and environmental challenges. This reorganized pattern in turn is the basis for developmental changes, new behaviors, and refinement of current abilities. Application of concepts is made to acquisition of skills for eating a meal.