Efficacy Of Early Intervention Research Articles

Does the Animal Fun program improve motor performance in children aged 4–6 years?

The Animal Fun program was designed to enhance the motor ability of young children by imitating the movements of animals in a fun, inclusive setting. The efficacy of this program was investigated through a randomized controlled trial using a multivariate nested cohort design. Pre-intervention scores were recorded for 511 children aged 4.83years to 6.17years (M=5.42years, SD=3.58months). Six control and six intervention schools were compared 6months later following the intervention, and then again at 18months after the initial testing when the children were in their first school year. Changes in motor performance were examined using the Bruininks-Oseretsky Test of Motor Proficiency short form. Data were analyzed using multi-level-mixed effects linear regression. A significant Condition×Time interaction was found, F(2,1219)=3.35, p=.035, demonstrating that only the intervention group showed an improvement in motor ability. A significant Sex×Time interaction was also found, F(2,1219)=3.84, p=.022, with boys improving over time, but not girls. These findings have important implications for the efficacy of early intervention of motor skills and understanding the differences in motor performance between boys and girls.

Interventions for preventing relapse and recurrence of a depressive disorder in children and adolescents.

Depressive disorders often begin during childhood or adolescence. There is a growing body of evidence supporting effective treatments during the acute phase of a depressive disorder. However, little is known about treatments for preventing relapse or recurrence of depression once an individual has achieved remission or recovery from their symptoms. To determine the efficacy of early interventions, including psychological and pharmacological interventions, to prevent relapse or recurrence of depressive disorders in children and adolescents. We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) (to 1 June 2011). The CCDANCTR contains reports of relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). In addition we handsearched the references of all included studies and review articles. Randomised controlled trials using a psychological or pharmacological intervention, with the aim of preventing relapse or recurrence from an episode of major depressive disorder (MDD) or dysthymic disorder (DD) in children and adolescents were included. Participants were required to have been diagnosed with MDD or DD according to DSM or ICD criteria, using a standardised and validated assessment tool. Two review authors independently assessed all trials for inclusion in the review, extracted trial and outcome data, and assessed trial quality. Results for dichotomous outcomes are expressed as odds ratio and continuous measures as mean difference or standardised mean difference. We combined results using random-effects meta-analyses, with 95% confidence intervals. We contacted lead authors of included trials and requested additional data where possible. Nine trials with 882 participants were included in the review. In five trials the outcome assessors were blind to the participants' intervention condition and in the remainder of trials it was unclear. In the majority of trials, participants were either not blind to their intervention condition, or it was unclear whether they were or not. Allocation concealment was also unclear in the majority of trials. Although all trials treated participants in an outpatient setting, the designs implemented in trials was diverse, which limits the generalisability of the results. Three trials indicated participants treated with antidepressant medication had lower relapse-recurrence rates (40.9%) compared to those treated with placebo (66.6%) during a relapse prevention phase (odds ratio (OR) 0.34; 95% confidence interval (CI) 0.18 to 0.64, P = 0.02). One trial that compared a combination of psychological therapy and medication to medication alone favoured a combination approach over medication alone, however this result did not reach statistical significance (OR 0.26; 95% CI 0.06 to 1.15). The majority of trials that involved antidepressant medication reported adverse events including suicide-related behaviours. However, there were not enough data to show which treatment approach results in the most favourable adverse event profile. Currently, there is little evidence to conclude which type of treatment approach is most effective in preventing relapse or recurrence of depressive episodes in children and adolescents. Limited trials found that antidepressant medication reduces the chance of relapse-recurrence in the future, however, there is considerable diversity in the design of trials, making it difficult to compare outcomes across studies. Some of the research involving psychological therapies is encouraging, however at present more trials with larger sample sizes need to be conducted in order to explore this treatment approach further.

PIENSA: Development of an Early Intervention Program for Adolescents With Early-Onset Psychosis and Their Families

Interest in the effectiveness of psychological interventions in patients with psychosis has increased in the last 2 decades, and early intervention programs are increasingly common. PIENSA (Programa de Intervención en Psicosis Adolescente; Intervention Program for Adolescent Psychosis) is a clinical program and pilot study based on previous research into the efficacy of early intervention in preventing relapse and improving outcome in patients with first-episode psychosis. We describe a psychoeducational intervention designed for adolescents with early-onset psychosis and their parents. The intervention is adapted from McFarlane’s Multiple Family Therapy model to our setting and population (adolescents treated in the Spanish public health system). It consists of 2 stages: an individual stage comprising 3 sessions and a subsequent group stage comprising 12 sessions. The total program lasts for 1 academic year (9 months). We present the design of our program and our preliminary experience in a Child and Adolescent Unit in Spain.

“Help for wayward children”: child guidance in 1930s Australia

PurposeHistorical studies of the expert management of childhood in Australia often make passing reference to the establishment of child guidance clinics. Yet beyond acknowledgement of their founding during the interwar years, there has been little explication of the dynamics of their institutional development. The purpose of this article is to examine the introduction of child guidance in Australia against the backdrop of the international influences that shaped local developments.Design/methodology/approachThe article investigates the establishment of child guidance clinics in Melbourne and Sydney in the 1930s. In doing so, it explores the influence of American philanthropy, the promise of prevention that inspired the mental hygiene movement, and some of the difficulties faced in putting its child guidance ideals into practice in Australia.FindingsAmerican philanthropy played an important role in the transnational carriage of ideas about mental hygiene and child guidance into Australia. However, it was state support of child guidance activities that proved critical to its establishment. In addition to institutional developments, what also emerges as important in the 1930s is the traction gained in the broader realm of ideas about “adjustment” and mental health, particularly in relation to the efficacy of early intervention and multidisciplinary approaches to treating problems of childhood.Originality/valueIn tracing its early development, the article argues for the importance of understanding child guidance not only in terms of its administrative successes and failures, but also more broadly in terms of how early intervention as an influential mode of thought and practice took root internationally.

Early intervention for Japanese cedar and cypress pollinosis

SummaryIt is considered that early intervention for pollinosis relieves symptoms during the pollen season in Japan. Therefore, initiating medication prior to pollen dispersal has recently become a popular trend under the influence of the mass media. However, the actual benefits of this kind of early intervention during the peak of the pollen season have not been evaluated enough. We review a randomized placebo‐controlled trial that was conducted to examine the efficacy of early intervention (before pollen dispersal) with the oral cysteinyl leukotriene receptor antagonist (LTRA) pranlukast against pollinosis symptoms in patients with allergy to Japanese cedar and cypress pollens in 2007. The subjects were treated with pranlukast or placebo for 4 weeks at the beginning of the cedar pollen dispersal season. Subsequently, all the patients received nasal steroid therapy concomitantly with pranlukast throughout the remaining period of the pollen dispersal season. The effects were evaluated by symptom scores based on allergy diaries and quality of life (QOL) scores as determined by the Japan Rhinoconjunctivitis Quality of Life Questionnaire. In the pranlukast‐pre‐treated patients, the nasal symptoms (paroxysmal sneezing, runny nose and nasal congestion) were improved during the early Japanese cedar pollen dispersal season. Subsequently, concomitant therapy with pranlukast plus nasal steroids for the rest of the pollen season significantly improved the symptom and QOL scores compared with the placebo‐pre‐treated patients. This study shows that LTRA administration to Japanese cedar and cypress pollinosis patients starting just before and continuing throughout the pollen dispersion season in high‐risk communities is effective for improving the clinical symptoms and indicators of pollinosis. Further assessment of the efficacy of early intervention with an LTRA is required in comparison with other drug therapies, with consideration of the associated cost–benefit effectiveness.

Incidental Detection of Renal Cell Carcinoma is an Independent Prognostic Marker: Results of a Long-Term, Whole Population Study

The true effect of incidental detection on the survival of patients with renal cell carcinoma has been debated. We used centralized databases in Iceland to study prognostic factors of survival, focusing on the effect of incidental detection. This retrospective study included all living patients diagnosed with renal cell carcinoma in Iceland from 1971 to 2005. Hospital charts and histology were reviewed. Incidentally diagnosed renal cell carcinomas were compared to symptomatic tumors and prognostic factors were evaluated using Cox multivariate analysis. Of the 910 patients 254 (27.9%) were diagnosed incidentally, most often by abdominal ultrasound (29.5%) or computerized tomography (28.3%). The incidental detection rate increased from 11.1% in 1971 through 1975 to 39.2% in 2001 through 2005 (p <0.001). During the same period the incidence increased significantly in males but in females only during the last 5 study years. Mortality remained unchanged for each gender. Incidentally detected tumors were an average of 2.6 cm smaller and diagnosed at lower stage and lower grade than symptomatic tumors. Age and histology were similar in each group. TNM stage was by far the strongest independent prognostic factor of survival but age, calendar year of diagnosis and ESR were also significant. After correcting for confounders patients with symptomatic renal cell carcinoma had worse survival than those diagnosed incidentally. With increased incidence and unchanged mortality the survival of patients with renal cell carcinoma has improved. This is mainly related to a steep increase in incidental detection. Incidental detection affects survival favorably and to a greater extent than can be explained by lower stage compared to the survival of patients diagnosed with symptoms.

Screening Young Children for Autism Spectrum Disorders in Primary Practice

The increasing prevalence of autism spectrum disorders as well as emerging evidence of the efficacy of early intervention has focused attention on the need for early identification of young children suspected of having an ASSD. Several studies have suggested that while parents report concerns early in development, it may be months before children can be evaluated and services provided, and these delays may be even more marked in under-served populations. The American Academy of Pediatrics recently recommended universal screening for autism spectrum disorders at the 18- and 24-month well-child pediatric visit. The authors review several early screening tools currently in use and offer recommendations for integrating autism specific screening into primary care practice.

Using real-time alerts for clinical trials

Clinical trials are widely accepted as a necessary step in evaluating the safety and efficacy of new pharmaceutical products. In order for a sufficiently powered study, a clinical trial depends on the effective and unbiased recruitment of eligible patients. Trials involving seasonal diseases like influenza pose additional challenges. This is a feasibility study of a mobile real-time alerting system to systematically identify potential study subjects for a randomized controlled trial evaluating the safety and efficacy of early intervention with interferon alfacon-1 for patients hospitalized for influenza virus infection. The alerting system was setup in a 471-bed acute care teaching hospital, enabled with computerized physician order entry (CPOE) and a rules-based alerting system. Patients were identified from the entire hospital using two alerts types: pharmacy prescription records for antiviral drugs, and positive influenza laboratory results. Email alerts were generated and sent to BlackBerry(®) devices carried by the study personnel for a 6 month period. The alerts were archived automatically on a secure server and were exported for analysis in Microsoft Access. Over a period of 21 weeks, 779 total alerts were received. The study team was alerted to 241 patients, of whom 85 were potential study subjects. The alert system identified all but one of the patients independently identified by infection control. Real-time identification of potential study subjects is possible with the integration of computerized physician order entry and BlackBerry(®) technology. It is a viable method for the systematic identification of patients throughout a hospital, particularly for trials investigating time-sensitive disease progression.

Thickness in Entorhinal and Subicular Cortex Predicts Episodic Memory Decline in Mild Cognitive Impairment

Identifying subjects with mild cognitive impairment (MCI) most likely to decline in cognition over time is a major focus in Alzheimer's disease (AD) research. Neuroimaging biomarkers that predict decline would have great potential for increasing the efficacy of early intervention. In this study, we used high-resolution MRI, combined with a cortical unfolding technique to increase visibility of the convoluted medial temporal lobe (MTL), to assess whether gray matter thickness in subjects with MCI correlated to decline in cognition over two years. We found that thickness in the entorhinal (ERC) and subicular (Sub) cortices of MCI subjects at initial assessment correlated to change in memory encoding over two years (ERC: r = 0.34; P = .003) and Sub (r = 0.26; P = .011) but not delayed recall performance. Our findings suggest that aspects of memory performance may be differentially affected in the early stages of AD. Given the MTL's involvement in early stages of neurodegeneration in AD, clarifying the relationship of these brain regions and the link to resultant cognitive decline is critical in understanding disease progression.

Prevention of long-term sickness absence and major depression in high-risk employees: a randomised controlled trial

ObjectivesTo examine the efficacy of early intervention on the prevention of long-term sickness absence and major depression among employees at high risk of future sickness absence and with mild to...

F08 The functional rating taskforce for pre-huntington's disease: results so far

BackgroundThe earliest clinical manifestations of Huntington's (HD) disease are poorly characterized, and there is a need for clinical scales designed specifically to measure early signs and symptoms in individuals with...

Case-Control Study of Risk Factors Associated with Feline and Canine Chronic Kidney Disease

An age-matched case-control study was initiated to determine the major risk factors associated with CKD in cats and dogs and to determine what clinical signs cat and dog owners observed before their veterinarian diagnosed their pet with CKD. When compared to controls, the feline cases were more likely to have had polydipsia and polyuria in the year before the owners' cats were diagnosed with CKD. In the dogs, increased water intake, increased urination, small size and a recent history of weight loss and bad breath were noticed by the dog owners before veterinary CKD diagnosis. Dog owners recognized abnormal drinking and urination behavior over half a year before their pet's veterinary diagnosis with CKD, and they recognized weight loss almost 4 months before CKD diagnosis. Bad breath was noticed 1.2 years before recognition of CKD by a veterinarian. Given that earlier CKD diagnosis should have been possible in most cases, clinical trials should proceed to measure the efficacy of early interventions.

A Selective Intervention Program for Inhibited Preschool-Aged Children of Parents With an Anxiety Disorder: Effects on Current Anxiety Disorders and Temperament

ObjectiveThe current study evaluated the efficacy of early intervention for preschool-aged children selected on the basis of risk who also met diagnostic criteria for anxiety disorders. MethodSeventy-one 3- to 4-year-old children were selected based on demonstrating high levels of inhibition and having a parent with a current anxiety disorder. They were randomly allocated to an eight-session parent intervention or waitlist. ResultsAt baseline, all of the children met criteria for one or more anxiety disorders. At 6-month follow-up, the intervention group showed a significantly greater reduction in anxiety disorders and less interference from their anxiety than the waitlist. In addition, children in the intervention condition showed greater reductions in parent and laboratory observed measures of behavioral inhibition. ConclusionsThe results suggest that a brief early intervention delivered through parents can reduce current anxiety and associated risk and may have the potential to alter the developmental trajectory of anxiety in a high-risk group of young children. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(6):602-609.

Development of Upper Body Coordination During Sitting in Typically Developing Infants

Our goal was to determine how the actions of the thorax and the pelvis are organized and coordinated to achieve independent sitting posture in typically developing infants. The participants were 10 typically developing infants who were evaluated longitudinally from first onset of sitting until sitting independence. Each infant underwent nine testing sessions. The first session included motor evaluation with the Peabody test. The other eight sessions occurred over a period of 4 mo where sitting behavior was evaluated by angular kinematics of the thorax and the pelvis. A physical therapist evaluated sitting behavior in each session and categorized it according to five stages. The phasing relationship of the thorax and the pelvis was calculated and evaluated longitudinally using a one-way analysis of variance. With development, the infants progressed from an in-phase (moving in the same direction) to an out-of-phase (moving in an opposite direction) coordinative relationship between the thorax and the pelvis segments. This change was significant for both sagittal and frontal planes of motion. Clinically, this relationship is important because it provides a method to quantify infant sitting postural development, and can be used to assess efficacy of early interventions for pediatric populations with developmental motor delays.

Cedar and Cypress Pollinosis and Allergic Rhinitis: Quality of Life Effects of Early Intervention with Leukotriene Receptor Antagonists

Background: Allergic rhinitis involves inflammation of the nasal passages. The use of nasal steroids is generally very effective in providing significant symptom relief. However, compliance for their use is sometimes poor. Methods: To examine the efficacy of early intervention (before pollen dispersal) with oral cysteinyl leukotriene receptor antagonists (LTRA) on pollinosis in patients with allergy to cedar and Japanese cypress pollens, groups of subjects were treated with LTRA or a placebo for 4 weeks at the beginning of the cedar pollen dispersal season. Subsequently, all patients received nasal steroid therapy concomitantly with LTRA throughout the remaining period of the pollen dispersal season. The effects of such early treatment with LTRA on pollinosis were investigated using symptom scores from an allergy diary and quality of life (QOL) scores. Results: Sneezing and nasal congestion scores were significantly lower in the LTRA-pretreated subjects than observed in the placebo-pretreated patients between weeks 4 and 6 and weeks 3 and 5, respectively. QOL scores improved significantly in all domains after concomitant therapy with nasal steroids. The percent improvement in the nasal congestion score after the concomitant therapy was significantly higher in the LTRA group (69%) than in the placebo group (41%). Conclusion: Significant differences observed in symptoms and in QOL effects between LTRA- and placebo-pretreated patients and the absence of major adverse effects noted in these studies suggest that early intervention with LTRA is beneficial and safe and should be considered in the management of pollinosis-associated allergic rhinitis.

Children and adolescents with fabry disease

Despite the observation that severe clinical signs and symptoms, with the exception of neuropathic pain and gastrointestinal symptoms, are rare in pediatric patients with Fabry disease, studies have shown extensive organ involvement in all pediatric patients. A recent study of renal biopsy findings in children and adolescents with Fabry disease (7 males, 2 females; age range, 7-18 years), all with normal estimated glomerular filtration rate (eGFR), found GL-3 accumulation in all patients and a broad spectrum of abnormalities, including glomerular, tubulointerstitial, and vascular changes, in many patients.? Another study in 20 children and adolescents (12 fe­ males, 8 males; age range, 6-16 years), without any overt cardiac signs or symptoms, found that all patients had a left ventricular mass indexed to height greater than the 75th percentile of healthy controls. 8 In addition, this study reported that heart rate variability in all male patients was significantly lowered (P < 0.05), suggesting a reduced parasympathetic stimulation of the heart. Results of these studies support the claim that pediatric pa­ tients with Fabry disease can have extensive renal and cardiac involvement, albeit subclinical, in addition to the overt neuropathic and gastrointestinal signs and symptoms. Enzyme replacement therapy (ERT) has been found to be well tolerated 9 ,!O and to reduce GL-3 accumulation in the dermal capillary endothelium 9 in pediatric patients with Fabry disease. However, the optimal age at which ERT should be initiated has not yet been determined. Research in adult patients with mild to moderate kidney disease found that ERT slowed the progression of the disease and was more effective in patients with less severe renal involvement, as determined by eGFR values.!! This finding supports the notion that initiation of ERT before substantial-and potentially irreversible---damage has occurred will provide greater clinical benefit. Extensive GL-3 accumulation may be present in pediatric patients with Fabry disease from an early age, result­ ing in demonstrable functional abnormalities in many patients; therefore, investigating whether initiating ERT during childhood (at least in male patients) might prevent disease progression appears justified. In addition, if ERT is started at an early stage of the disease, various dosage or dosing intervals may be efficacious. A random­ ized, multicenter, open-label study was recently initiated to evaluate the efficacy and tolerability of treating male pediatric Fabry disease patients without severe symptoms using a low-dose regimen of ERT (agalsidase beta 0.5 mg/kg every 2 weeks vs 1 mg/kg every 4 weeks).!2 This study was started in October 2008, and the goal is to include 45 patients. The study's estimated primary completion date is December 2014. In conclusion, Fabry disease can have serious clinical signs and symptoms during childhood which necessitate vigorous follow-up studies so that ERT can be initiated before irreversible damage has occurred. Studies on the efficacy of early intervention in children are greatly needed.

