Efficacy Of Early Intervention Research Articles

THE EFFICACY OF EARLY IDENTIFICATION AND INTERVENTION FOR CHILDREN WITH HEARING IMPAIRMENT

From these findings, the inevitable conclusion is that identification of hearing loss by 6 months of age, followed by appropriate intervention, is the most effective strategy for the normal development of language in infants and toddlers with hearing loss. Identification of hearing loss by 6 months can only be accomplished through universal newborn hearing screening. Some questions that arise as a result of these studies include: What can one conclude from the finding that the language skills of children with mild hearing losses are no better than those with greater losses? If the finding holds up, it indicates a great need for investigations into biobehavior theories of language acquisition and into the part played by the prenatal 4 months of hearing. And it also shows a need for answering the question, When does a hearing loss begin?, because it certainly seems that all hearing losses are similar in their outcomes. Can the findings from these studies be used to benefit normally hearing children who are at risk for language delays as a result of limited language environments? Such children suffer from auditory deprivation just as surely as those with hearing losses. If the language skills of the latter children can be brought to normal range by early intervention, the same strategy may help high-risk populations. The efficacy of early intervention is just as valid for these children as it is for the children with hearing impairment. Now that the benefits of early identification of children with congenital hearing loss have been demonstrated, these benefits should be extended to all children who are at risk for language delays, with appropriate interventions applied immediately.

Applying Q Methodology to Investigations of Subjective Judgments of Early Intervention Effectiveness

Most approaches to determining effectiveness in early intervention emphasize data collection procedures that are objective, unbiased, and reliable. Subjective views held by individuals usually are considered unreliable, and less relevant to early intervention efficacy research. However, systematic investigations of how early intervention services are viewed subjectively by both recipients and providers can facilitate the interpretation of efficacy data gained when more traditional, objective methods are used. This article describes Q methodology, a technique that can be used to gain important insights on individuals' judgments, attitudes, and points of view on topics or situations that involve early intervention effectiveness issues. Examples of Q application drawn from the extant literature of several disciplines are used to indicate how the technique might be used to address important questions of early intervention effectiveness. Specific steps involved in Q methodology are illustrated in a description of an early intervention efficacy study designed to explore views of family-centered practices held by family members of children enrolled in early intervention programs.

Early intervention and early experience.

For 4 decades, vigorous efforts have been based on the premise that early intervention for children of poverty and, more recently, for children with developmental disabilities can yield significant improvements in cognitive, academic, and social outcomes. The history of these efforts is briefly summarized and a conceptual framework presented to understand the design, research, and policy relevance of these early interventions. This framework, biosocial developmental contextualism, derives from social ecology, developmental systems theory, developmental epidemiology, and developmental neurobiology. This integrative perspective predicts that fragmented, weak efforts in early intervention are not likely to succeed, whereas intensive, high-quality, ecologically pervasive interventions can and do. Relevant evidence is summarized in 6 principles about efficacy of early intervention. The public policy challenge in early intervention is to contain costs by more precisely targeting early interventions to those who most need and benefit from these interventions. The empirical evidence on biobehavioral effects of early experience and early intervention has direct relevance to federal and state policy development and resource allocation.

Early intervention for very-low-birth-weight infants

To assess the efficacy of early intervention (EI) for very-low-birth-weight (VLBW) infants, we evaluated 62 2 year old children who were enrolled in an EI program and 48 control subjects aged 2 years. We determined the subjects' developmental quotients (DQ) and obtained information about the parents' evaluation of the children from a questionnaire sent to the parents. There was no significant difference in the DQ between the EI group and the control group. However, based on the responses to the questionnaire, subjects in the EI group showed slight, but statistically marginally significant, improvements in behavioral problems, especially a decrease in hyperkinesia, in adjusting to a circadian sleep cycle, and an improvement in language development, as compared with the control group ( P<0.1). Thus, EI for VLBW infants is considered useful to enhance some areas of development.

