A USER’S GUIDE TO EARLY INTERVENTION

SERVICES

Seminar I

Realistic Strategies to Identify

Children Eligible for Early Intervention Services

in Primary Care Practice

PRESENTED BY

• Early Intervention Section, DOH

• Center for Disabilities Studies, UH

• Support provided by

Why DOH needs your helpto find babies who need EI help

• Where are the missing babies?

• 26% of DOE Special Education students in 3 cohorts were not served by EI programs

ELIGIBILITY FOR EARLY INTERVENTION SERVICES

•Developmental Delay

•Biological Risk

•Environmental Risk

DEVELOPMENTAL DELAY

• Cognitive

• Physical, including vision and hearing

• Speech/language

• Social/emotional/behavioral

• Adaptive

BIOLOGICAL RISK

• WHEN: Prenatal, perinatal, neonatal, early development

• HOW: Biological insults to central nervous system

• RESULT: Probability of delayed development

• Diagnosed physical/mental condition

Examples of biological risk

• Down Syndrome• Fetal Alcohol

Syndrome• HIV/AIDS• Asphyxia• SGA• < 32 weeks GA• VLBW ( < 1500 g)

• Failure to thrive• Hearing loss from

chronic otitis media• Maternal diabetes• Maternal substance

abuse• Maternal mental

illness

ENVIRONMENTAL RISK

• Child abuse/neglect…. Healthy Start, PHN

• Teenage mom with low support……..PHN

• Substance abusing mom……………..PHN

• Cognitively impaired parent ………...PHN

EARLIER IS BETTER

Do early delays predict later status?

• Expressive language delay

•Motor, psycho-social and cognitive delay

• Risk factors

Paul, R. (1993, 1996)

Expressive language delay at age 2+

• SELD: < 50 words at age 2 or

• no 2-word phrases 25-34 mos

• middle class• no hearing/

cognitive/ motor problems

% of children with delays at age 3-5

0 20 40 60

Language5 yrs

Social 3yrs

Readiness5 yrs

No delays

SELD

EARLIER IS BETTER: EARLY BRAIN DEVELOPMENT

Brainstem - Prenatal through early infancy

Limbic system (Amygdala, hippocampus: emotion, memory) - Late infancy to 4 years

Cerebral cortex (Reasoning, behavior inhibition) - ToddlerLanguage - auditory cortex by 1 yearCapacity for logic & complex reasoning by age 4 years

EARLY BRAIN DEVELOPMENT

Synapse pruning: the child with developmental challenges

• Sensory deficits prevent stimulation

• Motor delays can decrease stimulation

• Cognitive delays make choice of stimulation critical

• Excessive loss of neuronal connections

• Learning problems• Attention problems• Activity regulation

Causes Secondary Conditions

What kind of experiences affect brain development?

• Nutrition - protein, calories • Physical environment: variety across all

modalities prevents excessive synapse loss• Emotional environment: attachment problems or

stress decrease cognitive potential and behavior regulation (ADHD etc)

Attachment Problems Influence Brain Development:

Babies with special needs

• PARENT: adjustment to diagnosis/problem

• Loss of hope

• Resentment

• Fatigue

• BABY: Sensory defensiveness

• Feeding problems

sense of self ability to organize

future learning ability to form

intimate relationships empathy

Causes Consequences

The brain develops from lower to higher levels therefore

Early experience has more pervasive impact

Babies with special needs may experience high stress levels

• Sensory defensiveness, communication delays etc.

• At risk for abuse

• Parents may be more stressed by the child’s special needs

• Delays are more frequent among children whose parents are teens, poorer, less educated, incarcerated - these children live with extra stress

• Match stimulation to child characteristics

• Reduce child stress through adaptations to accommodate disability

• Improve attachment• Reduce parent stress• Improve nutrition• Increase parent/child

language interaction

Adapt child’s environment

Parent education and support

How early intervention can help

How do we know informal screening and clinical judgement

aren’t enough?

• Many children in Hawai`i with significant special needs are missed until they reach schooling

• Research shows that informal methods miss ~ 50% of delays

THESE RESOURCES CAN provide standardized screening

• Parent Line - for literate and motivated parents

• Healthy Start or Head Start - for children enrolled in these programs

• PHN - for children already enrolled

- for other children if you or parent have concerns

Taking parent concerns seriously

• Improves rate of identification

• Builds stronger relationships with parents

• Adds data you don’t have a chance to observe

Infant-Toddler Development Programs (like North Hawai`i Child Development

Program or Hilo Easter Seals) offer

Evaluation by trained and certified professionals to

determine the extent and type of developmental delays