Early Developmental Intervention Programs Research Articles

Paternal speech directed to young children with Autism Spectrum Disorders and typical development

BackgroundFew studies have investigated the characteristics of father language directed to typically developing children (TD), and father speech directed to children with Autism Spectrum Disorders (ASD) is largely under investigated. Considering the importance of involving fathers of children with ASD in research and clinical practice, the main purpose of this study was to investigate paternal speech directed to children with ASD compared to that of fathers of TD children. MethodsTo this aim, we coded multiple functional aspects of speech during 10-min naturalistic dyadic play interactions between fathers and their preschool children with ASD (n = 20) and with TD (n = 20). ResultsResults showed that fathers of children with ASD displayed a peculiar child-directed language that seems to reflect the effort to provide enhanced scaffolding and reduced demands while sustaining a challenging social interaction. Specifically, fathers of children with ASD used more descriptions, fewer questions in general but more questions about child internal states. Moreover, fathers adapted aspects of their information-salient speech to the severity of child impairments. ConclusionsOur findings support the importance to include fathers in early developmental intervention programs for children with ASD, by underlying fathers’ spontaneous adaptation to their children's needs.

Impact of Early Childhood Developmental Intervention Programs: Cost-Benefit Analysis Using a Proposed Model

Impact of Early Childhood Developmental Intervention Programs: Cost-Benefit Analysis Using a Proposed Model

Goal setting within a tertiary-level early developmental intervention program.

To determine the domains of parent-therapist collaboratively set goals for intervention within a family-centered, tertiary-level early developmental intervention (EDI) program. To report changes in ratings for performance and satisfaction of performance pre- and postintervention for the set goals. This study includes all children with complex developmental disabilities (30 ± 3 months of age, 61% boys) registered in a tertiary-level EDI program from 2009 to 2012 whose parents completed the Canadian Occupational Performance Measure (COPM) to evaluate goal setting. The International Classification of Functioning, Disability and Health: Children & Youth version (ICF-CY) domain for each goal was recorded. Pre- and postintervention ratings for individual and averaged goals per child were calculated. Positive changes in ratings were determined by an increase of ≤2 and presented as a proportion and as means (standard deviation). Student t test, Fisher Exact and chi-square tests compared groups. Of 483 individual goals set for 168 children, 65.4% were in the ICF-CY activity domain, 16.4% participation, 10.3% body function, 7.4% environment and 0.4% body structure. Positive changes in ratings for performance occurred in 70%; for satisfaction, 68%, with no difference in relation to domain. Positive changes in average ratings per child showed: performance, 67%; satisfaction, 66%. Intervention goals for disabled children within tertiary-level EDI are primarily those of activity, not participation as ICF-CY recommends; two-thirds of goals show positive change. These results suggest the need for further evaluation of goal setting within EDI programs with the expectation of increasing goals of participation and improving ratings for performance and satisfaction.

Home-Based Early Intervention and the Influence of Family Resources on Cognitive Development.

To investigate whether early developmental intervention (EDI) can positively affect the trajectories of cognitive development among children from low-resource families. Longitudinal analyses were conducted of data from 293 children in the Brain Research to Ameliorate Impaired Neurodevelopment Home-based Intervention Trial, a randomized controlled trial of a home-based EDI program, to examine trajectories of Bayley Scales of Infant Development-Second Edition Mental Development Index (MDI) scores from 12 to 36 months of age among young children from high- and low-resource families in 3 low- to middle-resource countries. A 3-way interaction among family resources, intervention group, and age was statistically significant after controlling for maternal, child, and birth characteristics (Wald χ(2)(1) = 9.41, P = .002). Among children of families with high resources, both the intervention and control groups had significant increases in MDI scores over time (P < .001 and P = .002, respectively), and 36-month MDI scores for these 2 groups did not differ significantly (P = .602). However, in families with low resources, the EDI group displayed greater improvement, resulting in significantly higher 36-month MDI scores than the control group (P < .001). In addition, the 36-month MDI scores for children in families with low resources receiving EDI did not differ significantly from children from high-resource families in either the EDI (P = .509) or control (P = .882) groups. A home-based EDI during the first 3 years of life can substantially decrease the developmental gap between children from families with lower versus higher resources, even among children in low- to middle-resource countries.

