Early intervention can be both broadly and specifically defined. Generally speaking, the term refers to any specialized assistance provided to very young children, but can be used to define services needed by many, such as immunizations and child care, or it can be specifically targeted to a special population. It might even include programs that are not generally considered to be aimed at children but have a major influence on their lives, such as Medicaid and Food Stamps.
In the most common usage of the term, early intervention is most often recognized to be health, education, and social services and specific or targeted interventions for very young children and their families, with an emphasis on disadvantaged or developmentally delayed children.
Early intervention as we know it today is derived from over 300 years of political, social, and academic influence. Many of the fundamental theories in early childhood development are the foundation for the concepts of today’s interventions. Laws have enabled most people in the United States to receive the benefit of these services. Legislation was passed in 1975 to enact the Education for All Handicapped Children Act, known as Public Law (P.L.) 94−142. This law requires all states that accept federal aid for special education to offer all disabled students a free and appropriate education. The year 1990 brought major changes to the original Education for All Handicapped Children Act with the Individuals with Disabilities Education Act (IDEA) or P.L. 105−17.
IDEA specifically provides funding to those early intervention programs targeted to overcome the cognitive, emotional, and resource limitations that may characterize disadvantaged or developmentally delayed children during the first several years of life. This funding allows a broad population to receive treatment regardless of income level or social status.
Types Of Early Intervention
Specialized early intervention services are provided to children who are discovered to have, or to be at risk of developing, a disability, or who exhibit a weakness or delay in a particular area. These services begin at any time between birth and 3 years of age and focus on resolving, minimizing, or eliminating existing developmental problems or delays.
Children eligible for early intervention services must be experiencing developmental delays in one or more of the following areas: cognitive development; physical development, including vision and hearing; language and speech development; psychosocial development; and self-help skills. Children may also be eligible due to diagnosed physical or mental conditions (such as cerebral palsy or Down syndrome) or certain family circumstances that put them at risk of having substantial delays.
Early interventions include, but are not limited to: developmental evaluations and assessments, physical therapy, occupational therapy, speech/language therapy, audiology, nutrition services, special education, and psychological and social work services.
Services range from identification—that is, hospital or school screening and referral services—to diagnostic and targeted or direct intervention programs. These direct interventions may include occupational therapy to help an infant learn to hold her bottle, physical therapy to help her learn to roll over, or speech therapy to help her learn to eat. The following are examples of specific intervention therapies.
Speech and Language Therapy—Speech and language pathologists provide early intervention services for children with, or at risk for, speech, language, and swallowing disorders.
Occupational Therapy—Occupational therapists work with sensory integration disorders, arousal levels, tactile defensiveness, fine motor weaknesses, and oral motor needs. Occupational therapy may be provided in early intervention, early childhood, and school programs, in work settings, and through private agencies, such as Easter Seals.
Physical Therapy—Physical therapists work with at-risk children on developmental motor levels (gross and fine), oral motor, neuromusculoskeletal systems, and functional motor skills. The therapist will aid the family in areas of mobility, positioning, play skills, and handling techniques.
Nutrition Services—Nutritionists can provide services to children at risk for certain developmental delays that may be caused by or otherwise impact the child’s health through nutrition. The nutritionist analyzes and recommends treatments for anthropometric, biochemical, and clinical variables, feeding skills and feeding problems, and food habits and food preferences.
Audiology—Audiologists identify children with auditory impairment, using at-risk criteria and appropriate audiologic screening techniques. They determine the range, nature, and degree of hearing loss and communication functions and provide needed referral for medical and other services for children with auditory impairment. Audiologists also provide auditory training, aural rehabilitation, speech reading and listening device orientation and training, and other services such as selecting, fitting, and dispensing listening and vibrotactile devices.
