Early Intervention

Early Intervention and Early Detection

Early Intervention, in the broadest sense, is any resource that promotes a child developing to his or her fullest potential. It also refers to the system of professional services for families and their infants and toddlers who exhibit one or more development delays.

Early Intervention is governed by Part C of the Individuals with Disabilities Education Act (IDEA) a federal law that requires every state to have a coordinated, multidisciplinary system of services for infants and toddlers (0-3 years of age) who have or who are at risk for developmental delays.  Early Intervention services can include a range of therapeutic interventions and family support such speech, physical and/or occupational therapies, vision therapy, social work services and family/parent educational programs.  Formal Early Intervention services are designed to address one or more of five developmental areas: physical, cognitive, communication, social, emotional and adaptive development.  The initial evaluation and screening, development of a service plan, and some therapies must be made available to families free of charge.  In some states, families may be charged fees, based on a sliding-scale, for additional therapeutic interventions.

Early Intervention is based on the critical role that parents and other family members play in the lives of infants and children. Parents are considered to be equal members of the therapeutic team. Their dreams and hopes for their child often determine some of the interventions provided. Because family life is so important to successful Early Intervention programs, many services are provided in what is termed a “natural setting,” such as the family’s home, a grandparent’s house or at the childcare center.

Why is Early Intervention Important ?

Research across many disciplines clearly shows that a child’s earliest experiences influence the development of his/her brain.  Interactions with the environment (people and things) help to develop the pathways in a child’s brain that are the foundation for his/her development and later behaviors.  Because of the impact interactions have on the brain development of the very young child, early intervention, or specific interactions, have a tremendous capacity to positively impact a child’s development (unfortunately, the reverse is also true and a lack of specific, positive interactions will lead to a lack of brain development and could negatively impact a child’s future development).

While therapeutic intervention can be helpful throughout the life-span, for children, especially children with autism, the early years of life provide a unique window-of-opportunity to mitigate developmental delays.  It's important not to miss out on this crucial time in your child’s life as skill development may become more difficult later in life.

Early Detection

Early Intervention and early detection go hand-in-hand.  Unfortunately, most children with autism are not diagnosed until three years of age or even older.  The reasons for a lack of early diagnosis are varied.  Sometimes children do not exhibit autistic behaviors until they are older.  One of the hallmarks of autism is its impact on social engagement. Observing social interaction in infants and toddlers can be difficult, especially for first-time parents who have nothing to compare their child’s behavior with.  Many parents report having concerns about their child but are unsure and wait for several months before seeking professional help [Kleinman, 827-839].  Many pediatricians also take a wait-and-see attitude before they are willing to diagnose autism or other developmental delay. [Crane, 245-253]  The American Academy of Pediatrics (AAP) recommends that all children be screened for autism at 18 months.  However, in one study less than eight percent of pediatricians report screening for autism with any regularity [Kleinman, 827-839] (a second study indicated that only about 30 percent of pediatricians follow the AAP guidelines) [Crane, 245-253].  Further complicating early detection is that some children with autism appear to be developing typically until about two years of age when parents report a regression of the child’s development.  Autism is a “spectrum” disorder, that is a disorder with a range of disabling behaviors from modest to more severe; many children do not get diagnosed until much later in life when there behaviors appear more pronounced in comparison with their peers.  Although most parents are the best resource for early detection, some parents may be in denial about their child’s delay.  Unfortunately for these parents, their fears will ultimately further complicate their child’s life.

These and other factors can make early detection challenging.  It is important therefore that parents trust their own opinions early in their child’s life, especially when they suspect something isn’t quite right.  If you think something may be wrong, ask your pediatrician, as soon as possible, to conduct a diagnostic screening using a professional assessment.  If your pediatrician is unable or unwilling to use a standardized screening tool, you may want to seek a developmental pediatrician.  A development pediatrician is a medical doctor trained in children’s developmental delays.  One resource for finding a pediatrician with expertise in developmental disabilities is www.healthychildren.org.  

The following is a very brief list of possible indicators for Autism Spectrum Disorders from the National Institute of Mental Health:

• Does not babble, point, or make meaningful gestures by 1 year of age

• Does not speak one word by 16 months

• Does not combine two words by 2 years

• Does not respond to name

• Loses language or social skills

• Poor eye contact

• Doesn't seem to know how to play with toys

• Excessively lines up toys or other objects

• Is attached to one particular toy or object

• Doesn't smile

• At times seems to be hearing impaired

From the start, typically developing infants are social beings. Early in life, they gaze at people, turn toward voices, grasp a finger, and even smile.

National Institute of Mental Health - Autism Spectrum Disorders and Pervasive Development Disorders

Click on the links for other early intervention resources, including:

U.S. Department of Education - IDEA Regulations Early Intervening Services

First Signs -What's New and Worth Knowing About?

Center for Disease Control -What Should You Know?

National Dissemination Center National Search for State Organizations

American Academy of Pediatrics - Children's Health Topics- Autism

State of New Jersey - Department of Health and Senior Services - Family Health Services - Early Intervention System

Click on the links for additonal reading:

Early Intervention in Autism by Christina M. Corsello, Phd.

Study: Early Autism Intervention in Toddlers is Effective by Miriam Falco, CNN

Kleinman, Jamie M., Diana L. Robins, Pamela E. Ventola, Juhi Pandey, Hilary C. Boorstein, Emma L. Esser, Leandra B. Wilson, Michael A. Rosenthal, Saasha Sutera, Alyssa D. Verbalis, Marianne Barton, Sarah Hodgson, James Green, Thyde Dumont-Matjieu, Fred Volknar, Katarzyna Chawarska, Ami Klin, and Deborah Fein. "The Modified Checklist for Autism in Toddlers:  A Follow-up Study Investigation the Early Detection of Autism Spectrum Disorders." Journal of Developmental Disorders (2008) 38:827-839.

Crane, Jennifer L. and Adam Winsler.  "Early Autism Detection,  Implications for Pediatric Practice and Public Policy."  Journal of Disability Policy Studies.  Volume 18 Number 4, Spring 2008, 245-253.

Volkmar, Fred, Kasia Chawarska, and Ami Klin. "Autism in Infancy and Early Childhood." Annual Review of Psychology 2005.  56: 315-36.

Goin, Robin, P and Barbara J. Myers.  "Characteristics of Infantile Autism:  Moving Toward Earlier Detection." Focus on Autism and Other Developmental Disabilities.  Volume 19, Number 1, Spring 2004. 5-12.

Miller, Neil Z. and Gary S.Goldman.  "Infant Mortality Rates Regressed Against Number of Vaccine Doses Routinely Given:  Is There a Biochemical or Synergistic Toxicity?"  Human and Experimental Toxicology 000(00)1-9.