Shaping the Way We Use Technology Or Not….

A year or so back, I was sitting, catching up on reading mail one afternoon and i come across my graduate school alumni magazine.  The topic that month was related to the use of technology in education. One of the articles talked  about different types of careers that are developing in the field of education, that relate to technology. Really interesting.  It got me thinking about my day-to-day work and the types of things that have happened over the past few years. How are we changing??   

I avoid using technology at work, aside from some apps on my i-phone.  Call me old fashioned; but, there really is a logical reason when you are interacting with young children. Why?   there now is scientific evidence that the use of technology really impacts us.  For example, this article from Scientific America might be eye opening for some 

One might poo-poo the article that I site in the previous paragraph since the article was written in 2013.   Before YOU choose to do so, copyrighted in 2018 MaryAnneWolf writes the text Reader, Come Home: The Reading Brain in a Digital World.  (yes – you CAN get it online at Amazon ūüôā  )

  • Wolf continues the dialogue about the influence of technologic reading vs. tangible “book” reading. There are real differences that she suggests: the ability to critically think, reflect and being empathic. She even documents the neurology of reading and how our brains assists is with it (which I can’t give away – you will have to read her book!) and the fact that we don’t use the same aspects of neuroanatomy when reading online. The adage of “use it or lose it” may now be popping into your head. Scary isnt it. My conclusion was that reading a book may actually be a form of exercise for your brain. I myself wonder, is this going to be another addition to the recommended amount of aerobic exercise that we need to maintain health? Interesting rhetorical question or perhaps a “real one” to discuss at your next physical.

New screen-time guidelines for early childhood are outlined in and the American Academy of Pediatrics published the following

Among the AAP recommendations:

The idea of developing a Family Media Plan has been suggested  to help as a guide.

  • For children younger than 18 months, avoid use of screen media other than video-chatting. Parents of children 18 to 24 months of age who want to introduce digital media should choose high-quality programming, and watch it with their children to help them understand what they’re seeing.
  • For children ages 2 to 5 years, limit screen use to 1 hour per day of high-quality programs. Parents should co-view media with children to help them understand what they are seeing and apply it to the world around them.
  • For children ages 6 and older, place consistent limits on the time spent using media, and the types of media, and make sure media does not take the place of adequate sleep, physical activity and other behaviors essential to health. 
  • Designate media-free times together, such as dinner or driving, as well as media-free locations at home, such as bedrooms.
  • Have ongoing communication about online citizenship and safety, including treating others with respect online and offline.

Another question that I had in reviewing this information in preparing for a graduate student seminar being given to students studying the field of Speech-Language Pathology was what about adults? Who helps guide us in curbing use of technology so that it is used responsibly. After all, I would challenge my reader to make a list of 25 activities that you engage in during the week that do not involve battery operated devices. Can you? When I asked my students to do so, it was hard. Even the mundane task of grocery shopping in a “real” grocery store where you actually take a shopping cart, walk up and down an aisle and take items off of a shelf was not happening. By a show of hands, few students engaged in that task. No wonder we are becoming an overweight society!

With the above depressing news that has been documented – how technology is affecting our health, I dug up an article that may be of help. I will close with this and a request to consider how technology is affecting your life and how it is affecting the life of those around you. Consider how you can take care of yourself!


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  and relate to a variety of developmental areas such as vision, communication, hearing, motor function. 

Zero to Three

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



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



‚ÄúThank You A Million Times Over‚ÄĚ

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



October 1st EI Training Rescheduled!

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

519 Eighth Avenue, NY

Studio L




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.

‚ÄĘ Discuss NYS DOH Public Health Law, codes, rules and regulations as it applies to Early Intervention.
‚ÄĘ Discuss the Adopted Early Intervention Program Regulations 6/3/2010.
‚ÄĘ Discuss NYS Memorandum 2005-02 Standards and Procedures for Evaluations, Reimbursement, Eligibility requirements and Determinations under the Early Intervention Program.
‚ÄĘ Describe how no single procedure or instrument may be used as the sole indicator of eligibility in EI.
‚ÄĘ Discuss how to appropriately interpret and use test scores in MDE (Multidisciplinary Evaluations).
‚ÄĘ Describe how to incorporate¬†information from a variety of appropriate sources into MDE‚Äôs.
‚ÄĘ 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‚Äôs.
‚ÄĘ Formulate an Informed Clinical Opinion in MDE‚Äôs.

