Autism Awareness

We have all been preoccupied with the coronavirus pandemic, but how can we not be. It still is a month during which we acknowledge and bring awareness to the nature of Autism. For those with families where you have a child with this diagnosis, there are indeed ways in which we can more effectively cope in day-to-day life. So many have told me that it is just too hard to schedule appointments, or that they are overwhelmed and having trouble working. Temple Grandin https://en.wikipedia.org/wiki/Temple_Grandin has some thoughts that I felt might help others. I hope that it does and welcome your comments about what enables you to get through this challenging time. Please share…

https://parade.com/1019088/debrawallace/temple-grandin-tips-children-with-autism-coronavirus-quarantine/?fbclid=IwAR1L8M8petdXfGQyZdPhyx51viLP1usEaEOzhHHVEgWOH-o6rqu9SOKvtnA

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COVID19 RESPONSE: WHEN YOU STAY AT HOME

AND PERHAPS APPEARING FRUSTRATED …

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Photo by freestocks.org on Pexels.com

I will try to keep adding to this list for you as I come across items to add; but for starters, here are some concrete suggestions and resources available for you:

Is your child interested in music:  Tuesday and Wednesday online music classes  https://www.musicbrains.net/book-online

and from Daniel’s Music Foundation in NYC there are other virtual options https://www.danielsmusic.org/virtual-lessons

 

Continue reading

Memory and Autism

photo of girl sitting near christmas tree
Photo by Jonathan Borba on Pexels.com

For those who see that all in their child with Autism is bleak – please see a light of strength that they may possess.  The challenge to consider is how to use this productively:

“Visual memory for some types of material has been found to be an area of strength for children with autism but complexity of the stimuli appears to affect memory function in this modality as well. Interestingly, the right hemisphere may compensate for Visual memory for some types of material that has been found to be an area of strength for children with autism but the complexity of the stimuli appears to affect memory function”  (Prior & Chen, 1976).

With this knowledge – take a look at the text and alphabet letters that were duplicated from memory by an autistic individual who had viewed this page in the book Chicka Chicka Boom https://www.amazon.com/Chicka-Boom-Board-Book/dp/1442450703 Book/dp/1442450703    Hayden Gonzales posted this to Facebook on December 26, 2019. Thank you for bringing this to light!

Chicka Chicka Boom Boom is an easy story whose words are marvelous for teaching young children the alphabet. In fact, the following link provides some information about how the book can be used to elicit language development http://doodlebugshomeschool.blogspot.com/2011/08/chicka-chicka-boom-boom-with-l

No photo description available.No photo description available.

 

https://www.apa.org/pubs/journals/releases/neu-20121.pdf   “memory in autism appears to be organized differently than in normal individuals — reflecting differences in the development of brain connections with the frontal cortex”.

The post brought to mind my first cousin. Jerry was diagnosed with autism at a very young age and at a point when not much was known about the disorder.  He would memorize calendars and could tell you what day of the week you were born on, for example, four or even five years ago.  How remarkable, I thought. I wondered why – perhaps research now is answering that question.

What Is Declarative Memory? This is an area of strength in those who are autistic.  \

Your ability to recall addresses, locations of parking garages, intersection names, phone numbers, and an experience that you had at a restaurant are all a part of declarative memory. Declarative memory, also referred to as explicit memory, is the memory of facts, data, and events. For example, let’s say that you know that your favorite restaurant is only open until 6 PM on Sundays. The time that the restaurant closes is stored as a declarative memory. We can consciously recall declarative memory. Declarative memory is a type of long-term memory.  Here is a functional strategy that may be useful for daily activities that require this:

http://autism.sesamestreet.org/daily-routine-cards/?fbclid=IwAR0VKcWb_ZAHzheWdgT7ekqhwG_NuW8JLOMtCHZyT4PnolRXeyq6oeXxLSw

Declarative memory seems to help individuals with autism compensate for social deficits by memorizing scripts for navigating social situations. It supports the learning of strategies to overcome language or reading difficulties not only in autism, but also in SLI and dyslexia. And it appears to help people with OCD or Tourette syndrome learn to control compulsions and tics.

black and white blackboard business chalkboard
Photo by Pixabay on Pexels.com

References:

https://study.com/academy/lesson/declarative-memory-definition-examples-quiz.html

https://www.apa.org/news/press/releases/2006/01/autism

https://en.wikipedia.org/wiki/Autism_and_memory

Read the journal article

Prior MR, Chen CS. Short-term and serial memory in autistic, retarded, and normal children. Journal of Autism and Childhood Schizophrenia. 1976;6:121–131. [PubMed[]

http://www.judyendow.com/sensory-solutions/autism-and-the-sensory-system-part-6-of-8/

 
 
 

  Lindsay Strachan Fofana Thank you for this! My almost 4 year old son is receptive and expressive language delayed but loves to learn and seemingly has photographic memory. Yesterday he spelled his name backwards. I explained to him what he had done and he was tickled! It’s very promising and always exciting.

A Decade of Changed Communication

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Photo by Rakicevic Nenad on Pexels.com

Welcome to a new decade!   Where have you been and where you will go this year. I hope my readers will be able to increase their connectivity to others and opportunities to engage with those in many different venues.  As you do so- pause and think about how we are doing so. My question to you is where did talking face-to-face vs. FaceTime go?

Changes Over a Decade in How We Talk:  

Absolutely fascinating how it seems that social media has taken over so much of our means of communicating with one another! Take a look at the statistics https://www.oberlo.com/blog/social-media-marketing-statistics and recall that social media only became a phenomenon of the late 1900s.  Remember the movie “Social Network” and how famous Mark Zuckerberg became as a result?

Now he has new plans https://time.com/facebook-world-plan/

Cell phone usage has changed us too.  At the very bottom of this post, there is a link noting the evolution of this type of communication.

July 14, 2015, the following was published http://attentiv.com/we-dont-speak/  Text messaging leads to abbreviated speech. We can avoid faces by merely looking at a screen.  Fewer verbal productions are heard, and the duration of these discussions is shorter.  The way in which we “talk” has changed  and is different cross-generational groups October 17, 2016, the following was published:  https://www.languagetrainers.co.uk/blog/2016/10/17/with-texting-and-social-media-are-people-really-speaking-less/

August 24, 2018, an article was published indicating that ADHD as a diagnosis may not be linked to technology use.  I learned that as I was writing this post and was surprised by the finding.  https://www.psychcongress.com/article/has-easy-access-technology-increased-rates-adhd  Why?  I’ve seen it in my travels at work – children looking into computer screens-not acknowledging parents, becoming highly active with the rush of adrenalin-fueled by the use of the screen.   Digging further, I found this video    https://www.wsj.com/video/silicon-valley-renegades-take-on-tech-obsession/2D3A120C-C88F-4C81-A005-1439E464A507.html

What Can We Do Right Now to Positively Use Technology?In this upcoming second week of school vacation (at least in NYC, NY) there are some very useful apps that may be of help to use with your child.  When used, please consider the fact that you will want to implement their use under your supervision and guidance.https://ilslearningcorner.com/2015-09-15-kids-apps-for-learning-disabilities/?fbclid=IwAR2PGx4WLPViOnmxB6vFbCmpdtirsR293kzBThNHWy5ap7TvkHfmlo0cHu8

As well, you might want to include the use of age-appropriate school workbooks https://www.highlights.com/store/workbooks?gclid=CjwKCAiAuqHwBRAQEiwAD-zr3Zbarrj_KcVvfduGbsezrdoCgGZTzB2ARwgB-hm0_3Gc3040nL-75RoCIOEQAvD_BwEandr

and reading materials from the local library.

I’ve posted other potential activities that do not involve screen time so please scroll back for those and please don’t forget to look up at each other and look!

activity adult adventure backpacking
Photo by VisionPic .net on Pexels.com

 

 

 

 

 

 

 

 

 

 

 

Play and Holidays

 

IMAGE |  EDIT

top view photography of toddler playing with toy

 

Parents ask – what can I get for my special needs child for the holidays.  The gift of sharing time and allowing for this experience is probably one of the most important.  This is well documented in the literature and even pediatricians have weighed in on the subject of play with children.

Play is important for communication development as the below blog author illustrates http://www.playingwithwords365.com/the-importance-of-play-for-speech-and-language-development/   and as you step into the shopping mall on Black Friday or you are selecting toys online consider these developmental stages in play development https://pathways.org/kids-learn-play-6-stages-play-development/.   The reason to consider this would be to make sure that your child can actually benefit from the toy being purchased,

Recognize that for children – anything can become a toy.  The box collection (by age) of 52 quick and creative idea cards is great for easy ones which can be a guide for fun activities.  If money is an issue for you – take a look. All the materials can be found at home:

If it is hard financially to purchase toys, you may wish to contact The Salvation Army for assistance.

TRADITIONAL TOYS:

To me, a traditional toy is one that is not battery operated.  I remember using these as a child. For example lincoln logs, building blocks, board puzzles, board games such as Monopoly, CandyLand, Pick Up Sticks or numerous doll teal parties with a tea set, balls, frisbees. There are many others and this site offers

https://funandfunction.com/  

https://www.target.com/s/non+battery+toys?ref=tgt_adv_XS000000&AFID=google&fndsrc=tgtao&CPNG=Toys_Dolls%2BPuppets%2BPlush%2BAction+Figures&adgroup=Animal+Figures_3&LID=700000001171643&LNM=non+battery+toys&MT=b&network=g&device=c&location=9067609&targetid=kwd-302805841827&ds_rl=1246978&ds_rl=1248099&gclid=Cj0KCQiAt_PuBRDcARIsAMNlBdpoEMMECWDQDfTaVdTipJsGvkDwed41JpN0uX-c9KZSZ5mCPxmFoLYaAuqgEALw_wcB&gclsrc=aw.ds

The value of a traditional toy cannot be underestimated because the use o f these involves that of imagination expansion.  Here is some foood for additional thought https://www.greenchildmagazine.com/no-battery-gifts/

https://www.target.com/s/non+battery+toys?ref=tgt_adv_XS000000&AFID=google&fndsrc=tgtao&CPNG=Toys_Dolls%2BPuppets%2BPlush%2BAction+Figures&adgroup=Animal+Figures_3&LID=700000001171643&LNM=non+battery+toys&MT=b&network=g&device=c&location=9067609&targetid=kwd-302805841827&ds_rl=1246978&ds_rl=1248099&gclid=Cj0KCQiAt_PuBRDcARIsAMNlBdpoEMMECWDQDfTaVdTipJsGvkDwed41JpN0uX-c9KZSZ5mCPxmFoLYaAuqgEALw_wcB&gclsrc=aw.ds

BATTERY OPERATED, ELECTRONIC OR TRADITIONAL TOYS:

One of my favorites is Melissa and Doug toys because they are very sturdy, last a long time and can be used in so many different ways as children grow.  A number are available on their website and here are some links on the site for those who want them toys for upcoming vacations with packing limitations: https://www.melissaanddoug.com/search/?q=puzzles%20for%20toddlers   or https://www.melissaanddoug.com/search/?q=puzzles+in+a+box&lang=default   

Other toys through Melissa and Doug are Sensory Friendly toys      as well as on these sites:

https://www.specialneedstoys.com/usa/holiday-gift-guide

Whichever toy you may choose to purchase, have fun!  Without realizing it you will be building memories that will last a lifetime!

Understand Typical Developmental Milestones and Tips for Keeping Your Child Safe

We all hope for happy and healthy children. When there is a glitch…when a parent has the unfortunate situation of being told that their child will need help in the very early years, when neuroplasticity is at a peak, emotions may rage.  Cuts to the early intervention program, in many areas of the country have heightened anxiety about the future for disabled children, those receiving services through the early intervention program or those receiving services elsewhere.  Some parents have expressed reticence about enrolling their child in a specialized education program, or having professionals in their home to offer services to their child.   That feeling is respected.  Acceptance of a developmental delay or other type of handicapping condition may take a while to set in.  That said – I have a few suggestions.

I have realized that parents whose children receive early intervention services or those who would like their children considered for program participation are genuinely unsure of the process or they are not educated about what might qualify their child for services in a particular area.  Others are unaware of what they would expect to see in terms of skill development in a variety of areas.  That is unfortunate.  Parents need guidance and there are resources available for you.  Especially of concern is that you learn about when typically developing children acquire specific milestones like crawling, sitting, standing, speaking, eating solid food, drinking from a cup, assisting with dressing.  There are many more that could be mentioned.  Below is information that may be helpful: 

DVD:  A Life to Love: Preventing Accidental Injury to Our Most Precious Resource-available in English, Spanish, Chinese Creole, Arabic and Russian  (produced by the NYC Administration for Children’s Services @ 150 William Street New York, NY 10038.  NYC residents can call 311).

Clinical Practice Guidelines Quick Reference Guidelines for Parents and Professionals are available through the NY State Department of Health, Early Intervention Program, Corning Tower Building, Room 208, Albany, NY 12237-0618  These are available free of charge at http://www.health.state.ny.us/nysdoh/eipindex.htmeip@health.state.ny.us  and relate to a variety of developmental areas such as vision, communication, hearing, motor function. 

Zero to Three www.zerotothree.org

Early Intervention Providers: Important Training to Develop Evaluation Skills

 
 
A colleague of mine provides this training and it has served as an invaluable resource  in completion of evaluations to increase likelihoood of children receiving our services.  In a highly difficult economic climate it is imperative for those of us who act as the voices for children who cannot speak to enroll in these highly helpful courses.   Rebecca Alva is on linkedin and you can connect with her there as well. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Next EI Training Oct. 15th In NYC!

October 4th, 2011 | Author: Rebecca Alva
Performing Evaluations In Early Intervention is Coming Back to NYC!Location: Pearl Studios NYC, 519 Eighth Avenue (btw 35th & 36th), 12th Fl. (212) 904-1850

**********Early Bird Price of $227. applies for the September and October Dates!!**********

Look at The Trainings and Testimonial Tabs For Full Details

 

 
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EI Training In Commack, NY (LI) Held Today!

October 2nd, 2011 | Author: Rebecca Alva
Held my first EI Training in Commack, NY (LI) today. Here is what two attendees had to say:The course was very helpful in learning how to properly perform and write a complete Early Intervention Evaluation.
Erika Witt, Speech-Language Pathologist

Very informative, useful information.
Madelyn Ratkus, Speech-Language Pathologist

 

 
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“Thank You A Million Times Over”

September 30th, 2011 | Author: Rebecca Alva
An SLP Provider who has taken my trainings sent me the following e-mail with the subject line above, “I am writing up an eval on a bilingual baby that I saw with a translator….. I have your binder at my side…it is an invaluable resource right now.l’shanah tovah wherever you are today!

Robin Sue Kahn M.S., CCC/SLP
Speech-Language Pathologist

 

 
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October 1st EI Training Rescheduled!

September 30th, 2011 | Author: Rebecca Alva
The training has been rescheduled for Saturday – September 15th in NYC.Location: Pearl Studios NYC (212) 904.1850

519 Eighth Avenue, NY

Studio L

Thanks!

 

 
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Just finished giving a training yesterday on Performing Evaluations In Early Intervention!

September 25th, 2011 | Author: Rebecca Alva
Here is what two providers had to say about yesterday’s training:Rebecca Alva tailored this course to the immediate needs of Early Intervention Evaluators. This information is going to be so helpful when writing and performing evaluators. Many of the resources provided will help raise the quality of EI evaluations that are performed.
Karen M. Mackin, Speech-Language Pathologist

This course will really be helpful to me as I write my evals. Now I know exactly what the Evaluation Standards Unit wants as far as Informed Clinical Opinion…
Jennifer Sitler Redpath, Speech-Language Pathologist

 

 
 
 
 
 
 
 
 
 
 
 

Fall EI Trainings!

September 10th, 2011 | Author: Rebecca Alva
Performing Evaluations In Early InterventionCOURSE DESCRIPTION
Infants and toddlers from birth through age two, who live in New York City and who have a diagnosed physical or mental condition that has a high probability of resulting in a developmental delay, or who are suspected of having a developmental delay or disability are entitled to a developmental screening or a comprehensive evaluation to determine eligibility for additional early intervention services. Delays may be in one or more of the following areas of development: cognitive, physical, communication, social/emotional, and/or adaptive. Children at risk of a disability are eligible for initial screening, and will receive periodic screenings through the New York City Infant Child Health Assessment Program.

Providers are faced with increasing amounts of confusion and frustration in performing evaluations in the Early Intervention Program. EI providers will understand and learn how to properly incorporate several sources of information and improve the quality of their evaluations reports.

LEARNING OUTCOMES
• Discuss NYS DOH Public Health Law, codes, rules and regulations as it applies to Early Intervention.
• Discuss the Adopted Early Intervention Program Regulations 6/3/2010.
• Discuss NYS Memorandum 2005-02 Standards and Procedures for Evaluations, Reimbursement, Eligibility requirements and Determinations under the Early Intervention Program.
• Describe how no single procedure or instrument may be used as the sole indicator of eligibility in EI.
• Discuss how to appropriately interpret and use test scores in MDE (Multidisciplinary Evaluations).
• Describe how to incorporate information from a variety of appropriate sources into MDE’s.
• Describe how to appropriately use Clinical Clues and Predictors from the Clinical Practice Guideline: Communication Disorders, Autism/PDD, Hearing Impairments and Motor Disorders (Oral Motor Assessment for Feeding and Swallowing) in MDE’s.
• Formulate an Informed Clinical Opinion in MDE’s.

AGENDA
9:00 Registration & Refreshments
9:30 Introduction, Public Health Law & Adopted Early Intervention Program Regulations 6/3/2010
10:00 Regulations & Guidelines – Memo 2005-02
11:30 Break
11:45 Test Instruments, Use & Interpretation
1:00 Lunch on your own
2:00 Clinical Practice Guidelines, Clinical Clues/Predictors
3:30 Break
3:45 Integrating Several Sources of Information & Formulating your Informed Clinical Opinion
4:30 Group Discussion, Questions, Comment Form
5:00 Course Concludes

TARGET AUDIENCE
Speech-Language Pathologists*
Special Education Teachers
Physical Therapists
Occupational Therapists
Audiologist
Licensed Psychologists
Licensed Social Workers
Agency Directors & Personnel

CONTINUING EDUCATION CREDITS
*Participants must have paid registration fee, signed-in, miss no more than 1 hr., participate in a written self examination and signed out in order to receive a Certificate of Completion.

Failure to sign-in or out will result in forfeiture of credit for the entire course. No exceptions will be made. Partial credit is not available.

DATES & LOCATIONS
Sept 24th (Sat-Queens), Oct 1st (Sat-NYC), Oct 2nd (Sun-LI), Nov 5th (Sat-NYC) and Dec 17th (Sat-NYC)

Course Locations:
Queens
92-30 56th Avenue, Rego Park, NY 11373 (Toledo Court Community Room)
(Behind Queens Center Shopping Mall & Next to Newtown Preschool/Playground).

New York City
Pearl Studios NYC, 519 Eighth Avenue (btw 35th & 36th), 12th Fl. (212) 904-1850

Long Island
Wingate by Wyndham Commack, Long Island NY – 801 Crooked Hill Road Brentwood, NY 11717

REGISTRATION & FEES
Improve the quality of your evaluations by registering for this training!
Register by phone: 917.885.3146 or by e-mail: ralva@bigplanet.com

*****Early Bird Price of $227 applies for the September and October Dates!!!*****

Registration Fee: $257
Early Bird: $227 (Must Be Received/Paid for 25 days prior to the training dates for Nov & Dec)
Group Rates: $217 each (2+), $207 each (4+), $197 each (6+) and $187 each (8+)

ALL PAYMENTS MUST BE PAID IN FULL PRIOR TO ATTENDANCE
Mail Check Payments to: Rebecca Alva, 92-30 56th Ave, Apt. 4N, Rego Park, NY 11373 or
by Credit Card (VISA, MasterCard, Amex) via Paypal – http://www.paypal.com

Note: The fee includes materials/handouts and light refreshments.
Please submit your accommodation requests for special needs in writing via e-mail at lease two weeks prior to the course.

CONFIRMATIONS & CANCELLATIONS
Confirmation: is available upon receipt of payment and sent via e-mail in an effort to be “green”.

Cancellation Policy (Organization): Evaluations Standards Training, LLC reserves the right to cancel or reschedule any course/workshop/training due to insufficient registration or extenuating circumstances. A full refund will be provided to the participants unless they choose a credit towards a future training. If the refund is requested, it will be in the same format of payment either by check or credit card.

Cancellation Policy (Participant): A refund less a $50.00 administration fee will be provided upon receipt of written request. Refund requests must be received by mail (postmarked) or e-mail 8 days or more prior to the date of the training. There is no refund for cancellations received 7 days or less prior to the date of training; however, a credit will be issued toward a future training.

 

 
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Back From Hiatus!

September 9th, 2011 | Author: Rebecca Alva
EI Trainings To Continue This Fall!Performing Evaluations will be offered in October, November and December.

Dates and Locations (NYC/LI) to follow!

 

 
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Performing Evaluations In Early Intervention – February 13, 2011

February 25th, 2011 | Author: Rebecca Alva
On February 13, 2011 Providers attended the 2nd EI Training on Performing Evaluations In Early Intervention. Here is what one Provider had to say: This training truly was a training like no other. We were provided with tons of functional information that I intend to use ASAP! I now am more clear on the regulations put forth by Early Intervention Department of Health.
Alisha Price, SLP 

 
 
 
 
 
 
 
 
 
 
 

Teaching Students at Teachers College, Columbia University

February 25th, 2011 | Author: Rebecca Alva
I was asked by Catherine J. Crowley, CCC-SLP, J.D., Ph.D., ASHA Fellow and Board Recognized Specialist in Child Language, to teach her Assessment and Evaluation class on Thursday, February 24th at Teachers College, Columbia University. My lecture for the students was on the Standards and Procedures for Evaluations & Eligibility Requirements Under the Early Intervention Program. It was great sharing my knowledge with the students! 

 
 
 
 
 
 
 
 
 
 
 

Performing Evaluations In Early Intervention – January 23, 2011

February 25th, 2011 | Author: Rebecca Alva
Here is what two Providers had to say about the EI Training:Amazing! This workshop was very helpful & informative. I received a lot of documents that will help me when writing evaluations. The information received will also help me to evaluate myself in how I approach evaluations. I learned a lot regarding the laws and regulations that determine eligibility for Early Intervention. I am now able to provide support for any recommendations I make in future evaluations. Jeanel Burgess-Belfon, Speech-Language Pathologist

It was very informative and it was nice to get paper copies of all the materials. Rebecca was very knowledgeable and an engaging speaker. I loved learning about the laws that are in place and I think that this will help me to be a better report/eval writer in general. Maria Niemiec, Special Educator

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Copyright © 2011 Rebecca Alva, M.A. CCC-SLP. All Rights Reserved.

 
 
 
 

Scholarly Article Supports That There Is A Point To Early Intervention..Please Share..

For anyone who interacts with others who are questioning the point to early intervention and the effects that it can have on very young children, feel free to pass this article on.  It makes for a very good educational tool…. Thank you.

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Challenges and limitations in early intervention

  1. MIJNA HADDERS-ALGRA

Article first published online: 21 SEP 2011

DOI: 10.1111/j.1469-8749.2011.04064.x

Issue

Developmental Medicine & Child Neurology

Developmental Medicine & Child Neurology

Special Issue: Impact of Intervention: can we affect typical and atypical development of the human brain? Outcome papers from an International Workshop held 22-24 April 2010 in Groningen, the Netherlands

Volume 53, Issue Supplement s4, pages 52–55, September 2011

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How to CiteAuthor InformationPublication History

How to Cite

HADDERS-ALGRA, M. (2011), Challenges and limitations in early intervention. Developmental Medicine & Child Neurology, 53: 52–55. doi: 10.1111/j.1469-8749.2011.04064.x

Author Information

  1. Department of Pediatrics, Developmental Neurology, University Medical Center Groningen, Groningen, the Netherlands.

*Correspondence: Dr Mijna Hadders-Algra, University Medical Center Groningen, Developmental Neurology, Hanzeplein 1, 9713 GZ Groningen, the Netherlands. E-mail: m.hadders-algra@med.umcg.nl

Publication History

  1. Issue published online: 21 SEP 2011
  2. Article first published online: 21 SEP 2011
  3. PUBLICATION DATA Accepted for publication 28th February 2011.

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Jump to…Top of pageAbstractParent–Infant InteractionType and Timing of the Lesion of the Developing BrainAge at Which the Intervention is AppliedContents of Early InterventionConclusionAcknowledgementsReferences

Abstract

  1. Top of page
  2. Abstract
  3. Parent–Infant Interaction
  4. Type and Timing of the Lesion of the Developing Brain
  5. Age at Which the Intervention is Applied
  6. Contents of Early Intervention
  7. Conclusion
  8. Acknowledgements
  9. References

Research over the past three decades has shown that early intervention in infants biologically at risk of developmental disorders, irrespective of the presence of a brain lesion, is associated with improved cognitive development in early childhood without affecting motor development. However, at present it is unknown whether early intervention is also able to improve developmental outcome in infants with a serious lesion of the brain. This paper discusses factors that might play a role in the effect of early intervention. The following picture emerged from the limited evidence available: (1) coaching of parents seems an effective means of intervention; (2) our understanding of the plasticity of the developing human brain is currently too limited to allow a direct practical implementation in early intervention; (3) intervention before term age should primarily focus on stress reduction, intervention after term age on stimulation of infant development; and (4) our knowledge of the best ways to stimulate infant development is scant. Nevertheless, preliminary data suggest that offering the infant ample opportunities to explore by self-produced motor activities the borders of their own abilities might be a good strategy for promoting developmental outcome, including functional mobility.

Infants might be at risk of developmental disorders for a variety of reasons. The risk might consist of social or biological disadvantage or a combination of both.1 Well-known examples of biological disadvantage are prematurity or low birthweight, whether accompanied by a serious lesion of the brain or not.2 The usual care of infants at risk of developmental disorders includes early intervention. This comprises ‘the multidisciplinary services provided to children from birth to 5 years of age to promote child health and well-being, enhance emerging competencies, minimize developmental delays, remediate existing or emerging disabilities, prevent functional deterioration and promote adaptive parenting and overall family functioning’.1 Today a wide variety of early intervention programmes exists.3–6 The programmes have been shown to be effective in promoting developmental outcome, in particular cognitive outcome, in infants socially at risk of disadvantaged development.7 Gradually, evidence is also emerging of the effect of early intervention in infants biologically at risk of developmental disorders, i.e. those with prenatal, perinatal, and neonatal complications. The effect of early intervention in these groups has been studied most often in preterm infants. Recent systematic reviews, including meta-analyses, on the effect of early intervention in infants born preterm indicate that early intervention is associated with improved cognitive development during infancy and preschool age.5,6 Evidence that the effect persists into school age or later is lacking. In addition, the reviews indicate that early intervention in general has little effect on motor development. Interestingly, the beneficial effect of early intervention on cognitive development appears to be relatively independent of the specifics of the intervention programme.5 However, it should be realized that few studies investigated relationships between the contents of the intervention programmes and developmental outcome.

The aim of the present paper is to discuss factors that might play a role in the effect of early intervention in infants biologically at risk of developmental disorders. The following issues will be addressed: (1) the role of parent–infant interaction; (2) the type and timing of an early lesion of the brain; (3) the age at which the intervention is applied; and (4) the contents of intervention.

Jump to…Top of pageAbstractParent–Infant InteractionType and Timing of the Lesion of the Developing BrainAge at Which the Intervention is AppliedContents of Early InterventionConclusionAcknowledgementsReferences

Parent–Infant Interaction

  1. Top of page
  2. Abstract
  3. Parent–Infant Interaction
  4. Type and Timing of the Lesion of the Developing Brain
  5. Age at Which the Intervention is Applied
  6. Contents of Early Intervention
  7. Conclusion
  8. Acknowledgements
  9. References

Parents are the key persons in a child’s life. Awareness of the impact of parents, caregivers, and the family on child development has resulted in the recognition of the importance of family-centred intervention services in health care for infants with or at risk of neurodisability.8,9 However, the role of the family, parents, and caregivers in the various forms of family-centred service varies substantially. The interventions differ for instance in the extent to which family autonomy is respected, in the degree of parental instruction or parental coaching, and in the attention paid to parent–infant interaction.10 The effect of most components of family-centred service on the child’s developmental outcome is unknown. An exception to this rule is the effect of parent–infant interaction on developmental outcome. Various studies have indicated that greater dyadic tuning between parent and infant, and more responsive, positive, warm, and sensitive parenting, is associated with better developmental outcome at preschool and school age.11,12 However, it is important to realize that association does not automatically imply causation. The association between parental behaviour during interaction with the infant and developmental outcome might in part be mediated by the characteristics of the infant. For instance, infants with an early lesion of the brain might show more stereotyped and less adaptive behaviour than typically developing infants.13 This, in turn, might induce less positive parental behaviour and impaired dyadic interaction between parent and infant. Nevertheless, the recent randomized controlled study of Koldewijn et al.14 suggests that parental behaviour also has an independent effect on child outcome. The study indicated that the preterm infants who had received intervention that paid specific attention to the infants’ self-regulation and sensitive parent–infant interactions had a significantly better motor outcome at the age of 2 years than the comparison group of infants. In contrast to most other studies, the intervention was not associated with improved cognitive outcome.

In the Groningen Vroege Interventie Project (VIP project), a study on intervention from 3 to 6 months corrected age in infants at high biological risk of developmental disorders, we recently evaluated the contribution of specific elements of intervention to developmental outcome. The results suggested in particular that coaching of parents was associated with improved developmental outcome at the age of 18 months.15,16 Coaching is defined as professional guidance aiming to empower caregivers so that they can make their own decisions during daily care activities. This implies that coaching differs largely from instruction.17

Jump to…Top of pageAbstractParent–Infant InteractionType and Timing of the Lesion of the Developing BrainAge at Which the Intervention is AppliedContents of Early InterventionConclusionAcknowledgementsReferences

Type and Timing of the Lesion of the Developing Brain

  1. Top of page
  2. Abstract
  3. Parent–Infant Interaction
  4. Type and Timing of the Lesion of the Developing Brain
  5. Age at Which the Intervention is Applied
  6. Contents of Early Intervention
  7. Conclusion
  8. Acknowledgements
  9. References

Over the years, animal data have demonstrated that the effect of a lesion of the developing brain depends on the point in time at which the lesion occurs. Originally, it was thought that ‘the younger the age at insult, the better the outcome’ (the so-called Kennard-principle).18 However, gradually it became clear that the consequences of a lesion of the developing brain depend on developmental stage at insult, the site and the size of the lesion, animal species, exposure to chemical substances before and after the insult, and environmentally induced experience. It transpired that each stage, each neural system, and each species has specific vulnerabilities and resources of resilience to cope with the effects of an early lesion.19

Our knowledge on how this information translates to the human situation is limited. Recent advances in brain imaging and neurophysiological techniques have furnished some insights. It became clear that insults occurring during (the period equivalent to) the early third trimester of pregnancy usually affect the periventricular areas, including the periventricular white matter; those occurring near term more often affect the cortical grey matter.20 Staudt21 demonstrated that the organizational processes in response to an early lesion not only vary with the timing of the lesion but also with the neural system. For instance, in case of a unilateral lesion of the brain, the chance of motor recovery is higher for early third-trimester lesions than for lesions occurring near term. This is because, at early age, recovery might be mediated by persisting ipsilateral corticospinal projections that compensate for the lost ones on the side of the lesion. For the sensory systems the effect of an early third-trimester lesion is different. At that age the ascending thalamo-cortical somatosensory projections have not yet reached the cortex, allowing the system to use local deviations that bypass the lesion in order to reach the cortex.

Little is known, however, about the way in which we might facilitate the processes that mediate functional recovery in the developing human brain. Our knowledge is most advanced in unilateral spastic cerebral palsy (CP). Animal data pointed to the importance of balanced activity in both hemispheres and to the consequences of lesion-induced unbalanced activity during early development.22 The animal data, recent findings on the pathophysiology,23 and the effect of intervention in unilateral spastic CP (constraint-induced movement therapy or stimulation of bimanual activity)24 suggest that bilateral motor activity at early age is an important factor in functional recovery after an unilateral lesion of the brain.

Jump to…Top of pageAbstractParent–Infant InteractionType and Timing of the Lesion of the Developing BrainAge at Which the Intervention is AppliedContents of Early InterventionConclusionAcknowledgementsReferences

Age at Which the Intervention is Applied

  1. Top of page
  2. Abstract
  3. Parent–Infant Interaction
  4. Type and Timing of the Lesion of the Developing Brain
  5. Age at Which the Intervention is Applied
  6. Contents of Early Intervention
  7. Conclusion
  8. Acknowledgements
  9. References

The human nervous system changes and develops throughout life.25 But the way in which it changes varies with age. During prenatal life, focus is on neuron and glial cell proliferation, cell migration, neural apoptosis, and axon and dendrite formation. During infancy, dendrite formation, synapse production, and myelination are most prominent. In later childhood, the major developmental processes consist of synaptic reorganization and myelination. This implies that the nervous system has age-specific forms of plasticity. For specific lesions and functions this plasticity is associated with critical windows during which intervention might have an effect that no longer might be obtained once the window is past. Critical periods have been demonstrated in the treatment of amblyopia and for the effect of cochlear implants on cortical processing of auditory information and speech development.26,27 Interestingly, the critical periods of the two sensory functions share the following characteristics: (1) the earlier the intervention is started, the larger is the functional effect; (2) the critical period of substantial functional effect ends around the age of 7 years; and (3) also beyond the critical period, intervention might still induce functional changes.26,27 It has been hypothesized that in the development of unilateral spastic CP a similar critical period might exist,23 but further research is required to corroborate this suggestion. Extrapolation of some animal data that implied recovery of function after an early lesion of the brain is best during the period of dendritic outgrowth and formation, suggests that the period ranging from the third trimester of pregnancy to the postnatal age of about 1.5 years offers the best opportunities for effective intervention.25,28

Before term age the effect of intervention might also be affected by stress. The stress is related to the difficulties of the preterm infant to adapt to the extrauterine situation owing to immaturity of vital physiological functions.29 The stress might enhance the capacity to cope with extrauterine life and thus promote survival. But stress before term age might also induce ‘developmental programming’.30 Animal data indicate that stress during early life gives rise to changes in serotonergic and noradrenergic activity in the cerebral cortex and alterations in dopaminergic activity in the striatum and prefrontal cortex.31–33 These changes have been associated with impaired development of the maps of body representation in the primary somatosensory cortex, inappropriately developed ocular dominance columns in the visual cortex, and mild motor problems.13 Gradually, evidence is accumulating that stress during early human ontogeny is also associated with long-term modifications of neurobehavioural development.32,34 In addition, animal research has indicated that the hormonal changes induced by stress might modify the effect of a lesion of the developing brain and the effect of early intervention.19 The sensitivity of the young nervous system to stress-related factors implies that reduction of stress is an important goal of early intervention before term age.

Jump to…Top of pageAbstractParent–Infant InteractionType and Timing of the Lesion of the Developing BrainAge at Which the Intervention is AppliedContents of Early InterventionConclusionAcknowledgementsReferences

Contents of Early Intervention

  1. Top of page
  2. Abstract
  3. Parent–Infant Interaction
  4. Type and Timing of the Lesion of the Developing Brain
  5. Age at Which the Intervention is Applied
  6. Contents of Early Intervention
  7. Conclusion
  8. Acknowledgements
  9. References

Recent reviews3–6 have brought the limitations of our understanding on the effectiveness of specific components of early intervention clearly to light. Presumably the multifactorial composition of early intervention in children with or at risk of neurodisability is responsible for the lack of understanding. It is acknowledged that the effect of intervention might not only depend on the nature of the lesion of the brain and on family conditions, but also on the interaction of the intervention with the various personal and environmental factors.35

Still, the body of knowledge on early intervention steadily grows. It suggests that the nature of the most effective intervention before term differs from that applied after term age.3,4 Before term age, stress reduction appears to be essential. The Newborn Individualized Developmental Care and Assessment Program8 is a well-known example of a standardized intervention programme in which stress reduction is a major goal. This programme has been associated with a beneficial effect on developmental outcome in infancy, but the effects on outcome beyond infancy are controversial.3,4,36,37 The study of Guzzetta et al.38,39 suggests that, in addition to stress reduction, the application of infant massage during the preterm period might have a beneficial effect on development. The positive effect was found in low-risk infants. Further studies are required to investigate whether massage will have a similar positive effect on development in infants with a lesion of the brain. Animal data suggest that this might be the case.19

Little is known about the effectiveness of specific components of intervention applied after term age. A large diversity of general developmental programmes has been associated with better developmental outcome, in particular with improved cognition. The interventions presumably consist of a mix of effective, neutral, and counterproductive elements. Future research should aim at unravelling these components. The Groningen VIP project was a first step in this direction. In the VIP project the contents of intervention were systematically quantified and correlated to developmental outcome immediately after the end of intervention (at the corrected age of 6mo) and 1 year later. The data revealed (1) coaching of parents and (2) challenging the infant with a wide variety of self-produced motor activities were associated with better functional outcome at 18 months, in particular with improved functional mobility, (3) the proportion of time of the intervention sessions that was spent with handling techniques (hands-on) showed a negative association with functional outcome at 18 months, and (4) application of sensory and passive experiences was associated with a positive effect on cognition immediately after the end of the intervention, but these components of intervention showed a negative association with outcome at 18 months.15,16 The finding that self-produced activity in a variety of conditions is associated with better outcome is in line with the developmental principles of the neuronal group selection theory: the afferent information associated with self-produced trial-and-error activity guides the process of selection of the best strategy for each situation.13 The data suggest that coaching of parents to solve their own problems and to integrate motor activities in which the infant is allowed to explore the borders of its own abilities into daily routines might be a simple and effective means of promoting infant development.

Jump to…Top of pageAbstractParent–Infant InteractionType and Timing of the Lesion of the Developing BrainAge at Which the Intervention is AppliedContents of Early InterventionConclusionAcknowledgementsReferences

Conclusion

  1. Top of page
  2. Abstract
  3. Parent–Infant Interaction
  4. Type and Timing of the Lesion of the Developing Brain
  5. Age at Which the Intervention is Applied
  6. Contents of Early Intervention
  7. Conclusion
  8. Acknowledgements
  9. References

Research over the past three decades has shown that early intervention in infants biologically at risk of developmental disorders is associated with improved cognitive development in early childhood. The effects have been shown for groups of infants with varying degrees of biological risk of whom only a minority had a serious lesion of the brain. This means that it is currently unknown whether early intervention is able to improve outcome in infants with a serious lesion of the brain. The data of the VIP project suggest, however, that this might be possible: the previously mentioned associations between components of intervention, such as parental coaching and promotion of the exploration of a variety of self-produced motor activities, and functional outcome were found in particular in the small subgroup of children who developed CP.15,16 Additional studies on the effect of early intervention in infants with a lesion of the brain are urgently needed. These studies also should pay attention to the contents of intervention. The LEARN 2 MOVE 0 to 2 years project is a step in the desired direction.40

Jump to…Top of pageAbstractParent–Infant InteractionType and Timing of the Lesion of the Developing BrainAge at Which the Intervention is AppliedContents of Early InterventionConclusionAcknowledgementsReferences

Acknowledgements

  1. Top of page
  2. Abstract
  3. Parent–Infant Interaction
  4. Type and Timing of the Lesion of the Developing Brain
  5. Age at Which the Intervention is Applied
  6. Contents of Early Intervention
  7. Conclusion
  8. Acknowledgements
  9. References

I gratefully acknowledge Tineke Dirks, Ilse Ebbers-Dekkers, Elisa Hamer, and Tjitske Hielkema, for comments on a previous draft of the manuscript. The early intervention work of Mijna Hadders-Algra is financially supported by the Johanna KinderFonds, Stichting Fonds de Gavere, the Cornelia Stichting, ZonMW, Stichting Rotterdams Kinderrevalidatie Fonds Adriaanstichting, Phelpsstichting, Revalidatiefonds, Revalidatie Nederland, the Nederlandse Vereniging van Revalidatieartsen, and the Graduate School for Behavioural and Cognitive Neurosciences.

Jump to…Top of pageAbstractParent–Infant InteractionType and Timing of the Lesion of the Developing BrainAge at Which the Intervention is AppliedContents of Early InterventionConclusionAcknowledgementsReferences

References

  1. Top of page
  2. Abstract
  3. Parent–Infant Interaction
  4. Type and Timing of the Lesion of the Developing Brain
  5. Age at Which the Intervention is Applied
  6. Contents of Early Intervention
  7. Conclusion
  8. Acknowledgements
  9. References
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    Hielkema T, Blauw-Hospers CH, Dirks T, Drijver-Messelink M, Bos AF, Hadders-Algra M. Does physiotherapeutic intervention affect motor outcome in high-risk infants? An approach combining a randomized controlled trial and process evaluation. Dev Med Child Neurol 2011; 53: e8–15.

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    Gordon AM. To constrain or not to constrain, and other stories of intensive upper extremity training for children with unilateral cerebral palsy. Dev Med Child Neurol 2011; 53 (Suppl. 4): 56–61.
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    Holmes JM, Clarke MP. Amblyopia. Lancet 2006; 367: 1343–51.

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    Sharma A, Nash AA, Dorman M. Cortical development, plasticity and re-organization in children with cochlear implants. J Commun Disord 2009; 42: 272–9.

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