Early intervention broadly refers to a system of services for children from birth to 3 years of age, and it a is must for infants who are biologically at high risk of developmental disorders, or infants at risk for delays in one or more aspect of functioning. The rationale for the need of early intervention is three fold. Firstly – the prenatal, perinatal, and neonatal events occurring in the high-risk infant may have affected the infants brain by a significant brain lesion. Secondly, if the affliction of early life had a negative impact on the infant’s brain, then early life is the period that has the highest potential to counteract that negative sequalae due to high plasticity of the brain. And thirdly, families of high-risk infants are in dire need of guidance to understand that the behaviour of a high risk infant may differ from a typical developing child. The primary goal of early intervention is to support and facilitate the child’s development and increase participation within the context of the family and the community leading to better long term outcomes during infancy and preschool age. Systematic reviews on early intervention have concluded that infants born at term and at high risk preterm infants have shown improvement in motor and cognitive development with interventions aiming at developmental stimulation.
For Cerebral palsy (CP), clinical signs emerge and evolve before 2 years of age and hence, combination of standardized tools should be used to predict the risk. Before 5 months of corrected age, MRI, General movement assessment (GMs), or the HINE are the most predictive of risk of CP, and after 5 months corrected age, MRI and HINE are most predictive of risk of CP. For Autism Spectrum Disorder (ASD), clinical signs appear before 18 months or younger through developmental screening and by 2 years of age, a diagnosis by an experienced professional can be considered very reliable.
Early identification and intervention can play a crucial role in prevention as well as remediation of developmental delays, in a high risk cerebral palsy infant early intervention can maximize neuroplasticity and minimize deleterious modifications to muscle, bone growth and development and can help prevent functionality limitations by facilitating functional movements that would otherwise not be possible due to muscle weakness and poor motor control and enhance practise of meaningful and effective skills in varied environments to help acquire skills that will allow them to be more independent with ADLs and increase their level of participation in society. Early intervention targeted at development, cognition, communication, social skills, and behaviour modification as soon as ASD is diagnosed or suspected show good prognosis to an extent that children later go off the spectrum if intervened early, have a higher IQ and good cognitive skills.
However, a major challenge in providing early intervention has been the large scale implementation of using standardised assessment scales and using more precise earlier identification strategies for children with specific neurodevelopmental disorders. In addition to this, lack of awareness, poor access to facilities, absence of early resources at early years, the social stigma around labelling the child as ‘special’, lack of appropriate referral sources with expertise, and parents hesitance for acceptance that their child requires developmental support causes delays in identification and treatment.
Thus, there is a dire need for creating awareness about the importance of early intervention in the society as it can not only ensure that a child with developmental risk is provided with specialised support at the time of his maximum readiness to learn but it can also become a very significant source of support for families. Additionally, early intervention can create a support system and help bring an attitudinal change and acceptance in society towards differently abled children.
Dr. Snehal Gadhecha
Consultant at Surya Hospital
(Paediatric Physiotherapist, Certified Neonatal & Paediatric Early Intervention Specialist (UK), Paediatric Neuro-rehab Specialist, Neonatal Therapist, Feeding Specialist)\
References:
- Morgan C, Fetters L, Adde L, Badawi N, Bancale A, Boyd RN, Chorna O, Cioni G, Damiano DL, Darrah J, De Vries LS. Early intervention for children aged 0 to 2 years with or at high risk of cerebral palsy: international clinical practice guideline based on systematic reviews. JAMA pediatrics. 2021 Aug 1;175(8):846-58.
- Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, Cioni G, Damiano D, Darrah J, Eliasson AC, De Vries LS. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA pediatrics. 2017 Sep 1;171(9):897-907.
- Hadders‐Algra M, Boxum AG, Hielkema T, Hamer EG. Effect of early intervention in infants at very high risk of cerebral palsy: a systematic review. Developmental Medicine & Child Neurology. 2017 Mar;59(3):246-58.