Developmental Screening Tools for Motor Developmental Delay in High Risk Preterm Infants

The preterm very low birth weight infants are at high risk of motor developmental delays. The developmental screening tools used by health professionals in pediatric practice serves several purposes viz. as a discriminative screening tool to identify the developmental delay in such high risk infants; as an evaluation tool to quantify the levels of functional skills achieved; as a prognostic tool to quantify the changes in levels of functional skills following specific developmental care interventions and as a predictive tool to predict the quantum of existing or impending neuro-developmental disability in high risk infants. Thus developmental screening tools serves as an integral part of early intervention programs. Such screening tools also serve as program evaluation strategy in quantifying the efficacy of early developmental care intervention programs. This review is aimed at describing the properties of developmental screening tools for motor developmental delay in preterm infants.J Nepal Paediatr Soc 2015;35(2):162-167

A community-based early intervention program for toddlers with autism spectrum disorders.

This study examined Pathways Early Autism Intervention, a community-based, parent-mediated, intensive behavioral and developmental intervention program for children with autism spectrum disorders that could be used as a model for state-funded early intervention programs. A single-subject, multiple-baseline, across-participants design was used. Four boys with autism spectrum disorder and their mothers participated. Interventionists made weekly home visits and worked with caregivers to establish and maintain face-to-face reciprocal social interaction and eye contact. Each session included a 10-min video of parent-child interaction. Evidence of intervention effectiveness was measured by percentage of nonoverlapping data points. Social validity was measured using questionnaire items in regard to parents' perception of the intervention. The intervention was effective for the measures of eye contact, social engagement, and verbal reciprocity but not for nonverbal turn taking. Parents perceived the intervention as beneficial and easy to learn and incorporate into daily life.

Evaluation of stress and pain in young children with cerebral palsy during early developmental intervention programs: a descriptive study.

The aim of this study was to use the Face, Legs, Activity, Cry, Consolability Scale; salivary cortisol levels; and withdrawal reflex thresholds to assess pain, stress, and pain sensitivity in young children with cerebral palsy during early developmental intervention programs. A total of 40 children with cerebral palsy (age range, 1-4 yrs) participated in the early intervention programs, which included neurodevelopmental treatment, neuromuscular electrical stimulation, occupational therapy, head acupuncture, and Chinese traditional manipulation five times per week for 3 wks. The Face, Legs, Activity, Cry, Consolability Scale was applied during the course of each treatment, and salivary cortisol samples were obtained from each child 10 mins before and 10 mins after each treatment. Withdrawal reflex thresholds were assessed via mechanical stimulation of the foot with von Frey hairs. All treatment programs caused some degree of pain. In descending order, the extents of the pain caused by each treatment were head acupuncture, neurodevelopmental treatment, neuromuscular electrical stimulation, Chinese traditional manipulation, and occupational therapy. There were statistically significant increases in salivary cortisol levels after the head acupuncture (P < 0.001), neurodevelopmental treatment (P < 0.001), neuromuscular electrical stimulation (P < 0.001), and Chinese traditional manipulation (P < 0.001) treatments. No significant changes were found in the withdrawal reflex thresholds during the study (P > 0.05). The results of this study demonstrate that early developmental intervention programs cause pain and stress in young children with cerebral palsy.

Instituting Parent Education Practices in the Neonatal Intensive Care Unit: An Administrative Case Report of Practice Evaluation and Statewide Action

Infants born preterm are at high risk of developmental disabilities and benefit from early developmental intervention programs. Physical therapists with neonatal expertise are ideally suited to educate parents about ways to support their infant's development in the first months of life. However, administrative policies are needed to support the therapist in providing adequate parent education in the neonatal intensive care unit (NICU). This administrative case report describes the process used by a team of neonatal therapists to evaluate clinical practice, determine the need for change, and develop and implement a new parent education program in the NICU. Physical therapy parent education practices were evaluated in an academic medical center with a 36-bed, level-3 NICU. Physical therapists with neonatal expertise covered multiple units within the hospital each day. A series of focus groups, a small descriptive study, and staff discussion were used to evaluate parent education practices in this academic medical center. A new parent education program was developed based on data collected and literature to improve clinical care. The new parent education model was implemented over the course of several months using overlapping initiatives. Administrative support for the change was developed through collaboration, open communication, and presentation of clinical data. In addition, this hospital-based program contributed to the development of a statewide initiative to educate parents of preterm infants about the importance of supporting development in the first months of life. A collaborative and data-driven approach to evaluating parent education practices supported the development of a new parent education practice while acknowledging the need to meet staff productivity standards and provide excellent care throughout the hospital.

