EARLY INTERVENTION

• Systemic and planned effort to promote development

through a series of manipulations of environmental or
experimental factors initiated in the first 5 years of life

• According to IDEA – EI is designed to meet the

developmental needs of children from birth to 3 yrs
who have
“physical, cognitive, communicative, social, emotional
or adaptive development or have a diagnosed
condition that has a high probability of resulting in
developmental delay”.
 Reduce the occurrence of developmental
Primary Prevention Level disability through reduction of risk factors
such as LBW, malnutrition and family
awareness that child development can be
influenced by their efforts.

Goal is to reduce the extent of

Secondary Prevention
manifested childhood disability and
Level
shorten its duration.
INFANT STIMULATION + REMEDIATION

Aim is to prevent or reduce

Tertiary Prevention Level complications of disability (physical
and behavioral) that lead to a need
of institutionalization
 Program should
Enhance family’s understanding of Infant’s
limitations , strengths and needs
promote family’s ability to advocate for
their child

MULTIDISCIPLINARY APPROACH
Developmental Pediatrician, Psychiatrist
clinical psychologist, physio. occupational
therapist, speech therapist, social worker
and a special educator,
 Concept of the
disease, causes,
FIRST COUNSELLING SESSION prognosis,
Group session if similar disease misconceptions
type and queries ,
Second pregnancy
plan

SECOND COUNCELLING SESSION

Individualized therapeutic plan for that
child discussed with the parents
Also information regarding legal
provisions for the same
 SERVICES CHILD MAY NEED

Assistive technology (devices a child might

need)
Audiology or hearing services
Speech and language services
Counselling and training for a family
Medical services
Nursing services
Nutrition services
Occupational therapy
Physical therapy
Psychological services
Services may also be provide
FOCUS OF SERVICE SHOULD BE ON

physical (reaching, rolling, crawling, and walking);

cognitive (thinking, learning, solving problems);
communication (talking, listening, understanding);
social/emotional (playing, feeling secure and happy);
and
self-help (eating, dressing).
 INDIVIDUALIZED FAMILY ACTION
PLAN MADE -contains

Present developmental needs and level of child

Family information regarding resources, priorities,
concerns of parents and extended family
Major results or outcomes expected for the child
Specific services child would be receiving
Natural environment services would be provided
(home,community)
A designated service coordinator
INDIAN SCENARIO- EARLY INTERVENTION
THROUGH DEIC

Early identification and management of

Defects at Birth
Deficiencies,
Diseases,
Developmental delays
including disabilities– ‘4 Ds’, and assured link to care,
support, and treatment to meet these challenges.
 Early intervention -intervene early
and minimize disability.

Once the disability is established-enhancement

of child development for the child to reach the
highest potential for the child possible
and
Prevent progression to handicap that may arise
from activity limitation.
 SERVICES PROVIDED AT DEIC

1. MEDICAL SERVICE
2. DENTAL SERVICE
3. OCCUPATIONAL THERAPIST
4. PHYSICAL THERAPIST
5. PSYCHOLOGISTS
6. EARLY INTERVENTIONISTS
7. AUDIOLOGIST
8. SPEECH AND LANGUAGE PATHOLOGIST
9. VISION SERVICES
10.HEALTH SWERVICES
11.LAB TECHNICIAN
12.SOCIAL WORKER
13.NUTRITIONIST
14.TRANPORT
15.SERVICE COORDINATOR
 SUPPLIMENTARY SERVICES

DISABILITY CERTIFICATES

Assistive technology devices and service

Special Education services for School -six to sixteen age grp
Prevocational training for age 16-18 years
Vocational training for the age of 18
Aids and appliances: Assistance to Disabled Persons for Purchase /
Fitting of Aids and Appliances under the “Assistance to Disabled
Persons for Purchase/ Fitting of Aids/Appliances (ADIP)” Scheme

Rehabilitation of the differently abled child above 6 years of age at

the Rehabilitation centers in that state e.g. District Disability
Rehabilitation Centers
FAMILY support services
Guardianship
Parent association
Social security’s such as disability scholarship and disability pension
 Linkages with Ministry of Human Resource
Development (MoHRD), Department of School
Education & Literacy under “Education of
Children with Special Needs in “Sarva Shiksha
Abhiyan”

a) Provide inclusive education and support to

children from age of 6 -14 years
b) Provide Aids and appliances to school going
children with special needs and support of
trained special educators to these children.
c) To provide home based educational services to
children with special needs on need basis.
 Rehabilitation centres, Aids and
appliances, Assisted technology
devices with the help of Ministry of
Social Justice & Empowerment