Intensive-Treatment Gains Lost by Five-Year Follow-Up

Intensive-Treatment Gains Lost by Five-Year Follow-Up

Tracking and Prediction of Arterial Blood Pressure From Childhood to Young Adulthood in 868 Patients With Type 1 Diabetes

Arterial blood pressure was followed in 868 patients with type 1 diabetes aged 6.0-19.9 years in 95 centers in Germany and Austria. European blood pressure reference data for 28,043 children and adolescents were used with respect to age and sex. Data were stratified into three groups: prepubertal, pubertal, and postpubertal. Up to 4% of the participants in the younger age-groups and 13.9% of the postpubertal patients exhibited blood pressure values >97th centile. Blood pressure levels correlated with A1C level and BMI Z score. Tracking of blood pressure revealed that children with elevated blood pressure had higher blood pressure in adolescence and young adulthood. Patients with higher blood pressure in childhood showed elevated blood pressure later in life. We need to focus on the diagnosis of hypertension in children with type 1 diabetes and to study the efficacy of early intervention.

Abstract 2804: Early Invasive Management of Acute Coronary Syndromes without ST-elevation: Relation between Rate of Invasive Therapies and Very Long-term Mortality in the Randomized Trials

Background Randomized trials evaluating an early invasive against a conservative strategy show a benefit over a conservative approach in the composite of death, MI and revascularisation/recurrent ischemia. However, the rate of invasive therapies differed significantly in the trials. Moreover, there were also large differences in the rate of invasive therapies in the invasive versus the conservative arms ( cross-over rate) in the different studies. Therefore we studied the differences in rate of invasive therapy in the study arms of the above trials, and correlated them with the benefit of the invasive therapy with regard to the very long-term mortality as recently published. Methods and Results We analyzed very long-term mortality (30,932 patient-years) in the 9 trials carried out between 1996 and 2004, which randomized 10,558 patients with non-ST-elevation acute coronary syndromes to an early invasive or an ischemia-guided conservative strategy. Differences in the revascularization rate between the invasive and conservative strategies in the trials ranged between 10% and 39%. There was no relation of the differences in revascularization between invasive and conservative strategies and the benefit on mortality whatsoever (see figure ). Conclusion Although most trials on non ST-elevation ACS reported a reduction in the composite of death, MI and revascularisation/ recurrent ischemia, an early invasive strategy does not lead to improved survival on the very long-term. There seems no relation between the difference in revascularisation rate and benefit on the very long term, which may explain the lack of efficacy of early intervention on very long-term mortality.

Drs. Sijbrandij and Olff Reply

Back to table of contents Previous article Next article Letters to the EditorFull AccessDrs. Sijbrandij and Olff ReplyMARIT SIJBRANDIJ Ph.D.MIRANDA OLFF Ph.D.,MARIT SIJBRANDIJ Ph.D.Search for more papers by this authorMIRANDA OLFF Ph.D.Search for more papers by this author,Published Online:1 Jun 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To The Editor: Drs. Varma and Parashar comment on our randomized controlled trial in which we compared the administration of four sessions of CBT in patients with acute PTSD with a comparison group on a waiting list. Drs. Varma and Parashar argue that placing the comparison group on a waiting list did not adequately control for nonspecific factors that might have influenced outcome. We assume that they are suggesting that we should have included a treatment group that received only supportive counseling without specific CBT contents. However, we feel that an untreated comparison group on a waiting list is the best comparison group because it is the closest to studying natural recovery. Since it has been repeatedly shown that some early interventions impede natural recovery rather than promote it (1) , comparison with an untreated comparison group is essential in trials evaluating the efficacy of early interventions. Moreover, since randomized controlled trials comparing early treatment of PTSD relative to a natural recovery comparison group are somewhat scarce (e.g., 2 , 3) , studies evaluating the potential benefits or risks of any intervention relative to no intervention at all in the immediate aftermath following trauma are still necessary. Second, the authors comment that we did not perform screening for axis II disorders, specifically for borderline personality disorder. Indeed, performing extensive screening for personality disorder would have meant a significant burden for participants in our trial. We did, however, exclude patients with complex or chronic PTSD and risk for suicide. Therefore, the possibility of inclusion of many patients with borderline personality disorder influencing treatment outcome is implausible. Furthermore, we did not find an interaction effect between prior traumatic experiences—known to be present in many patients with borderline personality disorder—and treatment response in our exploratory subgroup analyses. In conclusion, we feel that any influence of the presence of borderline personality disorder on the efficacy of CBT in our study is highly unlikely.Amsterdam, the NetherlandsThe authors’ disclosures accompany the original article.