Assessment-Based Behavior Support—Assessment based or psychological test–based approaches address challenging behaviors associated with developmental delays. Focus is on the development of communication, social interaction, and language skills. Many families rely heavily on this type of support to help them cope with the behavioral difficulties associated with children with special needs. When positive behavior is forthcoming, parents are more likely to spend time teaching and providing intensive care to their child. Families thus are eager to collaborate with professionals in understanding how to guide a child’s social and communication development.
No matter which service is provided, the best early interventions are designed to provide a secure, stimulating environment for children to learn and to overcome the challenges that they face.
Enhancing Child Development
There are three primary reasons for intervening early with any child who exhibits disability, weakness, or delays. These reasons are (1) to enhance the child’s development, (2) to provide support and assistance to the family, (3) and to maximize the child’s benefit to society. When properly administered, early intervention can correct existing developmental problems or prevent potential delays.
Research in child development has established that the rate of learning and development is most rapid in the first 3 years of life. With diagnosis of a delay, disability, or high-risk factors at birth or soon after and the imposition of intervention, developmental gains are greater, and the likelihood of developing further problems is reduced. If this stage of optimal readiness is not taken advantage of, a child may have difficulty learning a particular skill at a later time. Thus, timing of the intervention becomes particularly important.
Researchers have noted that along with early identification of a deficit, the assignment of the appropriate program can best help children develop their full potential. To be most effective, early intervention programs should include these important features: the age of the child at the time of intervention, the amount of parent involvement, and the intensity and structure of the program.
Successful programs are highly structured and clearly specify actions and objectives. These programs closely monitor child and family behaviors and frequently examine the provider’s interaction, session plans, and regular activities. In addition to structure, the intensity of the services, particularly for severely disordered children, appears to affect outcomes. Individualizing instruction and services to meet each child’s needs also is reported to increase effectiveness.
In any early intervention, the effective outcome can only come from a partnership between the service provider, the child, her family, and the case manager and community resources.
The Importance Of Family Support
The family is a critically important and sustaining influence on a young child’s development and is considered a major participant in the early intervention process. Intervention efforts are focused on providing the support, resources, and services the family needs to support their child. The main goal of a family-centered approach is to enhance the developmental and behavioral progress of the child and to strengthen and empower the entire family unit.
Both the child and family work together with a service provider to help the child achieve predetermined goals. Service providers such as physicians, diagnosticians, speech and language pathologists, nurses, teachers, early childhood educators, occupational/physical therapists, and special educators are those usually associated with helping the child and family.
Early intervention services have a significant impact on the parents and siblings of a developmentally delayed infant or young child. The family of the at-risk or delayed child often feels disappointment, social isolation, frustration, and helplessness. This stress may affect the family’s well-being and interfere with the child’s development. Families of these children are found to experience increased instances of divorce and suicide, and the challenged child is more likely to be abused than are his nondelayed peers. Early intervention can result in parents having improved attitudes about themselves and their child, improved information and skills for teaching their child, and more downtime for leisure and enjoyment of other family members. Parents of gifted preschoolers also need early services so that they may better provide the supportive and nourishing environment needed by the child.
Parents of disadvantaged, developmentally delayed, and gifted children need a variety of support and skills to cope with their child’s special needs. A parent’s involvement in their child’s treatment is especially important, as it affects both the well-being of the child and the entire family. When family members are fully engaged in the intervention, they can expect outcomes to include the ability to implement the child’s program at home and a reduction in the stress that impacts the health of the entire family.
Lasting Benefits To Society
The long-term goal of early intervention services is the development of a healthy member of society. Intervening as early as possible in a child’s life seems to predict a more successful outcome and long-lasting effect. Many years of research on intervention between the ages of birth and 3 years have resulted in evidence of developmental and educational gains for the child. Early intervention increases the odds of improvement for functioning of the family and results in long-term benefits for society. Early intervention has been shown to result in the child needing fewer special education and other habilitative services later in life, being retained in grade less often, and in some cases being indistinguishable from nondelayed peers years after intervention.