Early intervention and identification: finding the family

Following the growth of early intervention programmes for very young children with special educational needs and their families in the 1960s and 1970s, there came a reflective period during which the efficacy of early intervention was questioned (Marfo and Kysela, 1985). This was followed in the 1990s by a challenge to narrow interpretations of effectiveness in favour of a more holistic analysis of the benefits of intervention programmes for the whole family (Buckley, 1994). It was suggested that more attention should be given to the quality of relationships being established between the child and family members and the context in which early intervention programmes are delivered. Families themselves have begun to assert this (Fitton, 1994; Hebden, 1985) and recent legislation, both in the UK and abroad, has underlined the need for strong interdisciplinary approaches to meet the diversity of special educational needs that exist in our child population. This multidisciplinary approach necessitates a change of focus. It recognises the parent, with their child, as central, implicit and fundamental to the early intervention team, and endorses their right to request appropriate access to services. The model also gives parents the freedom to expand the concept of the family to include extended family and friends (for example, Ballard, 1994). Other parent‐empowering initiatives include parent‐to‐parent schemes (Hornby, 1989 and 1995) which increase the capacity of families to provide resources to other families. The days of professionals as experts have passed. This change in approach to families of children with special educational needs will challenge some professionals and demand a radical reappraisal of the structure of their role and their style of delivery of early intervention, but, if we want quality early intervention, such a review is fundamental to re‐establishing its place as a valid and valuable resource to families.

Early intervention and identification: finding the family

Following the growth of early intervention programmes for very young children with special educational needs and their families in the 1960s and 1970s, there came a reflective period during which the efficacy of early intervention was questioned (Marfo and Kysela, 1985). This was followed in the 1990s by a challenge to narrow interpretations of effectiveness in favour of a more holistic analysis of the benefits of intervention programmes for the whole family (Buckley, 1994). It was suggested that more attention should be given to the quality of relationships being established between the child and family members and the context in which early intervention programmes are delivered. Families themselves have begun to assert this (Fitton, 1994; Hebden, 1985) and recent legislation, both in the UK and abroad, has underlined the need for strong interdisciplinary approaches to meet the diversity of special educational needs that exist in our child population. This multidisciplinary approach necessitates a change of focus. It recognises the parent, with their child, as central, implicit and fundamental to the early intervention team, and endorses their right to request appropriate access to services. The model also gives parents the freedom to expand the concept of the family to include extended family and friends (for example, Ballard, 1994). Other parent-empowering initiatives include parent-to-parent schemes (Hornby, 1989 and 1995) which increase the capacity of families to provide resources to other families. The days of professionals as experts have passed. This change in approach to families of children with special educational needs will challenge some professionals and demand a radical reappraisal of the structure of their role and their style of delivery of early intervention, but, if we want quality early intervention, such a review is fundamental to re-establishing its place as a valid and valuable resource to families.

Physical therapy interventions for patients with movement disorders due to cerebral palsy.

The purpose of this paper is to present evidence of the efficacy of physical therapy interventions for patients with cerebral palsy and identify goals for these patients. Studies suggest that neurodevelopmental treatment and Vojta techniques improve postural control. Little evidence supports the efficacy of early intervention, but researchers have not yet studied effects on the family. Strengthening, electrical stimulation, the use of orthoses, and seating show positive effects in studies of small numbers of subjects. For severely involved children, ease of care and comfort are important goals, as well as prevention of deformity, which is important for all children. To the extent possible, therapy should prepare a child for independent adult life. In early intervention through school age, therapy focuses on promoting communication, self-care, and mobility. Independence is a key issue for adolescents transitioning into adulthood. The rehabilitation and health needs of adults with cerebral palsy need to be addressed. Research needs to determine the effects of physical therapy not only on impairment but also on function and disability.

Vitreous Hemorrhage in Infants

To evaluate the efficacy of early intervention with vitrectomy for dense, nonclearing, infantile vitreous hemorrhage. Case series. Referral practice at a major university hospital eye center. Consecutive, referred sample of six patients (< 1 year old) with dense vitreous hemorrhages. The causes of the vitreous hemorrhages were varied. Follow-up was from 8 months to 15 months, with an average of 10 months. Three-port, pars plana, complete posterior vitrectomies were performed. Improved visual acuity postoperatively and frequency of complications. Complications of the infantile vitreous hemorrhage included traction retinal detachment (two of six), epiretinal membrane formation (one of six), pigmentary retinopathy (four of six), strabismus (two of six), large anisometropic myopia (two of six), and occlusion amblyopia (three of six). These serious complications occurred as early as 5 weeks after the onset of the vitreous hemorrhage. Iatrogenic retinal dialyses, which occurred in two of six patients, were successfully treated. Marked to moderate visual improvement was noted in five of six patients. Vitrectomy is an acceptable early therapy for infantile vitreous hemorrhage, and we recommend that vitrectomy be considered as early as 3 to 4 weeks after the onset of a dense, infantile, vitreous hemorrhage in an attempt to avert serious complications of the hemorrhage.

