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Expand Early Intervention And

Education of Children With Disabilities

Dr Tunku Nor Taayah Tunku Zubir

Consultant Rehabilitation Physician

WQ Park Health And Rehabilitation Centre

INCHEON STRATEGY 2013 – 2022:

A New Decade For Persons

with Disabilities In Malaysia

Autism

Learning

Disabilities

Traumatic

brain

injury/tumour

Cerebral

Palsy

ADHD

Down

syndrome

and other

genetic

Vision /

hearing

impairment

Congenital

deformity Special needs

child

Type of Disability Rate

Intellectual/Learning disability

Intellectual Handicap (Mental retardation – includes Mild, Moderate, Severe, Profound)

10-30 per 1000

Attention Deficit Hyperactivity Disorder School Going: 50-100 per 1000 US estimates 20-50 per 1000 UK estimates

Pervasive Developmental Disorders (Autism, ASD, Asperger)

10 per 1000

Learning Disability (eg. Dyslexia) 50-100 per 1000

Physical disability

Cerebral palsy 3-4 per 1000

Sensory disability

Hearing Impairment 1-2 per 1000

Visual Impairment 1-2 per 1000

Visual disorders (squint, amblyopia, refractive error) 20-50 per 1000

Overall Rates of Disability/Behavioural Problems 12-17% of all children

Frequency of various childhood disabilities in the pre-school age groups - Amar-Singh et.al

Special needs

children

Weakness

swallowing/

Eating

problem

Speech

impairment

Emotional/

Psychological

issues

Hearing/vision

problem Seizures/ chest

problem

motor skills/

coordinatio

n

problem

Bladder/bowel

problem

Contracture/

Pressure sore Academic

issues

Social

issues

Behavioural

issues ADL

impairment

Complication

Key things a child needs to promote

development • Close and ongoing caring relationship with parents or

caregivers

• Adults who recognise and are responsive to the particular

child‟s needs, feeling and interests

• Adults who are able to help children understand and regulate

their emotions

• Adults who are able to help children understand their own

mental states and those of others

• Adults who are able to help children negotiate temporary

breakdowns and ruptures in relationships

• Protection from harms that children fear and from threats of

which they may be unaware

• Clear behavioural limits and expectations that are

consistently and benignly maintained

• Opportunities and support for children to learn new skills

and capabilities that are within their reach

• Opportunities for children to develop social skills through

regular contact with a range of adults and other children

• Opportunities and support for children to learn how to

resolve conflict with others cooperatively

• Stable and supportive communities that are accepting of a

different families and cultures

• Center for Community Health, Murdoch Children

Research Institute and The Royal Children Hospital,

Melbourne (2010)

Early Intervention Programme

Early intervention program

• Neurobiological development, critical and sensitive

periods, attachment theory, infant learning

paradigms, prevention theory, intervention

research and quality of change occurring in the

early years of life. The early years present an

opportunity to have a significant impact and

accordingly , the key issue for early intervention is

how we make the most of this plasticity.

• based on the environment, including family

systems theory, stress and coping, ecological

perspectives on development, the role parents play

in shaping child‟s development, cultural influences

and collective experiences shared by parent.

Family environment have a significant influence

on learning and development and the success of

any early intervention strategy.

• Bailey,D ,Aytch, L, Odom,S, Symons,( 1999)

Early Intervention

• Is an umbrella term that is used by various

service providers to represent a

heterogeneous range, combination, and

intensity of services and treatments

employed to meet the needs of individual

children with a range of primary conditions

and associated problems and their families.

Goals of early intervention

• Is both an intervention program that can remediate the

extent of impairment or lessen future difficulties, or do both

for children with moderate and relatively severe disabilities

identified early in life.

• EI also helps these children acquire compensatory skills for

typical functions they will never acquire because of a

disability.

• For children with mild developmental problems or risk

condition, a high quality EI program can prevent the

development of poor functioning later in life that may be

associated with early developmental problems or risk

conditions.