Both developmentally delayed and socioeconomically disadvantaged children benefit from early intervention. Results of studies on disadvantaged children showed that children involved in early intervention programs significantly maintained the gains they made as young children through early adulthood. These children were more committed to schooling, and more of them finished high school and went on to postsecondary programs and employment than children who did not attend the intervention programs. They scored higher on reading, arithmetic, and language achievement and showed fewer antisocial or delinquent behaviors outside of school.
While there is still much research to be done, current measures show that carefully targeted early childhood interventions can yield measurable benefits in the short run and that some benefits persist long after the program has ended. Most of the earliest research involved structured service to disadvantaged children. The children were at risk for delays due to socioeconomic factors rather than specific organic developmental delays. This research was the precursor to the services we know today and is an important part of the overview of early intervention services. Below is a sample of a few of the major research projects conducted over the last 50 years.
Early Intervention Research Programs
Well-designed, well-funded early intervention programs can have large and significant effects. Designing successful intervention programs includes general guidelines. It is considered optimum to begin intervention before age 3, but intervening at the preschool and school-age level can also be effective. Disadvantaged and developmentally delayed children seem to benefit most from early intervention, and therefore provide ideal target populations. The most important aspect of intervention is the nature of the interaction between provider and child. Several university-based model programs have followed these guidelines and, as a result, have shown desirable long-term outcomes. These include the Carolina Abecedarian Project, the Early Training Project, the Early Intervention Collaborative Study, and the High/Scope Perry Preschool Project. Large, publicly funded programs such as Project Head Start have also exhibited positive results.
The Carolina Abecedarian Project
The Carolina Abecedarian project was started in 1972 at the Frank Porter Graham Child Development Center of the University of North Carolina. The goal of the intervention was to remedy mild mental retardation and improve both academic and social competence for disadvantaged children. Specifically, the study was designed to examine the relative effects of early education, day care, and other methods of early intervention on intellectual functioning and early academic achievement.
The Carolina Abecedarian Project involved full-day intervention from birth to age 5 and then followed up with an intervention for school-aged children. The Abecedarian Project revealed that, at age 15, those children who had received a preschool intervention scored higher on achievement tests and had lower incidence of special education and grade retention. At age 21, the children who received the preschool intervention were twice as likely to still be in school or to have attended a 4-year college.
The Early Training Project
One of the very first large studies was the Early Training Project directed by Susan Gray in Murfreesboro, Tennessee, in 1962. The motivation for this program was concern over the progressive retardation of low-income children in school. The intervention was designed to improve academic performance through better cognitive performance and achievement orientation.
The Early Training Project showed dramatic reductions in use of special education among youth at age 12, although there were no statistically significant differences between treatments and controls in achievement test scores, grade retention, or high school graduation.
Early Intervention Collaborative Study
The Early Intervention Collaborative Study (EICS) is a longitudinal investigation of approximately 190 children with developmental disabilities (Down syndrome, motor impairment, developmental delay) and their families. Participants entered the study during the infant or toddler years at the time of enrollment in an early intervention program. This important national study followed the children in 29 programs. All but 11 children made significant gains. Although those with severe impairments made slower progress, early intervention helped them maintain their skills and prevent regression.
The High/Scope Perry Preschool Project
The Perry Preschool Project involved a half-day of preschool every weekday plus weekly 90-minute home visits over a fairly long time span. Teacher-to-student ratios were 1:6, and all teachers had master’s degrees and training in child development. The Perry Preschool Project resulted in positive effects on achievement tests, grades, high school graduation rates, and earnings, as well as lowering crime and welfare use.
The study of long-term outcomes in Perry Preschool has been closely aligned with Head Start in an attempt to promote the benefits of early intervention and to draw attention to the effects of investments in program quality.
Project Head Start
The most well-known of all early intervention programs, and certainly one of the largest, is Head Start. Initially designed and implemented as Project Head Start in 1965, its chief architects included child development experts Julius Richmond and Edward Zigler. The project was the result of a combination of factors, including public and policymakers’ concern about the growing number of children living in poverty in the United States.
