What does ‘early’ Early Intervention look like?

It is well documented in the research that intervention is likely to be more effective and less costly when it is provided earlier in life, hence the term Early Intervention. The neurological circuits, which create the foundation for learning,   behaviour and health, are most flexible or ‘plastic’ during the first 3 years of life. Over time, they become increasingly difficult to change. High quality early intervention services can change a child’s developmental trajectory and improve outcomes not only for the children but for their families and communities.

 

There is great variability of what Early Intervention looks like in Ireland. I have been working within the field for the past 16 years as a therapist but this is my first time being on the other side, a parent with a child with special needs requiring early intervention. So I started looking at what Early Intervention should look like and how ‘early’ Early Intervention should start. The following few blogs I am dedicating to what I’ve learned, what made a difference and hopefully we’ll all learn something new. As my following is mostly from professionals working in the field of health, education and disability I welcome your input, feedback and any recommendations.

 

After my son’s diagnosis I started reviewing articles on some of the best evidence-based intervention techniques in early intervention as well as the more controversial ones. I read a lot and I spoke to numerous experts in the field, but it was one book which made its way over to me from Galway which caught my attention. The title of the book was ‘Why love matters’ and to be honest I didn’t rank this book very high on my list of literature to read. But one sentence caught my attention which made me reconsider the value of ‘love’ as an intervention technique. Sue Gerhardt  wrote … ‘Rather than holding up flash cards to your baby, it would be more appropriate to the baby’s stage of development to simply hold him and enjoy him.’ She stated that love is essential to brain development especially in the early years of life and that early interactions between babies and their parents can have lasting consequences. In her book, Sue writes about how the earliest relationship shapes the baby’s nervous system. She wrote that these foundations are laid during pregnancy and in the first two years of life. This is when the social brain is shaped and an individual’s emotional style and emotional resources are established.

 

In a brilliant article by Meltzoff and Kuhl (2016) they stated that a child is born with 86 billion neurons, most of the neurons they will ever have. We have all our neurons at birth and we cannot or do not need to grow any more. What we do need is to connect them up and make them work for us. With more connections there is better performance and more ability to use particular areas of the brain. Sue Gerhardt wrote that in particular, between 6 and 12 months, there is a massive burst of these synaptic connections in the prefrontal cortex. The first part of the prefrontal cortex to mature is the orbitofrontal part (which is behind the eyes). This orbitofrontal cortex plays a key role in emotional life and with other parts of the prefrontal cortex is responsible for emotional intelligence.

 

Meltzoff and Kuhl made the same claims when they said that the 86 billion neurons haven’t yet formed all of the trillion connections that make up the human brain. During the first years of life, these billions of neurons reach out to other neurons, each with multiple connection points that will be systematically shaped and reshaped by the experiences life as well as maturational growth. The social brain develops – we are not born with these capacities. The orbitofrontal cortex (which is so much about being human) develops almost entirely postnatally. This part of the brain develops after birth and doesn’t begin to mature until toddlerhood. Nor is it a matter of waiting for your baby to develop an orbitofrontal cortex. Instead, the kind of brain that each baby develops is the brain that comes out of his/her experiences with people.

 

From the moment of birth, humans are primed to seek and respond to social partners around them. Research continues to demonstrate that rapid infant learning happens on the cortex of these rich social interactions. During infancy and early childhood, the brain shows an extraordinary ability to change with experience (neuroplasticity) indicating that the young brain is highly malleable and open to revision. The experiences children have shape their brains. Children’s brains are built in part through the experiences they have including the social experiences they receive from interacting with adults.

 

It was at this point in my journey that I packed away the brightly coloured board books, black and white pictures and musical toys and decided that for the next 3 months just to focus on social interaction and touch as the foundation for Michael’s intervention.

 

In the article ‘exploring the infant social brain’ the authors wrote that ‘a symphony of neural activity erupts in an infant’s brain in response to the sound of his/her native language or a touch on the hand. Meltzoff and Kuhl (2016) used brain science technology (EEG, MEG, fMRI, fNIRS) to measure brain activity in response to babies hearing their native language and touch. They found the following:

 

  • As infants listen to language, brain areas that coordinate and plan motor movements become activated by speech sounds, even before infants talk. These findings suggest that infant brains rehearse the mechanics of speech in preparation for their first words. These results highlight the value of engaging in social interactions even if they do not yet talk back.
  • When talking about ‘social interactions’ the researchers found that parentese (the sing-song style we adopt when talking to babies where we exaggerate speech and stretched out vowel sounds) appears to be most effective when parents interact with their babies on a one-to-one basis. The more back-and-forth exchanges that occur, the more opportunities for infants to learn language. How adults talk, is more important than what they say or how many words they use.
  • Other components such as eye-gaze also correlated with increased language learning outcomes.
  • Touch and the sense of one’s own body are essential in infant development and mental health. Researchers have hypothesised that babies’ body maps are crucial for connecting self and other and may form the foundation for empathy and social emotional connectedness.

