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From Current Opinion in Psychiatry

Early Intervention

Posted 09/02/2003

Bruce L Baker, Abbott Feinfield

Abstract and Introduction

Abstract

Purpose of Review: This review focuses on papers published during

the past year on early childhood intervention. We consider literature reviews,

program descriptions, and empirical studies in two broad areas of early

intervention: for children with developmental disabilities, and for children

considered at-risk for developmental problems.

Recent Findings: This year's empirical studies utilized a broad

array of outcome variables, going beyond cognitive factors to include children's

socio-emotional development and family functioning as well. The 'at-risk'

studies made contributions in three areas: predictors of outcome, parent-child

relationships, and comparisons and replications of programs. The developmental

disability reviews and studies were concentrated on autism, with a

methodological focus. Their conclusion was that despite much encouraging

evidence for early intervention effectiveness with autism, there is still no one

approach that meets accepted criteria for an empirically validated treatment.

Summary: Comprehensive early intervention programs can be quite

effective for young children with developmental disabilities, as well as for

children who are at risk due to biological or environmental factors. There is a

need for additional development and evaluation of evidence-based treatments, as

well as a further understanding of mediators and moderators of treatment

outcome.

Introduction

Early intervention is undertaken to influence the development and

learning of children from birth to 5 years who have a developmental

disability/delay, or who are at risk due to biological or environmental

factors.[1*] Early intervention includes systems, services, and supports

designed to enhance the development of young children, minimize the potential of

developmental delay and need for special education services, and enhance the

capacity of families as caregivers.[2] We refer the reader to two excellent

books on early intervention, by Guralnick[3] and Shonkoff and Meisels.[4]

We provide an overview of the early intervention literature from

January 2002 through March 2003. McCollum,[1**] discussing current themes in

early intervention, noted the evidence that high quality, comprehensive

intervention programs do, indeed, work. However, she further noted that there is

considerable diversity in early intervention populations, purposes, approaches,

and indicators of success. In The Mozart effect: not learning from history,

and Zigler[5*] argue against simplistic and unsubstantiated solutions,

citing evidence that early intervention needs to be comprehensive,

developmentally appropriate, and of sufficient duration and intensity.

Ramey and his coauthors[6*] drew on the well known Abecedarian

Project, a replication (Project CARE), and an extension (Infant Health and

Development Program), to consider how center-based treatment can augment and

improve parenting effectiveness. The authors summarized five primary components

in these interventions: (1) multidisciplinary, (2) focused both on child and

parent needs, (3) individualized, (4) embedded within local service delivery

systems, and (5) research-based with randomized control designs. Early

intervention outcomes of interest go beyond the child's cognitive functioning to

include also child developmental gains in emotional, behavioral, communication,

and social spheres, as well as parent/family benefits in improved well being,

teaching and parenting, and health care.

Persistent themes in this literature are that early intervention

programs must be comprehensive and that they should be supported by

well-conducted evaluation. We have organized our review by program focus, first

on children at-risk and then on children already diagnosed with developmental

disability; the majority of the latter papers concern early treatment for

autism. These papers represent early intervention in centers, home, or a

combination of the two. Many of the studies we review followed a systems

perspective model, recommended by McCollum,[1**] which includes family centered,

natural environments, interdisciplinary collaboration, and cooperation among

agencies.

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Section 1 of 5 Next Page: Early Intervention for At-Risk Children

Bruce L Baker and Abbott Feinfield, Department of

Psychology, UCLA, Los Angeles, California, USA

Curr Opin Psychiatry 16(5):503-509, 2003. © 2003 Lippincott

& Wilkins