The main concern was over subpar educational standards among the inner-city poor. From its inception, Head Start and Early Head Start focused on services specifically geared toward the development of healthy and skillful relationship building between very young children and their parents and caregivers.
A few studies have attempted to follow the children participating in Head Start past elementary grades, and there is evidence that, in the short term at least, Head Start is contributing to school readiness by improving verbal skills and health.
Given the paramount importance of health for very young children, a major focus of the Early Head Start program was to ensure that women received the health services needed to promote a healthy pregnancy and birth and that very young children received early and ongoing well-baby care, immunizations, and other essential health services to support their development. This continues today.
The Head Start program has served more than 15 million children at a cost of $31 billion since 1965 and, as of this writing, is serving approximately 900,000 children a year.
Current Research Models
Guided by the results of the programs developed in the 1960s and the ongoing evaluations of even earlier interventions, researchers have continued to design and evaluate new and more targeted intervention programs. Recent efforts include selecting strict criteria to better identify families and children at risk. For example, scientists are using new research tools such as brain scans to test new interventions. Researchers have recognized that intensive intervention prior to age 2 can result in significant gains for the targeted group of children with autism and related disorders.
The focus on intervention at the earliest ages continues, with many programs in place that start not only with the birth of the child, but with prenatal care designed to provide the child with the best possible life outcome.
Cost To Society
What is the long-term cost effectiveness of early intervention? Even though the highly specialized nature of the comprehensive services needed to produce significant developmental gains can be costly, results are generally positive. Researchers have made an effort to quantify the costs of intervention programs and have found examples of significant long-term cost savings.
The total costs of educating a child are actually less if intervention services begin at birth. It has been calculated that the total cost of special services if begun at birth is $37,273 and the total cost if begun at age 6 is between $46,816 and $53,340. The cost is less when intervention is earlier because of the remediation and prevention of developmental problems that would have required special services later in life.
Children with preschool education had fewer years in grades and a higher projected lifetime earning than children without interventions. When schools invest about $3,000 for 1 year of preschool education for a child, they immediately begin to recover their investment through savings in special education services. Studies have shown improved performance and less need for later intervention, and for every dollar spent on early treatment, $4.00 to $7.00 in savings are realized.
For nearly 50 years, researchers, universities, and governments have made significant efforts to close the gap between children with disabilities and those who experience normal development. Children with disadvantageous circumstances are at risk for a host of problems starting as early as birth and persisting through adulthood. Particularly damaging conditions to these children include, but are not limited to, developmental disabilities and delays, socioeconomic disadvantage, and poverty. Additionally, gifted and special needs children without the associated risk of poverty also benefit from some type of intervention. Early intervention has been based on the premise that children of poverty and, more recently, children with any type of developmental differential can achieve significant improvements in cognitive, academic, and social outcomes. A great deal of progress has been made in our ability to provide effective early intervention for young children with problem behaviors and compromised abilities.
Early childhood—the prenatal period through the beginning of school—is a unique developmental period that serves as a foundation for behavior, wellbeing, and success later in life. Some children are subjected to stressors during early childhood that impede normal development. These stressors may include insufficient cognitive stimulation, nutritional deprivation, inadequate health care, and maladaptive social interaction. Early intervention to correct these impediments has the potential to promote healthy development in at-risk children.
Program development over the past 25 years has been based on the knowledge that providing highly effective services results in prevention of serious problem behaviors. The challenge now is to continue to create new methods of delivering the highest quality and successful intervention means possible. As new knowledge is acquired, services can be implemented in a consistent and thorough manner and result in effective early intervention.
Family participation and constructive support teams are necessary for meaningful and durable outcomes for both the child and the family. Service providers can identify children at risk and supply services and education to improve diverse developmental issues. Placing emphasis on the important elements of early intervention—diagnosis, planning, program selection, and development—in the first few crucial years results in better experiences throughout a child’s life.
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