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VOLUME 65 S MARCH 1980 #{149}NUMBER 3
PEDIATRICS Vol. 65 No. 3 March 1980 463
Pediatrics
Early Intervention for Infants with DownSyndrome: A Controlled Trial
Martha C. Piper, PhD, and I. B. Pless, MD
From the School of Physical and Occupational Therapy and Department ofEpidemiology and Health, McGill University, Montreal
ABSTRACT. The mental development of 37 infants with
Down syndrome, allocated either to an experimental or
control group, was assessed over a six-month period byan independent evaluator. The experimental group par-
ticipated in biweekly therapy sessions designed to stim-ulate normal development while the control group re-
ceived no intervention. The Griffiths Mental Develop-mental Scales were used to assess changes in the devel-
opmental status in the two groups, which were shown to
be equal initially on a variety of variables. No statistically
significant differences in mental development betweenthe experimental and control groups were found. The
early intervention regimen investigated in this study wasnot efficacious in altering the pattern of mental develop-
ment in those Down syndrome infants participating in
the program. Pediatrics 65:463-468, 1980; Down syn-drome, early intervention, infants, mental development.
Infant stimulation and training programs have
been developed as means to ameliorate the severity
of the mental handicap associated with Down syn-
drome. Unfortunately, the influence of such pro-
grams on the mental functioning of Down syndrome
children remains uncertain in spite of the fact that
infants with Down syndrome are easily identified at
birth, thereby permitting early intervention within
the first months of life.
Received for publication June 8, 1979; accepted July 16, 1979.
Reprint requests to (M.C.P.) School of Physical and Occupa-
center and received instruction in an activity pro-
gram to be carried out in the home between treat-
ment sessions. In all other intervention studies, with
the exception of that of Hayden and Haring,’2 the
therapist conducted the training sessions in the
infant’s home. However, routine home visiting is
not only expensive in time and personnel, but also
is often not conducive for teaching.� Moreover,
because parents of handicapped children are fre-
quently isolated, the regular weekly visit may be-
come more social than educational. Although in
terms of “support” this may be of great importance,
it may nonetheless interfere with the productivity
of a therapy session. Bronfenbrenner3 in his review
of early intervention programs for culturally disad-
vantaged children, strongly advocated frequent
home visits by a therapist to foster the mother’s
role in the treatment. While home-based programs
may facilitate this parent-child interaction more
successfully than center-based approaches, parent
participation may be more important than the site
of the treatment.
Finally, we did not attempt to assess compliance
with the prescribed regimens. The issue of compli-
ance as it pertains to therapy for handicapped chil-
dren is a complex one; immediate gains from treat-
ment are seldom seen and parents may become
discouraged and discontinue treatment. If parents,
for whatever reason, fail to carry out the recom-
mended program, the problem is one of ineffective
delivery rather than the technique itself. Our con-
cern was not primarily with the intervention tech-
niques per se but rather with assessing the effec-
tiveness of an early intervention program as a
whole.
Assuming that none of these issues were of suf-
ficient importance to detract from the main find-
ings, it should, nonetheless, be stressed that the
results of this study are only based on one mea-
sure-the Griffiths Mental Development Scales.
Although it may be that the use of another assess-
ment instrument would have been more sensitive
in detecting developmental advances, it is impor-
tant to note that the Griffiths Scales were employed
as the outcome measure in several earlier interven-
tion studies where positive findings were
“4,5
Obviously the objectives of early intervention
programs encompass other areas besides the reme-
diation of a child’s retardation. The acceptance of
the child into the family structure, the resolution of
guilt feelings, and the establishment of realistic
expectations are additional reasonable goals. We
limited the focus of our study, however, to the effect
of early intervention on mental retardation. This by
no means rules out the value of other components
of this or other infant stimulation programs al-
though these also remain to be proven objectively.
The failure to demonstrate benefits for the
treated group in this study is disappointing for those
who believe such therapy is an effective method for
minimizing the retardation in Down syndrome. Al-
though other possible explanations exist for these
results, the findings clearly suggest that the efficacy
of this form of early intervention is doubtful. We
conclude, with some minor reservations, that the
particular early intervention regimen investigated
was not efficacious in altering the pattern of mental
development in those Down syndrome infants par-
ticipating in the program.
ACKNOWLEDGMENT
This research was supported in part by a grant fromthe National Health Research and Development Pro-
gram, Health and Welfare, Canada.
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ENDORPHINS AND SHOCK
B endorphin is likely released during shock states and may contribute to
hypotension. Naloxone, in an animal model, rapidly reverses endotoxin-induced
hypotension and also prevents its occurrence. The same findings are noted in
experimental hypovolemic shock. The low toxicity of naloxone and its effect on
shock in experimental animals makes it an attractive agent. Naloxone may be
efficacious in septic shock and in hypovolemic shock.
Comment: Animals only, so far, but these are fantastic data and raise wonderful
possibilities. The soon to come primate data will be exciting to see.
R.H.R.
Abstracted from J. W. Holaday et al: Naloxone reversal of endotoxin hypotension suggests role of
endorphins in shock (Nature 275:450, 1978); A. I. Faden, et al: Opiate antagonists: A role in thetreatment of hypovolemic shock (Science 205:317, 1979).
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