DIC

Block Early Intervention Center (with the help of

Ministry of HRD under “Education of Children with
Special Needs in “Sarva Shiksha Abhiyan”

COMMUNITY EARLY INTERVENTION CENTRE

 INTERSDISCIPLINARY APPROACH

A B C D

CHILD

MULTIDISCIPLINARY APPROACH

A B C D

CHILD
 TRANSDISCIPLINARY APPROACH

A B C D

Case manager

Child
 DEIC

ANGAN PHC/CHC ASHA OR SELF

SNCU SCHOOL
WADI PLAY
SCHOOL

DOMAIN SPECIFIC INTERVENTION

SCREENING EVALUATION
DIAGNOSTIC DEIC REVIEW FOLLOW
ASSESMENTS UP

REFERRAL TO REFERRAL TO
REFERRAL TO OTHER WINGS
TERTIARY REHABILITATION
OF DISTRICT HOSPITAL ESP
HOSPITALS FOR CENTRE/CLINIC ESP >
ABOVE 6 YR
SURGERY 6 YR
 WHY EARLY INTERVENTION

William James was the first to suggest the theory of

neuroplasticity in his work Principles of Psychology-- human
brain is capable for continuous functional changes -

Jerzy Konorski was the first to define the term

‘neuroplasticity’ in 1948.--neurons which have been
activated by closeness of an active neural circuit, change
and incorporate themselves into that circuit

Hebb, a Canadian psychologist established a Hebb’s rule,

defined as pre-post coincidence--changes of biochemical
processes in one neuron can stimulate neighbouring
simultaneously activated synapses---basic principle of
synaptic plasticity
 Paul Bach-y-Rita is the pioneer in demonstrating
neuroplasticity on actual cases-----healthy regions of
the brain can take over the functions of injured parts
of the brain

CEREBRAL PLASTICITY refers to brain’s ability to learn,

remember,forget,reorganize, and recover from injury
NEUROPLASTICITY is the structural and functional
changes in brain after training and experience
 STRUCTURAL NEUROPLASTICITY-DEF

Synaptic plasticity -changes in the strength between neurons

(synapses)—
long-term changes in the number of receptors for certain
neurotransmitters, or changes where some proteins are being
synthesized more within the cell

Synaptogenesis -- formation and fitting of synapse or group of

synapses into a neural circuit

Structural plasticity is a normal making of fetal neurons during

brain development and is called developmental plasticity,
including neurogenesis and neuronal migration
Neuronal migration is a process in which neurons travel
from their ‘place of birth’ in fetal ventricular or
subventricular zone, towards their final position in the
cortex

Other forms of structural neuroplasticity include changes in

white or gray matter density which can be visualized by
magnetic resonance.
FUNCTIONAL NEUROPLASTICITY

Depend on two basic processes learning and

memory--During learning and memory permanent
changes occur in synaptic relationships between
neurons due to structural adjustments or
intracellular biochemical processes
Stages of brain development

1.Cell birth (neurogenesis, gliogenesis)

2.Cell migration
3.Cell differentiation
4.Cell maturation (dendrite and axon growth)
5.Synaptogenesis (formation of synapses)
6.Cell death and synaptic pruning
7.Myelogenesis (formation of myelin)
As cells migrate upwards their ultimate fate depends on genes, maturation,
and environment
They mature by growing dendrites and extending axons.
Dendrites grow slow and axons faster and hence can target dendrites before
they are completely formed
Axons can hence influence dendritic differentiation and the formation of
cerebral circuits
Synapse formation in brain (over 10 to power 14 trillion) –overall outline of
neuronal connections is genetically determined and rest guided be
ENVIORONMENTAL CUES

Peak of synapse formation between 1-2 yrs

Parallel system of brain of removing unnecessary cells and synaptic

connections –PRUNNING

Prunning determined by epigenetic, experience,hormones, stress ---affects the

thickness of cortex
The relation between cortical thickness and behavioural development is likely
an explanation for the variance in the development of behavioural skills in
children
 WHY BEGIN EARLY

SYNAPTIC
CONNECTIONS AT
VARIOUS AGES

BRAIN Grows 80%

by 2-3 yrs

AT BIRTH 7500 DOUBLE SYNAPTIC PRUNNING OF

CONNECTIONS CONNECTIONS AT SYNAPSIS THROUGH
2YR TO ADULT PROGRAMMED CELL
DEATH OR
APOPTOSIS
NEURONS WHICH FIRE TOGETHER
WIRE TOGETHER

HEBB’S RULE

EARLY EXPERIENCE HAS GRT EFFECT ON

DEVELOPMENT ,LEARNING, BEHAVIOUR, MEMORY

PRUNNING OF EXCESSIVE SYNAPSES OCCURS

THROUGH 16 YRS
 PHENOMENA OF LTP (LONG TERM POTENTIATION)
studied in mammal studies where they gave intense
high freq stimulation to low intensity synapses for a
short time f/b cont low intensity stimulus

BASIS OF
NEUROP
ENHANCEMENT OF LOW INTEN STIMULUS
LASTICIT
CONT EVEN AFTERWORDS
Y AND
EARLY
STIMULA
SYNAPTIC FASCILITATION IS CAPABLE OF TION
STORING EXPERIENCES FOR A LONG TIME

PROGRAMS AND ENRICHED ENVIRONMENT THAT STIMULATE VARIOUS

SENSORY MOTOR AND LANGUAGE DEV WILL ENHANCE
SYNAPTOGENESIS AND BRING CHANGE IN INFANTS
 AT MOLECULAR LEVEL
FUNCT OF NMDA REC
GLUTAMATE MOST ENHANCED IN
POST NATAL BRAIN –
MAX PLASTICITY
AMPA RECEPTOR(alpha –amino- 3- hydroxy-5-methyl-4
isoxazole-propionate

WITH EVERY NEW EXPERIENCE –

NA CHANNEL OPEN -DEPOLARIZATION BRAIN REWIRES ITS PHYSICAL
STRUCTURE MEDIATED
THROUGH SIGNALLING
GLUTAMATE BINDS NMDA REC CASCADE

CA ENTERS THROUGH NMDA

ACTIVATION OF GENE
REC & STARTS SIGNAL
TRANSCRIPTION IN NUCLEUS
CASCADE AND RELEASE OF
WHICH SUPPORTS SYNAPSES
TROPHIC FACTORS
EXPERIENCE AFFECTS NEURAL SYTEM IN 3 WAYS

1. BY AFFECTING GENE EXPRESSION

2. INFLUENCING RELEASE OF NEUROTROPHINS
3. INFLUENCING RELEASE OF
NEUROTRANSMITTERS LIKE NE

PLASTICITY OF BRAIN

MAX INFIRST FEW YRS BUT CONT THROUGH OUT LIFE

MORE IN SOME PARTS OF BRAIN
MORE IN CERTAIN PERIODS OF LIFE
SENSITIVE AND CRITICAL PERIOD OF BRAIN DEVELOPMENT

 When the effect of experience on the brain is

particularly strong during a limited period in
development, this period is referred to as a sensitive
period.
 Such periods allow experience to instruct neural
circuits to process or represent information in a way that
is adaptive for the individual.
 When experience provides information that is
essential for normal development and alters
performance permanently, such sensitive periods are
referred to as critical periods.
The Kennard principle suggests that the immature brain
should be more able to recover from injury than the more
developed brain.
JAMAICA STUDY -20 YR FU OF NUTRTION
SUPPLIMENTATION AND PSYCHOSOCIAL STIMULATION ON
STUNTED CHILDREN

ENROLLED CHILDREN AT 9-24 MONTHS : EFFECT OF

STIMULATION LASTED NOT THE FOOD

WHEN CHILDREN WERE 17-18 YR

Had higher IQ, READING VOCABULARY

Higher self esteem, less depression and anxiety

WHEN AT 20-22 YR
Had 25% higher earnings and caught up with nonstunted
group
 BUCHAREST EARLY INTERVENTION PROJECT

Findings through the assessment at 12 years of age -early

institutionalization leads to profound deficits in cognitive (i.e.,
IQ) and socio-emotional behaviors (i.e., attachment), brain
activity and structure, alterations in reward sensitivity and
processing, and a greatly elevated incidence of psychiatric
disorders and impairment.

FOSTER CARE INTERVENTIONS enhanced children’s

development, and for specific domains, including brain activity
(EEG), attachment, language, and cognition, there appear to be
sensitive periods regulating their recovery

Best results with < 2 yr start

ROMANIAN ORPHANAGES

Children who experienced socioemotional deprivation a

structural change in the left uncinate fasciculus that partly
may underlie the cognitive, socioemotional, and behavioral
difficulties that commonly are observed in these children.

Thomas J. Eluvathingal et
al,Pediatrics 2006
 EARLY INTERVENTION IN HIGH RISK INFANTS

WHAT IS THE
EVIDENCE?

The limited evidence available However, the

suggests that the newborn evidence on long-
individu- alized developmental term effects of
care and assessment program these interventions
(NIDCAP) and infant massage is inconclusive
are associated with a short-
term beneficial effect on brain DevMedChildNeurol (2011)
development.

DevMedChildNeurol (2005

Early intervention by means of
general developmental programs is
associated with a positive effect on
cognitive development until the age
of 3 years
Effect dissppears at preschool age
Vanderween J Of Perinatology 2009
Spittle et al Chocharane syst review 2009
The IBAIP program applied in very low-
birth weight infants was associated
with a minor advantage in
performance intelligence quotient,
visuomotor integration, and the ball
task “aiming and catching” at the age
of 5.5 years
Van Hues JW Jof Perinatology 2013
Follow-up of the infant
behavioral assessment and
intervention program (IBAIP)
and the infant health and
development program (IHDP)
indicates that some effects of
early intervention may sustain
beyond preschool age
Van Hues JW Jof Perinatology
2013
The IHDP program, applied in low-
birthweight infants, was associated
with higher scores on vocabulary
and mathematics tests and with
less risk behavior at 18 years of age.
However, these effects were found
only in the subgroup of participants
with a birth weight of 2000–2500 g
and not in those with a lower birth
weight
Pediatrics 2006
CEREBRAL PALSY

The early intervention studies also

showed that in general the effect of
developmental programs on motor
development is small and does not persist
beyond infancy

Vanderween J Of Perinatology 2009

Spittle et al Chocharane syst review 2009
 The concept of family coaching as opposed to
parent training

Families set the goals for intervention and

that the coach provides – by means of an
open dialog – hints and suggestions how the
goals may be achieved during daily routines,
such as feeding and bathing

Hielkema T, Blauw-Hospers CH
DevMedChildNeurol (2011)
 EARLY INTERVENTION IN NICU

Touching and Caressing -

DCI- DEVELOPMENTAL CARE Tender in
INTERVENTION Care (TAC-TIC)

Unnecessary alarms and noises to be

reduced
Lighting s/be dimmed and day-light Enhances mental
cycles maintained development, improve
Mother’s voice recording or music can be physiological states and
played sometimes
behavioral reactions,
Promotion of bonding through KMC
Passive excercises of joints and gentle improve sucking behavior
massage and
Stimulation program 0-2 months cognitive performance
Swaddling within the neonatal period
Supplimental tactile stimulation at same
time with min handling
Auditory, Tactile, RISS (Rice Infant
Sensory Stimulation) Home-based
Vestibular and Visual early stimulation
(ATVV) intervention on intervention, that
combines talking, carried out by the
increased mother has been
alertness, faster massage, eye
contact and rocking, reported to
transition to nipple- improve the
feeding, and has
reported to enhance developmental
decreased length of status of at-risk
hospitalization. mother-infant
interaction babies at 1 year
 EARLY INTERVENTION IN NEGLECT

NATIONAL SCIENTIFIC COUNCIL ON THE DEVELOPING

CHILDREN- HARVAD UNIVERSITY-3 INTERVENTION MODELS

Attachment and Child-Parent

Biobehavioral Catch-Up (ABC) Psychotherapy
Intervention (CPP)

Multidimensional
Treatment Foster Care for
Preschoolers