Brain research to ameliorate impaired neurodevelopment--home-based intervention trial (BRAIN-HIT).

BackgroundThis randomized controlled trial aims to evaluate the effects of an early developmental intervention program on the development of young children in low- and low-middle-income countries who are at risk for neurodevelopmental disability because of birth asphyxia. A group of children without perinatal complications are evaluated in the same protocol to compare the effects of early developmental intervention in healthy infants in the same communities. Birth asphyxia is the leading specific cause of neonatal mortality in low- and low-middle-income countries and is also the main cause of neonatal and long-term morbidity including mental retardation, cerebral palsy, and other neurodevelopmental disorders. Mortality and morbidity from birth asphyxia disproportionately affect more infants in low- and low-middle-income countries, particularly those from the lowest socioeconomic groups. There is evidence that relatively inexpensive programs of early developmental intervention, delivered during home visit by parent trainers, are capable of improving neurodevelopment in infants following brain insult due to birth asphyxia.Methods/DesignThis trial is a block-randomized controlled trial that has enrolled 174 children with birth asphyxia and 257 without perinatal complications, comparing early developmental intervention plus health and safety counseling to the control intervention receiving health and safety counseling only, in sites in India, Pakistan, and Zambia. The interventions are delivered in home visits every two weeks by parent trainers from 2 weeks after birth until age 36 months. The primary outcome of the trial is cognitive development, and secondary outcomes include social-emotional and motor development. Child, parent, and family characteristics and number of home visits completed are evaluated as moderating factors.DiscussionThe trial is supervised by a trial steering committee, and an independent data monitoring committee monitors the trial. Findings from this trial have the potential to inform about strategies for reducing neurodevelopmental disabilities in at-risk young children in low and middle income countries.Trial RegistrationClinicaltrials.gov NCT00639184

The clinical significance of preschool depression: Impairment in functioning and clinical markers of the disorder

ObjectiveWhile much is now known about depression during school age and adolescence, whether clinical depression can onset even earlier in development during the preschool period remains under explored. The earliest possible identification of depression may be important for the design of prevention and early developmental intervention programs. This study investigated functional impairment associated with depression, symptoms that served as the best markers of depression vs. other disorders, as well as depression severity between two depressed sub-groups and other diagnostic comparison groups. MethodThree hundred and five preschoolers between the ages of 3.0 and 6.0 and their primary caregivers were recruited using a depression screening checklist distributed at community sites. The Preschool Age Psychiatric Assessment (PAPA) was used to derive psychiatric diagnoses in the study sample. Multivariate analyses of covariance were used to investigate the effects of depression on independent measures of functional impairment while controlling for the effects of co-morbidities. ResultsFunctional impairment specifically associated with depression was found in multiple domains and contexts, however depressed preschoolers were not developmentally delayed. The symptoms of guilt and extreme fatigue were found to be highly specific for preschool depression. A statistically significant hierarchy of depression severity was found between diagnostic comparison groups, in the expected direction with the highest in a melancholic subgroup. ConclusionsValidation for preschool depression with associated functional impairment across contexts was found in preschool children. These findings replicate and extend earlier evidence for validity of MDD diagnosed in the preschool period and highlight the need for clinical attention. The finding that these depressed and impaired preschoolers were not yet developmentally delayed may have important public health significant significance as it suggests a possible window of opportunity for early intervention. Study findings were limited by reliance on parent and teacher informants and a cross-sectional view.