What is it? How Effective is it?

Summary The findings and methodology of evaluative studies of Clay's Reading Recovery scheme are examined and the extent to which they provide evidence for success is considered. It is argued that the very large claims made by apologists for Reading Recovery receive only limited support and that further carefully designed evaluative studies are required. There follows a comparison of Clay's theoretical stance with that of a modern theorist, Marilyn Adams. It is argued that while Clay claims to adopt a pragmatic and eclectic practical position, her ‘top‐down’ approach has militated against the systematic utilisation of various ‘lower order’ strategies which would appear to enhance the scheme, in particular the inclusion of phonological recoding strategies as advocated by Iversen and Tunmer (1993). Several related matters are then examined: the efficacy of early intervention; the appropriateness of parental involvement to the scheme; the relevance of the integration debate. It is concluded that Reading Reco...

Evaluating the Effects of Early Intervention

As Turnbull1concludes in her elegant and provocative qualitative analysis of early intervention studies for children with or at risk of cerebral palsy, it is quite possible that failure to demonstrate the efficacy of early intervention is due to inadequate methods of assessment. She goes on to suggest that some of the new technological devices that are available now in sophisticated movement analysis laboratories may provide better tools for the assessment of therapy efficacy. As an applied clinical researcher and a self-described techno-peasant, I believe that we have adequate and appropriate tools available to us in our daily treatment settings. From my perspective as a practicing physical therapist, the problem has not been one of inadequate methods of assessment but rather of our failure to provide a match between what we are trying to change in children with cerebral palsy and what strategies we are

Labeling Preschoolers as Learning Disabled: A Cautionary Position

The purpose of this article is to explore the issues concerning the adaptation of school-based service delivery concepts for use in early childhood special education programs. The use of categorical labels for determining eligibility for preschool children is not required by law—and may be detrimental. The following concerns are discussed: (a) definitional issues in learning disabilities versus low achievement, (b) the dangers of labeling and low expectation sets, (c) repeated failure to demonstrate movement through a continuum of services (particularly to least restrictive environments), and (d) the efficacy of early intervention and school-based special services for those with mild or suspected developmental disabilities. Research is reviewed concerning definitional and assessment issues utilizing learning disabilities as a construct. Alternatives for describing the characteristics of young children who are significantly at risk or developmentally delayed are provided.

Infant Health and Development Program for Low Birth Weight, Premature Infants: Program Elements, Family Participation, and Child Intelligence

The Infant Health and Development Program was an eight-site randomized controlled trial testing the efficacy of early intervention to enhance the cognitive, behavioral, and health status of low birth weight, premature infants. The 377 intervention families received for the first 3 years of life: (1) pediatric follow-up, (2) home visits, (3) parent support groups, and (4) a systematic educational program provided in specialized child development centers. The control group (n = 608) received the same pediatric follow-up and referral services only. This paper describes the delivery of the intervention and its outcomes. A Family Participation Index that was the sum of participation frequencies in each of the program modalities unique to the intervention revealed that program implementation was not different across the eight sites. Index scores did not vary systematically with mother's ethnicity, age, or education or with child's birth weight, gender, or neonatal health status; but they were positively related to children's IQ scores at age 3. Only 1.9% of children of families in the highest tercile of participation scored in the mentally retarded range (IQ less than or equal to 70), whereas 3.5% and 13% of children in the middle and lowest participation terciles, respectively, scored in the retarded range. Similar findings were obtained for borderline intellectual functioning. These findings are consistent with previous research linking intensity of intervention services with degree of positive cognitive outcomes for high-risk infants. The determinants of variations in individual family participation remain unknown.