• Given the variability of children served in EI, different kinds

of long term outcomes for different types of children

Critical factors that determine the

success of early intervention

• Early identification and access to early

intervention

• Family involvement

• Inclusion into community

• Qualified professional

Early intervention and access to early

intervention

First three years of life: “Prime times” or “window of opportunity”

when brain is a kind of “supersponge”

absorbing new information more easily than

at other times and developing in major

leaps.

Family involvement

teacher/ counsellor

child

doctors/psychologist

Speech therapist

Occupational/physio Therapist

parents

Qualified

Professionals

EIP: benefits are subject to a number of

factors

The nature and extent of the child‟s impairments

before intervention

Their age of referral to an intervention program

The nature and intensity of the intervention received

The child‟s response to the intervention

The influence of other environmental and contextual

factors

The presence and influence of comorbid conditions

and /or associated health problems

Source Study details Results

Lovaas (1987) Assessed outcomes achieved by 19

children with autism from

intensive behavioural intervention

therapy

Group receiving therapy

achieved average IQ

increase of 30 points

compared to control

group

Swallows &

Graupner

(1999)

Use of several sites to assess

outcomes from early intervention

treatment

Average IQ increased by

22 points with 33% of

participants achieving an

IQ of 90 or higher

Remington et al

(2007)

Study assessing benefits of

intensive early intervention for 23

preschool children with autism

26% of children in the

program achieved a

statistically reliable

positive IQ change

No children showed

regression in IQ

levels

Improvements in IQ scores in children with autism resulting

from early intervention

Source Study details Results

Perry et al

(2008)

Outcomes of children with

autism in intensive

behavioural intervention

program

332 children aged 2-7 years

Average increase in IQ of 12

points with 39% recording

increase of over 15 points

and 17% over 30 points

• Improvements in autism

diagnosis in significant

proportions

Hayward et al

(2009)

Assessed progress of children

with autism receiving

intensive behavioural

intervention therapy

Mean IQ for participants

increased by 16 points, with

50% gaining over 15 IQ

points

• Also improvements in

visual-spatial IQ

Dawson et al

(2010)

Study assessing efficacy of

Early Start Denver Model –

comprehensive developmental

behavioural

intervention

Significant improvements in

IQ scores, adaptive

behaviour skills and autism

diagnosis

Improvements in IQ scores in children with autism resulting

from early intervention

Cost effectiveness of early intervention

• “Intervention that are well developed ,adequately

resourced and implemented successfully can

produce tangible effects on children and families eg

improvement in parent/child relationship, higher

cognitive function, improved „school readiness‟ and

school attainment and lower levels of domestic

violence. Children with improved cognitive,

emotional and social functioning are likely to cost

the public purse considerably less than children

with problems, These translate into dollar saving

for the public purse over the long term and then

compare the benefit with the cost of the program”

• Queensland Council of social Services (2007)

Studies assessing employment outcomes for

individual with Cerebral Palsy

Authors Study details Employment outcomes

Murphy, Molnar &

Lankasky

2000

Study of 101 participants

with

Cerebral Palsy aged

between 27 and

74 years living

independently

53% were found to be

competitively employed with

22% being in a position that an

increase in income

would result in financial loss due

to the termination

of disability benefits

Van der Dussen,

et al

2001

Study of 80 young adults

with

Cerebral Palsy aged

between 21 and

31 years

53% had completed some form

of secondary

education with 36.3% in paid

employment

Michelsen, et al

2005

Study of educational and

employment

outcomes of 819 adults

with Cerebral

Palsy in Denmark

29% of adults with Cerebral

Palsy found to be

competitively employed

compared to 82% from the

control group

Early intervention strategies

• Physiotherapy

• Occupational therapy

• Speech and language therapy

• Behavioural modification/intervention

• Orthosis/prosthesis/equipments

• Psychology

• Social

• Medical and surgery

• Diet/ audiology

Physiotherapy

Academic

Learning

Behaviour Daily

Living

Auditary

Language

Skills

Visual

Spatial

Perception

Attention

Centre

Functions

Eye-Hand

Coordination

Ocular Motor

Control

Postural

Adjustment

Body

Scheme

Reflex

Maturity

Ability to

Screen Input

Postural

Security

Awareness of

Two Sides of Body

Motor

Planning

Olfactory Visual Auditory Gustatory

Tactile Vestibular Proprioceptive

CENTRAL NERVOUS SYSTEM

Intellect

Development

System

Development

Cognition

Perceptual

Motor

Sensory

Motor

Sensory

Sensory Motor Development and Learning

Occupational Therapy

Our bodies are intended to function as "well-oiled machines," which receive

input from the senses, and organize and process that information to be able

to use it appropriately, or to act on it.

Sensory Processing

Speech and Language Therapy

Alternative Augmentative Communication

Equipment/modification

Orthosis

Prosthesis

Best practise guidelines

• Preparation- a comprehensive, multidisciplinary

assessment. Individualised educational plan.

• Timing- intervention should begin as early as possible in

child life( 2 and 4 years)

• Intensity- a programme needs to be at least 20 hours per

week over an extended period of at least 2 years, with

continuing support into and through the school age years.

• Setting- can be delivered in various setting, individually

and with peers. Both center based and individual/home

based intervention are valuable.

Class activities

• Family collaboration- Parents need information about child condition and services. Programme should include provision of support, counselling and parent education.

• Associated therapies- multidisciplinary teams colloboration( ST, OT and counselling)

• Research and evaluation- Evaluation of treatment outcomes using systematic assessment.

• Transition- should be a systematic connection and integration between EIP and the next stage for the child. Parents,teachers and therapist need to coolaborate .

Establish an early detection

network

• Strengthen the national developmental

surveillance and screening system.

• Routine developmental surveillance/screening for

all children from age 0-8 years

• Establish a network of early detection points in the

community.

• Ensure early referral for intervention for medically

at risk infants diagnosed at hospital level.

Enable access to early intervention

services

• Well integrated and comprehensive intervention

services.

• Enhance network to better provide for community

based early intervention and family support.

• Enhance current intervention services

Ensure service quality and

effectiveness

• To identify best practices guidelines

• To ensure well trained , highly skilled

professional

• To include modules on childhood

disabilities intervention for all relevant

health professionals

• To ensure continuity from early

intervention program to school program

Promote Family Involvement

• To empowered family and carer with

regards the needs of their child

• To equip family and caregivers to become

active partners in early intervention.

National Early Childhood Intervention Council

(Malaysia) :

Overview of initiatives and programmes, key challenges and

obstacles to the full realisation of rights of children with

disabilities.

Early Childhood Intervention Analysis of Situation in

Europe.

Synergies Economic Consulting (Australia)

Not for profit children lobby group

Enabling Master Plan 2012-2016 Singapore:

Early intervention for children with special needs

REHABILITATION

ABILITY GOVERNMENT

INDIVIDUAL

MEDICAL

COMMUNITY

ENVIRONMENT

EDUCATION

health

SUPPORT

parents

Teachers

Special prog

facilities

SPEECH OT/CPO

PHYSIO

ENFORCE MENT

POLICY

INJURY

DISEASE

DOCTORS

ACCEPT ANCE

SUPPORT

REPAIR

Barrier

access TRANSPORT

Quotations of the beauty of having and raising children

While we try to teach our children all about life, our children teach

us what life is all about.

Angela Schwindt

The soul is healed by being with children.

Fyodor Dostoevsky

Children are the hands by which we take hold of heaven

Henry Ward Beecher

What right has any human being to talk of bringing up a child? You do not bring up a tree or a

plant. It brings itself up. You have to give it a fair chance by tilling

the soil.

George Bernard Shaw

If you can give your son or daughter only one gift, let it be

enthusiasm

Bruce Barton

Children are educated by what the grown-up is and not by his

talk

Carl Jung

How paramount the future is to the present when one is

surrounded by children.

Charles Darwin

Children are remarkable for their intelligence and ardour,

for their curiosity, their intolerance of shams, the

clarity and ruthlessness of their vision.

Aldous Huxley

Of all nature’s gifts to the human race, what is sweeter to

a man than his children?

Cicero

Nature

Inspiration

Success

Peace

Life

Love

Wisdom

Imagination

Dreams

Happiness

Motivation

Honesty

Hope

Family

Beauty

Duty

Forgiveness

Perseverance