9:00 Registration & Refreshments
9:30 Introduction, Public Health Law & Adopted Early Intervention Program Regulations 6/3/2010
10:00 Regulations & Guidelines ‚Äď 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

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

*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.

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

Course Locations:
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 ‚Äď 801 Crooked Hill Road Brentwood, NY 11717

Improve the quality of your evaluations by registering for this training!
Register by phone: 917.885.3146 or by e-mail:

*****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+)

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 ‚Äď

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.

Confirmation: is available upon receipt of payment and sent via e-mail in an effort to be ‚Äúgreen‚ÄĚ.

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.



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!



Performing Evaluations In Early Intervention ‚Äď 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 ‚Äď 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




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.

Advertise with us - Wiley Online Library


You have free access to this content

Challenges and limitations in early intervention


Article first published online: 21 SEP 2011

DOI: 10.1111/j.1469-8749.2011.04064.x


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‚Äď55, September 2011

Additional Information(Show All)

How to CiteAuthor InformationPublication History

How to Cite

HADDERS-ALGRA, M. (2011), Challenges and limitations in early intervention. Developmental Medicine & Child Neurology, 53: 52‚Äď55. 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:

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.


Search Scope All contentPublication titlesIn this journalIn this issueBy Citation

Search String


Jump to‚ĶTop of pageAbstractParent‚ÄďInfant InteractionType and Timing of the Lesion of the Developing BrainAge¬†at Which the Intervention is AppliedContents¬†of Early InterventionConclusionAcknowledgementsReferences


  1. Top of page
  2. Abstract
  3. Parent‚ÄďInfant 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 ‚Äėthe 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‚Äô.1¬†Today a wide variety of early intervention programmes exists.3‚Äď6¬†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‚Äďinfant 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‚ĶTop of pageAbstractParent‚ÄďInfant InteractionType and Timing of the Lesion of the Developing BrainAge¬†at Which the Intervention is AppliedContents¬†of Early InterventionConclusionAcknowledgementsReferences

Parent‚ÄďInfant Interaction

  1. Top of page
  2. Abstract
  3. Parent‚ÄďInfant 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‚Äôs 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‚Äďinfant interaction.10¬†The effect of most components of family-centred service on the child‚Äôs developmental outcome is unknown. An exception to this rule is the effect of parent‚Äďinfant 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‚Äô self-regulation and sensitive parent‚Äďinfant 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‚ĶTop of pageAbstractParent‚ÄďInfant 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‚ÄďInfant 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 ‚Äėthe younger the age at insult, the better the outcome‚Äô (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‚ĶTop of pageAbstractParent‚ÄďInfant 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‚ÄďInfant 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 ‚Äėdevelopmental programming‚Äô.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‚Äď33¬†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‚ĶTop of pageAbstractParent‚ÄďInfant 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‚ÄďInfant 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‚Äď6¬†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‚ĶTop of pageAbstractParent‚ÄďInfant InteractionType and Timing of the Lesion of the Developing BrainAge¬†at Which the Intervention is AppliedContents¬†of Early InterventionConclusionAcknowledgementsReferences


  1. Top of page
  2. Abstract
  3. Parent‚ÄďInfant 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‚ĶTop of pageAbstractParent‚ÄďInfant InteractionType and Timing of the Lesion of the Developing BrainAge¬†at Which the Intervention is AppliedContents¬†of Early InterventionConclusionAcknowledgementsReferences


  1. Top of page
  2. Abstract
  3. Parent‚ÄďInfant 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‚ĶTop of pageAbstractParent‚ÄďInfant InteractionType and Timing of the Lesion of the Developing BrainAge¬†at Which the Intervention is AppliedContents¬†of Early InterventionConclusionAcknowledgementsReferences


  1. Top of page
  2. Abstract
  3. Parent‚ÄďInfant 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
  • 1
    Shonkoff JP, Meisels SJ. Handbook of Early Childhood Intervention. Cambridge, UK: Cambridge University Press, 2000.

  • 2
    Allen MC. Neurodevelopmental¬†outcomes of preterm¬†infants. Curr¬†Opin¬†Neurol 2008; 21: 123‚Äď8.

  • 3
    Blauw-Hospers¬†CH, Hadders-Algra¬†M. A systematic review on the effects of early intervention on motor development. Dev Med Child Neurol 2005; 47: 421‚Äď32.

  • 4
    Blauw-Hospers¬†CH, De Graaf-Peters VB, Dirks T, Bos AF, Hadders-Algra¬†M. Does early intervention in infants at high risk for a developmental motor disorder improve motor and cognitive development? Neurosci¬†Biobehav Rev 2007; 31: 1201‚Äď12.

  • 5
    Spittle AJ, Orton J, Doyle LW, Boyd R. Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants. Cochrane Database Syst Rev 2007; 18: CD005495.
  • 6
    Orton J, Spittle A, Doyle L, Anderson P, Boyd R. Do early intervention programmes improve cognitive and motor outcomes for preterm¬†infants after discharge? A systematic review Dev Med Child Neurol 2009; 51: 851‚Äď9.

  • 7
    Halpern R. Early intervention in low-income children and families. In: Shonkoff¬†JP, Meisels¬†SJ, editors. Handbook of Early Childhood Intervention, 2nd edn. Cambridge, UK: Cambridge University Press, 2000, p 361‚Äď86.

  • 8
    McAnulty¬†G, Duffy FH, Butler S, et al.¬†Individualized developmental care for a large sample of very preterm¬†infants: health, neurobehaviour¬†and neurophysiology. Acta Paediatr 2009; 98: 1920‚Äď6.

  • 9
    Rosenbaum P. Family and quality of life: key elements in intervention in children with cerebral palsy. Dev Med Child Neurol 2011; 53 (Suppl. 4): 68‚Äď70.
  • 10
    Dirks T, Hadders-Algra¬†M. The role of the family in intervention of¬†infants at high risk for cerebral palsy: a systematic analysis. Dev Med Child Neurol 2011; 53 (Suppl. 4): 62‚Äď67.
  • 11
    Smith KE, Landry SH, Swank PR. The role of early maternal responsiveness in supporting school-aged cognitive development for children who vary in birth status. Pediatrics 2006; 117: 1608‚Äď17.

  • 12
    Treyvaud K, Anderson VA, Howard K, et al.¬†Parenting behavior is associated¬†with the early neurobehavioral¬†development of very preterm children. Pediatrics 2009; 123: 555‚Äď61.

  • 13
    Hadders-Algra¬†M. Variation and variability: keywords in human motor development. Phys Ther 2010; 90: 1823‚Äď37.

  • 14
    Koldewijn¬†K, van Wassenaer A, Wolf MJ, et al.¬†A neurobehavioral¬†intervention and assessment program in very low birth weight infants: outcome at 24 months. J Pediatr 2010; 156: 359‚Äď65.

  • 15
    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‚Äď15.

  • 16
    Blauw-Hospers CH, Dirks T, Hulshof LJ, Bos AF, Hadders-Algra M. Pediatric physical therapy in infancy: from nightmare to dream? A two arm randomized trial. Phys Ther 2011. In press.

  • 17
    Dirks T, Blauw-Hospers¬†C, Hulshof¬†H, Hadders-Algra¬†M. Differences between the family-centered¬†program ‚ÄėCoping and caring for infants with special needs‚Äô and infant treatment based on principles of neurodevelopmental¬†treatment. Phys Ther 2011. In press.

  • 18
    Kennard MA. Reactions of monkeys of various ages to partial and complete decortication. J Neuropathol¬†Exp¬†Neurol 1944; 3: 289‚Äď310.

  • 19
    Kolb B, Mychasiuk¬†R, Williams P, Gibb R. Brain plasticity and recovery from early cortical injury. Dev Med Child Neurol 2011; 53 (Suppl. 4): 2‚Äď3.
  • 20
    Kr√§geloh-Mann¬†I, Horber¬†V. The role of magnetic resonance imaging in elucidating the pathogenesis of cerebral palsy: a systematic review. Dev Med Child Neurol 2007; 49: 144‚Äď51.

  • 21
    Staudt¬†M. Reorganization after pre-¬†and perinatal brain lesions. J Anat 2010; 217: 469‚Äď74.

  • 22
    Martin JH, Chakrabarty¬†S, Friel¬†KM. Harnessing activity-dependent plasticity to repair the damaged corticospinal¬†tract in an animal model of cerebral palsy. Dev Med Child Neurol 2011; 53 (Suppl. 4): 9‚Äď13.
  • 23
    Eyre JA, Smith M, Dabydeen L, et al.¬†Is hemiplegic¬†cerebral palsy equivalent¬†to amblyopia of the corticospinal¬†system? Ann Neurol 2007; 62: 493‚Äď503.

  • 24
    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‚Äď61.
  • 25
    De Graaf-Peters VB, Hadders-Algra M. Ontogeny of the human central nervous system: what is happening when? Early Hum Dev 2006; 82: 257‚Äď66.

  • 26
    Holmes JM, Clarke MP. Amblyopia. Lancet 2006; 367: 1343‚Äď51.

  • 27
    Sharma A, Nash AA, Dorman M. Cortical development, plasticity and re-organization in children with cochlear implants. J Commun¬†Disord 2009; 42: 272‚Äď9.

  • 28
    Kolb B, Brown R, Witt-Lajeunesse¬†A, Gibb R. Neural compensations after lesion of the cerebral cortex. Neural Plast 2001; 8: 1‚Äď16.

  • 29
    Klaus MH, Fanaroff AA. Care of the High Risk Neonate, 5th edn. Philadelphia: WB Saunders, 2001.
  • 30
    McEwen BS. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev 2007; 87: 873‚Äď904.

  • 31
    Van den Bergh BR, Mulder EJ, Mennes¬†M, Glover V. Antenatal¬†maternal anxiety and stress and the neurobehavioural¬†development of the fetus and child: links and possible mechanisms. Neurosci¬†Biobehav Rev 2005; 29: 237‚Äď58.

  • 32
    Van den Bergh BRH. Developmental programming of early brain and behaviour development and mental health: a conceptual framework. Dev Med Child Neurol 2011; 53 (Suppl. 4): 19‚Äď23.
  • 33
    Braun K, Bock J. The experience-dependent maturation of prefronto-limbic¬†circuits and the origin of developmental psychopathology: implications for the pathogenesis and mental disorders. Dev Med Child Neurol 2011; 53 (Suppl. 4): 14‚Äď18.
  • 34
    Kikkert¬†HK, Middelburg KJ, Hadders-Algra¬†M. Maternal anxiety is related to infant neurological condition, paternal anxiety is not. Early Hum Dev 2010; 86: 171‚Äď7.

  • 35
    Bartlett DJ, Chiarello LA, McCoy SW, et al.¬†The Move and Play study: an example of comprehensive rehabilitation outcomes research. Phys Ther 2010; 90: 1‚Äď13.

  • 36
    Symington A, Pinelli J. Developmental care for promoting development and preventing morbidity in preterm infants. Cochrane Database Syst Rev 2006; 19: CD001814.

  • 37
    Wielenga¬†JM, Smit BJ, Merkus¬†MP, Wolf MJ, van Sonderen¬†L, Kok¬†JH. Development and growth in very preterm¬†infants in relation to¬†NIDCAP¬†in a Dutch NICU: two years of follow-up. Acta Paediatr 2009; 98: 291‚Äď7.

  • 38
    Guzzetta¬†A, Baldini¬†S, Bancale A, et al.¬†Massage accelerates brain development and the maturation of¬†visual function. J Neurosci 2009; 29: 6042‚Äď51.

  • 39
    Guzzetta¬†A, D‚ÄôAcuto MG, Carotenuto¬†M et al. The effects of preterm¬†infant massage¬†on brain electrical activity. Dev Med Child Neurol 2011; 53 (Suppl. 4): 46‚Äď51.
  • 40
    Hielkema¬†T, Hamer EG, Reinders-Messelink HA, et al.¬†Learn 2 move 0‚Äď2 years: effects of a new intervention program in infants at very high risk for cerebral palsy ‚Äď a randomized controlled trial. BMC¬†Pediatr 2010; 10: 76.


Early Intervention….What is the Point??

I have been writing a lot about education and what we can do for our older children¬†who have an IEP (individualized education plan); but, what about our younger citizens.¬† I am talking about the children who have an IFSP.¬† Do you know what that is?¬† It is a document that is less well known¬†to those in the education world¬† – at least i¬†think that is the case.¬† I am talking about an IFSP (individualized family service plan).¬† It is somewhat different.¬† An IFSP¬†is issued¬†to infants and toddlers from ages from zero to thirty six¬†months.¬† What age is zero?¬†Some readers may not know that this refers to a child under one month of age.¬† Some people have asked me and readers may not realize what can be done for children at this age.¬† the answer is “a lot”.¬†

The reason that we can do a great deal to help children in this “window”¬†is because there is a great deal of plasticity in the brain¬†at this age.¬† That means that the brain is in the process of growing quite rapidly in these¬† early years.¬† Those of us who work with children in this age group¬†are working towards helping create connections in different parts of the brain.¬† It necessitates that we work with the family.¬† That is where the “family service plan” comes into play.¬† The involvement of the whole family is imperative towards any type of improvement.¬† These are really young children.¬† If you have a child who has a birth injury such as¬†cerebral palsy, those of us in the industry may work together to write a justification so that your child can get a wheelchair.¬†

So – who are we??

physical therapists who could be working with children who are not turning over, are not able to crawl or stand up.  

occupational therapists who could be working  with children who have sensory problems Рthey have  difficulty eating independently, holding a botttle to drink, dressing themselves, using the smaller muscles in their fingers to hold a pencil.  They may not be able to hold a stuffed animal.  Children may not tolerate certain textures of clothes.  They may have trouble falling asleep. 

speech-language pathologists who  could be working with children who have difficulty swallowing liquids or eating solid foods.  We may see children who cough when drinking, or may need a different consistency of food so that they do not cough on it.  The muscles in their mouth might be weak, they may be drooling, they may not allow you to come near their face.  We deal with children who may not have adequate hearing skill so that they can learn language and we may need to help parents arrange  for testing. Some children may not allow their parents to brush their teeth and we work on desensitizing the mouth so that the child will allow a toothbrush in their mouth.  Some children have a neurological problem that impacts on function and all of us may  work together along with

special instructors who address the cognitive delays and educational needs of the child.  Some special instructors have a specialty area in using an approach called applied behavioral analysis. 

social workers come in the home and work with families regarding a wide range of issues such as support services Рrespite care, financial matters such as application for WIC so that their children can eat! 

nutritionists who may work with the parents in consultation with a speech-language pathologist and pediatrician or gastroenterologist to ensure adequate management of this area.

Does this help answer “what is the point?”¬† Look at all the work that we are doing!¬† Things that we take for granted are issues that the allied health professions and educators are acutely involved with in their daily practice, in treatment of¬†infants and toddlers.¬† We can make a huge difference!¬†¬† Read more about the concept of brain plasticity.¬† i¬†found a link when i¬†searched this term that talks more about neuroplasticity.¬†¬†learning changes your brain. ¬†I encourage¬†you to read this and any other articles you can find on the topic.¬† i also would love to hear about other articles that you may read.¬† Please comment with the references.

In NY state there is an organization of us who are advocating for our special needs children and highly concerned caregivers.  There are significant cuts to the funding for the early intervention program that we feel are highly detrimental.  Gains that we can help facilitate in the window of time to which i have referred will be lost if intervention is not provided.  I encourage those of you in ny state to be aware of and read about ways that you can help.  A group will be lobbying in Albany this week, on September 20th.  Information about the agenda and issues that we are advocating for in ny state is on the website i have listed.  I believe that there are similar groups in other states that are advocating for the same needs because of so many cuts to the Department of Health and programming funded through medicaid.  If there are some in your state, please publicize them and get the word out. 

Let’s intervene before it is too late!