Efficacy of Early Intervention in Pediatric Rehabilitation: A Decade of Evaluation and Review

The initial goals of this article are to define early intervention as it pertains to pediatric rehabilitation and to critically review examples of early intervention studies published during the past decade. A third goal is to summarize other recent review papers on efficacy of early intervention and efficacy of physical and occupational therapy for children with developmental disabilities of a variety of ages. The final goal of this article is to describe future directions for early intervention research in pediatric rehabilitation, including the development of new and more sensitive outcome measures, assessment of the impact of technologic devices on functional independence, and completion of multisite, collaborative studies to evaluate the effects of developmental therapies.

Recent Developments in Early Intervention Efficacy Research

Contemporary developments concerning the effectiveness of family involvement in early intervention programs are described within the framework of P.L. 99-457 and illustrated with recent investigations focusing on children at biological risk, those with cerebral palsy, and children with general developmental delays. Studies emphasizing parental involvement are discussed in the context of the quality of research, the application of contemporary developmental principles, and the specificity of the experimental designs and approaches. The research and public policy implications of efficacy research following the implementation of P.L. 99–457 also are discussed.

Early Intervention Efficacy Research

This article describes a variety of conceptual and methodological limitations of existing research on the efficacy of early intervention programs. Problems related to the specification of both independent and dependent variables are noted, and recent studies using meta-analytic techniques to generate testable hypotheses are reviewed. Recommendations for greater precision in measurement and for improved research design are presented. Finally, some reasons for the persistence of common problems in program evaluation are offered in conjunction with suggestions for future research efforts.

Conducting Longitudinal Research on the Efficacy of Early Intervention with Handicapped Children

An historical analysis of early intervention efficacy research documents the need for rigorously conducted longitudinal studies of early intervention with handicapped children. In this article the issues to be addressed in a series of 16 longitudinal studies recently funded by the U.S. Department of Education are described, the design characteristics of these studies are discussed, and the projected benefits of such research are summarized.

The Effects of Preschool Integration on the Development of Nonhandicapped Children

Nine research studies that reported child change data for nonhandicapped children participating in integrated preschool settings were analyzed in terms of methodology and specific program variables. The findings indicate that the methodological weaknesses in studies of the effectiveness of integration are the same that plague early intervention efficacy studies in general. Analysis of specific program variables indicates that studies of the outcomes of integration have typically viewed integration as a single treatment variable rather than as a process having many possible variations. The implications of the findings are discussed.

Introduction to Special Education Textbooks: What They Say About the Efficacy of Early Intervention

Frequentiy used introductory special education textbooks were analyzed (a) to summarize the information presented and conclusions drawn about the efficacy of early Intervention, (b) to determine the consistency of those conclusions with previously published efficacy reviews and with existing meta-analysis data as summarized by the Early Intervention Research Institute at Utah State University, and (c) to draw conclusions about the implications of the findings for training special and regular educators. Textbooks were consistent in the content covered, and conclusions were generally consistent with major reviews. Chapters concluded with more advocacy-oriented statements than empirically supported ones. In addition, several studies that were cited tended to be from the disadvantaged preschooler literature, with these results used as data for supporting the efficacy of early intervention for handicapped preschoolers. Findings are discussed in relation to the training of special education and regular education teachers.

Early intervention care in the acute stroke patient.

Early intervention care has been identified as an important factor in the functional outcome of patients with completed stroke. Little has been published, however, on the efficacy of early intervention in the acute hospital setting. In a retrospective study of 30 patients in an acute care hospital, there was a statistically significant difference in length of stay and ambulatory status (p less than 0.05) for the group receiving rehabilitation treatment within the first 72 hours after admission. There was no significant difference between the two groups with regard to age, sex, site of lesion, or previous cardiovascular disease. The present study indicates that early intervention shortens hospital stay and improves outcome, considerations especially important with the adoption of Diagnosis-Related Groups (DRGs), as hospitals seek measures of cost-containment in the provision of quality cost-effective health care.

The efficacy of early intervention programs: a meta-analysis.

This article reviews primary research studies investigating the efficacy of early intervention with handicapped preschoolers. Meta-analysis techniques were employed to integrate statistically the findings from 74 studies. Findings indicate that: (a) early intervention with handicapped populations produces a positive sizeable effect size; (b) longer, more intense programs are associated with efficacy; and (c) little support was found for commonly held beliefs about early intervention, such as the importance of age at start and the degree of parental involvement. Implications for future research are discussed.