 

So, what have I learned: the best early intervention you can offer your baby with special needs is love. Love your baby, cuddle and touch your baby, talk to him up close so he can see you, hear you, feel you and smell you.

 

This is Early Intervention in the very early months at its best!

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An introduction to Early Intervention Centre

The story of the Early Intervention Centre’s online service, (EIC-online), started while working at Beacon Audiology in Dublin South. Clients who commonly attended for paediatric hearing assessments included children presenting with:

• hearing loss due to recurrent ear infections or glue ear,
• children with a speech and language delay or
• children whose parents were concerned about a possible Autism Spectrum Disorder.

Some children presented with only ear-related issues, where others had multiple health and developmental concerns. Most of these children were already on HSE waiting lists either awaiting an assessment or were wait-listed for therapy.

The persistent problem of waiting Lists

Many parents expressed their frustration at the:

• Length of waiting lists
• The length of breaks between blocks of therapy and the
• Exasperating time between being diagnosed and receiving intervention with no advice or guidelines except to wait.

Parents reported that they were at a loss of what to do, to start addressing their child’s identified needs or where to access private therapists. Another observation was that some parents were uncertain of which developmental milestones were appropriate and what their child should be achieving at their current age and stage of development.

On speaking with parents, it often transpired that many children had been placed on lengthy waiting lists for specific developmental concerns e.g. difficulty with ‘s’ and ‘r’ sounds, which in reality should have caused no concern, as the perceived difficulty was indicative of normal child development for their age. This is an example of how the EIC-online Tool is hugely valuable in both educating a parent as to whether a developmental milestone is age appropriate and if so to offer much needed interim advice so as to give parents the tools to assist their child in stimulating their development while awaiting an assessment with the appropriate professional, which this tool will also identify.

The EIC-online Tool has numerous tips & advice for parents which will assist them in addressing a range of developmental concerns. It is one thing to find out that your child needs help, it is entirely another when we as parents are helpless to assist them. The Early Intervention Centre understands this and is committed to ensuring that parents remain central in their child’s development. Parents have always shown extreme interest in learning more about resources and training courses designed to target specific developmental concerns. Just as important in their eyes are recommendations for the most appropriate ‘referral pathway’ to access:

• Private consultants
• Autism specialists
• Paediatricians and therapists.

Another observation was the need for parental education on the different roles of therapists. Particularly the importance of:

Occupational Therapists in addressing self-help skills, sensory processing and attention issues &  Paediatricians who are uniquely qualified to perform comprehensive ‘Medical & Developmental Assessments’ in a clinical setting with access to psychologists, and other therapists.
So after many months of researching the literature, studying evidence-based developmental screening and assessment questionnaires and consulting practising medical professionals & therapists, over 1000 questions were selected and changed into parent friendly language with 3 goals in mind:

1) To detect areas of delayed development based on typical developmental milestones

2) To identify health and developmental problems that warrant further investigation

3) To recommend what developmental milestones need to be stimulated at the child’s current age of development.

And hence the EIC-online was created as an early detection tool designed to screen for behavioural, health and developmental problems in children aged 0-5 years.

The software has 5 easy steps, and once the child is registered and payment is processed, parents can choose which of the 12 developmental areas they want to check. Parents have 48 hours to complete the check-lists and can select all areas if they want to monitor their child’s holistic development or simply concentrate on the specific areas of concern.

Questionnaires are displayed with options of (yes), (no) or (not applicable). Once completed, the results will be generated to show which developmental milestones are being reached and which are showing cause for concern. It also identifies areas that might warrant further diagnostic assessment or investigation – which are called ‘red flags’ or risk factors.

Parents have the option of adding their family GP contact details to the summary report and a copy of the results with identified red flags will be automatically emailed to their GP.

Other Resources

The Early Intervention Centre’s website offers the following additional supports and resources:

Educational & Therapy Resources – A resource section which is regularly updated with tried and tested therapy and educational materials.

Specialist Consultant & Practitioners – It also has a list of advisors who are known to be family-focused and child-centred if they have any specific discipline-specific questions or queries.

EIC Newsletter – Parents can also sign up to a monthly newsletter which will contain information on training courses, new resources and information on local therapy and medical services available to young children.

So, the Early Intervention Centre in its online form, aims to offer an excellent, cost-effective interim service for those who want to ascertain whether their child’s development is age appropriate and for those with children on lengthy HSE waiting lists.

It is a good resource for informing parents, educating parents and empowering parents to help their child reach their full potential.

Marinet Brennan – B.Speech & Audio, M.Sc in Speech Pathology
Director
Early Intervention Centre