Cochrane review: Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants

AbstractBackgroundInfants born preterm are at increased risk of developing cognitive and motor impairments compared with infants born at term. Early developmental interventions have been used in the clinical setting with the aim of improving the overall functional outcome for these infants. However, the benefit of these programs remains unclear.ObjectivesTo review the effectiveness of early developmental intervention post‐discharge from hospital for preterm (&lt; 37 weeks) infants on motor or cognitive development.Search strategyThe Cochrane Neonatal Review group search strategy was used to identify randomised and quasi‐randomised controlled trials of early developmental interventions post hospital discharge. Two review authors independently searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE Advanced, CINAHL, PsychINFO and EMBASE (1966 through February 2006).Selection criteriaStudies included had to be randomised or quasi‐randomised controlled trials of early developmental intervention programs that commenced within the first 12 months of life for infants born at &lt; 37 weeks with no major congenital abnormalities. Intervention could commence as an inpatient; however, a post discharge component was necessary to be included in this review. The outcome measures were not pre‐specified other than that they had to assess cognitive and/or motor ability. The rates of intellectual impairment, cerebral palsy and development co‐ordination disorder were also documented.Data collection and analysisData were extracted and entered by two independent review authors. Cognitive and motor outcomes were pooled in three age groups ‐ infant (0 to 2 years), preschool (3 to &lt; 5 years) or school age (5 to 17 years). Meta‐analysis was carried out using RevMan 4.2 to determine the effects of early developmental intervention in the short (0 to 2 years), medium (3 to &lt; 5 years) and long term (5 to 17 years). Subgroup analysis was carried out in relation to; gestational age, birthweight, brain injury, commencement of intervention, focus of intervention and study quality.Main resultsSixteen studies met the inclusion criteria (2379 randomised patients). Six of these studies were RCTs and had strong methodological quality. There was variability with regard to the focus and intensity of the intervention, and in length of follow‐up. Meta‐analysis concluded that intervention improved cognitive outcomes at infant age (developmental quotient [DQ]: standard mean difference [SMD] 0.46 SD; 95% CI 0.36 0.57; P &lt; 0.0001), and at preschool age (intelligence quotient [IQ]; SMD 0.46 SD; 95%CI 0.33, 0.59; P &lt; 0.0001). However, this effect was not sustained at school age (IQ; SMD 0.02 SD; 95% CI ‐0.10, 0.14; P = 0.71). There was significant heterogeneity between studies for cognitive outcomes at infant and school ages. There was little evidence of an effect of early intervention on motor outcomes in the short, medium or long‐term, but there were only two studies reporting outcomes beyond 2 years.Authors' conclusionsEarly intervention programs for preterm infants have a positive influence on cognitive outcomes in the short to medium term. However, there was significant heterogeneity between the interventions included in this review. Further research is needed to determine which early developmental interventions are the most effective at improving cognitive and motor outcomes, and on the longer‐term effects of these programs. Cost‐effectiveness and access to services should also be evaluated since they are important factors when considering implementation of an early developmental intervention program for a preterm infant.Plain language summaryPreterm infants (babies born before 37 weeks) are at risk of development problems, including problems with cognitive and motor development. Cognitive development refers to thinking and learning ability and motor development refers to the way infants move, such as sitting, crawling and walking. Early developmental interventions aim to reduce cognitive and/ or motor problems; however, the benefits of these programs are not clear. A review of trials suggests early developmental intervention programs post discharge from hospital for preterm infants are effective at improving cognitive development in the short to medium term (up to preschool age). There is limited evidence that early developmental interventions improve motor outcome or long term cognitive outcome (up to school age). The early developmental intervention programs in this review had to commence within the first 12 months of life, focus on the parent‐infant relationship and/or infant development and, although they could commence while the baby was still in hospital, they had to have a component that was delivered post‐discharge from hospital. The early developmental intervention programs included in this review are different in content, frequency of intervention and focus of intervention. The variability in the intervention programs limits the conclusions that can be made about the effectiveness of early developmental interventions.

Commentary on ‘Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants’

AbstractThis is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Spittle AJ, Orton J, Doyle LW, Boyd R. Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005495. DOI: 10.1002/14651858.CD005495.pub2.Further information for this Cochrane review is available in this issue of EBCH in the accompanying EBCH Summary and Characteristics and Key Findings Tables articles. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration

Summary of ‘Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants’

AbstractThis is a summary of a Cochrane review, published in this issue of EBCH, first published as: Spittle AJ, Orton J, Doyle LW, Boyd R. Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005495. DOI: 10.1002/14651858.CD005495.pub2.Further information for this Cochrane review is available in this issue of EBCH in the accompanying EBCH Commentary and Characteristics and Key Findings Tables articles. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration

Characteristics and key findings for ‘Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants’

AbstractThese are the characteristics and key findings for a Cochrane review published in this issue of EBCH, first published as: Spittle AJ, Orton J, Doyle LW, Boyd R. Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005495. DOI: 10.1002/14651858.CD005495.pub2.Further information for this Cochrane review is available in this issue of EBCH in the accompanying EBCH Summary and Commentary articles. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration